Continuous Blood Purification Therapy Research Articles

Coagulation Risk Predicting in Anticoagulant-Free Continuous Renal Replacement Therapy.

Continuous renal replacement therapy (CRRT) is a prolonged continuous extracorporeal blood purification therapy to replace impaired renal function. Typically, CRRT therapy requires routine anticoagulation, but for patients at risk of bleeding and with contraindications to sodium citrate, anticoagulant-free dialysis therapy is necessary. However, this approach increases the risk of CRRT circuit coagulation, leading to treatment interruption and increased resource consumption. In this study, we utilized artificial intelligence machine learning methods to predict the risk of CRRT circuit coagulation based on pre-CRRT treatment metrics. We retrospectively analyzed 212 patients who underwent anticoagulant-free CRRT from October 2022 to October 2023. Patients were categorized into high-risk and low-risk groups based on CRRT circuit coagulation within 24 h. We employed eight machine learning methods to predict the risk of circuit coagulation. The performance of the model was evaluated using the area under the curve (AUC) of the receiver operating characteristic. 5-fold cross-validation was used to validate the machine learning models. Feature importance and SHAP plots were used to interpret the model's performance and key drivers. We identified 88 patients (41.51%) at high risk of circuit coagulation within 24 h of CRRT. Our machine learning models showed excellent predictive performance, with ensemble learning achieving an AUC of 0.863 (95% CI: 0.860-0.868), outperforming individual algorithms. Random forest was the best single-algorithm model, with an AUC of 0.819 (95% CI: 0.814-0.823). The top three features identified as most important by the SHAP summary plot and feature importance graph are platelet, filtration fraction (FF), and triglycerides. We created a model using machine learning to predict the risk of circuit coagulation during anticoagulant-free CRRT therapy. Our model performs well (AUC 0.863) and identifies key factors like platelets, FF, and triglycerides. This facilitates the development of personalized treatment strategies by clinicians aimed at reducing circuit coagulation risk, thereby enhancing patient outcomes and reducing healthcare expenses.

Evaluation of continuous blood purification in patients with urosepsis caused by ureteral calculi and heart failure after catheterization.

To detect the continuous blood purification (CBP)'s application value in patients with urosepsis caused by ureteral calculi and heart failure after catheterization. This is a clinical comparative study. Sixty patients with ureteral calculi complicated with heart failure and urosepsis were admitted at Affiliated Hospital of Hebei University from January 2021 to March 2023 randomly split into control and experimental group(n=30). Based on conventional treatment after indwelling the DJ tube, the experimental group was treated with CBP therapy. The control group dealt with conventional anti-inflammatory, oxygen inhalation and other treatments only. Compared and analyzed in terms of alterations in blood inflammatory factors, cardiac function, BNP prior to and after therapy, blood pressure, blood WBC recovery time, and so on. TNF-a, CRP, and PCT levels in the control and experimental groups were substantially more prominent than the average reference value prior to treatment. They decreased considerably at distinct time points after therapy, with substantial distinctions (p< 0.05). A more meaningful decrease was noticed in the experimental group in comparison with the control group (p< 0.05). BNP and cardiac function were improved in both groups prior to and after therapy, and the amelioration of indexes in the experimental group was more substantial than that in the control group after therapy, with statistically considerable distinctions. The improvement time in experimental group was earlier than in the control group, with statistically substantial differences. Patients with urosepsis complicated with heart failure after indwelling DJ tube have their inflammatory factors improved significantly, with more thorough excretion by using conventional treatment combined with CBP therapy.

Clinical Impact of Targeted Nursing Combined with Nutritional Intervention on Nutritional Status, Complications and Rehabilitation of Pyemia Patients Treated with Blood Purification

This research aimed to clarify the importance of targeted nursing combined with nutritional intervention in pyemia patients treated with blood purification. According to nursing methods, patients were divided into a control group (CG, n = 50) and an experimental group (EG, n = 50). All patients underwent continuous blood purification therapy and were observed for 14 days. The CG received conventional nursing measures, while the EG received targeted nursing combined with nutritional interventions. After the intervention, serum calcium and phosphorus levels were lower (P &lt; 0.05), and the levels of serum albumin, prealbumin, total plasma protein, transferrin, and fibronectin were higher (P &lt; 0.05) in the EG compared to the CG. The incidence of complications, including hypotension, malnutrition, and chest distress, was lower in the EG than in the CG (P &lt; 0.05). Additionally, bodily pain, physical functioning, social functioning, and mental health scores were higher in the EG than in the CG (P &lt; 0.05). In summary, applying targeted nursing combined with nutritional intervention can effectively improve the nutritional status of pyemia patients treated with blood purification, reduce the incidence of complications, and elevate their quality of life.

