Apache Research Articles

A clinical study on the effect of early activities on risk factors of acute gastrointestinal injury in patients with chronic obstructive pulmonary disease induced by mechanical ventilation

Objective To investigate the effect of early activities on risk factors of acute gastrointestinal injury (AGI) in patients with chronic obstructive pulmonary disease (COPD) induced by mechanical ventilation. Methods A total of 118 mechanically ventilated non-diabetic patients with chronic obstructive pulmonary disease who were admitted to our hospital from August 2017 to April 2018 were enrolled in the study. The patients were divided into AGI group (71 cases) and non-AGI group (47 cases) according to the presence or absence of AGI. The examined data were collected in the patients prospectively such as preprocalcitonin (PCT), D-lactic acid, serum albumin (ALB), fasting plasma glucose (FPG), fasting insulin (FINS), and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores were calculated. The homeostasis model insulin resistance index was used (HOMA-IR) to assess the subjects′ insulin resistance. Logistics regression analysis screened for risk factors that affected patients' AGI. The AGI patients were divided into treatment group (36 cases) and control group (35 cases) according to the random number table method. On the basis of the same conventional treatment, the treatment group were received early mobilization. The differences of PCT, D-lactate, FPG, HOMA-IR, APACHE Ⅱ scores, and AGI grades before and after treatment for 3 days were observed for both groups of patients. Results The PCT, D-lactate, FPG, HOMA-IR, and APACHE Ⅱ scores were higher in the AGI group than in the non-AGI group [(2.72±0.54)ng/ml vs (1.81±0.62)ng/ml; (17.43±2.63)mg/ml vs (13.61±1.6)mg/ml; (10.1±1.0)mmol/L vs (8.4±0.9)mmol/L; (2.4±0.5) vs (1.7±0.4); (23.8±2.9)point vs (21.7±4.3)point], and the ALB were lower than non-AGI group [(29.1±2.2)g/L vs (30.6±3.2)g/L], with statistically significant difference (P 0.05). The PCT, D-lactic acid, FPG, HOMA-IR, and APACHE Ⅱ scores in the treatment group were significantly lower than those in the control group after early treatment [(2.00±0.49)ng/ml vs (2.34±0.34)ng/ml; (15.38±1.71)mg/ml vs (17.38±2.88)mg/ml; (8.9±0.9)mmol/L vs (9.6±0.7)mmol/L; (1.9±0.4) vs (2.2±0.4); (21.0±1.8)point vs (22.2±2.7)point], and AGI severity was reduced (There were 8, 18, 6, 3 and 1 cases of 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ in the treatment group, and 4, 12, 9, 7 and 3 in the control group respectively), with statistically significant differences (P<0.05). Conclusions PCT, D-lactic acid, FPG, HOMA-IR, and APACHE Ⅱ scores were risk factors for AGI in mechanically ventilated non-diabetic patients with COPD. Early mobilization could reduce the level of these risk factors and the severity of AGI. Key words: Pulmonary disease, chronic obstructive; Ventilators, mechanical; Gastrointestinal diseases; Risk factors

Analysis of prognosis-relating factors in the elderly patients after the initial onset of delirium

Objective To investigate the correlations of risk factors of age, delirium-inducing factors, dementia, delirium severity, and disease severity with the prognosis of elderly patients with delirium. Methods A total of 112 patients aged 70 years and older with initial onset of delirium during hospital stay were enrolled in this study.They were hospitalized in Dalian Municipal Central Hospital from Jan.2013 to Dec.2015.The severity of delirium was evaluated by delirium rating scale-revised-98(DRS-R-98). The acute physiology and chronic health enquiry(APACHE-Ⅱ)score and the sequential organ failure assessment(SOFA)score were recorded within 48 h after delirium onset.After periods of hospitalization of Jan.2013 to Dec.2015, patients were followed up until 31 Dec 2017.Correlations of age, delirium-inducing factors and dementia with survival time and long-term viability after delirium onset were statistically analyzed. Results Age, delirium-inducing factors, cognitive impairment, duration of cognitive impairment, type of dementia, and delirium severity had no correlations with the lifetime and long-term viability in patients with delirium.While, APACHE Ⅱ score for assessment of severity degree of delirium(P<0.001, r=-0.390)and SOFA score(P<0.001, r=-0.638)were negatively correlated with the lifetime in patients with delirium.SOFA score(P=0.004)and delirium recurrence(P<0.001)were significantly correlated with the long-term viability in patients with delirium. Conclusions The severity and recurrence of delirium are strongly correlated with the lifetime and quality of life in patients with delirium.Compared with APACHE Ⅱ score, SOFA score may have a more important clinical application value in predicting the prognosis of patients with delirium. Key words: Delirium; Prognosis

