Search

Background: The effect of oxygen therapy in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline was uncertain. Objectives: We aimed to perform a rigorous and comprehensive meta-analysis to robustly quantify the efficacy of oxygen therapy in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline. Methods: We searched EMBASE, MEDLINE, Web of Science, and the Cochrane Library from inception to August 2018. Two researchers screened studies and collected the data independently. Randomized controlled trials were included. The main outcome was mortality at the longest duration of follow-up. Results: Seven studies involving 7732 patients (median = 157 patients; range = 72–6629 patients; interquartile range = 136–441 patients; oxygen therapy group = 3856 patients; conservative group = 3876 patients) were included. Compared with conservative therapy, oxygen therapy did not significantly reduce mortality at the longest follow-up (risk ratio = 0.97; 95% confidence interval = 0.68 to 1.40; z = 0.15; p = 0.88), at discharge (risk ratio = 1.04; 95% confidence interval = 0.48 to 2.26; z = 0.11; p = 0.91), 30 days (risk ratio = 1.08; 95% confidence interval = 0.78 to 1.49; z = 0.44; p = 0.66), and 6 months (risk ratio = 0.93; 95% confidence interval = 0.73 to 1.17; z = 0.66; p = 0.51) in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline. Furthermore, there was no significant difference between two groups with regard to infarct size (standard mean difference = 0.15, confidence interval = –0.13 to 0.44; z = 1.07, p = 0.28), cardiac troponin levels (standard mean difference = 0.30, confidence interval = –0.09 to 0.69; z = 1.51, p = 0.13), in hospital reinfarction (risk ratio = 1.49, confidence interval = 0.80 to 2.78; z = 1.25, p = 0.21), and new-onset atrial fibrillation (risk ratio = 0.91, confidence interval = 0.69 to 1.18; z = 0.72, p = 0.47). Multiple subgroup analysis, sensitivity analysis, and trial sequential analysis were consistent with overall findings. Conclusion: Compared with conservative therapy, oxygen therapy did not decrease the mortality at the longest duration of follow-up, discharge, 30 days, and 6 months in patients with suspected uncomplicated myocardial infarction and without hypoxemia at baseline. Furthermore, large-scale, multicenter studies are needed to confirm our results. Registration: PROSPERO, number CRD42017078807.

Introduction: The discrimination and calibration accuracy of prediction models tends to become poor over time. The performance of predictive models should be reevaluated periodically. The aim of this study was to reassess the discrimination of the six commonly used models for predicting 28-day mortality in patients with sepsis based on the Sepsis 3.0 criteria. Methods: Patient data were extracted from the fourth edition of the Medical Information Mart for Critical Care (MIMIC IV) database. The systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), Oxford Acute Severity of Illness Score (OASIS), Logistic Organ Dysfunction System (LODS), and Simplified Acute Physiology Score II (SAPS II) and III (SAPS III) scores were calculated and collected. The area under the receiver operating characteristic curve (AUROC) was used to compare the discrimination abilities of the models using non-parametric Wilcoxon statistics. The Delong method was used to perform pairwise comparisons of the AUROCs of the models. Multiple subgroup analyses for age, body mass index, and sex were performed with regard to the 28-day mortality prediction of the models. Results: A total of 12 691 patients were included. The mean age of the patients was 65.97 ± 15.77 years; 7673 patients (60.50%) were male. The mean SIRS, SOFA, OASIS, SAPS II, LODS, and SAPS III scores were higher in the non-survivor group than in the survivor group. The discrimination for 28-day mortality with the SAPS III (AUROC 0.812, 95% confidence interval (CI) 0.802–0.822) and LODS (AUROC 0.804, 95% CI 0.743–0.765) models was superior to that of the SIRS (AUROC 0.575, 95% CI 0.562–0.589), SOFA (AUROC 0.612, 95% CI 0.598–0.626), OASIS (AUROC 0.753, 95% CI 0.742–0.764), and SAPS II (AUROC 0.754, 95% CI 0.743–0.765) models. The Youden index of the SAPS III model was 0.484, which was the highest among the models. Subgroup analyses showed similar results to the overall results. Conclusions: The discrimination for 28-day mortality with the SAPS III and LODS models was superior to that of the SIRS, SOFA, OASIS, and SAPS II models. The SAPS III model showed the best discrimination capacity for 28-day mortality compared with the other models.

