Objective:To explore the correlation between the intensity of net ultrafiltration in continuous renal replacement therapy (CRRT) and the survival prognosis in critically ill patients with acute kidney injury (AKI), and provide evidence-based references for establishing optimal net ultrafiltration target during CRRT.Methods:This was a retrospective observational study. Demographic and clinical data of critically ill AKI patients who received CRRT in the Intensive Care Unit of West China Hospital, Sichuan University from May 2021 to September 2023 were collected. Net ultrafiltration was defined as the hourly fluid clearance volume in the 72 hours prior of CRRT. This variable was converted into a categorical variable, including low net ultrafiltration <1.01 ml·kg -1·h -1, moderate net ultrafiltration 1.01-1.38 ml·kg -1·h -1 and high net ultrafiltration >1.38 ml·kg -1·h -1, and the differences of baseline characteristics and clinical treatment conditions among the three groups were compared. Kaplan-Meier survival curve and log-rank test were used to compare the survival conditions among the three groups in patients at 28 days and 60 days after CRRT. Logistic regression analysis method was used to analyze the related factors of mortality in patients 28 days and 60 days after CRRT. Results:This study included a total of 661 critically ill AKI patients who underwent CRRT for more than 72 hours. The age was 56.00 (43.00, 68.00) years, and 488 patients (73.83%) were males. The net ultrafiltration rate was 1.36 (0.94, 1.89) ml·kg -1·h -1. Among them, 188 patients (28.44%) were in the low net ultrafiltration group, 152 patients (23.00%) were in the medium net ultrafiltration group, and 321 patients (48.56%) were in the high net ultrafiltration group. There were statistically significant differences among the three groups in terms of gender distribution ( χ2=17.81, P<0.001), body mass index ( H=32.37, P<0.001), urine volume 24 hours before admission ( H=9.41, P=0.009), fluid overload ( H=6.02, P=0.049), platelets ( H=13.49, P=0.001), pro-B type natriuretic peptide ( H=14.18, P<0.001), serum creatinine ( H=9.66, P=0.008), lactate ( H=9.83, P=0.007), AKI stage distribution ( χ2=15.51, P=0.004), admission indication ( P<0.001), total CRRT duration ( H=8.45, P=0.015), ultrafiltration ( H=456.10, P<0.001), net ultrafiltration ( H=561.20, P<0.001), and vasoactive-inotropic score at 72 hours of CRRT treatment ( H=10.42, P=0.005). Kaplan-Meier survival analysis showed that there were statistically significant differences in the 28-day (Log-rank test, χ2=10.89, P=0.004) and 60-day (Log-rank test, χ2=8.55, P=0.014) survival rates among the three groups in patients after CRRT. Multivariate logistic regression analysis showed age ( OR=1.03, 95% CI 1.02-1.04, P<0.001), mean arterial pressure ( OR=0.98, 95% CI 0.97-1.00, P=0.011), bilirubin ( OR=3.02,95% CI 1.39-5.59, P=0.006), 72-hour vasoactive-inotropic score ( OR=1.01, 95% CI 1.00-1.02, P=0.004), low net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.66, 95% CI 1.02-2.72, P=0.042), and high net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.78, 95% CI 1.14-2.78, P=0.011) were independent correlated factors of 28-day mortality after CRRT. Age ( OR=1.02，95% CI 1.01-1.04， P<0.001), mean arterial pressure ( OR=0.98，95% CI 0.97-1.00， P=0.016), fluid overload ( OR=1.10, 95% CI 1.02-1.19, P=0.012), bilirubin ( OR=4.96，95% CI 1.00-17.80， P=0.013), 72-hour vasoactive-inotropic score ( OR=1.02，95% CI 1.01-1.03， P=0.003), and high net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.91，95% CI 1.22-3.00， P=0.005) were independent correlated factors of 60-day mortality after CRRT. Conclusions:During the first 72 hours of CRRT, net ultrafiltration > 1.38 ml·kg -1·h -1 and net ultrafiltration < 1.01 ml·kg -1·h -1 are associated with a higher mortality rate at 28 days or 60 days after CRRT. Net ultrafiltration of 1.01-1.38 ml·kg -1·h -1 may be a relatively safe range.

