To determine the physicians′compliance of hour-1 bundle for sepsis. A management system of hour-1 bundle for sepsis was established. The clinical data of 286 sepsis patients were collected, who were classified into 3 months before the bundle (control group), 9 months during process (observation group) and 3 months after bundle (study group). The compliance of hour-1 bundle implementation was compared in three groups. The results showed that with the application and implementation of the management system, the compliance of hour-1 bundle for sepsis in the control group, observation group and study group was 58.3%(28/48), 69.1%(105/152) and 88.4%(76/86) respectively (χ 2=7.053, P=0.029). The 28 day mortality in sepsis patients was 41.7%(20/48), 34.9%(53/152) and 23.3%(20/86) respectively (χ 2=5.576, P=0.062).The management system of hour-1 bundle for sepsis can effectively improve the physicians′ compliance.

BACKGROUNDHigh-frequency oscillatory ventilation (HFOV) allows for small tidal volumes at mean airway pressures (mPaw) above that of conventional mechanical ventilation (CMV), but the effect of HFOV on hemodynamics, oxygen metabolism, and tissue perfusion in acute respiratory distress syndrome (ARDS) remains unclear. We investigated the effects of HFOV and CMV in sheep models with ARDS.

METHODSAfter inducing ARDS by repeated lavage, twelve adult sheep were randomly divided into a HFOV or CMV group. After stabilization, standard lung recruitments (40 cmH2O × 40 seconds) were performed. The optimal mPaw or positive end-expiratory pressure was obtained by lung recruitment and decremental positive end-expiratory pressure titration. The animals were then ventilated for 4 hours. The hemodynamics, tissue perfusion (superior mesenteric artery blood flow, pHi, and Pg-aCO2), oxygen metabolism and respiratory mechanics were examined at baseline before saline lavage, in the ARDS model, after model stabilization, and during hourly mechanical ventilation for up to 4 hours. A two-way repeated measures analysis of variance was applied to evaluate differences between the groups.

RESULTSThe titrated mPaw was higher and the tidal volumes lower in the HFOV group than the positive end-expiratory pressure in the CMV group. There was no significant difference in hemodynamic parameters between the HFOV and CMV groups. There was no difference in the mean alveolar pressure between the two groups. After lung recruitment, both groups showed an improvement in the oxygenation, oxygen delivery, and DO2. Lactate levels increased in both groups after inducing the ARDS model. Compared with the CMV group, the superior mesenteric artery blood flow and pHi were significantly higher in the HFOV group, but the Pg-aCO2 decreased in the HFOV group.

CONCLUSIONCompared with CMV, HFOV with optimal mPaw has no significant side effect on hemodynamics or oxygen metabolism, and increases gastric tissue blood perfusion.

Animals ; Disease Models, Animal ; Hemodynamics ; physiology ; High-Frequency Ventilation ; methods ; Male ; Oxygen ; metabolism ; Positive-Pressure Respiration ; methods ; Respiration, Artificial ; methods ; Respiratory Distress Syndrome, Adult ; metabolism ; therapy ; Sheep

OBJECTIVETo study the current situation of coagulation factor VIII (FVIII) inhibitor development in children with hemophilia A (HA) through a cross-sectional survey, and to explore the risk factors of inhibitor development in order to provide evidence for further prevention and management strategies.

METHODThe clinical data of outpatients with hemophilia A in Beijing Children's Hospital seen from November 2012 to May 2013 were collected, FVIII inhibitor was screened and analyzed its risk factors.

RESULTA total of 102 HA children were enrolled, 5 were mild cases, 32 were moderate, and 65 were severe cases; the median age on enrollment was 55.5 (3.0-200.0) months:19(18.6%) of patients had inhibitors and 9 (8.8%) had low-titer inhibitors, 10 (9.8%) had high-titer inhibitors. Receiving FVIII treatment for life-threatening bleeding (P = 0.03) ,OR 4.10 (95%CI:1.17-14.32) was a risk factor for inhibitor generation and patients within 20 exposure days have more chances of inhibitor development (P = 0.04) ,OR 3.32 (95%CI:1.02-10.86) . High and intense FVIII exposure within short term was the risk factor for high titer inhibitor development (P = 0.01) ,OR 5.25 (95%CI:1.45-21.92) .

CONCLUSIONIntense FVIII exposure for severe hemorrhage was the risk factor of inhibitors development especially of high titer inhibitors.