Construction and evaluation of a prognostic model for severe acute pancreatitis based on CT scores and inflammatory factors

To construct a prognostic model for severe acute pancreatitis (SAP) based on CT scores and inflammatory factors, and to evaluate its efficacy. 128 patients with SAP diagnosed admitted to the First Hospital Affiliated to Hebei North College from March 2019 to December 2021 were enrolled and given Ulinastatin combined with continuous blood purification therapy. The levels of C-reactive protein (CRP), procalcitonin (PCT), interleukins (IL-6, IL-8), tumor necrosis factor-α (TNF-α), and D-dimer were measured before and on the third day of treatment. An abdominal CT was performed on the third day of treatment to assess the modified CT severity index (MCTSI) and extra-pancreatic inflammatory CT score (EPIC). Patients were divided into the survival group (n = 94) and the death group (n = 34) according to the 28-day survival prognosis after admission. The risk factors for the SAP prognosis were analyzed using Logistic regression, which was then used to build nomogram regression models. The value of the model was evaluated using the concordance index (C-index), calibration curves and decision curve analysis (DCA). Before treatment, the levels of CRP, PCT, IL-6, IL-8 and D-dimer in the death group were higher than those in the survival group. After treatment, the levels of IL-6, IL-8 and TNF-α in the death group were higher than those in the survival group. MCTSI and EPIC scores in the survival group were lower than those in the death group. Logistic regression analysis shows that, pre-treatment CRP > 140.70 mg/L, D-dimer > 2.00 mg/L, and post-treatment IL-6 > 31.28 ng/L, IL-8 > 31.04 ng/L, TNF-α > 31.04 ng/L, and MCTSI > 8 points were all independent risk factors for SAP prognosis [odds ratios (OR) and 95% confidence intervals (95%CI) were 8.939 (1.792-44.575), 6.369 (1.368-29.640), 8.546 (1.664-43.896), 5.239 (1.108-24.769), 4.808 (1.126-20.525), 18.569 (3.931-87.725), all P < 0.05]. Model 1 (consisting of pre-treatment CRP, D-dimer, and post-treatment IL-6, IL-8 and TNF-α) had a lower C-index than that model 2 (consisting of pre-treatment CRP, D-dimer, and post-treatment IL-6, IL-8 and TNF-α, and MCTSI; 0.988 vs. 0.995). The mean absolute error (MAE) and mean square error (MSE) of model 1 (0.034, 0.003) were higher than those of model 2 (0.017, 0.001). When the threshold probability was in the range of 0-0.66 or 0.72-1.00, the net benefit of model 1 was lower than that of model 2. When the threshold probability was in the range of 0.66-0.72, the net benefit of model 1 was higher than that of model 2. In addition, model 2 had a higher C-index than acute physiology and chronic health evaluation II (APACHE II) and bedside index of acute pancreatitis severity (BISAP, 0.995 vs. 0.833, 0.751). Model 2 had a lower MAE (0.017) and MSE (0.001) than APACHE II (0.041, 0.002). Model 2 had a lower MAE than BISAP (0.025). Model 2 had a higher net benefit than both APACHE II and BISAP. The prognostic assessment model of SAP consisting of pre-treatment CRP, D-dimer, and post-treatment IL-6, IL-8 and TNF-α, and MCTSI has high discrimination, precision and clinical application value, and is superior to APACHE II and BISAP.

Effects of hydrophilic polymer-embedded membrane on permeability and cell adhesion during continuous hemofiltration

