Objective:To evaluate the efficacy and safety of utilizing bicarbonate derived from the metabolism of regional citrate anticoagulation (RCA) as the sole base source for replacement fluid in continuous veno-venous hemofiltration (CVVH).Methods:A retrospective analysis was conducted on ICU patients who underwent RCA combined with CVVH between July 2024 and February 2025, with pre-treatment serum bicarbonate levels ranging from 18 mmol/L to 27 mmol/L. Patients managed with the "traditional RCA protocol" (4% citrate initially set at 1.2–1.5 times blood flow rate), using commercial calcium-containing replacement fluid (4 L/bag) with additional sodium bicarbonate supplementation, were assigned to the control group. Those treated with the "fixed RCA protocol" (targeting an extracorporeal citrate concentration of approximately 4 mmol/L), with a total effluent-to-citrate flow ratio of 9–10:1 and no supplemental sodium bicarbonate, were assigned to the study group. Outcomes included the incidence of metabolic acid-base disorders, amount of sodium bicarbonate used, filter lifespan, adverse events (e.g., bleeding), and 28-day mortality.Results:A total of 86 patients were enrolled, with 42 in the control group and 44 in the study group. The incidence of metabolic alkalosis was significantly higher in the control group (30.9%) than in the study group (2.3%) ( P < 0.001), while no significant difference was observed in the incidence of metabolic acidosis. Three patients in the study group received additional sodium bicarbonate during CVVH. The median sodium bicarbonate usage in the study group was 0 (0–5.6) mL, significantly lower than that in the control group [15.3 ( 8.3–24.3)] mL, P = 0.002). Filter lifespan was significantly shorter in the control group (36.4 ± 19.2 hours) compared to the study group (51.2 ± 17.6) h; P < 0.001]. Post-filter ionized calcium was significantly higher in the control group [(0.39 ± 0.08) mmol/L) than in the study group [(0.32 ± 0.09) mmol/L; P < 0.001]. CVVH was discontinued due to filter clotting in 71.4% of control patients, compared to 36.4% in the study group ( P < 0.05). In contrast, 45.5% of study group patients discontinued CVVH due to meeting treatment goals, versus only 9.5% in the control group ( P < 0.05). No treatment-related bleeding or citrate accumulation events occurred in either group. The 28-day mortality was 28.6% in the control group and 29.5% in the study group, with no statistically significant difference. Conclusions:In relatively stable patients, RCA can serve as a safe and effective independent base source for CVVH replacement fluid. This approach not only ensures adequate anticoagulation but also significantly reduces the incidence of metabolic alkalosis.

Objective:To explore the potential advantages and application prospects of cardiopulmonary resuscitation ventilation mode (CPRV) for ventilation during CPR, through comparing of the resuscitation effect of CPRV, intermittent positive pressure ventilation (IPPV) and impedance threshold device (ITD) during advanced cardiovascular life support (ACLS).Methods:30 miniature landrace pigs [weighing (31.7±4.5) kg] were randomly divided into three groups: CPRV group, IPPV group and ITD group (10 pigs in each group). Each animal received 5 min of chest compressions only CPR after 3 min of untreated ventricular fibrillation. Then in the ACLS stage, chest compressions and mechanical ventilation (tidal volume of 7 mL/kg, respiratory rate 10 times/min) were performed according to the divided groups. Defibrillation was delivered after 16 min of ACLS, and intravenous epinephrine was administered for the pigs without return of spontaneous circulation (ROSC). A second defibrillation was delivered after 2 more minutes of CPR. Blood gases, respiratory parameters, and hemodynamic parameters were collected at baseline, ACLS 8 min and ACLS 16 min. ROSC after defibrillation was also recorded.Results:At ACLS 8 min and 16 min, intrathoracic high pressure and intrathoracic pressure variability of CPRV group were significantly higher than those of IPPV and ITD group, while the absolute value of intrathoracic negative pressure in CPRV group was higher than that in IPPV group (all P <0.01), but no difference was found between CPRV group and ITD group. The levels of arterial pH, PaO 2 and venous oxygen saturation in CPRV group were significantly higher than those in IPPV group and ITD group during ACLS, while PaCO 2 was significantly lower in CPRV group than in IPPV group and ITD group (all P <0.05). Aortic blood pressure, coronary perfusion pressure and carotid blood flow during ACLS in CPRV group were significantly higher than those in IPPV group, and right atrial pressure of CPRV group was significantly lower than that of IPPV group (all P <0.05). Coronary perfusion pressure of CPRV group was significantly higher than that of ITD group at ACLS 16 min but not ACLS 8 min, and there were no differences of aortic blood pressure and carotid blood flow between CPRV group and ITD group. The total ROSC rate in the CPRV group (90%) was significantly higher than that in the IPPV group (30%) and the ITD group (40%) (P <0.05). Conclusion:Ventilation with CPRV during ACLS showed better ventilation, oxygenation, hemodynamic effects and higher ROSC than IPPV and ITD, and the use of CPRV during CPR shows a certain application prospect.