Preliminary study on the value of the new community acquired pneumonia severity index

Objective To explore the value of a new community-acquired pneumonia severity index(CPSI) in predicting the severity and mortality of patients with community-acquired pneumonia(CAP). Methods A retrospective analysis was conducted. Patients with CAP in critical care medicine of the First People’s Hospital of Chenzhou were enrolled in this study. According to whether the patients died within 28 days, patients were divided into the survival group and the death group. The difference of sex, age, vital signs, blood test, the lowest Glasgow coma score (GCS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sepsis related organ failure assessment (SOFA) score, CURB-65 (confusion, uremia, respiratory rate, BP, age 65 years) score, pneumonia severity index (PSI) score and community-acquired pneumonia severity index (CPSI) score were compared between the two groups. Logistic regression analysis was performed for the scoring systems with statistical significance in univariate analysis. The receiver operating characteristic (ROC) was drawn to analyze the prognostic value of each scoring system. Results Totally 283 patients were enrolled in this study (184 survivals and 99 deaths, mortality rate 35%). Univariate analysis showed that age, mechanical ventilation (MV) ratio , the fastest heart beat rate (HR), the lowest systolic blood pressure (SBP), the lowest mean blood pressure (MAP), pressure adjusted shock index (PASI), inspired oxygen concentration (FiO2), arterial oxygen partial pressure (PaO2), and oxygenation index (PO2/FiO2), blood urea nitrogen concentration (BUN), serum creatinine concentration (Scr), urine output, length of ICU stay, the lowest GCS, and APACHE II score were significantly different between the two groups (P<0.05). Multivariate regression analysis showed that CPSI score and SOFA score were independent risk factors for patients with CAP. The ROC curve of CAP patients was predicted in each scoring system, and the area under the ROC curve of CPSI score (0.728), SOFA and age score (0.708), PSI score (0.701), APACHE II score (0.690), CURB-65 score (0.687) and SOFA score (0.683) gradually decreased. The sensitivity and specificity of the area under curve prediction showed that CPSI score was superior to the other scores. Conclusions The CPSI score can evaluate the severity of CAP patients, efficiently predict the outcome of patients with CAP, and can be widely used in clinical practice. Key words: Community-acquired pneumonia; Pneumonia severity index; CURB-65 score; Acute physiology and chronic health evaluation Ⅱ; Sepsis related organ failure assessment; Shock index; Receiver operating characteristic curve; Early goal guiding treatment

Expression and clinical significance of the novel inhibitory cytokine IL-35 in patients with sepsis and multiple organ dysfunction syndrome

Objective To investigate the expression of interleukin-35 (IL-35) in patients with sepsis and multiple organ dysfunction syndrome (MODS), and to explore its effect on disease prognosis. Methods A prospective study was conducted. Twenty-two patients with sepsis and MODS were selected as study group, and 20 healthy volunteers were selected as controls. Blood samples of the patients and the volunteers were taken within 1 hour of the patient's visit, and cytokines, such as IL-35, IL-4, IL-10, IL-17, INF-γ, and TGF-β, were simultaneously detected by enzyme-linked immunosorbent assay (ELISA). The expression level of CD4+CD25+FOXP3+ Treg cells was detected by flow cytometry, and the acute physiology and chronic health status scoring systemⅡ (APACHE Ⅱ) was calculated. According to the survival outcome at 28 days after admission, the expression levels of IL-35 in the survival group (12 cases) and the death group (8 cases) were compared. The Spearman method was used to analyze the correlation between IL-35 level and the above indicators in patients with sepsis and MODS. Results Compared with the control group, the IL-35 levels were significantly increased in the study group (P 0.05). The IL-35 level in the death group was significantly lower than that in the survival group (P<0.05). IL-35 levels in the survival and death groups were analyzed by ROC curve with a AUC of 0.78 (P=0.03). The IL-35 level was negatively correlated with the APACHE-Ⅱ score in the study group (r=-0.78, P<0.01). Conclusions The IL-35 levels in patients with sepsis and MODS is significantly higher than that in healthy controls, and negatively correlated with APACHE Ⅱ score. The level of IL-35 has an important implication for the prognosis for patients with sepsis. Key words: Interleukin-35; Cytokine; Sepsis; Multiple Organ Dysfunction Syndrome; Immune

Failure factors of non-invasive mechanical ventilation in the treatment of community acquired pneumonia

