Background: The aim of this study was to evaluate the ability of platelet parameters to predict outcomes in elderly patients with severe pneumonia. Methods: We retrospectively analyzed the clinical data of 197 elderly patients with severe pneumonia. The patients were divided into two groups based on their survival in 28 days: the survival group (148 cases) and the death group (49 cases). Results: The Acute Physiology and Chronic Health Evaluation (APACHE II) scores were significantly higher in the death group compared to the survival group (p < 0.05). Platelet count (PLT) was significantly lower (p < 0.05), while platelet distribution width (PDW), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were significantly higher in the death group than the survival group (p < 0.05). Receiver operating characteristic (ROC) curve analysis revealed that the platelet parameters PLT, PDW, MPV and P-LCR had area under curve (AUC) values of 0.834, 0.760, 0.847 and 0.842, respectively, for predicting 28-day mortality in elderly patients. The combined AUC for these four platelet parameters was 0.964, which was significantly higher than that of any individual parameter (p < 0.05). Kaplan-Meier analysis also demonstrated that PLT, PDW, MPV and P-LCR were all associated with the 28-day prognosis of patients (p < 0.05). Multivariable logistic regression analysis identified APACHE II score, PDW, MPV and P-LCR as independent risk factors for poor prognosis in elderly patients with severe pneumonia (p < 0.05). Conclusions: Our findings suggest that PLT, PDW, MPV and P-LCR could be utilized as prognostic indicators for elderly patients with severe pneumonia as these parameters were notably different between the death and survival groups of these patients. Integrating changes in various platelet parameters hold the potential for improving the prognostic evaluation of elderly individuals with severe pneumonia.

This study is to evaluate the efficacy of erythropoietin in treating sepsis -associated acute respiratory distress syndrome (ARDS). One hundred patients with sepsis -related ARDS were randomized into the placebo group and Erythropoietin (EPO) group. Patients in the placebo group received saline as placebo on the standard therapy, while the EPO group received recombinant human erythropoietin injections on the standard therapy. It was found that the heart rate and mean arterial pressure did not differ significantly between days 7 and 14 after treatment initiation (p > 0.05). The partial pressure of oxygen (PaO2) and oxygenation index levels measured on days 7 and 14 were significantly higher than the placebo group and partial pressure of carbon dioxide (PaCO2) was significantly lower than the placebo group (p < 0.05). Lung capacity and functional residual capacity (and FRC) increased significantly in tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL -10), and C -reactive protein (CRP) concentrations (p < 0.05). In the EPO group, the duration of mechanical ventilation was significantly shorter and the mortality rate was significantly reduced (Log -Rank test, chi(2 )= 4.651, p = 0.031). The results confirm that EPO significantly improves lung function and blood gas parameters, reduces serum levels of inflammatory markers, and reduces the risk of death in sepsis -induced ARDS patients, highlighting the potential therapeutic role of EPO in the management of this disease.

目的 总结播散性堪萨斯分枝杆菌病的临床特征及有效诊治方法.方法 对1例播散性堪萨斯分枝杆菌病患者的临床资料作回顾性分析.结果 患者主要临床表现为反复发热、全身多发淋巴结肿大,胸部影像学检查可见双下肺实变伴不张,双侧胸腔积液、心包积液,痰液涂片和左侧锁骨上淋巴结抗酸染色阳性,右侧大腿背侧皮下肿块穿刺液16S rRNA检测结果堪萨斯分枝杆菌阳性,结合患者临床症状明确诊断为播散性堪萨斯分枝杆菌病.予四联(利福平、异烟肼、乙胺丁醇、克拉霉素)抗非结核分枝杆菌(NTM)药物治疗8周,疗效较好.结论 播散性堪萨斯分枝杆菌病主要临床表现为反复发热、全身淋巴结肿大、皮肤包块及皮下结节.临床症状、抗酸杆菌检查阳性结合皮下结节穿刺液16S rRNA检测结果可明确诊断播散性堪萨斯分枝杆菌病,抗NTM药物治疗播散性堪萨斯分枝杆菌病效果较好.