Background The administration of mesenchymal stem cells (MSCs) remains the most promising approach for cardiac repair after myocardial infarct (MI). However, their poor survival and potential in the ischemic environment limit their therapeutic efficacy for heart repair after MI. The purpose of this study was to investigate the influence of FoxC1-induced vascular niche on the activation of octamer-binding protein 4 (Oct4) and the fate of MSCs under hypoxic/ischemic conditions. Methods Vascular microenvironment/niche was induced by efficient delivery of FoxC1 transfection into hypoxic endothelial cells (ECs) or infarcted hearts. MSCs were cultured or injected into this niche by utilizing an in vitro coculture model and a rat MI model. Survival and neovascularization of MSCs regulated by Oct4 were explored using gene transfer and functional studies. Results Here, using gene expression heatmap, we demonstrated that cardiac ECs rapidly upregulated FoxC1 after acute ischemic cardiac injury, contributing to an intrinsic angiogenesis. In vitro, FoxC1 accelerated tube-like structure formation and increased survival of ECs, resulting in inducing a vascular microenvironment. Overexpression of FoxC1 in ECs promoted survival and neovascularization of MSCs under hypoxic coculture. Overexpression of Oct4, a FoxC1 target gene, in MSCs enhanced their mesenchymal-to-endothelial transition (MEndoT) while knockdown of Oct4 by siRNA altering vascularization. In a rat MI model, overexpression of FoxC1 in ischemic hearts increased post-infarct vascular density and improved cardiac function. The transplantation of adOct4-pretreated MSCs into these ischemic niches augments MEndoT, enhanced vascularity, and further improved cardiac function. Consistently, these cardioprotective effects of FoxC1 was abrogated when Oct4 was depleted in the MSCs and was mimicked by overexpression of Oct4. Conclusions Together, these studies demonstrate that the FoxC1/Oct4 axis is an essential aspect for survival and neovascularization of MSCs in the ischemic conditions and represents a potential therapeutic target for enhancing cardiac repair.

BACKGROUND The use of dobutamine in patients with sepsis is questionable. Some studies reported milrinone was used as an alternative inotropic agent. We aim to evaluate whether milrinone is better than dobutamine in patients with sepsis. METHODS Based on the analysis of MIMIC III public database, we performed a big data, real-world study. According to the use of dobutamine or milrinone, patients were categorised as the dobutamine group or milrinone group. We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality. RESULTS In this study, after screening 38 605 patients, 235 patients with sepsis were included. One hundred and eighty-three patients were in the dobutamine group and 52 patients were in the milrinone group. For the primary outcome of hospital mortality, there was no significant between-group difference (73/183 in dobutamine group vs 23/52 in milrinone group, OR 0.84, 95% CI 0.45-1.56; P = .574). After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistent with the overall result (50% vs 41.3%, OR 1.42, 95% CI 0.68-2.97; P = .349). For the secondary outcomes, more patients in milrinone group received RRT use (46.2% vs 22.4%, P = .001), had longer length of ICU stay (20.97 ± 22.84 days vs 11.10 ± 11.54 days, P = .004) and hospital stay (26.14 ± 25.13 days vs 14.51 ± 13.11 days, P = .002) than those in dobutamine group. CONCLUSIONS Compared with dobutamine, the use of milrinone did not decrease hospital mortality in patients with sepsis. Furthermore, milrinone was associated with more RRT therapy, longer length of ICU stay and hospital stay than dobutamine.

