Objective To study the effects of total saponins of panax notoginseseng injection on the coagulation function in sepsis. Methods 50 sepsis patients with normal coagulation function were randomly divided into two groups. 25 patients in the control group received the routine treatment and the other 25 patients in the treatment group received total saponins of panax notoginseseng injection additionally. The levels of Plt, PT, TT, APTT, FIB and D-D were measured before the therapy and on 1st, 3rd and 7th day after the therapy. Results The levels of Plt, PT, TT, APTT, FIB and D-D before the therapy had no significant differences between the two groups ( P gt; 0. 05) . The levels of Plt and FIB had significant differences between the two groups on 7th day after therapy ( P lt;0. 01, P lt; 0. 05) . PT, TT, and APTT were prolonged in the controlled group gradually, butwere not prolonged or even shortened in the treatment group,which were significantly shorter in the treatment group on 7th day after therapy ( P lt; 0. 05) . D-D slightly elevated in the control group, but slightly elevated at first and dropped gradually in the treatment group, which was significantly lower in the treatment group on7th day after therapy. Conclusion Total saponins of panax notoginseseng injection has a protective effect on coagulation function in sepsis.
Objective To explore the predictive value of simplified acute physiological score Ⅱ (SAPS-Ⅱ) combined with lactate clearance rates (LCR) at different moments for mortality in sepsis patients. Methods A total of 188 patients with sepsis admitted in the hospital from April 2020 to February 2023 were selected, who were evaluated using the SAPS-Ⅱ scale. Spectrophotometry was used to detect blood lactate at baseline, after 6h, 12h, 24h, and 48h, then the LCR after 6h, 12h, 24h, and 48h were calculated. The patients were divided into a survival group (n=139) and a death group (n=37) based on 28 day outcome. Logistic regression analysis was used to explore the risk factors of sepsis death, and the efficacy of SAPS-Ⅱ scores combined with LCR at different moments in predicting patient death was analyzed using receiver operating characteristic (ROC) curve. Results Twelve patients fell off, and 37 died in the remaining 176 patients, the mortality rate was 21.02%. The age, temperature, random blood glucose, blood urea nitrogen, serum creatinine, and SAPS- Ⅱ scores in the death group were significantly higher than those in the survival group (P<0.05), while platelet count and LCR at all moments were significantly lower than those in the survival group (P<0.05). The LCR of the death group continued to decrease with time. The trend of changes in the survival group were opposite, and the differences in the two groups between each two moments were statistically significant (P<0.05). The SAPS-Ⅱ scores and LCR at all moments were risk factors for patient death (P<0.05). The SAPS-Ⅱ score and LCR at all moments had predictive value for patient death, and the area under ROC curve of the combined prediction was 0.921 (95%CI 0.825 - 1.000), which was higher than the individual prediction and LCR at each moment combined with SAPS II score prediction (P<0.05). Conclusion The SAPS-Ⅱ scores and LCR at different moments are all related to death of sepsis patients, and the combined prediction of death by the above indicators is highly effective.
This article aims to interpret the consensus report of the 30th Acute Disease Quality Initiative (ADQI) workgroup on hemoadsorption (HA) technology, providing reference for clinical practice and research. HA has shown therapeutic advantages in various diseases. The ADQI workgroup assessed the research progress of HA technology, confirming its clinically acceptable short-term biocompatibility, safety, and technical feasibility, as well as experimental demonstration of specified target molecule removal. Preliminary studies have shown a potential benefit of endotoxin-based HA in sepsis. However, due to insufficient clinical evidence, HA is still considered an experimental intervention. The ADQI consensus report focuses on filling existing knowledge gaps, pointing out future research directions, and providing important guidance for the clinical application and further research of HA technology.
Sepsis, a serious clinical syndrome known as organs dysfunction caused by an unbalanced host inflammatory response to infection, is of great concern in emergency medicine. Over the past two decades, the definition of sepsis has changed from systemic inflammatory response syndrome lead by infection to organs damage caused by infection. Under the new diagnostic criterion, septic patients are too serious to be treated in Emergency Department, and need intensive treatment of Intensive Care Unit. In this paper, by analyzing the development process from infection to sepsis and expounding the role of cytokines in the development of sepsis, we think that measures should be taken at the early stage of infection in order to prevent and block the occurrence of sepsis.