BACKGROUND:Severe pneumonia is a kind of disease that develops from lung inflammation, and new drugs are still required to treat the same. Erythropoietin (EPO) is widely used to treat anemia in patients. However, there are fewer studies on the role of EPO in neutrophil extracellular trappings (NETs) and pneumonia, and the mechanism is unclear.OBJECTIVE:To investigate the possible effects of EPO on the formation of NETs and progression of pneumonia.METHODS:Mice pneumonia model was induced by tracheal lipopolysaccharide (LPS) administration. Hematoxylin and eosin (H&E) staining and automatic blood cell analysis were performed in this model to confirm the effects of EPO on lung injury. Flow cytometry, enzyme-linked immunosorbent serological assay, and immunostaining assay were conducted to detect the effects of EPO on the inflammation as well as formation of NETs in mice. Immunoblot was further conducted to confirm the mechanism.RESULTS:EPO alleviated LPS-induced lung injury. EPO reduced the release of inflammatory factors induced by LPS. In addition, EPO inhibited the formation of NETs. Mechanically, EPO inhibited tumor necrosis factor (TNF) receptor associated factor 2 (TRAF2)/nuclear factor kappa-B (NF-κB) activity in mouse models, and therefore suppressed the progression of pneumonia.CONCLUSION:EPO inhibited formation of NETs to ameliorate lung injury in a pneumonia model, and could serve as a drug of pneumonia.

Erythropoietin (EPO) has antiapoptotic, antioxidative, and anti-inflammatory effects on ischemia tissues and protects against acute lung injury (ALI) induced by ischemia-reperfusion (I/R). p38 mitogen-activated protein kinases (p38 MAPK) signaling is involved in the processes of I/R-induced ALI. However, the interaction of EPO with p38 MAPK signaling in I/R-induced ALI has not been reported. To explore this issue, we constructed an I/R-induced ALI model in vivo and in vitro using Sprague Dawley rats and BEAS-2B cells. Some I/R rats and hypoxia-reoxygenation (H/R)-induced cells were treated with EPO, and the others were used as control groups. The injuries of lung tissues and cells were respectively assessed by inflammatory cytokine, morphologic changes, cell viability, apoptosis, and oxidative damage-related factors. Western blot determined key proteins in the p38 MAPK signaling. Results indicated that I/R induced the increase of inflammatory factors, lung weight, filtration coefficient, bronchoalveolar lavage fluid protein content, apoptosis, neutrophil, and lung peroxidation, and H/R caused cell growth inhibition, apoptosis, and oxidative damage-related factors' release. EPO attenuated I/R-induced injury in vivo and in vitro. Furthermore, the increase of p-p38, p-JNK, and p-ERK1/2 in lung tissues and cells induced by I/R was downregulated by EPO. Moreover, both EPO and an inhibitor of p38 MAPK (SB203580) alleviated H/R-induced cell injury. Erythropoietin along with SB203580 had more obvious protection effects than EPO alone. Collectively, EPO alleviated I/R-induced ALI by blocking p38 MAPK signaling. The interaction mechanism of EPO with p38 MAPK signaling contributes to understanding the processes of I/R-induced ALI and provides new insights for the disease treatment.