Adolescent ; Blood Coagulation Factor Inhibitors ; blood ; Child ; Child, Preschool ; Cross-Sectional Studies ; Dose-Response Relationship, Drug ; Factor VIII ; administration & dosage ; antagonists & inhibitors ; Female ; Hemophilia A ; blood ; therapy ; Humans ; Infant ; Male ; Multivariate Analysis ; Risk Factors ; Time Factors

Objective To explore the clinical signiifcance of combined detection of thyroid stimulating hormone (TSH) and free thyroxin (FT4) in dried blood spots in screening for congenital hypothyroidism (CH) in neonates. Methods The TSH and FT4 levels in dried blood spot were measured by time-resolved lfuorescence immunity in live born neonates from June to December 2013. If the screening was positive, the blood was drawn and the serum TSH and FT4 were measured and compared with the results from dried blood spots. Results In a total of 31 199 neonates screened, 12 cases were diagnosed with CH and the prevalence rate of CH was 1/2 600;4 cases were hyperthyropinemia and no pituitary CH was detected. There was no signiifcant difference between TSH or FT4 levels in dried blood spot and those in serum in neonates diagnosed with CH (P>0.05). Conclusions Combined detection of TSH and FT4 in dried blood spot can be used for neonatal screening of CH. It can be applied for early distinguishing CH from hyperthyropinemia, and also helpful for early diagnosis and treatment of central CH.

Objective To evaluate the effect of sucralfate and acid-suppressive drugs on preventing ventilator-associated pneumonia (VAP) in mechanically ventilated patients.Methods All randomized controlled trials (RCTs),which studied the effect of sucralfate and acid-suppressive drugs on the incidence of VAP in mechanically ventilated patients,were searched from PubMed,Embase and the Cochrane Library during January 1966 to March 2013 via manual and computer retrieval.All related data were extracted.Meta analysis was conducted using the statistical software RevMan 5.2 and the quality of the RCTs was strictly evaluated with the methods recommended by the Cochrane Collaboration.Results A total of 15 RCTs involving 1315 patients in the sucralfate group and 1568 patients in the acid-suppressive drug group were included in this study.The incidence of VAP was significantly reduced in the sucralfate group (RR =0.81,95％ CI 0.7-0.95,P =0.008),while no difference was found between the two groups in the incidence of stress-related gastrointestinal bleeding (RR =0.96,95％ CI 0.59-1.58,P =0.88).No statistical difference was found in the days on ventilator,duration of ICU stay and ICU mortality in the two groups (all P values ＞ 0.05).Conclusion In patients with mechanical ventilation,sucralfate could decrease the incidence of VAP,while has no such effect on the stress-related gastrointestinal bleeding,the days on ventilator,duration of ICU stay and ICU mortality.

OBJECTIVE: To explore the effect of clinical pathway of health education in patients with kidney transplantation. METHODS: A total of 116 patients with kidney transplantation were randomly divided into an experimental group and a control group (n=58 in each group). The patients in the control group received traditional health education, and the patients in the experimental group experienced the clinical pathway of health education. The effect of health education was assessed and compared. RESULTS: There was significant difference in the effect of health education between the two groups (P<0.05). CONCLUSION Clinical pathway of health education in patients after kidney transplantation can significantly improve the effect of health education.
Critical Pathways ; Humans ; Kidney Transplantation ; Patient Education as Topic

Objective To investigate the effect of the genotypic analysis of donor from cardiac death donation on the initial dose of Tac for liver transplant recipients and provide individualized administration for the early use of Tac in liver transplantation patients.Method Thirty recipients with a different genotype of CYP3A5 from cardiac death donors were collected from March 2010 to February 2013.The matched recipients were randomly divided into experiment group and control group.There was an adjustment of initial doses of Tac according to the donors' different CYP3A5 genotypes in experiment group but not in control group.Result In experiment and control groups,the average Tac blood concentrations at the 7th day after operation were (7.47 ± 1.83) and (8.68 ± 5.14) ng/mL,and the percent of recipeints reaching the optimal Tac concentrations was 72.2％ and 38.9％,respectively (P＜0.05).In experiment and control groups,22.2％ and 55.6％ recipients needed adjustments of Tac concentrations respectively (P＜0.05).Conclusion Individualized adjustment of Tac initial doses of recipients according to cardiac death donors' different CYP3A5 genotypes was benefit for reaching optimal concentrations as soon as possible and could decrease the rate of rejection,and reduce the side effects of Tac.