Objective:To explore the correlation between the intensity of net ultrafiltration in continuous renal replacement therapy (CRRT) and the survival prognosis in critically ill patients with acute kidney injury (AKI), and provide evidence-based references for establishing optimal net ultrafiltration target during CRRT.Methods:This was a retrospective observational study. Demographic and clinical data of critically ill AKI patients who received CRRT in the Intensive Care Unit of West China Hospital, Sichuan University from May 2021 to September 2023 were collected. Net ultrafiltration was defined as the hourly fluid clearance volume in the 72 hours prior of CRRT. This variable was converted into a categorical variable, including low net ultrafiltration <1.01 ml·kg -1·h -1, moderate net ultrafiltration 1.01-1.38 ml·kg -1·h -1 and high net ultrafiltration >1.38 ml·kg -1·h -1, and the differences of baseline characteristics and clinical treatment conditions among the three groups were compared. Kaplan-Meier survival curve and log-rank test were used to compare the survival conditions among the three groups in patients at 28 days and 60 days after CRRT. Logistic regression analysis method was used to analyze the related factors of mortality in patients 28 days and 60 days after CRRT. Results:This study included a total of 661 critically ill AKI patients who underwent CRRT for more than 72 hours. The age was 56.00 (43.00, 68.00) years, and 488 patients (73.83%) were males. The net ultrafiltration rate was 1.36 (0.94, 1.89) ml·kg -1·h -1. Among them, 188 patients (28.44%) were in the low net ultrafiltration group, 152 patients (23.00%) were in the medium net ultrafiltration group, and 321 patients (48.56%) were in the high net ultrafiltration group. There were statistically significant differences among the three groups in terms of gender distribution ( χ2=17.81, P<0.001), body mass index ( H=32.37, P<0.001), urine volume 24 hours before admission ( H=9.41, P=0.009), fluid overload ( H=6.02, P=0.049), platelets ( H=13.49, P=0.001), pro-B type natriuretic peptide ( H=14.18, P<0.001), serum creatinine ( H=9.66, P=0.008), lactate ( H=9.83, P=0.007), AKI stage distribution ( χ2=15.51, P=0.004), admission indication ( P<0.001), total CRRT duration ( H=8.45, P=0.015), ultrafiltration ( H=456.10, P<0.001), net ultrafiltration ( H=561.20, P<0.001), and vasoactive-inotropic score at 72 hours of CRRT treatment ( H=10.42, P=0.005). Kaplan-Meier survival analysis showed that there were statistically significant differences in the 28-day (Log-rank test, χ2=10.89, P=0.004) and 60-day (Log-rank test, χ2=8.55, P=0.014) survival rates among the three groups in patients after CRRT. Multivariate logistic regression analysis showed age ( OR=1.03, 95% CI 1.02-1.04, P<0.001), mean arterial pressure ( OR=0.98, 95% CI 0.97-1.00, P=0.011), bilirubin ( OR=3.02,95% CI 1.39-5.59, P=0.006), 72-hour vasoactive-inotropic score ( OR=1.01, 95% CI 1.00-1.02, P=0.004), low net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.66, 95% CI 1.02-2.72, P=0.042), and high net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.78, 95% CI 1.14-2.78, P=0.011) were independent correlated factors of 28-day mortality after CRRT. Age ( OR=1.02，95% CI 1.01-1.04， P<0.001), mean arterial pressure ( OR=0.98，95% CI 0.97-1.00， P=0.016), fluid overload ( OR=1.10, 95% CI 1.02-1.19, P=0.012), bilirubin ( OR=4.96，95% CI 1.00-17.80， P=0.013), 72-hour vasoactive-inotropic score ( OR=1.02，95% CI 1.01-1.03， P=0.003), and high net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.91，95% CI 1.22-3.00， P=0.005) were independent correlated factors of 60-day mortality after CRRT. Conclusions:During the first 72 hours of CRRT, net ultrafiltration > 1.38 ml·kg -1·h -1 and net ultrafiltration < 1.01 ml·kg -1·h -1 are associated with a higher mortality rate at 28 days or 60 days after CRRT. Net ultrafiltration of 1.01-1.38 ml·kg -1·h -1 may be a relatively safe range.