Objective:To explore the effect of probiotics on reducing ventilator-associated pneumonia (VAP) in sepsis patients.Methods:A total of 94 cases were randomly (random number) divided into the probiotic group ( n = 46) and the control group ( n = 48). All of the patients were given enteral nutrition therapy by nasogastric tube within 24-72 h after admission. And patients in the probiotic group were given live combined bifidobacterium, lactobacillus and enterococcus powder besides the regular therapy. The incidence of VAP, bacteremia, mortality, mechanical ventilation time and length of ICU stay were compared between the two groups. Results:Compared with the control group, the incidences of VAP and bacteremia in the probiotics group were significantly lower (χ 2=4.763, P=0.029; χ 2=4.438, P=0.035). There were no significant differences in 28-day mortality and the length of hospital stay between the two groups (χ 2=2.02, P=0.167; t=1.29, P=0.208). Mechanical ventilation time in the probiotics group was significantly shorter than that in the control group ( t=2.16, P=0.038). The Log-Rank test showed that the time of VAP-free in the probiotics group was significantly longer than that in the control group ( P < 0.05). After adjusting for APACHEⅡ score and age, COX proportional risk model analysis showed that the RR values of the probiotics group and the control group for 28-day VAP were 0.18 (95% CI: 0.12-0.74, P=0.025) and 0.21 (95% CI: 0.19-0.95, P=0.042), respectively. Conclusions:Probiotics treatment can reduce the incidence of VAP in sepsis patients.

目的 比较经鼻高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)和无创通气(non-invasive ventilation,NIV)在急性左心衰竭中的治疗效果.方法 选择2016年8月—2018年6月我院重症医学科收治的急性左心衰竭患者68例,按随机数字表法分为HFNC组和NIV组,HFNC组35例,NIV组33例.观察两组患者治疗后2 h、12 h、24 h、48 h生命体征、动脉血气及心功能指标.比较两组患者的临床疗效;比较两组患者治疗后各时间点心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、PaO2、PaCO2;比较两组患者治疗后各时间点Tei指数、左心室射血分数(LVEF)及脑利钠肽前体(NT-proBNP);比较两组患者气管插管率、28 d病死率、ICU住院时间.结果 两组患者的临床疗效无统计学差异(P>0.05);两组治疗后各时间点PaO2、PaCO2、SaO2、HR、RR无统计学差异(P>0.05);两组治疗后各时间点Tei指数、LVEF、NT-proBNP无统计学差异(P>0.05);HFNC组气管插管率5.7％,NIV组15.2％,HFNC组气管插管率明显低于NIV组,差异有统计学意义(P<0.05);两组28 d病死率、ICU住院时间无统计学差异(P>0.05).结论 HFNC可改善急性左心衰竭患者氧合和心功能,气管插管率低于NIV,病死率、ICU住院时间与NIV无明显差异,疗效不劣于NIV.

Objective To study the therapeutic effect of high-flow nasal cannula oxygen therapy (HFNC) in patients with acute left heart failure. Methods From June 2016 to April 2018, 76 patients with acute left heart failure in the Department of Intensive Care Medicine, Sir Run Run Hospital, Nanjing Medical University were divided into the observation group (n= 38) and control group (n= 38). Patients in the control group were given routine treatment and patients in the observation group were given HFNC on the basis of control group. The partial pressure of arterial oxygen(PaO2), partial pressure of arterial carbon dioxide(PaCO2), arterial oxygen saturation (SaO2), heart rate, respiratory rate, left ventricular ejection fraction (LVEF), stroke volume (SV), and N-terminal pro-brain natriuretic peptide (NT-proBNP) of these two groups were observed at 2, 6, 12 and 24 hours after treatment. The tracheal intubation rate, 28-day mortality and ICU stay in the two groups were compared. Results There were significant differences in PaO2, PaCO2, SaO2, heart rate, respiratory rate, LVEF, SV and NT-proBNP of patients with acute left heart failure between the two groups at each time point(F= 28.302, 18.402, 32.514, 24.510, 16.165, 23.452, 19.167, 30.424; all P < 0.05). Further pairwise comparison showed that PaO2, SaO2, LVEF and SV in the observation group were significantly higher (all P < 0.05), and the PaCO2, heart rate, respiratory rate and NT-proBNP were significantly lower than those in the control group at each time point (all P < 0.05). There were significant differences in the PaO2, PaCO2, SaO2, heart rate, respiratory rate, LVEF, SV and NT-proBNP of these two groups at 6 h, 12 h and 24 h compared with those in the same group at 2 h (all P < 0.05). There were significant differences in the PaO2, PaCO2, SaO2, heart rate, respiratory rate, LVEF, SV and NT-proBNP of these two groups at 12 h and 24 h compared with those in the same group at 6 h (all P < 0.05). The tracheal intubation rate [7.89% (3/38) vs. 23.68% (9/38), χ2= 3.982, P= 0.026], 28 d mortality [2.63% (1/38) vs. 10.53% (4/38), χ2= 4.307, P= 0.011) and ICU stay [(6 ± 3) d vs. (10 ± 5) d, t= 2.654, P= 0.034] between the two groups were all statistically significantly different. Conclusion HFNC in the early stage can significantly improve oxygenation and cardiac functions, reduce tracheal intubation rate and mortality, shorten ICU stay, and improve prognosis in patients with acute left heart failure. Key words: High-flow nasal cannula oxygen therapy; Acute left heart failure; Arterial blood gas; Left ventricular ejection fraction; Stroke volume