Objective To investigate the failure factors of no-invasive ventilation (NIV) as an initial ventilation mode for the treatment of community acquired pneumonia (CAP). Methods Totally 237 cases of CAP patients with NIV as initial ventilation were analyzed retrospectively in the emergency department of Beijing Chaoyang Hospital. According to the failure of NIV, patients were divided into two groups. General clinical data and acute physiological and chronic health score (APACHEⅡ), physiological parameters, pulmonary infection and the prognosis of the patients were recorded, and were compared between the two groups. The risk factors of NIV1 hour and 3 hours later were analyzed by multivariate logistic regression. Results Compared with the NIV failure group, the mortality of the patients in the NIV successful group (17.6 and 35.6, P< 0.01) was significantly lower. The risk factors for the NIV1 hour failure of the patients included the APACHE Ⅱ score(OR=1.352,95%CI:1.132-3.015,P=0.035),the hemodynamic support (OR=9.826,95%CI:2.525-86.377,P=0.002) and the severity of the pulmonary infection, and the risk factors for the physiological index of the failure of NIV3 hours included hemodynamic support(OR=6.365,95%CI:2.552-28.316,P=0.004),respiratory frequency and pH value. Conclusions Hemodynamic support is the most important risk factor for the failure of NIV in CAP patients. During the NIV treatment, the patients' respiratory frequency, pH and blood pressure should be closely monitored to ensure the success and safety of the treatment. Key words: NIV; CAP; Hemodynamic support; Respiratory frequency; pHvalue

Detección de anomalías en grandes volúmenes de datos

El desarrollo de la era digital ha traído como consecuencia un incremento considerable de los volúmenes de datos. A estos grandes volúmenes de datos se les ha denominado big data ya que exceden la capacidad de procesamiento de sistemas de bases de datos convencionales. Diversos sectores consideran varias oportunidades y aplicaciones en la detección de anomalías en problemas de big data. Para realizar este tipo de análisis puede resultar muy útil el empleo de técnicas de minería de datos porque permiten extraer patrones y relaciones desde grandes cantidades de datos. El procesamiento y análisis de estos volúmenes de datos, necesitan de herramientas capaces de procesarlos como Apache Spark y Hadoop. Estas herramientas no cuentan con algoritmos específicos para la detección de anomalías. El objetivo del trabajo es presentar un nuevo algoritmo para la detección de anomalías basado en vecindad para de problemas big data. A partir de un estudio comparativo se seleccionó el algoritmo KNNW por sus resultados, con el fin de diseñar una variante big data. La implementación del algoritmo big data se realizó en la herramienta Apache Spark, utilizando el paradigma de programación paralela MapReduce. Posteriormente se realizaron diferentes experimentos para analizar el comportamiento del algoritmo con distintas configuraciones. Dentro de los experimentos se compararon los tiempos de ejecución y calidad de los resultados entre la variante secuencial y la variante big data. La variante big data obtuvo mejores resultados con diferencia significativa. Logrando que la variante big data, KNNW-BigData, pueda procesar grandes volúmenes de datos.

Prognostic value of procalcitonin combined with CURB-65 score in elderly patients with community acquired pneumonia

Objective To evaluate the value of procalcitonin (PCT) combined with CURB-65 score in the elderly patients with community acquired pneumonia(CAP). Methods Seventy-eight elderly patients with CAP were selected in the Emergency Department of Xuanwu Hospital Capital Medical University, After admission, blood routine, PCT, blood gas analysis and biochemical examination were given, and Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ) and CURB-65 score were carried out.According to the prognosis, the patients were divided into death group (16 cases) and survival group (62 cases), The difference of PCT, white blood cell(WBC), CURB-65 score and APACHE Ⅱ score in the two groups were compared.The differences of area under ROC curve of APACHE II score, procalcitonin (PCT), CURB-65 score, PCT and CURB-65 score were compared. Results The PCT, CURB-65 and APACHEE Ⅱ scores of the death group and the survival group were (3.35±1.79) μg/L vs.(2.05±1.89) μg/L, (2.06±0.85)points vs.(1.40±0.99) points, (20.50±4.06) points vs.(14.13+ 5.63) points, respectively.There were significant differences between the two groups (P<0.05). The number of WBCs in survival group and survival group were(9.90±3.04)×109 /L and(8.77±3.70)×109 /L, respectively, with no significant difference between the two groups (P=0.263); the area under the ROC curve of PCT predicting death was 0.716 (P=0.001), the area under the ROC curve of CURB-65 predicting death was 0.679 (P=0.005), and the area under the ROC curve of APACHE II score was 0.836 (P=0.001) , which was larger than PCT and CRUB-65 (P<0.05). The area under ROC curve of death predicted by PCT and CRUB-65 was 0.775 (P=0.001). There was no significant difference between PCT and CRUB-65 and APACHE II (P=0.345). Conclusion PCT combined with CURB-65 score can accurately and rapidly assess the condition of elderly patients with community-acquired pneumonia, and has important application value. Key words: CURB-65 score; Procalcitonin; APACHE Ⅱ score; CAP