Objective To observe the expression of I-Ab/I-E on circulating,lung and splenic dendritic cells (DC) in acute lung injury (ALI) mice.Methods Twenty-four C57BL/6 mice were randomly divided into four groups:control group,ALI 6 h,ALI 12 h and ALI 24 h group.Blood,lungs and spleens were harvested after lipopolysaccharide or phosphate butter solution administration.The expression of I-Ab/I-E on DC was assessed by flow cytometry (FCM).IL-6 level in the lung was measured by enzymelinked immunosorbent assay (ELISA).Lung wet weight/body weight (LW/BW) was recorded to assess lung injury.Meanwhile,pathological changes were examined under optical microscope.Results (1) lipopolysac charide-induced ALI mice resulted in a significant increase in lung LW/BW ratio.(2) Histologically,widespread alveolar wall thickening caused by edema,marked and diffuse interstitial infiltration with inflammatory cells,and severe hemorrhage in the interstitium and alveolus were observed in the ALI groups.(3) The level of IL-6 in lung tissue was significantly enhanced in ALI mice.(4) FCM analysis showed that I-Ab/I-E expressions on lung DC [(73 ±9)％],and splenic DC [(81 ±8)％] were significantly higher than that on circulating DC [(24 ± 7) ％ ; P ＜ 0.05] in control mice.(5) In ALI mice,the expressions of I-Ab/I-E on peripheral blood DC were (34 ± 17)％ at 6 h,(51 ± 16)％ at 12 h,(50 ± 17)％ at24 h respectively; I-Ab/I-E expressions on lung DC were (82 ± 14)％ at 6 h,(88 ±6)％ at 12 h,(90 ±10)％ at 24 h respectively; the expressions of I-Ab/I-E on splenic DC were (88 ± 8)％ at 6 h,(89 ± 4)％ at 12 h,(93 ± 9)％ at 24 h respectively,which were also significantly higher than those on the peripheral blood DC (P ＜ 0.05).(6) The I-Ab/I-E expressions on circulating DC in ALl mice at 12 h and 24 h was significantly higher than that on circulating DC in control mice (P ＜ 0.05).(7) The I-Ab/I-Eexpressions on lung DC and splenic DC in ALI mice at 24 h were significantly higher than those on lung DC and splenic DC in control mice (P ＜ 0.05).(8) There was a significant correlation of I-Ab/I-E expression on respiratory DC with the IL-6 level and lung injury score in LPS-induced ALI group (P ＜ 0.05).Conclusions There is a dynamic characteristic in the expression I-Ab/I-E on circulating,lung and splenic DC populations in ALI mice.I-Ab/I-E on pulmonary DC seems to play an important role in the pathogenesis of ALI.

Objective To investigate the effect of intralesional lauromacrogol therapy on infantile hemangioma.Methods 30 cases all received intralesional injection of lauromacrogol.The changes of tumor size,texture and color were monitored and recorded.The adverse effects after medication were observed and managed accordingly.The adverse effects after medication were observed.The times of treatment were determined according to degree of reduction of tumor volume.To assess the efficacy,a 4 scales system was adopted.Results All patients had completed the treatment and followup.The overall response was scale Ⅰ in 2 cases (6.7 ％),scale Ⅱ efficacy in 4 patients (13.3 ％),scale Ⅲ efficacy in 5 cases (16.7 ％) and scale Ⅳ in 19 cases (63.3 ％).The smaller the tumor,the fewer the times of treatment,and the better the results.The effects of treatment were better if patient could be treated by intralesional lauromacrogol therapy in early stage.No severe adverse effects were observed during 6 months of follow-up.Conclusions Intralesional injection of lauromacrogol sclerotherapy is a safe and effective way to treat infantile hemangioma.

ObjectiveTo compare the outcomes of 3 modes of weaning,e.g.SmartCare (a computerdriven knowledge-based system),spontaneous breathing trials (SBBT) and empirical methods,used in patients with chronic obstructive pulmonary diseases (COPD) weaned off mechanical ventilation.MethodsSixty-eight COPD patients were enrolled and randomly (random number) assigned to receive SmartCare (SC group,n =24),SBT (SBT group,n=24) or empirical methods (EM group,n =20).The following data were recorded including beginning of weaning:time consumed for weaning,duration of mechanical ventilation,length of ICU stay,success rate of weaning,survival rate during hospitalization and the complications of mechanical ventilation.The patients were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing.ResultsTime required for weaning and total time for mechanical ventilation in SC group were greatly shorter than those in EM group (P =0.002,0.002),but there were no differences between SC group and SBT group (P =0.540,0.573).Though the length of ICU stay (7.5 d) in SBT group was notably shorter than that in EM group (82.5 d) (P=0.015),there was no difference between SBT group and SC group (8.0 d).Weaning success rate was greater in the SC group (88.3％) than that in EM group (50.0％),but there was no difference between SBT group (66.7％ ) and SC group.No significant differences in survival rate during hospitalization,rate of re-intubation,self-extubation and need for noninvasive ventilation were found among three groups.ConclusionsCompared to empirical methods for weaning,SmartCare could greatly increase the success rate of weaning,but it was not superior to SBT.