BACKGROUND: COVID-19 can lead to acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is considered to be a salvage strategy for severe ARDS. However, the effect of ECMO therapy on severe ARDS remains inconclusive. We aimed to evaluate the effects of ECMO for adults with severe ARDS. METHODS: We searched six databases (EMBASE, Medline, the Cochrane Library, Web of Science, Wanfang databases and CNKI) from inception to May 2020 to screen relevant high-quality observational studies and randomised controlled trials. We used the random effects model for outcome calculation. Trial sequential analysis (TSA), heterogeneity, sensitivity analysis and publication bias were explored. The primary outcome was 90-day mortality. RESULTS: Seven studies (two RCTs and five observational studies) with a total of 867 patients were included. Compared with MV therapy alone, ECMO therapy significantly reduced the mortality at 90 days (based on RCT studies, Risk Ratio [RR] 0.74, 95% confidence Interval (CI) 0.59-0.93, P = .01, I2 = 0%, moderate quality; based on observational studies, RR 0.61, 95% CI 0.46-0.81, P

Background The use of dobutamine in patients with sepsis is questionable currently. As the benefit of dobutamine in septic patients is unclear, we aimed to evaluate whether the use of dobutamine was associated with decreased hospital mortality in sepsis patients. Methods Based on the analysis of MIMIC III public database, we performed a big-data, real world study. According to the use of dobutamine or not, patients were categorized as the dobutamine group or non dobutamine group.We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality. Results In the present study, after screening 38,605 patients, 2826 patients with sepsis were included. 121 patients were in dobutamine group and 2165 patients were in non dobutamine group. Compared with patients in non-dobutamine group, patients in dobutamine group had a lower MAP, higher HR, higher RR, higher severity of illness scores. 72 of 121 patients (59.5%) in the dobutamine group and 754 of 2165 patients (34.8%) in the non-dobutamine group died in the hospital, which resulted in a significant between-group difference (OR 1.56, 95% CI 1.01–2.40; P = 0.000). For the secondary outcomes, patients in dobutamine group received more MV use, more renal replacement therapy use, had longer ICU stay durations and more cardiac arrhythmias than those in non-dobutamine group. After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistently higher in dobutamine group than that in non-dobutamine group (60.2% vs. 49.4%, OR 1.55, 95% CI 1.01–2.37; P = 0.044). Conclusions Among patients with sepsis, our study showed that the use of dobutamine was not associated with decreased hospital mortality. Further large scale, randomized controlled studies are warrented to confirm our findings.

Objectives We compared the potential benefits of mini-KBI (M-KBI), an optimized kissing balloon inflation (KBI), and classical KBI (C-KBI) in provisional bifurcation stenting. Background The long-term clinical outcomes of C-KBI in a provisional stenting strategy continue to be under debate due to main vessel (MV) stent deformation and overexpansion. Methods Twelve stents were deployed in a silicone coronary bifurcation model using a provisional stenting strategy: C-KBI (two non-compliant balloons juxtaposed within the MV stent) was performed in six cases, and M-KBI (the side branch (SB) balloon protruded only into the MV at the upper edge of the SB ostium) was performed in the remaining six cases, all of which were followed by proximal optimization technique POT. Stent geometry was evaluated by bench photos, videoscope, micro-CT, microscopy, and intravascular ultrasound (IVUS). Results C-KBI rectified the MV stent malapposition, but resulted in stent deformation, overexpansion and the "bottleneck" effect, which could not be rectified by POT. M-KBI also rectified the MV stent malapposition, without notable stent deformation, overexpansion, or the "bottleneck" effect. POT optimized the MV strut apposition. Conclusions M-KBI, an optimized KBI, is recommended to prevent stent deformation and overexpansion and to optimize stent deployment in a provisional stenting strategy.

A 22-year-old man suffered from acute pulmonary hemorrhage and deteriorated renal function occurred within 3 days after traumatic brain injury. Mechanical ventilation cannot correct his severe hypoxemia, therefore, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support was initiated and finally resolved his hypoxemia. Concomitantly, continuous renal replacement therapy was performed to improve his kidney function. Although no anti-glomerular basement membrane (anti-GBM) antibody was detected in serum, Goodpasture's syndrome was considered. After treated with methylprednisolone pulse therapy and plasmapheresis, his renal function was significantly improved. ECMO was eventually discontinued after 60 hours of treatment and extubated on day 10. He was discharged home with normal pulmonary and renal functions.