Lo stato dell'arte dell'innovazione tecnologica per le architetture web: presente e futuro per Archeologia e Calcolatori

The paper illustrates the recent evolution of web architectures and the choices made for the web portal of ‘Archeologia e Calcolatori’. The website needed an urgent restyling to update its ASP platform, even though for 15 years it had performed its interactive work very well. Today, the ASP language is no longer supported by Microsoft and the infrastructural choices of the CNR are and will be increasingly oriented towards the world of open source and LAMP architectures (Linux, Apache, MySQL, PHP/Phyton). For this reason, a transformation was not only suggested, but vital. It was therefore decided to completely renew the website, a task consisting of about 70 physical pages to be rewritten in PHP. This work transformation has helped to pave the way for new technologies that today are modifying the web architecture of the entire WWW and that will soon allow us to implement new services and functions. Particular attention was paid to the most significant phenomena in the innovative technological panorama of Web Information Systems, with particular emphasis on the Semantic Databases and the new RIA (Rich Internet Application) technologies, the latter a splendid evolution of client-side web architectures.

Apache Adaptation to Hispanic Rule by Matthew Babcock

Apache Adaptation to Hispanic Rule by Matthew Babcock

The predictive value of sFlt-1 combined with extravascular lung water index in severe pneumonia patients with acute respiratory distress syndrome complicated with septic shock

Objective To evaluate the prognosis value of plasma soluble vascular endothelial growth factor receptor (sFlt-1) combined with extravascular lung water index (EVLWI) in acute respiratory distress syndrome (ARDS) complicated with septic shock caused by severe pneumonia. Methods A retrospective analysis was conducted in Respiratory Intensive Care Unit of the Affiliated Zhengzhou Central Hospital of Zhengzhou University from January 2015 to July 2017. The study included 52 severe pneumonia patients with ARDS complicated with septic shock, who was performed by measurement of pulse index continuous cardiac output (PICCO) and survived more than 3 days after admission. According to the 28-day mortality, these patients were divided into the survival group (31 cases) and the death group (21 cases). PICCO was used to record the EVLWI level. The plasma level of sFlt-1 was measured by enzyme-linked immunosorbent assay (ELISA). Acute physiology and chronic health evaluation II (APACHE II) score and sequential organ failure assessment (SOFA) score were calculated. Independent risk factors were analyzed by multiple logistic regression. Correlation analysis between plasma sFlt-1 and EVLWI and APACHE II values was performed on the 1st, 2nd and 3rd day after admission. Receiver operating characteristic curve (ROC) was calculated, and the prognostic value of each parameter was assessed. Results The blood lactate, APACHE II score and SOFA score in the death group were significantly higher than those in the survival group at RICU admission (P<0.05), and the length of RICU stay was significantly shorter than that in the survival group (P<0.05), while differences in other clinical characteristics between the two groups were not statistically significant. The levels of EVLWI, sFlt-1 and blood lactate, APACHE II score and SOFA score in the death group were significantly higher than those in the survival group on the 1st, 2nd and 3rd day (all P<0.05), whereas the PaO2/FiO2 was significantly lower than that of the survival group on the 2nd and 3rd day (all P<0.05). Logistic regression analysis showed that sflt-1 level and EVLWI were significantly related with the patient mortality. The levels of sFlt-1 on day 1, 2 and 3 after RICU admission were positively related to EVLWI and APACHE II score (all P<0.01). The sensitivity and specificity of sFlt-1 combined with EVLWI in prognosis evaluation were 89.7%, 78.2% and 86.3%, 75.7%, respectively. The AUC of sFlt-1 combined with EVLWI was 0.875 and 0.856 on the 1st and 3rd day, respectively (all P<0.01), which had a better prognostic value than each of them. Conclusions SFlt-1 could be used as a biomarker of mortality for severe pneumonia patients with ARDS complicated with septic shock. The combination of sFlt-1 and EVLWI might be important in early prediction of the prognosis of the 28-day mortality in patients with ARDS complicated with septic shock caused by severe pneumonia. Key words: sFlt-1; PICCO; Extravascular lung water index; Septic shock; Prognosis

Roles of cerebral metabolic rate for oxygen in evaluating the prognosis of cerebral function after cardiopulmonary resuscitation