Objective:To observe the clinical effect of Shenfu injection in preventing septic cardiomyopathy (SIC) in septic patients.Methods:From June 2022 to January 2023, patients with sepsis or septic shock who did not develop SIC were randomly divided into treatment group and control group according to the ratio of 1:1. In the treatment group, Shenfu injection (50 mL) was pumped intravenously once every 12 hours for 5 days. In the control group, 50 mL of normal saline was pumped intravenously once every 12 hours, and the course of treatment was 5 days. The primary end point was the incidence of SIC in the first 5 days. The secondary end points were the application time of vasoactive drugs, fluid balance in the previous week, hospitalization time in ICU, total ventilation time and 28-day mortality.Results:112 patients were randomly divided into two groups. Seven patients in the treatment group were excluded twice, and finally 49 patients were included in the analysis, while six patients in the control group were excluded twice and 50 patients included in the analysis. The total incidence of SIC in the treatment group within 5 days was significantly lower than that in the control group (42.9% vs. 64.0%, P = 0.035). Among them, the left ventricular systolic dysfunction in the treatment group was significantly lower than that in the control group (24.5% vs 52.0%, P=0.005), and there was no significant difference in the incidence of left ventricular diastolic dysfunction between the two groups. The incidence of right ventricular dysfunction in the control group was 28.0%, which was significantly higher than 10.2% in the treatment group ( P = 0.025). The duration of using vasoconstrictors in the treatment group was 75(48, 97) hours, which was significantly lower than 97(66, 28) hours in the control group ( P = 0.039). The duration of inotropic drugs use in the treatment group was 32(18, 49) h, which was also significantly shorter than 44(25, 61) h in the control group ( P=0.046). The fluid balance of the control group in the first week was (1 260±850) mL, which was significantly higher than (450±520) mL in the treatment group ( P=0.008). There was no statistical difference in ICU stay, total ventilation time and 28-day mortality between the two groups (all P > 0.05). Conclusion:Early application of Shenfu injection can significantly reduce the incidence of SIC, accompanied by less use of vasoactive drugs and positive fluid balance, which has a good clinical application prospect.