Background. Critical care medicine is a branch of medical science that deals with the characteristics and regularity of life-threatening processes initiated by any injury or disease and, accordingly, relevant treatment for patients with critical illness. Conceptions of critical care medicine in China stemmed in the early 1970s. Ever since the establishment of the first intensive care unit (ICU) along with the increasingly incomparable role of ICU in medical practices, critical care medicine has become an indispensable part of the Chinese medical and health system. Currently, critical care medicine as a secondary clinical discipline and a well-constructed science is in sustainable development on the way towards systematization and standardization. Methods. The gross domestic product (GDP) and population data were obtained from the National Bureau of Statistics. The number of ICUs, ICU beds, and hospital beds and other data regarding ICU staffing and facility resources were obtained from the Yearbook of Health in the People’s Republic of China and National Bureau of Statistics. The mortality rates of SARS and COVID-19 and the number of health workers aiding Hubei amid COVID-19 pandemic were obtained from the National Health Commission. Findings. Critical care medicine in mainland China has made significant strides: both quantity and quality are progressing at a fast pace after SARS in 2003. Although there exist some disparities in healthcare personnel and medical resources, they have not hindered the country from mobilizing its healthcare workers and resources against a public health emergency.

Background Main vessel (MV) stent deformation and overstretch caused by classical kissing balloon inflation (C-KBI) using two balloons with a longer overlapping in the MV for bifurcation lesions has caused a widespread concern. Purpose This bench study tested our hypothesis that mini-KBI (M-KBI) with a shorter protrusion of side branch (SB) balloon would ascertain a better result after Culotte stenting. Methods Twenty-four coronary stents were deployed using Culotte approach in twelve bifurcation models with a bifurcation angle of 45°, 3.5 mm in MV diameter, and 3.0 mm in SB diameter. After stent implantation, the final KBI were assigned to C-KBI (two kissing balloons juxtaposed within the MV stent, at least overlap for 3 mm; n = 6) and M-KBI (the proximal marker of SB balloon just sited at the level of upper edge of SB ostium; n = 6). Proximal optimization technique (POT) was performed after KBI. Stent geometry was visually evaluated based on bench photos, microscopy, videoscopy, micro-CT, and scanning electron microscopy. Stent deformation index, minimal lumen diameter, and cross-sectional area at either carina level of MV and ostium of SB were measured from optical coherence tomography (OCT). Results In Culotte technique, C-KBI was associated with visually significant stent deformation, overexpansion and the "bottleneck" effect of the MV stent, which could not be effectively rectified by POT, while M-KBI could keep the circle shape of MV stent with good stent apposition in both MV and SB stent. By quantitative measurements, deformation index of MV was 0.06 ± 0.01 after M-KBI, significantly lower than 0.25 ± 0.02 if C-KBI was performed. In the line in carina, compared to C-KBI, M-KBI has smaller CSA-stent/CSA-reference, which indicated a less overstretch of MV stent. However, minimal lumen diameter and cross-sectional area of SB ostium was not different in the mini-KBI group (3.0958 ± 0.0285 mm and 7.9667 ± 0.1741 mm), when compared those after C-KBI (3.1217 ± 0.0772 mm and 7.9083 ± 0.3115 mm, p > .05). Conclusions Followed by POT, M-KBI is preferable than C-KBI in preventing stent deformation, overexpansion in MV stent and could get well apposed of MV stent and well-opened SB stent as expected in a Culotte technique.