ObjectiveTo explore the quality differences between steamed products and raw products of Citri Reticulatae Pericarpium（CRP）. MethodThe color of steamed products and raw products of CRP was determined from the perspective of appearance by electronic eye technique， and the quality differences between them was objectively characterized by the luminous value（L^*）， yellow-blue value（b^*）， red-green value（a^*） and total chromatic value（E^*_ab）. Based on this， ultra-high performance liquid chromatography（UPLC） was used to establish a fingerprint evaluation method with the mobile phase of acetonitrile（A）-0.1% formic acid aqueous solution（B） for gradient elution（0-5 min， 5%A； 5-30 min， 5%-20%A； 30-60 min， 20%-52%A）， detection wavelength at 270 nm， flow rate of 0.3 mL·min^-1 and column temperature of 30 ℃. The quality differences between steamed products and raw products of CRP were compared from the perspective of chemical composition， and correlation analysis was used to reveal the correlation between the difference in appearance color and the difference in internal chemical composition. ResultAfter being steamed， L^*， b^* and E^*_ab of CRP showed an overall decreasing trend， indicating that the color of the steamed products darkened and deepened from yellow to blue but still tended to be yellow， while a^* showed an overall increasing trend， indicating that the color of the steamed products tended to red. A total of 24 peaks were identified in the fingerprint profiles of raw products and steamed products of CRP， and 13 of the main peaks were identified. The precision， stability and repeatability studies showed that compared with the reference peak （peak 14， hesperidin）， the relative standard deviations（RSDs） of the relative peak area and relative retention time of the remaining peaks were<3.0%.The results of chemometric statistical analysis showed that there were some differences between raw products and steamed products of CRP， and 7 main differential components were identified， among which 5-hydroxymaltol（peak 1） and 5-hydroxymethylfurfural（peak 2） were the characteristic components of steamed products. The correlation analysis results showed that， in addition to the above two characteristic components， four components of peak 4， peak 10 （vicenin-2）， peak 23 （tangeretin） and peak 24 （5-demethylnobiletin） also correlated significantly with the color change （E^*_ab） of the samples （P<0.05， P<0.01）. ConclusionBefore and after steaming， not only the chemical composition changes， but also the color. Comparing the characteristic peaks of chemical composition difference and color difference before and after steaming of CRP， it is found that 5-hydroxymaltol， 5-hydroxymethylfurfural and peak 4 are common characteristic difference components， which can provide a reference for establishing the characteristic quality control method of steamed products， and quickly evaluating the quality difference between raw products and steamed products of CRP.

