Zhonghua nei ke za zhi
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Zhonghua nei ke za zhi · Feb 2021
[The correlation of plasma thrombomodulin plasminogen activator inhibitor-1 and endothelial cell injury in septic patients].
To study the correlation of plasma thrombomodulin (TM), plasminogen activator inhibitor-1 (PAI-1) and endothelial cell injury in septic patients. A total of 100 septic patients were enrolled from February 2017 to February 2019 in Intensive Care Unit (ICU), Union Jiangbei Hospital, Huazhong University of Science and Technology. Subjects were divided into two groups including 50 patients with septic shock and 50 patients with only sepsis. ⋯ Correlation analysis suggested that cEPCs, ESM-1 and vWF were positively correlated with TM and PAI-1 (r=0.561, 0.576, P<0.05;r=0.558, 0.603, P<0.05;r=0.677, 0.692, P<0.05). In conclusion, plasma TM and PAI-1 are closely related to the severity of endothelial cell injury in patients with sepsis. The more serious the damage of endothelial cells is, the higher the TM, PAI-1,cEPCs,ESM-1 and vWF levels are, which could be criterion for treatment evaluation.
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Zhonghua nei ke za zhi · Oct 2020
Multicenter Study[The prognostic role of the programmed death-1 expression on T lymphocytes in septic patients].
Objective: To investigate the value of programmed death-1（PD-1） expression on the T lymphocytes for the prognosis of septic patients. Methods: From September 2017 to May 2019, septic patients were included in Department of Intensive Care Unit at 6 hospitals. The PD-1 expression on T cells were measured by flow cytometry. ⋯ The percentage of PD-1+/CD8+T cell was 3.91%, with AUC 0.771, sensitivity 64.29%, specificity 81.25%，(P=0.000 3). Conclusions: The T cell PD-1 expression is an independent risk factor to predict the 28-day mortality in septic patients. Combining the proportions of PD-1+/CD3+, PD-1+/CD4+and PD-1+/CD8+T cells may further enhance the predictive value for death.
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Zhonghua nei ke za zhi · Sep 2020
[Recommendations for the treatment of severe coronavirus disease 2019 based on critical care ultrasound].
Severe patients with coronaviras disease 2019 (COVID-19) are characterized by persistent lung damage, causing respiratory failure, secondary circulatory changes and multiple organ dysfunction after virus invasion. Because of its dynamic, real-time, non-invasive, repeatable and other advantages, critical ultrasonography can be widely used in the diagnosis, assessment and guidance of treatment for severe patients. ⋯ The recommendations mainly cover the following aspects: (1) lung ultrasound in patients with COVID-19 is mainly manifested by thickened and irregular pleural lines, different types of B-lines, shred signs, and other consolidation like dynamic air bronchogram; (2) Echocardiography may show right heart dysfunction, diffuse cardiac function enhancement, stress cardiomyopathy, diffuse cardiac depression and other multiple abnormalities; (3) Critical ultrasonography helps with initiating early treatment in the suspect patient, screening confirmed patients after intensive care unit admission, early assessment of sudden critical events, rapid grading assessment and treatment based on it; (4) Critical ultrasonography helps to quickly screen for the etiology of respiratory failure in patients with COVID-19, make oxygen therapeutic strategy, guide the implementation of lung protective ventilation, graded management and precise off-ventilator; (5) Critical ultrasonography is helpful for assessing the circulatory status of patients with COVID-19, finding chronic cardiopulmonary diseases and guiding extracorporeal membrane oxygenation management; (6) Critical ultrasonography contributes to the management of organs besides based on cardiopulmonary oxygen transport; (7) Critical ultrasonography can help to improve the success of operation; (8) Critical ultrasonography can help to improve the safety and quality of nursing; (9) When performing critical ultrasonography for patients with COVID-19, it needs to implement three-level protection standard, pay attention to disinfect the machine and strictly obey the rules from nosocomial infection. (10) Telemedicine and artificial intelligence centered on critical ultrasonography may help to improve the efficiency of treatment for the patients with COVID-19. In the face of the global spread of the epidemic, all we can do is to share experience, build a defense line, We hope this recommendations can help COVID-19 patients therapy.