Background The effect of high-flow nasal cannula (HFNC) therapy in patients after planned extubation remains inconclusive. We aimed to perform a rigorous and comprehensive systematic meta-analysis to robustly quantify the benefits of HFNC for patients after planned extubation by investigating postextubation respiratory failure and other outcomes. Method We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Library from inception to August 2018. Two researchers screened studies and collected the data independently. Randomized controlled trials (RCTs) and crossover studies were included. The main outcome was postextubation respiratory failure. Results Ten studies (seven RCTs and three crossover studies; HFNC group: 856 patients; Conventional oxygen therapy (COT) group: 852 patients) were included. Compared with COT, HFNC may significantly reduce postextubation respiratory failure (RR, 0.61; 95% CI, 0.41, 0.92; z = 2.38; P = 0.02) and respiratory rates (standardized mean differences (SMD), − 0.70; 95% CI, − 1.16, − 0.25; z = 3.03; P = 0.002) and increase PaO2 (SMD, 0.30; 95% CI, 0.04, 0.56; z = 2.23; P = 0.03). There were no significant differences in reintubation rate, length of ICU and hospital stay, comfort score, PaCO2, mortality in ICU and hospital, and severe adverse events between HFNC and COT group. Conclusions Our meta-analysis demonstrated that compared with COT, HFNC may significantly reduce postextubation respiratory failure and respiratory rates, increase PaO2, and be safely administered in patients after planned extubation. Further large-scale, multicenter studies are needed to confirm our results.

Supplemental material, Supplemental_material for Oxygen therapy versus conservative therapy in suspected uncomplicated myocardial infarction without hypoxemia: A meta-analysis of randomized controlled studies by Rui Zhang, Youfeng Zhu, Min Zhang, Haiyan Yin and Jianrui Wei in Hong Kong Journal of Emergency Medicine

Introduction Early postpyloric nasoenteric nutrition is considered an accepted method of nutritional support in critically ill patients. Both endoscopy and fluoroscopy placement of postpyloric nasoenteric tubes (PNTs) have the highest percentages of placement success rate. We aimed to evaluate the differences in efficacy and safety between endoscopy and fluoroscopy methods for the placement of PNTs in critically ill patients. Method We searched MEDLINE, Embase, and electronic databases of Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing endoscopy and fluoroscopy placement of PNTs in critically ill patients. Two reviewers assessed the quality of each study and collected data independently. We performed the meta-analysis with Cochrane Collaboration RevMan 5.3. Results Three randomized controlled trials involving 243 patients were included. There were no significant differences in the placement success rate (RR, 0.99; 95% CI, 0.93, 1.06; z = 0.20, P = .84,) or procedure time (standardized mean difference, − 0.08; 95% CI, − 6.93, 6.77; z = 0.02, P = .98) between the 2 groups. No severe complications (digestive tract hemorrhage, perforation, respiratory problems, hemodynamic instability, or death) were noted in the three studies. There was a slight difference in the incidence of minor complications (RR, 8.12; 95% CI, 1.07, 61.53; z = 2.03, P = .04) between the 2 groups. Conclusions Endoscopy and fluoroscopy placement of PNTs can be accurately and safely performed in critically ill patients. Endoscopy may be at least equally as safe as fluoroscopy for the placement of PNTs.