Objective:To compare the efficacy of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with moderate typeⅡ respiratory failure, to clarify the feasibility of HFNC in the treatment of AECOPD, and to explore the influencing factors of HFNC failure.Methods:This study was a randomized controlled trial of non-inferiority. Patients with AECOPD with moderate type Ⅱ respiratory failure [arterial blood gas pH 7.25-7.35, partial pressure of arterial blood carbon dioxide (PaCO 2)> 50 mmHg] admitted to the Intensive Care Unit (ICU) from January 2018 to December 2021 were randomly assigned to the HFNC group and NIV group to receive respiratory support. The primary endpoint was the treatment failure rate. The secondary endpoints were blood gas analysis and vital signs at 1 h, 12 h, and 48 h, total duration of respiratory support, 28-day mortality, comfort score, ICU length of stay, and total length of stay. Multivariate logistic regression analysis was used to evaluate the failure factors of HFNC treatment. Results:Totally 228 patients were randomly divided into two groups, 108 patients in the HFNC group and 110 patients in the NIV group. The treatment failure rate was 29.6% in the HFNC group and 25.5% in the NIV group. The risk difference of failure rate between the two groups was 4.18% (95% CI: -8.27%~16.48%, P=0.490), which was lower than the non-inferiority value of 9%. The most common causes of failure in the HFNC group were carbon dioxide retention and aggravation of respiratory distress, and the most common causes of failure in the NIV group were treatment intolerance and aggravation of respiratory distress. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (-29.02%, 95% CI -49.52%~-7.49%; P=0.004). After 1 h of treatment, the pH in both groups increased significantly, PaCO 2 decreased significantly and the oxygenation index increased significantly compared with baseline (all P < 0.05). PaCO 2 in both groups decreased gradually at 1 h, 12 h and 48 h after treatment, and the pH gradually increased. The average number of daily airway care interventions and the incidence of nasal and facial lesions in the HFNC group were significantly lower than those in the NIV group ( P < 0.05), while the comfort score in the HFNC group was significantly higher than that in the NIV group ( P=0.021). There was no significant difference between the two groups in the total duration of respiratory support, dyspnea score, ICU length of stay, total length of stay and 28-day mortality (all P > 0.05). Multivariate logistic regression analysis showed that acute physiology and chronic health evaluation Ⅱ score (≥15), family NIV, history of cerebrovascular accident, PaCO 2 (≥60 mmHg) and respiratory rate (≥32 times/min) at 1 h were independent predictors of HFNC failure. Conclusions:HFNC is not inferior to NIV in the treatment of AECOPD complicated with moderate type Ⅱ respiratory failure. HFNC is an ideal choice of respiratory support for patients with NIV intolerance, but clinical application should pay attention to the influencing factors of its treatment failure.

BACKGROUND: Immunotherapies such as adoptive immune cell infusion and immune-modulating agents are widely used for cancer treatment, and the concomitant symptoms, including cytokine release syndrome (CRS) or immune-related adverse events (irAEs), are frequently reported. However, clinical manifestations induced by mismatched donor granulocyte colony-stimulating factor mobilized peripheral blood mononuclear cell (GPBMC) infusion in patients receiving microtransplant (MST) have not yet been well depicted. METHODS: We analyzed 88 cycles of mismatched GPBMC infusion in patients with acute myeloid leukemia receiving MST and 54 cycles of chemotherapy without GPBMC infusion as a comparison. Clinical symptoms and their correlation with clinical features, laboratory findings, and clinical response were explored. RESULTS: Fever (58.0% [51/88]) and chills (43.2% [38/88]) were the significant early-onset symptoms after GPBMC infusion. Patients possessing less human leukocyte antigen-matching loci with the donor or those with unrelated donors experienced more chills (3 [2-5] loci vs. 5 [3-5] loci, P  = 0.043 and 66.7% [12/18] vs. 37.1% [26/70], P  = 0.024). On the other hand, those with decreased CD4 + /CD8 + T-cell ratio developed more fever (0.8 [0.7-1.2] vs. 1.4 [1.1-2.2], P  = 0.007). Multivariable analysis demonstrated that younger patients experienced more fever (odds ratio [OR] = 0.963, 95% confidence interval [CI]: 0.932-0.995, P  = 0.022), while patients with younger donors experienced more chills (OR = 0.915, 95% CI: 0.859-0.975, P  = 0.006). Elevated ultra-sensitive C-reactive protein levels in the absence of cytokine storm were observed following GPBMC infusion, which indicated mild and transient inflammatory response. Although no predictive value of infusion-related syndrome to leukemia burden change was found, the proportion of host pre-treatment activated T cells was positively correlated with leukemia control. CONCLUSIONS Mismatched GPBMC infusion in MST induced unique infusion-related symptoms and laboratory changes, which were associated with donor- or recipient-derived risk factors, with less safety and tolerance concerns than reported CRS or irAEs.