Objective To investigate the roles of cerebral metabolic rate for oxygen (CMRO2) monitoring in the evaluation of cerebral function after cardiopulmonary resuscitation (CPR) through transcranial doppler (TCD) and SjvO2. Methods In this prospective/retrospective analysis, we included 46 cases admitted to the general intensive care unit (GICU) of the Second Affiliated Hospital of Soochow University from January 2012 to December 2014. Upon admission, TCD and SjvO2 were performed, and the patients’ characteristics were recorded. Based on the CPC score upon GICU discharge, the patients were divided into two groups with satisfactory cerebral function and poor cerebral function, respectively. Then the clinical symptoms, cerebral blood flow (CBF), a-vDO2, SjvO2 and CMRO2 were analyzed, followed by investigating their correlation with the prognosis of cerebral function. The measurement data that were normally distributed were presented by mean ± standard deviation. Student’s t test was utilized for the inter-group comparison. Correlation analysis was performed. ROC was plotted, followed by evaluating roles of each index in the specificity and sensitivity of nervous prognosis. Results No statistical differences were noted in the gender, age, initial monitoring indicators, ICU duration and initial GCS between the two groups (P>0.05). The CA-ROSC time and APACHE II score in the satisfactory cerebral function group were significantly shorter than those of the poor cerebral function group (P<0.05). The SjvO2 in the satisfactory cerebral function group was significantly lower than that of the poor function group (67.33±10.30 vs. 76.89±13.08, t=-3.579, P<0.05). The Vs and Vd as revealed by TCD in the satisfactory function group were higher than those of the poor function group, together with the CBF. Significant decrease was noted in the PI and RI in the satisfactory function group compared with that of the poor function group (P<0.05). Besides, the CMRO2 and a-vDO2 in the satisfactory function group showed significant increase compared with those of the poor function group (P<0.05). ROC indicated that CMRO2, CBF, a-vDO2 and SjvO2 could be utilized for the evaluation of cerebral function, among which CMRO2 showed the highest accuracy for the cerebral function prognosis. Conclusions CMRO2, CBF, a-vDO2 and SjvO2 were associated with cerebral function prognosis. CMRO2 was the most appropriate parameter to evaluate the oxygen metabolism in brain tissues, which could evaluate the prognosis of cerebral function. Key words: Cardiac arrest; Resuscitation; Jugular venous oxygen saturation; Transcranial Doppler; Cerebral metabolic rate for oxygen

Clinical retrospective analysis of Klebsiella pneumoniae bloodstream infection

Objective To explore the clinical characteristics, drug resistance and prognosis of Klebsiella pneumoniae bloodstream infection (KP-BSI), and to analyze the risk factors of death and drug resistance. Methods The clinical data of hospitalized patients with KP-BSI from April 2015 to April 2017 in Huashan Hospital were retrospectively analyzed. Continuous variables were compared using t test. Categorical variables were compared using χ2 test or Fisher exact test. The independent risk factors for death were determined by logistic regression model. Results The majority of the 74 patients with KP-BSI were male (67.6%) and elderly patients (78.4%). Nosocomial infection occurred in 58 cases (78.4%) and a total of 24 (32.4%) cases died. The patients were widely distributed in various departments of the hospital. The first was the Department of Infectious Diseases (29.7%), followed by the intensive care unit (23.0%). The patients were often complicated with various underlying diseases and the most common was pulmonary infection (56.8%). There were 45 (60.8%) multiple drug resistance (MDR) strains and 29 (39.2%) Carbapenems resistant Klebsiella pneumoniae (CRKP) strains. There were significant differences of nosocomial infections (χ2=4.655, P=0.031), deep venous catheters (χ2=5.432, P=0.02), and invasive mechanical ventilation (χ2=7.630, P=0.006) between MDR and non-MDR patients. Deep venous catheters (χ2=5.923, P=0.015), invasive mechanical ventilation (χ2=16.845, P=0.000), other catheters (χ2=4.009, P=0.045) and surgery (χ2=3.910, P=0.048) were all significantly different between CRKP and non-CRKP patients. APACHE Ⅱ scores were performed in all patients. The average APACHE Ⅱ score was 8.74±5.32 of the 50 cases (67.6%) in the survival group and that was 16.46 ± 6.62 of the 24 cases (32.4%) in the death group. The APACHE Ⅱ score in the survival group was significantly lower than that in the death group. The difference was statistically significant (t=5.091, P=0.000). APACHE Ⅱ≥15 was the independent factor of death (B =-2.708, P=0.000). Conclusions The situation of drug-resistant KP-BSI is severe in the clinic. According to the clinical data, nosocomial infections, invasive mechanical ventilation and deep venous catheters may be the risk factors for MDR bloodstream infection. Deep venous catheters, invasive mechanical ventilation, other catheters and surgery may be the risk factors for bloodstream infection with CRKP. APACHEⅡ≥15 is the independent risk factor for death. The evaluation of APACHE Ⅱ score may predict the prognosis of patients with bloodstream infection. Key words: Klebsiella pneumoniae; Risk factors; Bloodstream infection; Clinical features

