OBJECTIVE: To investigate the association between fluid balance trajectories within the first 3 days of intensive care unit (ICU) admission and 28-day mortality as well as the incidence of continuous renal replacement therapy (CRRT) in patients with severe acute pancreatitis (SAP). METHODS: Clinical data of SAP patients were extracted from the Medical Information Mart of Intensive Care-IV (MIMIC-IV). Group-based trajectory modeling (GBTM) was used to analyze the daily fluid balance of patients within 3 days of ICU admission, and grouping them accordingly. Univariate and multivariate Logistic regression analyses were performed to assess the association between fluid balance trajectory and 28-day mortality and ICU CRRT in SAP patients. RESULTS: A total of 251 SAP patients were included, with 33 deaths within 28 days, and a 28-day mortality of 13.15%; 49 patients (19.52%) continued to receive bedside CRRT after 3 days of ICU admission. The fluid balance on the 3rd day, cumulative fluid balance within 3 days of ICU admission, and incidence of CRRT in the death group were significantly higher than those in the survival group. According to GBTM groups, there were 127 cases in the moderate fluid resuscitation with rapid reduction (MF group), 44 cases in the large fluid resuscitation with rapid reduction (LF group), 20 cases in the moderate fluid resuscitation with slow reduction (MS group), and 60 cases in the small fluid resuscitation with slow reduction (SS group). The cumulative fluid balance within 3 days of ICU admission of the MF group, LF group, MS group, and SS group were 8.60% (5.15%, 11.70%), 16.70% (13.00%, 21.02%), 23.40% (19.38%, 25.45%), and 0.65% (-2.35%, 2.20%), respectively, and the incidence of CRRT during ICU hospitalization were 11.02%, 29.55%, 85.00%, and 8.33%, respectively, with statistically significant differences among the groups (both P < 0.05); the 28-day mortality were 11.02%, 18.18%, 20.00%, and 11.67%, respectively, with no statistically significant difference among the groups (P > 0.05). Kaplan-Meier survival curve analysis showed there was no statistically significant difference in 28-day cumulative survival rate among groups with different fluid balance trajectories (Log-rank test: χ ² = 2.31, P = 0.509). Multivariate Logistic regression analysis showed that cumulative fluid balance within 3 days of ICU admission was an independent risk factor for 28-day mortality [odds ratio (OR) = 1.071, 95% confidence interval (95%CI) was 1.005-1.144, P = 0.040] and CRRT requirement (OR = 1.233, 95%CI was 1.125-1.372, P < 0.001); early aggressive fluid resuscitation on day 1 reduced CRRT risk (OR = 0.866, 95%CI was 0.756-0.978, P = 0.030). CONCLUSIONS Dynamic fluid management is essential in SAP patients. While early aggressive fluid resuscitation may reduce CRRT demand, excessive cumulative fluid balance is associated with increased 28-day mortality and CRRT incidence.
Humans ; Male ; Female ; Middle Aged ; Water-Electrolyte Balance ; Continuous Renal Replacement Therapy ; Intensive Care Units ; Aged ; Adult ; Pancreatitis/mortality* ; Logistic Models ; Retrospective Studies ; Renal Replacement Therapy

Objective:To explore the active components, targets and mechanism of Guizhi Fuling Pills in the treatment of atherosclerosis (AS) based on network pharmacology and molecular docking technology.Methods:The active components and potential target information of Guizhi Fuling Pills in the treatment of AS was obtained using Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), SwissTargetPrediction database and Genecards database. The target protein interaction network was constructed by using STRING database. The DAVID database was used to perform the Gene Ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment on potential targets. AutoDockVina and PyMOL software were used to verify the molecular docking of the main active components and key targets of Guizhi Fuling Pills.Results:A total of 74 active components, 239 potential targets and 4 710 AS-related disease targets were screened, and 182 intersection targets were obtained. A total of 484 biological process items, 132 molecular function items and 74 cellular component items were obtained by GO functional enrichment analysis, and 116 signal pathways were screened by KEGG enrichment analysis. The results of molecular docking suggested that the active components of Guizhi Fuling Pills have good binding activity to the key intersection targets.Conclusion:The active components of Guizhi Fuling Pills, such as sitosterol and paeoniflorin, mainly treat AS by regulating estrogen signal pathway and inflammatory signal pathway through TNF, VEGFA and other targets.