Objective To observe the protective effects of unfractionated heparin (UFH) on high-mobility group box-1 protein (HMGB1) induced increased permeability of endothelial cells, and investigate the protective mechanism of UFH on HMGB1 induced defective expression of zonula occludens-1 (ZO-1). Methods Human umbilical vascular endothelial cells (HUVECs) were culturedin vitro and divided into 4 groups (n=5), namely a control group, a HMGB1 group (100 ng/ml), a heparin group (UFH 10 U/ml), a HMGB1/heparin group (100 ng/ml HMGB1 + UFH 10 U/ml). Endothelial cell viability was measured by methyl thiazolyl tetrazolium (MTT) colorimetric method. Endothelial permeability was determination by Transwell chamber method. Immunofluorescence and laser confocal microscopy were used to assess the distribution of ZO-1. The protein expressions of tight junction protein ZO-1 and nuclear factor kappa B (NF-κB) were detected by Western blot. Results HMGB1 (100 ng/ml) had no inhibitory effect on endothelial cell viability (P＞0.05). UFH pretreatment could reduce the permeability increment of endothelial cells induced by HMGB1. UFH pretreatment could reduce the close loop reduction and damage of ZO-1 induced by HMGB1, enhance the fluorescence intensity and expression of ZO-1, and decrease the NF-κB translocation. Conclusions UFH can protect HMGB1-mediated defect of ZO-1 expression and increased permeability of the endothelial cells. The mechanism may be related to the decreased nuclear translocation of NF-κB.
ObjectiveTo explore the effect of continuous renal replacement therapy (CRRT) to treat sepsis associated acute kidney injury (AKI) in patients aged over 80.MethodsForty-one patients diagnosed with sepsis and AKI were enrolled in geriatric RICU department of Huadong Hospital from January 2013 to July 2018, 38 patients were male and 3 were female. All patients were treated with anti-infection and fluid resuscitation therapy. After comprehensive judgment of the indication of renal replacement, they were divided into two groups by the choices of using CRRT. There were 20 patients in CRRT group and 21 in control group. Clinical data such as age, body mass index, previous diseases, 28-day mortality rate, blood cells, APACHEⅡ as well as SOFA scores were compared between two groups. Blood renal function and inflammatory markers at the first day were also compared to those after 3-day treatment of initial time.ResultsNo statistical difference was observed in sex ratio, age, body mass index and previous diseases between two groups (all P>0.05). There was also no difference in APACHEⅡ score, SOFA score, blood cells, hemoglobin and survival time. The 28-day mortality rate in CRRT group was lower than that in control group (P<0.05). The levels of serum UA and C reactive protein (CRP) in CRRT group decreased after 3-day treatment compared with those at the onset, and the differences were statistically significant (all P<0.05). The level of serum blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA) and cystain C in control group increased after 3 days compared with those at the onset, and the difference were statistically significant (all P<0.05). There was no significant difference in serum BUN, Cr, UA, cystain C, CRP and procalcitonin (PCT) between two groups at the onset (all P>0.05). After 3 days of CRRT, the levels of serum PCT, BUN, Cr and UA in CRRT group were lower than those in the control group (all P<0.05).ConclusionCRRT can improve hyperuricemia, control deterioration of renal function, reduce early systemic inflammatory response and 28-day mortality rate in aged patients with sepsis and AKI.
Objective To systematically review the efficacy of enteral nutrition with eicosapentaenoic acid ( EPA) , gamma-linolenicacid ( GLA) , and anti-oxidants for patients with sepsis. Methods We searched the PubMed, EMbase, Cochrane Library, Wanfang Database, CNKI and VIP for all randomized controlled trials about the efficacy of an enteral diet enriched with EPA, GLA, and anti-oxidants for patients with sepsis. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration’s RevMan 5.0 software.Results Three RCTs involving 350 patients were included in our systematic review. The results showed a significant reduction in the length of ICU stay ( MD =6.21, 95% CI: 4.61-8.19; P lt;0.00001) and hospital stay ( P lt;0.0001) , a fewer development of neworgan dysfunctions in the patients fed with the study diet and no more adverse events were observed. However, no significant difference in 28-day mortality of all cause was revealed( RR=0.83, 95% CI: 0.60-1.16, P = 0.27) . There were controversial results about the duration of mechanical ventilation.Conclusion A diet enriched with EPA, GLA, and elevated antioxidants is safe and beneficial for the clinical outcome in patients with sepsis.