The value of early changes in platelet counts in assessing the prognosis of aged patients with severe pneumonia

Objective To explore the predictive value of early changes in platelet counts in the prognosis of severe pneumonia in aged patients. Methods This retrospective study included elderly patients with severe pneumonia, who were ≥65 years old and whose length of ICU stay ≥72 hours, admitted to the intensive care unit(ICU)of NO.2 People's Hospital of Changzhou from January 2014 to January 2017.They were divided into a survival group and a death group according to the 28-day outcome.General information and serum platelet levels at 0, 24, 36, and 72 hours after admission were collected.Receiver operating characteristic curve(ROC)was plotted according to platelet counts, changes in platelet counts and rates of change in platelet counts to evaluate their predictive value for 28-day prognosis.Kaplan-Meier survival curve was used to analyze the 28-day cumulative survival rate between different groups of patients, who were further divided according to platelet counts at 0 and 72 hours after admission to ICU, changes in platelet counts and rates of change in platelet counts at 72 hours after admission. Results (1)One hundred elderly patients with severe pneumonia were enrolled, among whom 41 cases were in the death group, thus with a mortality of 41.0%.The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), sequential organ failure assessment(SOFA), C-reactive protein(CRP), and procalcitonin(PCT)in the death group were significantly higher than those in the survival group.2)Serum platelet levels showed a downward trend in both the death group and the survival group.The level of serum platelets at 72 hours after admission to ICU in the death group was significantly lower than that in the survival group(80.00×109/L vs.171.00×109/L, Z=5.786, P<0.05); changes in platelet counts and rates of change in platelet counts in the death group were significantly higher than those in the survival group, especially at 72 hours after admission to ICU(△PLT72: -79.00×109/L vs.-38.00×109/L, Z=4.938, P<0.05; △PLT 72%: -43.6% vs.-17.7%, Z=6.816, P<0.05). (3)ROC curve analysis showed that platelet levels, changes in platelet counts, and rates of change in platelet counts could predict 28-day mortality in aged patients with severe pneumonia.The largest area under ROC curve was 0.902 when plotted with the rate of platelet counts at 72 hours after admission to ICU.Using the cut-off value of -36.14% in the rate of change at 72 hours after admission to evaluate the predictive value in 28-day mortality, the sensitivity and specificity were 89.8% and 75.6%, respectively.(4)Kaplan-Meier survival analysis showed that the 28-day survival rate was significantly higher and the length of survival was significantly greater when platelet counts at 0 and 72 hours after admission to ICU were higher than the cut-off value, and this also occurred in changes in platelet count and rates of change at 72 hours after admission to ICU. Conclusions Continuous decline in serum platelet levels indicates poor prognosis.When combined with platelet counts, changes in platelet counts and rates of change in platelet counts at 72 hours after admission to ICU, it may play an important role in assessing the prognosis of aged patients with severe pneumonia. Key words: Blood platelets; Pneumonia; Prognosis

Clinical study of Rhubarb water extract gavage combined with external application of mirabilite and western medicine in the treatment of severe acute pancreatitis

Objective To investigate the effects of Rhubarb water extract gavage combined with external application of mirabilite and western medicine in the treatment of severe acute pancreatitis (SAP). Methods A total of 62 patients with SAP meeting the inclusion criteria were randomly divided into 2 groups, with 31 cases in each group. The control group was treated with western medicine routine treatment. The study group was given the combination of raw and rhubarb water infusion and mirabilite external application on the basis of the control group. After treated with 28 d, the duration of blood purification, abdominal pain disappeared time, blood amylase recovery time, bowel peristalsis recovery time, hospitalization time and 28 d mortality were observed in the 2 groups. Results The duration of blood purification time, abdominal pain disappeared time, blood amylase recovery time, bowel peristalsis recovery time, hospitalization time of the study group were significantly lower than those of the control group (t=2.434, 2.507, 2.804, 2.318, 2.614, P<0.05). After treatment 1, 3, 7 d, the level of D-lactic acid in the study group was respectively which were significantly lower than those of the control group (t=38.752, 36.975, 36.018, P<0.05). The level of DAO in the study group was respectively which were significantly lower than those of the control group (t=4.119, 4.632, 3.907, P<0.05). The level of ET in the study group was respectively which were significantly lower than those of the control group (t=25.699, 23.805, 24.472, P<0.05). The level of hs-CRP in the study group was respectively which were significantly lower than those of the control group (t=4.791, 5.025, 5.288, P<0.05). The level of PCT in the study group was respectively which were significantly lower than those of the control group (t=4.350, 4.742, 6.012, P<0.05). The APACHE II scores in the study group were respectively which were significantly lower than those of the control group (t=3.988, 4.350, 5.722, P<0.01). Conclusions The application of Rhubarb water extract gavage combined with external application of mirabilite and western medicine in the treatment of severe acute pancreatitis can protect the intestinal mucosal barrier of SAP patients, reduce the level of inflammatory reaction, shorten the time of symptom relief and improve the curative effect. Key words: Severe acute pancreatitis; Rheum officinale; Natrii sulfas; Hypersensitive C reactive protein; procalcitonin