Background and AimsClotting within the membrane and/or venous ‘air trap’ chamber is common problems during continuous blood purification therapy. Frequent clotting during continuous blood purification therapy leads to inadequate solute removal, an increased circuit and filter cost, and an increased burden for the medical staff. Improvements in filter membrane materials may reduce the extent of clotting and prolong the filter life. The purpose of the present study was to clarify the characteristics of an NV polymer-embedded membrane (NV-PS) after long-term use, especially the adhesiveness of blood cells and changes in the solute removal performance.MethodsContinuous hemofiltration (CHF) experiments using a permeate recycle mode were performed for 24 h using the same porcine whole blood divided into two portions to compare the NV-PS with a conventional polysulfone membrane (PS). The activated clotting time was adjusted to within a range of 300–400 s. The change in the dextran sieving coefficient (SC) of the membrane and the residual blood clots in the filters were evaluated after the completion of the CHF experiment.ResultsThe increase in the transmembrane pressure and the pressure drop of the hemofilter were significantly smaller using the NV-PS than with the PS. For larger molecules (SC leqq 0.4), the reduction in SC after blood contact was significantly smaller for the NV-PS. Fewer blood cells remained in the residual blood clots when the NV-PS was used.ConclusionNV-PS has the advantages of showing a lower degree of reduction of the solute removal performance and also a lower degree of clogging of the hollow fibers during prolonged circulation. These characteristics may be expected to be advantageous when this membrane is used for continuous blood purification therapy in acute-phase patients.

Continuous renal replacement therapy using a cellulose triacetate hemofilter for severe coronavirus disease

BackgroundIn patients with severe coronavirus disease (COVID-19), the use of acrylonitrile hemofilters can reduce cytokine concentrations. However, acrylonitrile hemofilters can easily coagulate, and the effect of hemofilters on improvement in patient prognosis remains unclear. Therefore, we aimed to investigate the changes in serum cytokine concentrations, alleviation of organ damage, and improvement in patient prognosis with continuous renal replacement therapy (CRRT) using a cellulose triacetate (CTA) filter with excellent anticoagulation property in patients with severe COVID-19.MethodsThis was a retrospective, single-center study conducted by the Advanced Critical Care Center in Sapporo Medical University Hospital, Japan. Seven patients with severe COVID-19 between March 01 and June 30, 2020, were included. The patients were under mechanical ventilation and received continuous blood purification therapy with a CTA filter. We summarized the CRRT status and patient prognosis and measured their serum cytokine (interleukin [IL]-1β, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor-α, and interferon-γ) and serum marker levels, before and after CRRT. In addition, we evaluated the changes in their respiratory status, hemodynamics, and organ dysfunction scores. The average age of the patients was 61.5 years, and five patients were male. Extracorporeal membrane oxygenation was used in five patients. The treatment outcome included three deaths.ResultsThe median CRRT duration was 7 days. The hemofilter was replaced once a day. After CRRT, the IL-6 concentration decreased from 393 to 85 pg/mL (p = 0.016), the Krebs von den Lungen-6 concentration decreased from 554 to 350 U/mL, and the PaO2/FiO2 ratio increased significantly from 90 to 248, and therefore, oxygenation improved. In addition, the norepinephrine dose and lactate level decreased, and the circulation tended to improve; however, the renal function and Sequential Organ Failure Assessment score did not change.ConclusionsThe serum IL-6 level decreased, and the respiratory status improved upon CRRT using a CTA filter in patients with severe COVID-19.

CT Image Feature under Intelligent Algorithm in the Evaluation of Continuous Blood Purification in the Treatment and Nursing of Pulmonary Infection-Caused Severe Sepsis.

This study was to explore the CT image features based on intelligent algorithm to evaluate continuous blood purification in the treatment of severe sepsis caused by pulmonary infection and nursing. 50 patients in the hospital were selected as the research objects. Convolutional neural network algorithm was used to segment CT images of severe sepsis caused by pulmonary infection. They were randomly divided into 25 cases of experimental group and 25 cases of control group. The experimental group was given continuous blood purification treatment, combined with comprehensive nursing. The control group was given routine treatment and basic nursing. Fasting plasma glucose (FPG) and fasting insulin (FIN), interleukin-6 (IL-6), tumor necrosis factor (TNF-α), high-sensitivity c-reactive protein (hs-CRP) levels, CD3+, CD4+, CD4+/CD8+ levels, ICU monitoring time, malnutrition inflammation score (MIS), and incidence of adverse events were compared between the two groups before and after treatment. There was no difference in FPG and FIN between the two groups before treatment. After treatment, the FPG and FIN of the experimental group were lower than those of the control group, and there was statistical significance (P < 0.05). There was no difference in IL-6, TNF-α, and hs-CRP between the two groups before treatment. After treatment, IL-6, TNF-α, and hs-CRP in the experimental group were lower than those in the control group. There was no difference in the percentage of CD3+, CD4+, and CD4+/CD8+ between the two groups before treatment. After treatment, the CD3+, CD4+, and CD4+/CD8+ in the experimental group were higher than those in the control group. The ICU monitoring time, MIS, and incidence of adverse events in the experimental group were lower than those in the control group (P > 0.05). Convolutional neural network algorithm can accurately identify and segment CT images of patients with severe sepsis, which has high clinical application value. Continuous blood purification therapy can effectively control blood glucose level, improve immune function, and reduce the content of inflammatory factors in patients with severe sepsis caused by pulmonary infection. Effective nursing measures can improve the therapeutic effect.