Humans ; Leukocytes, Mononuclear ; Hematopoietic Stem Cell Transplantation/adverse effects* ; Leukemia, Myeloid, Acute/therapy* ; Unrelated Donors ; Granulocyte Colony-Stimulating Factor ; Graft vs Host Disease

Objective:To compare the therapeutic effects of nasal high-flow oxygen therapy (HFNC) and nasal canal oxygenation (NCO) during breaks off non-invasive ventilation (NIV) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to explore the feasibility of NIV combined with HFNC in the treatment of AECOPD.Methods:From August 2017 to July 2019, AECOPD patients with type Ⅱrespiratory failure (arterial blood gas pH <7.35, PaCO 2 > 50 mmHg) who were treated with NIV were randomly (random number) assigned to the HFNC group and NCO group at 1:1. The HFNC group received HFNC treatment during breaks from NIV and the NCO group received low-flow NCO during the NIV interval. The primary endpoint was the total respiratory support time. The secondary endpoints were endotracheal intubation, duration of NIV treatment and breaks from NIV, length of ICU stay, total length of hospital stay and so on. Results:Eighty-two patients were randomly assigned to the HFNC group and the NCO group. After secondary exclusion, 36 patients in the HFNC group and 37 patients in the NCO group were included in the analysis. The total respiratory support time in the HFNC group was significantly shorter than that in the NCO group [(74 ± 18) h vs. (93 ± 20) h, P = 0.042]. The total duration of NIV treatment in the HFNC group was significantly shorter than that in the NCO group [(36 ± 11) h vs. (51 ± 13) h, P=0.014]. There was no significant difference of the mean duration of single break from NIV between the two groups, but durations of break from NIV in the HFNC group were significantly longer than those in the NCO group since the third break from NIV ( P < 0.05). The intubation rates of the HFNC and NCO groups were 13.9% and 18.9%, respectively, with no significant difference ( P=0.562). The length of ICU stay in the HFNC group was (4.3 ± 1.7) days, which was shorter than that in the NCO group [(5.8 ± 2.1) days, P=0.045], but there was no significant difference in the total length of hospital stay between the two groups. Heart rate, respiratory rate, percutaneous carbon dioxide partial pressure and dyspnea score during the breaks from NIV in the NCO group were significantly higher than those in the HFNC group, and the comfort score was lower than that in the HFNC group ( P<0.05). Conclusion:For AECOPD patients receiving NIV, compared with NCO, HFNC during breaks from NIV can shorten respiratory support time and length of ICU stay, and improve carbon dioxide retention and dyspnea. HFNC is an ideal complement to NIV therapy in AECOPD patients.