Epidemiological investigation and logistic regression analysis of nosocomial fungal infection in severe sepsis patients

Objective To investigate the epidemiological characteristics of nosocomial fungal infections in severe sepsis patients and analyze the influencing factors by logistic regression. Methods The clinical data of 578 patients with severe sepsis admitted to our hospital from January 2008 to January 2016 were retrospectively analyzed. The epidemiological characteristics were investigated. The possible influencing factors of nosocomial fungal infection were analyzed by univariate analysis and multivariate logistic regression analysis. Results Among 578 cases of severe sepsis, 215 cases were accompanied by nosocomial fungal infection (infection rate 37.20%). The infection sites were mostly lungs and the fungal types were Candida albicans. The prognosis of the patients was poor. The survival time was less than 90 days, accounting for 42.33%(91/215). There were significant differences in age, length of stay in intensive care unit (ICU), duration of more than two antibiotics, use of ventilators, hormones, invasive procedures, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score between the infected group and the uninfected group (P 7 d (OR=3.287), use steroid (OR=2.141). Conclusions Severe sepsis with hospital acquired fungal infection is more common in the lung, and most of them are Candida albicans infection, with poor prognosis and high mortality. ICU stay ≥100 h, use respirator and steroid, invasive operation, age ≥65 years, and continuous use of two antibiotics >7d are risk factors. Specific preventive measures should be taken to reduce fungal infections. Key words: Sepsis; Mycoses/EP; Cross infection; Hospitals; Factor analysis, statistical

Evaluation of six scoring systems and four laboratory tests in the prognostic assessment of severe acute pancreatitis

Objective To evaluate the six scoring systems and four laboratory tests, including pancreatitis outcome prediction (POP), Ranson score, bedside index for severity in acute pancreatitis (BISAP), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), systemic inflammatory response syndrome (SIRS), and Glasgow score as well as four laboratory tests including C-reactive protein (CRP), hematocrit (HCT), blood urea nitrogen (BUN) and serum creatinine (Scr) in the prognostic assessment of severe acute pancreatitis (SAP). Methods From January 2016 to December 2017, at Sir Run Run Shaw Hospital, 151 SAP patients who met the enrollment criteria were retrospectively analyzed. According to the time from onset to treatment, the patients were divided into less than three days group (n=102) and over three days group (n=49). The evaluation of six scoring systems and four laboratory tests, including CRP, HCT, BUN and Scr at 0, 24 and 48 h after hospitalization in the prognostic assessment of SAP patients was measured by receiver-operating characteristic (ROC) curve. Results The Ranson score had the highest area under curve (AUC) value (0.916) in the evaluation of the prognosis of SAP patients less than three days group followed by BISAP, APACHEⅡ, Glasgow and POP score, and their AUC values were 0.832, 0.823, 0.793, and 0.787, respectively, all of them were statistically significant in the prognostic assessment of SAP patients in less than three days group (all P<0.05). There were statistically significant of BISAP and APACHEⅡ scores in the prognostic evaluation of SAP patients in over three days group (both P<0.05), and the AUC values were 0.751 and 0.735, respectively, which were less than those of SAP patients in less than three days group. There were statistical significance of BUN and Scr at 24 and 48 h after hospitalization in the prognostic assessment of SAP patients in less than three days group (all P<0.05), and the AUC values were 0.856, 0.853 and 0.793, 0.874, respectively. There were statistical significance of BUN at 0, 24, 48 h and Scr at 48 h after hospitalization in the prognostic assessment of SAP patients in over three days group (all P<0.05), and the AUC value was 0.709, 0.754, 0.742 and 0.716, respectively. Conclusions Ranson, POP and Glascow score systems are only suitable for patients with SAP less than three days. APACHEⅡ, BISAP score systems, BUN and Scr can be used to evaluate patients with SAP over three days, but are more suitable for patients with SAP less than three days group. Key words: Severe acute pancreatitis; pancreatitis of outcome prediction; Ranson score; BISAP; APACHE Ⅱ; systemic inflammatory response syndrome; Glasgow; ROC curve

Matthew Babcock. Apache Adaptation to Hispanic Rule.