Background The risk of ventilator-associated pneumonia (VAP) is reduced when postpyloric enteral nutrition (EN) is administered compared to when gastric EN is administered in specific populations. In the present study, we tested the hypothesis that postpyloric EN is superior to gastric EN in reducing the incidence of VAP in elderly patients (age ≥ 75 years) who are admitted to the intensive care unit (ICU) and require mechanical ventilation. Methods We performed a single-center randomized clinical trial involving elderly patients (age ≥ 75 years) who were admitted to the ICU and required mechanical ventilation. The patients were randomly assigned to either the postpyloric EN group or the gastric EN group. The primary outcome was the VAP rate. Results Of the 836 patients screened, 141 patients were included in the study (70 in the postpyloric EN group and 71 in the gastric EN group). The patients in the postpyloric EN group were 82.0 (75.0–99.0) years old (male 61.4%), and those in the gastric EN group were 82.0 (75.0–92.0) years old (male 63.4%). The Acute Physiology and Chronic Health Evaluation II scores were 28.09 ± 6.75 in the postpyloric EN group and 27.80 ± 7.60 in the gastric EN group (P = 0.43). VAP was observed in 8 of 70 patients (11.4%) in the postpyloric EN group and in 18 of 71 patients (25.4%) in the gastric EN group, which resulted in a significant between-group difference (OR 0.38, 95% CI 0.15–0.94; P = 0.04). In the postpyloric EN group, there were significant reductions in vomiting (12 patients in the postpyloric EN group vs 29 patients in the gastric EN group; OR 0.30, 95% CI 0.14–0.65; P = 0.002) and abdominal distension (18 patients in the postpyloric EN group vs 33 patients in the gastric EN group; OR 0.40, 95% CI 0.20–0.81; P = 0.01). No significant differences were observed between the two groups regarding mortality and other secondary outcomes. Conclusions Our study demonstrated that, compared with gastric EN, postpyloric EN reduced the VAP rate among elderly patients who were admitted to the ICU and required mechanical ventilation. Trial registration Chinese Clinical Trial Registry, ChiCTR-IPR-16008485. Registered on 17 May 2016.

Recent studies have revealed there are three presentations of septic shock in patients: refractory hypotension without hyperlactatemia, hyperlactatemia without refractory hypotension, and both refractory hypotension and hyperlactatemia. In this study, we sought to identify differences in the outcomes of septic shock patients with these three presentations. We performed a secondary analysis of a large-scale, multicenter, controlled trial. The septic shock patients were categorized into the following three groups according to the presence or absence of refractory hypotension and hyperlactatemia: a hypotension group (refractory hypotension without hyperlactatemia), a hyperlactatemia group (hyperlactatemia without refractory hypotension), and a typical group (both refractory hypotension and hyperlactatemia). The 90-day all-cause mortality was compared among these three groups. A total of 1588 septic shock patients were enrolled in the present study, including 854 (53.8%) in the hypotension group, 477 (30.0%) in the hyperlactatemia group, and 257 (16.2%) in the typical group. The 90-day all-cause mortality were 12.3 per cent for the patients in the hypotension group, 23.1 per cent for those in the hyperlactatemia group, and 31.9 per cent for those inthe typical group, these differences among the three groups were significant (Pearson's χ2 = 58.49, P < 0.001). And also, there was a significant difference between hyperlactatemia group and typical group (Pearson's χ2 = 6.77, P < 0.05). In this study, we demonstrated that the three different presentations of septic shock resulted in significantly different outcomes, suggesting that septic shock should be stratified.

Details of Search Strategy. (DOC 28Â kb)

The use of high-flow nasal cannula (HFNC) for the treatment of many diseases has gained increasing popularity. In the present meta-analysis, we aimed to assess the efficacy and safety of HFNCs compared with conventional oxygen therapy (COT) in adult postextubation cardiac surgical patients.We reviewed the Embase, PubMed, Cochrane Central Register of Controlled Trials, Wanfang databases, and the China National Knowledge Infrastructure. Two investigators independently collected the data and assessed the quality of each study. RevMan 5.3 was used for the present meta-analysis.We included 495 adult postextubation cardiac surgical patients. There was no significant heterogeneity among the studies. Compared with COT, HFNCs were associated with a significant reduction in the escalation of respiratory support (risk ratio, 0.61; 95% confidence interval [CI], 0.46-0.82; z = 3.32, P.001). There were no significant differences in the reintubation rate (risk ratio, 0.96; 95% CI, 0.04-24.84; z = 0.02, P = .98) or length of intensive care unit stay (weighted mean difference, 0.13; 95% CI, -0.88 to 7.92; z = 1.57, P = .12) between the 2 groups. No severe complications were reported in either group.The HFNC could reduce the need for escalation of respiratory support compared with COT, and it could be safely administered in adult postextubation cardiac surgical patients.