Objective To investigate the benefits and risks of stress ulcer prevention (SUP) using proton pump inhibitors (PPI) for critical patients. Methods The clinical data of adult critically ill patients admitted to the intensive care unit (ICU) of Northern Jiangsu People's Hospital from January 2016 to December 2018 were retrospectively analyzed. All patients who were treated with PPI for SUP within the first 48 hours after ICU admission were enrolled in the SUP group. Those who not received PPI were enrolled in the control group. A one-to-one propensity score matching (PSM) was performed to control for potential biases. The gender, age, underlying diseases, main diagnosis of ICU, drug use before ICU admission, sequential organ failure score (SOFA) at ICU admission, risk factors of stress ulcer (SU) and PPI usage were recorded. The end point was the incidence of gastrointestinal bleeding, hospital acquired pneumonia, Clostridium difficile infection and 30-day mortality. Kaplan-Meier survival curves were plotted, and survival analysis was performed using the log-rank test. Results 1 972 critical patients (788 in the SUP group and 1 184 in the control group) were enrolled, and each group enrolled 358 patients after PSM. Prior to PSM, compared with the control group, the SUP group had older patients, more underlying diseases, higher proportion of acute coronary syndrome (ACS), acute cerebrovascular disease, acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and poisoning in main diagnosis of ICU, more serious illness, and more risk factors of SU, indicating that ICU physicians were more likely to prescribe SUP for these patients. The incidence of gastrointestinal bleeding in the SUP group was significantly lower than that in the control group [1.8% (14/788) vs. 3.7% (44/1 184), P < 0.05], while the incidence of hospital acquired pneumonia and 30-day mortality were significantly higher than those in the control group [6.6% (52/788) vs. 3.5% (42/1 184), 17.9% (141/788) vs. 13.1% (155/1 184), both P < 0.01]. There was no significant difference in the incidence of Clostridium difficile infection between the SUP group and the control group [2.9% (23/788) vs. 1.8% (21/1 184), P >0.05]. After the propensity scores for age, underlying diseases, severity of illness and SU risk factors were matched, there was no significant difference in the incidence of gastrointestinal bleeding or 30-day mortality between the SUP group and the control group [2.2% (8/358) vs. 3.4% (12/358), 15.9% (57/358) vs. 13.7% (49/358), both P > 0.05], but the incidence of hospital acquired pneumonia in the SUP group was still significantly higher than that in the control group [6.7% (24/358) vs. 3.1% (11/358), P < 0.05]. Kaplan-Meier survival curve analysis showed that the 30-day cumulative survival rate of the SUP group was significantly lower than that of the control group before the PSM (log-rank test: χ2 = 9.224, P = 0.002). There was no significant difference in the 30-day cumulative survival rate between the two groups after PSM (log-rank test: χ2 = 0.773, P = 0.379). Conclusion For critical patients, the use of PPI for SUP could not significantly reduce the incidence of gastrointestinal bleeding and mortality, but increase the risk of hospital acquired pneumonia.

PURPOSE: The -1237T/C polymorphism of the Toll-like receptor 9 (TLR9) gene has been implicated in the susceptibility of inflammatory bowel diseases (IBDs), but the results remain conflicting. We further investigated this association via meta-analysis. MATERIALS AND METHODS: Multiple electronic databases were extensively searched until February, 2015. The strength of association was evaluated by calculating the pooled odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 2987 cases and 2388 controls from eight studies were analyzed. Overall, association was found between TLR9 -1237T/C polymorphism and the risk of IBDs when all the studies were pooled (recessive model, OR: 1.59, 95% CI: 1.02-2.47, p=0.04; homozygote comparison, OR: 1.62, 95% CI: 1.04-2.52, p=0.03; allele model, OR: 1.13, 95% CI: 1.00-1.27, p=0.05). Stratification by ethnicity indicated an association between TLR9 -1237T/C polymorphism and IBDs risk in Caucasians (recessive model, OR: 1.59, 95% CI: 1.02-2.47, p=0.04; homozygote comparison, OR: 1.62, 95% CI: 1.04-2.52, p=0.03; allele model, OR: 1.12, 95% CI: 1.00-1.27, p=0.05). When stratified by disease type, significant correlation were only found in the Crohn's disease subgroup (recessive model, OR: 1.69, 95% CI: 1.05-2.73, p=0.03; homozygote model, OR: 1.74, 95% CI: 1.07-2.82, p=0.02; allele model, OR: 1.15, 95% CI: 1.01-1.32, p=0.04). CONCLUSION: The present study suggested that the TLR9 -1237T/C polymorphism might act as a risk factor in the development of IBDs, particularly in Caucasians.