Matthew Babcock. Apache Adaptation to Hispanic Rule.

Value of strong ion gap for predicting the severity of acute pancreatitis

Objective To investigate the value of strong ion gap (SIG) in predicting the severity of acute pancreatitis (AP) based on the revised Atlanta classification. Methods A total of 133 patients with AP admitted from January, 2015 to December, 2016 were enrolled. Of them, there were 55 with mild AP (MAP), 52 with moderately severe AP (MSAP) and 26 with severe AP (SAP). All patients with AP conformed to the diagnostic criteria of Guidelines or Diagnosis and Treatment of Acute Pancreatitis set in 2014 in China. Patients with other underlying diseases that might influence the clinical outcome were excluded, including those with diabetic ketoacidosis, chronic renal failure and other disorders. The changes in blood SIG levels in each group were observed. The correlations between SIG and acute physiology, chronic health evaluation (APACHE) Ⅱ score, Ranson score and length of hospital stay were analyzed. The receiver operating characteristic curves (ROC) were plotted to determine the efficiency of SIG, Scr, APACHEⅡ score, and Ranson score for predicting the severity of acute pancreatitis. Results The level of SIG in the SAP group was the highest, followed by the MSAP group and the lowest in the MAP group. There were significant differences in pairwise comparisons (P 0.05) and as well as Ranson score (0.874±0.029 vs. 0.890±0.027, P>0.05) for predicting moderately-severe acute pancreatitis, but SIG was superior to Scr (0.874±0.029 vs. 0.735±0.043, P 0.05) and Ranson score (0.910±0.030 vs. 0.871±0.032, P>0.05) for predicting severe acute pancreatitis. Conclusion SIG has important clinical significance for predicting the severity of acute pancreatitis. Key words: Acute pancreatitis; Strong ion gap; Severity; Prediction

Comprehensive nursing intervention combined with routine nursing care in patients with ICU blood purification and its effect on prognosis

Objective To explore the effect of comprehensive nursing intervention combined with routine nursing in patients with severe ICU (intensive care unit) blood purification and its influence on prognosis. Methods From April 2014 to March 2017, 82 patients with ICU blood purification admitted to the hospital were selected and randomly divided into two groups with 41 cases each.Patients in the control group were treated with routine nursing, and patients in the research group were treated with combined comprehensive nursing intervention.The nursing effect and prognosis of the two groups were compared. Results After treatment, the indexes of MAP, HR, Scr, BUN, AST and ALT of the study group were significantly better than those of the control group, with statistically significant differences (P>0.05). APACHE Ⅱ score all time points of the study group were significantly better than the control group, and the differences were statistically significant (P<0.05). Conclusions The combined application of comprehensive nursing intervention and routine nursing in patients with severe ICU blood purification is conducive to improving the nursing effect and improving the prognosis of patients. Key words: Comprehensive nursing intervention; Routine nursing care; ICU; Blood purification; Prognosis

Association of the immature platelet fraction with sepsis diagnosis and severity

Objective To explore the relationship between immature platelet fraction(IPF) with severity of sepsis and prognosis in patients with septic shock. Methods A total of 40 patients admitted to intensive care units of Tianjin First Central Hospital from June 2016 to June 2017 were enrolled. Of them,10 patients contracted non-sepsis infected,13 patietns with septic shock, and 17 patients with non-complicated sepsis. Ten healthy subjects were recruited as control groups from Tianjin Medical University.IPF and immature reticulocyte fraction (IRF) were detected, and SOFA and APACHEⅡ scores were calculated, and clinical findings of all groups were recorded. The differences in IPF and IRF between the groups were analyzed. The relationship between the IPF and SOFA score was studied, and the role of IPF in the diagnosis of septic shock was evaluated. Statistical methods include t test, Mann-Whitney test, Spearman correlation analysis, and ROC procedure,and P<0.05 was considered significant. Results Significantly higher IPF level was observed in patients with sepsis than that in patients with non-sepsis infection.(6.25±2.92) vs. (2.49±1.03), P<0.01. Significantly higher IPF level was observed in patients with septic shock than that in patients with non-complicated sepsis(4.71±1.79) vs. (8.25±2.94), P<0.01. IPF correlated with sepsis severity scores (7.41±3.51) vs. (4.5±1.7), P=0.005; r=0.58, P=0.001. This study presented the highest diagnostic accuracy for the presence of sepsis by all studied clinical and laboratory parameters (AUC=0.78, P=0.01). Conclusion IPF levels could be used as a biomarker for diagnosis and severity of sepsis. Key words: Immature platelet fraction; Sepsis; Septic shock; APACHE Ⅱ; SOFA