Knowledge concerning nutritional status of patients with chronic kidney disease (CKD) is limited. Nutritional Risk Screening-2002 (NRS-2002) has been used to evaluate the nutritional aspects of patients according to the recommendation of European Society for Clinical Nutrition and Metabolism. Here we aim to assess the prevalence and characteristics of nutritional risk in CKD patients by using NRS-2002. NRS-2002 scores of 292 CDK patients were recorded in first 24 hours subsequent to their admission to hospital. All patients have never been on dialysis. BMI, weight and various biochemical parameters were also characterized for these patients. Possible correlations between these parameters and NRS-2002 score were investigated. The overall prevalence of nutritional risk was 44.9% (53.6% in CKD stage 4-5 patients and 38.3% in stage 1-3 patients). Statistically significant differences were found in serum Albumin, Haemoglobin B, and lymphocyte counts between patients with or without increased nutritional risk. Under the situation that attending physicians were completely unaware of NRS-2002 scores, only 35.1% of the patients at risk received nutritional support. The nutritional risk status was associated with CKD stages but independent from primary diagnosis type. More attention should be paid to the nutritional status in CKD patients (including early stage patients). We recommended using NRS-2002 for nutritional risk assessment among non-dialysis CKD patients in routine clinical practice.目前人们对于慢性肾脏病患者（CKD）的营养状况了解非常有限。根据欧洲 临床营养与代谢协会推荐，营养风险筛查标准NRS-2002 已被广泛应用于评估 其他疾病患者的营养风险。本研究旨在利用NRS-2002 评估CKD 患者的营养 风险。我们针对292 例未经过透析的CDK 患者进行了NRS-2002 评估，记录 了他们的体重指数（BMI）和各种生化指标，并对NRS-2002 评分与各种指标 之间的相关性进行了分析。在所有样本中，处于营养风险状态的患者比例为 44.9%（CKD 4-5 级患者中比例为53.6%，1-3 级为38.3%）。血清白蛋白、血 红蛋白B 和淋巴细胞计数与患者的营养风险状态显著相关。在主治医师未得 知NRS-2002 评分的状况下，仅有35.1%存在营养风险的患者接受了营养支持 治疗。患者的营养风险状况与其初诊类型无关。本研究结果表明，临床实践 中应该重视CKD 患者（包括早期病人）的营养状况，及时给予营养治疗。我 们建议针对非透析的CKD 患者使用NRS-2002 进行营养风险评估。.

To investigate the effects of trimetazidine on renal function in patients with shock.A prospective randomized controlled double-blind study was conducted. 128 patients with shock admitted to intensive care unit (ICU) of Guangzhou Red Cross Hospital from April 2011 to April 2013 were enrolled and randomly divided into control group and trimetazidine treatment group, each n=64. All patients received anti-shock treatment, while the patients in trimetazidine group received trimetazidine treatment (20 mg orally, tid) for 7 days, and patients in control group received placebo (10 mL of sterile water for injection, tid) for 7 days. The urinary output, serum creatinine (SCr), blood urea nitrogen (BUN), cystatin C, and creatinine clearance (CCr) reflecting renal function were recorded in both groups, and the values were compared before treatment, 48 hours after treatment, and 1 week after the treatment. At the same time, dynamic mean arterial pressure (MAP) was monitored, and 48-hour and 1-week mortality rates were recorded.There was no significant difference in results in all the renal function parameters before the treatment between two groups. The levels of SCr, BUN, cystatin C were gradually decreased after treatment in both groups, but CCr and MAP were gradually increased. Compared with the control group, cystatin C at 48 hours after treatment was significantly decreased, while CCr was significantly increased in treatment group (cystatin C: 0.85±0.81 mg/L vs. 1.01±0.91 mg/L, t=2.562, P=0.017; CCr: 0.93±0.64 mL/s vs. 0.69±0.40 mL/s, t=2.155, P=0.033). SCr and BUN at 1 week after treatment were significantly decreased in treatment group (SCr: 94.23±88.31 μmol/L vs. 104.99±98.37 μmol/L, t=2.921, P=0.003; BUN: 9.46±8.24 mmol/L vs. 11.87±8.65 mmol/L, t=2.611, P=0.010). Urine output per hour and MAP was improved after treatment in both groups, and no significant difference was found between treatment group and control group (urine output: 48 hours after treatment 55.67±31.43 mL vs. 45.34±11.79 mL, t=0.934, P=0.323; 1 week after treatment 71.67±37.23 mL vs. 75.35±22.88 mL, t=1.280, P=0.210; MAP: 48 hours after treatment 72.13±33.24 mmHg vs. 69.28±39.98 mmHg, t=1.408, P=0.179; 1 week after treatment 71.44±21.98 mmHg vs. 72.32±31.11 mmHg, t=1.184, P=0.252]. Mortality rate in treatment group was lowered compared with control group, however no statistical significance was found [48 hours after treatment: 31.2% (20/64) vs. 32.8% (21/64), χ2=0.084, P=0.785; 1 week after treatment: 32.8% (21/64) vs. 35.9% (23/64), χ2=2.084, P=0.173].Trimetazidine can improve renal function in patients with shock.