Alleles ; European Continental Ancestry Group/genetics ; Genetic Predisposition to Disease/*genetics ; Homozygote ; Humans ; Inflammatory Bowel Diseases/ethnology/*genetics ; Odds Ratio ; Polymorphism, Genetic/*genetics ; Risk Factors ; Toll-Like Receptor 9/*genetics/metabolism

Objective To investigate the relationship of body mass index with hiatal hernia (HH) and reflux esophagitis (RE).Methods Two hundreds and twenty seven gastroesophageal reflux disease (GERD) patients with typical acid regurgitation and heartburn were enrolled and categorized into three groups according to body mass index (BMI, kg/m2) as normal weight (18.5≤BMI ＜24), overweight (24≤BMI＜28), and obesity (BMI≥28).RE, non-erosive reflux disease (NERD) and HH were diagnosed by gastroscopy.All the patients underwent ambulatory 24-hour pH monitoring and the pathological acid reflux was considered when the DeMeester score≥15.Effects of BMI on RE and HH were estimated by using logistic regression analysis.Results The percentages of RE and HH were 30.0%(68/227) and 5.7%(13/227), respectively.76.9% (10/13) HH patients had RE. Proportions of RE and HH increased significantly with increasing BMI (P＜0.05), so was that of RE above grade B in three groups (6.4%, 16.9% and 31.6%,P=0.003).DeMeester scores of the three groups were 15.9, 19.8 and 36.9, respectively (P＜0.05).The average 24-hour intra-esophagus pH value of overweight group, was significantly lower than that of normal weight patients in the afternoon and midnight (P＜0.01).Multivariate analysis showed obesity was a risk factor for HH with OR 7.058 (95% CI: 1.294～38.488, P=0.024), male (OR: 2.537, 95% CI: 1.350～4.766, P=0.004), overweight (OR: 1.921, 95% CI: 1.005～3.670, P=0.048), obesity (OR: 3.305, 95% CI: 1.123～9.724, P=0.030) and HH (OR: 6.879, 95% CI: 1.695～27.913, P=0.007) were risk factors for RE.Conclusion BMI has a significant association with HH and RE, obesity is a common risk factor for both HH and RE, HH may induce the development of RE.

Objective To analyze the differences of morphological and microvascular characteristics between hyperplastic polyps and colorectal adenoma (CA) under narrow band imaging (NBI) without magnification endoscopy,and to evaluate the value of NBI in differential diagnosis.Methods Patients with rectal polyps diagnosed by common endoscopy and pathologically confirmed CA and hyperplastic polyps were recruited in this study and under NBI examination.The pit pattern was divided into type A and B according to modified Kudo pit pattern classification.And the vascular pattern was classified into three types,type Ⅰ with invisible microvascular,type Ⅱ with even microvascular arranged along pit and type Ⅲ with uneven microvascular and irregular arranged.The differences of morphological and microvascular characteristics between hyperplastic polyps and CA were compared and the inter-observer consistency of NBI without magnification endoscopy was evaluated.Results Overall,87 patients with 107 polyps (73 CAs,34 hyperplastic polyps) underwent NBI without magnification endoscopy examination.The maximum diameter and the proportion of polyps with sublobe was higher in CA group than that of hyperplastic polyps group (P =0.0023 and 0.0047).In CA group,most pit shapes were type B (86.3％,63/73),and most vascular pattern types were Ⅱ/Ⅲ (82.2％,60/73).The sensitivity,specificity and accuracy of CA diagnosed with features of type B pit shape or Ⅱ/Ⅲ vascular pattern type was 97.3％,82.4％ and 92.5％.The sensitivity,specificity and accuracy of CA diagnosed with combined features of type B pit shape and Ⅱ/Ⅲ vascular pattern type was 71.2％,91.2％ and 77.6％.The mean kappa value of inter-observer consistency was 0.761.Conclusions There are differences in pit shapes and vascular pattern characteristics between CA and hyperplastic polyps.According to these two facts,CA and hyperplastic polyps can be initially differential diagnosed by NBI without magnification endoscopy.