Background::A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient for use in continuous renal replacement therapy (CRRT). We aim to design a randomized clinical trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solutions in CRRT with RCA.Methods::Of the 64 patients receiving RCA-based postdilution continuous venovenous hemodiafiltration (CVVHDF) enrolled from 2017 to 2019 in West China Hospital of Sichuan University, 35 patients were randomized to the calcium-containing group and 29 to the calcium-free replacement solution group. The primary endpoint was circuit lifespan and Kaplan-Meier survival analysis was performed. Secondary endpoints included hospital mortality, kidney function recovery rate, and complications. The amount of 4% trisodium citrate solution infusion was recorded. Serum and effluent total (tCa) and ionized (iCa) calcium concentrations were measured during CVVHDF.Results::A total of 149 circuits (82 in the calcium-containing group and 67 in the calcium-free group) and 7609 circuit hours (4335 h vs. 3274 h) were included. The mean circuit lifespan was 58.1 h (95% CI 53.8-62.4 h) in the calcium-containing group vs. 55.3 h (95% CI 49.7-60.9 h, log rank P = 0.89) in the calcium-free group. The serum tCa and iCa concentrations were slightly lower in the calcium-containing group during CRRT, whereas the postfilter iCa concentration was lower in the calcium-free group. Moreover, the mean amounts of 4% trisodium citrate solution infusion were not significantly different between the groups (171.1 ± 15.9 mL/h vs. 169.0 ± 15.1 mL/h, P = 0.49). The mortality (14/35 [40%] vs. 13/29 [45%], P = 0.70) and kidney function recovery rates of AKI patients (19/26, 73% vs. 14/24, 58%, P = 0.27) were comparable between the calcium-containing and calcium-free group during hospitalization, respectively. Six (three in each group) patients showed signs of citrate accumulation in this study. Conclusions::When compared with calcium-free replacement solution, RCA-based CVVHDF with calcium-containing replacement solution had a similar circuit lifespan, hospital mortality and kidney outcome. Since the calcium-containing solution obviates the need for a separate venous catheter and a large dose of intravenous calcium solution preparation for continuous calcium supplementation, it is more convenient to be applied in RCA-CRRT practice.Registration::Chinese Clinical Trial Registry ( www.chictr.org.cn, ChiCTR-IPR-17012629)

Objective To investigate the effects of methylprednisolone pulse therapy on the expression of phosphorylated signal transducer and activator of transcription 1 (STATI) and DNA-binding activity of STATI in T cells in patients with severe systemic lupus erythematosus (SLE). Methods Six patients were included. Patients were given 0.5～1 g of methylprednisolone on 3 consecutive days. Western Blotting was conducted to explore the phosphorylated STATI expression and electrophoretic mobility shift assays (EMSA) were carried out to detect the DNA-biding activity of STATI. Results Methylprednisolone pulse therapy decreased phosphorylated STATI expression of T cells from patients with severe SLE. The expression of phosphorylated STATI decreased to about 30% 72 h after the methylprednisolone pulse therapy started (t=2.858, P<0.05). Methylprednisolone pulse therapy down-regulated DNA-biding activity of STATI of T cells in patients with severe SLE. The STATI DNA-biding activity was inhibited to about 40% 72 h after methy-Iprednisolone pulse, therapy started (t=3.058, P<0.05). Conclusion Phosphorylated STATI expression and DNA-binding activity of T cells is markedly decreased in patients after methylprednisolone pulse therapy, suggesting that inhibition of STATI signaling contributes to the clinical efficacy of this agent.

OBJECTIVE: To investigate the epidemiological characteristics of allergic rhinitis (AR) in urban and rural areas of Ningbo and Yongzhou. METHOD: Fifteen fields in the two cities from October 2006 to June 2007 were randomly selected. Cases suspected with symptoms of AR by a self-administered and interview questionnaire were recommended to special examinations for confirmed diagnosis. RESULT: 1. A total of 9969 individuals from 3803 families were surveyed, of whom 303 suffered with AR. 2. The prevalence rate was 4.10% in Ningbo and 1.65% in Yongzhou (the sex-adjusted rate was 4.10% and 1.64% respectively, and the age-adjusted rate was 4.33% and 1.58%); the population of island inhabitants had the lowest prevalence rate of 0.73%. 3. The prevalence rate in patients with asthma and that with family genetic history was 8% and 12% respectively. CONCLUSION It demonstrates that the prevalence rate is higher in Ningbo than in Yongzhou, in urban than in rural and in adolescent than in other ages. Allergic rhinitis may be associated with asthma and related to genetic factors. Allergic rhinitis may be curable.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asthma ; epidemiology ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Infant ; Male ; Middle Aged ; Prevalence ; Rhinitis, Allergic, Perennial ; epidemiology ; Rhinitis, Allergic, Seasonal ; epidemiology ; Rural Population ; Surveys and Questionnaires ; Urban Population ; Young Adult