Apoptosis and caspase-3 play an important role in the pathogenesis of sepsis. In this study, the authors monitored myocardial apoptosis and investigated caspase-3 protein expression change in rats with sepsis. In addition, we investigated the protective effect of glutamine (Gln) on myocardial injury in septic rats. A rat model of sepsis was established by intraperitoneal injection of lipopolysaccharide (LPS). Rats were divided into control group, endotoxin (LPS) group and LPS + Gln group, which were further divided into 4 subset groups (0, 6, 12 and 24 hour subgroups; n = 6). The rate of myocardial apoptosis, caspase-3 mRNA expression and caspase-3 protein expression were examined. Data were analyzed using the F-test or linear correlation test. The results revealed that the rate of myocardial apoptosis in the LPS group was significantly higher than that in the control group (P0.05). Compared with the control group, LPS group has an upregulated caspase-3 mRNA expression level. However, the caspase-3 protein was low expressed (P0.05). The LPS + Gln group has significant lower myocardial apoptosis rate compared with the LPS group (P0.05). In addition, caspase-3 mRNA expression levels and caspase-3 protein expression levels were lower in the LPS + Gln group (P0.05). We found that Gln reduces the extent of myocardial apoptotic cell death by decreasing the gene and protein expression of caspase-3. Therefore, Gln may be used to prevent the onset of sepsis at an early stage.

Activation of adenosine monophosphate-activated protein kinase (AMPK) has been shown to inhibit cardiac hypertrophy through peroxisome proliferators-activated receptor-α (PPARα) signaling pathway, but the detailed mechanism remains unclear. A rat model of cardiac hypertrophy created by transaortic constriction (TAC) was used to investigate the mechanism involved in regulation of PPARα activity by AMPK. It was observed that treatment with AICAR (5-aminoimidazole 1 carboxamide ribonucleoside), an AMPK activator, significantly inhibited cardiac hypertrophy in vivo and in vitro. Phosphorylated extracellular signal regulated protein kinase (phospho-ERK1/2) and phospho-p38 mitogen-activated protein kinase (MAPK) protein levels were significantly up-regulated, while PPARα protein level was down-regulated in TAC rats. AICAR treatment reversed the changes of PPARα and phospho-ERK1/2, but increased phospho-p38 MAPK protein level in TAC rats. Similar changes of PPARα and phospho-ERK1/2 protein levels were observed in the hypertrophied cardiomyocytes induced by phenylephrine treatment. Epidermal growth factor (EGF, ERK1/2 activator), but not SB203580 (p38 inhibitor) blocked the up-regulation of PPARα protein level induced by AICAR. Luciferase assay showed that AICAR increased PPARα transcriptional activity which was abrogated by EGF, but not by SB203580. These results demonstrate that AMPK activation enhances the activity of PPARα to inhibit cardiac hypertrophy through ERK1/2, but not p38 MAPK, signaling pathway.