Objective To compare the clinical effect of conventional polyvinyl chloride (PVC) endotracheal tube with silicone wire reinforced endotracheal tube to prevent ventilator-associated pneumonia (VAP) in mechanical ventilation patients.Methods A total of 240 mechanical ventilation patients in the ICU were enrolled in this study,which were divided into two groups,PVC endotracheal intubation group (PVC group,n=1 13) and wire reinforced endotracheal intubation group (WR group,n=127).Gender,age,APACHE Ⅱ score,one-time success rate of intubation,intubation time,the rate of changing endotracheal,ventilation time,rate of tracheotomy and the incidence of VAP were compare between the two groups.Predictive factors for VAP were identified by the univariate and multivariate analyses in step-wise logistic regression model.Results The rate of changing endotracheal tube in the PVC group was lower than that in the WR group (x2=5.785,P=0.016);the mechanical ventilation time in the PVC group was shorter than that in the WR group (t=2.180,P=0.018);and compared with the WR group,the PVC group had significantly lower incidence of VAP (x2=6.215,P=0.012).The univariate analysis showed that the selection ofPVC endotracheal tube,APACHE Ⅱ score and mechanical ventilation time were the significant risk factors for VAP (P ＜ 0.05).Multivariate analysis showed that the different selection of endotracheal tube and mechanical ventilation time were independent influencing factors ofVAP (P ＜ 0.05).Conclusions PVC tracheal tube can effectively reduce the incidence of VAP in patients with mechanical ventilation.

目的 探讨开放式探视模式在重症监护室(ICU)中的应用.方法 回顾性分析2016年6月至2018年6月入住南京医科大学附属逸夫医院重症医学科432例患者的临床资料,以开放式探视实施时间(2017年7月)为截点,以实施开放式探视模式之前的患者作为对照组(n=211),开放式探视实施后的患者作为开放组(n=221).统计比较2组患者的入院时和出院时焦虑和抑郁评分量表(HADS)评分、沟通质量评分量表(QOC scale)评分、校正的患者对以患者为中心的评价(校正的PPPC)评分,比较2组患者的住院时间,统计机械通气患者需的机械通气时间、呼吸机相关性肺炎(VAP)发病率,并评估临床各评分指标与患者住院时间的相关性.结果 出院时开放组较对照组的HADS评分[(11.39±2.14)分vs(14.62±2.72)分]和校正的PPPC评分[(1.57±0.32)分vs(1.76±0.28)分]显著降低,QOS评分显著升高[(72.30±6.26)分vs(61.45±6.47)分],差异均有统计学意义(P<0.05).开放组患者机械通气时间[(15.36±2.16)d]、ICU住院时间[(12.34±3.28)d]和总住院时间[(20.18±4.45)d]均短于对照组[(18.63±3.27)d、(15.68±3.78)d、(25.37±5.14)d],差异均有统计学意义(P<0.05),但2组VAP发生率比较差异无统计学意义(28.96％vs 27.96％,P>0.05).相关性分析显示APACHEⅡ评分和校正的PPPC评分与患者住院时间呈正相关(r=0.338,P=0.03;r=0.356,P=0.034).结论 开放式探视模式有助于改善医患沟通质量、家属心理应激,对改善患者的病情及预后有利.