Spinal cavernous hemangiomas (SCH) represent a rare subtype of cavernous hemangiomas (CH). Existing literature predominantly indicates a higher prevalence of SCH in the thoracic region, although a comprehensive explanation for segmental distribution variations remains elusive. Current investigations suggest that the etiology of SCH may be linked to mutations in genes such as TEK, KRIT1, MGC4607, and PDCD10, and can also be precipitated by external factors including radiation, trauma, and infection. However, the specific impact of radiation dosage and modality on the incidence and severity of SCH warrants further in-depth study. The onset of this disease is concealed, but it can cause serious motor and sensory disorders. The symptoms mostly progress slowly or disappear gradually, but there are also cases of acute onset or sudden exacerbation. Recent research emphasizes the more prevalent magnetic resonance imaging (MRI) features of "flame-like" or "linear" intramedullary hemorrhages over the formerly identified "popcorn" or "mulberry-like" heterogeneous signals. Surgical intervention is generally recommended for patients with severe or progressively worsening symptoms, large lesion volumes, high risk of hemorrhage, or those with rapid increase in lesion size upon follow-up. Optimal outcomes are achieved when surgery is performed within three months of symptom onset. Surgical strategies typically involve laminectomy or laminoplasty via a posterior approach to achieve maximal lesion resection, although deep-seated lesions still pose considerable surgical challenges and risks. Ongoing clinical innovations are focusing on optimizing surgical approaches and techniques, such as employing anterior or dorsolateral approaches into the spinal cord via dorsal root entry zones and utilizing orthopedic robotic systems. Intraoperative monitoring technologies like neurophysiological monitoring and intraoperative ultrasound have been widely implemented, yet uniform warning criteria are yet to be established. A limited array of pharmacotherapies, including propranolol and sirolimus, have been clinically deployed, but their efficacy awaits validation from multicenter studies. In terms of disease management, patients with a history of spinal lesions, subarachnoid hemorrhages, or large lesions generally have poorer prognoses, while the impact of underlying comorbidities like hypertension and diabetes on hemorrhage risk remains unclear. The likelihood of re-hemorrhage in SCH patients increases over time, and tailored conservative treatment plans for diverse clinical scenarios are yet to be refined.

Humans ; COVID-19 ; Quarantine ; Renal Dialysis ; SARS-CoV-2 ; Hospitals

[Objective] To explore the method for knee joint osteoarthritis. [Method] 97 patients take the said method above, observe its effect. [Result] 41 cases were excellent, 29 good, 22 just so so, 5 bad, the total effective rate was 94.85%. [Conclusion] TCM external cleansing coordinated with small needle-knife has good clinical effect.

[Objective]To analyze the causes of complication following percutaneous vertebroplasty and to find out the methods on its prevention and treatment.[Method]Complications of 140 patients (233 vertebral bodies) performed percutaneous vertebroplasty from August 2002 to July 2006 and long-term complications and its correlative prognosis after followed-up 7-52 months (average 28.4 months were observed and analyzed.[Result]Sixty-one patients of 140 cases showed complications (43.6%).Forty-five of the 61 patients with complications revealed with leakage of bone cement,2 with transient low blood pressure or lethargy,3 with dyspneic respiration or slight cough or chest discomfort,1 with subcutaneous herniation.In 12 patients complicated with leakage of bone cement,10 complained aggravation of pain,1 of radiating pain of back and low limb,1 with incomplete paraplegia. The 11 patients complicated with various postoperative pain induced by bone-cement leakage were complete recovery after treatment with anti-imflamatory analgetics orally for 3-7 days.One patient with incomplete paraplagia caused by leakage of bone cement demonstrated satisfactory walking function recovery but still remained slight disability of lower limbs after 26 months by treatment of laminectomy decompression,with drawing of bone cement combined with anti-biotics,dehydration agent,hormone,nerve-nourisling agent and 3-month acupuncture. Two patients with transient low blood pressure or lethargy were treated and recovery after fluid infusion and 30-60 oxygen taking. Three patients with dypneic respiration or slight cough or chest discomfort but without abnormality on radiographs were convalesced after treatment of fluid infusion,taking oxygen and anti-biotics for 3-5 days.The subcutaneous homotoma of 1 patient was absorbed 7 days later.Ten patients complicated with new adjacent vertebral body fracture 1-12 months postoperatively were healed after conservative treatment of PVP operation.[Conclusion]Complications after percutaneous vertebroplasty are not uncommon(43.6%).Leakage of bone cement is most common complication. Strict pre-operation plan and improving operation skill are the most important preventive measures.

AIM: To explore the pathogenic mechanism of high altitude pulmonary edema(HAPE). METHODS: Haemodynamic changes and effects of 100 percent oxygen breathing were measured by Swan-Ganz thermistor catheters, high altitude healthy volunteers were served as controls. RESULTS: The important features of haemodynamic changes in HAPE: (1)Pulmonary arterial pressure was raised; (2)Pulmonary arterial resistance and cardiac output were raised; (3)Pulmonary artery wedge pressures and right atrial pressure were normal; (4)Pulmonary arterial pressure and resistance were induced by oxygen breathing. CONCLUSIONS: The normal pulmonary artery wedge pressures with a high cardiac output indicated that HAPE was recognized as a form of noncardiogenic pulmonary edema. The pulmonary hypertension may play an important role in the development of HAPE.