Sepsis, an overwhelming systemic inflammatory disease, is the leading cause of acute lung injury (ALI). Despite plenty of researches have been done, effective drugs treating septic ALI are still eagerly needed in the clinic. Dexmedetomidine (Dex), a potent alpha-2 adrenoreceptor agonist, has been reported to possess antioxidant, anti-apoptosis and anti-inflammatory abilities. Taurine, a kind of intracellular free amino acid, has been used to treat various diseases. This study aimed to explore the combination effect of Dex and Taurine on septic ALI and the underlying mechanism in vivo. The establishment of septic ALI was set up in SD rats by cecal ligation and puncture (CLP) operation. Results indicated that Dex or Taurine could reduce septic ALI-induced cell apoptosis via decreasing caspase-3 activity. However, the combination of Dex or Taurine produced greater effect. Besides that, Dex combined with Taurine could better promote cell proliferation with remarkably elevated Ki67 expression. The combination of Dex and Taurine significantly suppressed the activation of NF-κB pathway via inhibiting P65 phosphorylation and P65 nuclear translocation, leading to the down-regulation of interleukin (IL)-6 and IL-1β. Moreover, co-administration of Dex and Taurine alleviated the imbalance of Th1/Th2 induced by septic ALI to a great extent. All in all, our study suggested the synergistic therapeutic effect of Dex and Taurine on septic ALI.

Objective:To evaluate the protective effects of erythropoietin( EPO) on the lung of rats after cardiopulmonary resuscitation ( CPR) . Methods:The rats were randomly divided into the sham group,CPR group and EPO group. The levels of MDA,SOD and GSH-Px in lung were detected using ELISA. Results:At the time of restoration of spontaneous circulation,the levels of CaO2 in CPR group and EPO group were lower than that in sham group(P<0. 05),and with the lengthening of restoration time,the level of which gradually returned to normal. After 3 h,6 h and 12 h of CPR,the levels of MDA in CPR group and EPO group were significantly higher than that in sham group(P<0. 01),the levels of MDA in CPR group after 6 h and 12 h of CPR were significantly higher than that after 3 h of CPR(P<0. 01),and the levels of MDA in EPO group after 6 h and 12 h of CPR were lower than that in CPR group(P<0. 05 and P<0. 01). Compared with the sham group,the levels of SOD and GSH-Px in CPR group and EPO group decreased after 3 h,6 h and 12 h of CPR(P<0. 05 to P<0. 01),the levels of SOD and GSH-Px in CPR group after 6 h of CPR were significantly lower than those after 3 h of CPR(P<0. 01),and the levels of SOD and GSH-Px in CPR group after 12 h of CPR were significantly higher than those after 6 h of CPR(P<0. 01). The levels of SOD and GSH-Px in EPO group after 3 h,6 h and 12 h of CPR were significantly lower than those in CPR group(P<0. 01). Before treatment with EPO,the content of MDA was negatively correlated with SOD(P<0. 05) and GSH-Px (P<0. 01) in rats. After treatment with EPO,the content of MDA was negatively correlated with GSH-Px(P<0. 05),but uncorrelated with SOD in rats(P>0. 05). Conclusions:EPO can reduce the oxidative stress and injury of lung,and promote the recovery of lung function after CPR.

Intraosseous infusion plays an important role in emmergency fields in recent years.In particular,patients in acutely life-threatening conditions such as cardiac arrest,acute haemorrhage and hypovolaemia shock should receive an intraosseous cannula if intravenous access cannot be rapidly established.This article describes the technique of intraosseous infusion,introduces 3 kinds of different cannulation systems and discusses its characteristics.