Research Progress of Continuous Blood Purification in the Treatment of Severe Sepsis in Children

Pediatric sepsis is the most common disease in pediatric critical illness, because the main reason for the disease is that children's immune level is not high or the immune system is not perfect, when children's lung, abdominal cavity and blood system are infected, it will cause systemic inflammation and immune dysfunction. Early clinical symptoms are mainly irregular and intermittent fever. When the disease develops to severe sepsis, the children will suffer from acute heart failure, oliguria, respiratory alkalosis and even multiple organ failure. The incidence of death is high. It is reported that the incidence rate of sepsis in children can reach 0.3%, and the mortality rate is 50%. High incidence rate, high mortality rate and high treatment cost are the biggest problems in the pediatric field. In the past, the clinical hope of clearing away heat and toxin, promoting blood circulation and removing stasis, strengthening inflammation and other methods in traditional Chinese medicine, but the treatment effect is not ideal. With the improvement of modern medical understanding of sepsis, continuous blood purification therapy is introduced into the treatment of children with severe sepsis. In order to further explore the effect of continuous blood purification in the treatment of children with severe sepsis, the author summarizes the clinical practice experience and relevant literature, hoping to provide reference for relevant medical staff.

Gut-lymph-lung pathway mediates sepsis-induced acute lung injury.

This review attempts to unveil the possible mechanisms underlying how gut lymph affects lung and further gives rise to acute respiratory distress syndrome, as well as potential interventional targets under the condition of ischemia-reperfusion injury. We searched electronic databases including PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Google Scholar, Web of Science, and Embase to identify relevant literatures published up to December 2019. We enrolled the literatures including the Mesh Terms of “gut lymph or intestinal lymph and acute lung injury or acute respiratory distress syndrome.” Gut is considered to be the origin of systemic inflammation and the engine of multiple organ distress syndrome in the field of critical care medicine, whereas gut lymph plays a pivotal role in initiation of ischemia-reperfusion injury-induced acute respiratory distress syndrome. In fact, in the having been established pathologic model of sepsis leading to multiple organ dysfunction named by Gut Lymph theory, a variety of literatures showed the position and role of changes in gut lymph components in the initiation of systemic inflammatory response, which allows us to screen out potential intervention targets to pave the way for future clinic and basic research.

Efficacy analysis of continuous blood purification therapy for patients with severe acute pancreatitis and acute kidney injury.

article: Efficacy analysis of continuous blood purification therapy for patients with severe acute pancreatitis and acute kidney injury - Panminerva Medica 2022 December;64(4):593-4 - Minerva Medica - Journals

Current Status of Continuous Blood Purification Therapy in the Tokai and Hokuriku Regions: Results of a Questionnaire Survey

Current Status of Continuous Blood Purification Therapy in the Tokai and Hokuriku Regions: Results of a Questionnaire Survey

Study on blood return of continuous blood purification therapy for patients with heart failure

Objective To explore the method of the blood return of continuous blood purification therapy for patients with heart failure. Methods A total of 69 patients with heart failure treated by continuous blood purification therapy in our ICU from January 2017 to January 2018 were randomly divided into experimental group (blood return with blood bag,35 patients) and the control group (blood return with machine,34 patients). The vital signs, clinical manifestations and hemodynamic indicators of each patient were collected during the blood return of the first CBP therapy, and the data were analyzed between the two groups. Results After blood return of the first CBP therapy, the exacerbation of New York Heart Association (NYHA) heart function grade, SpO2, CVP, HR of patients in the control group were 33.27% (11/31), 0.91 ± 0.06, (12.44 ± 1.43) cmH2O (1cmH2O=0.098 kPa), (118.17 ± 3.27) times per minute and those in the experimental group were 6.25% (2/32), 0.96±0.04, (8.98±1.36) cmH2O, (90.45 ± 3.35)times per minute, respectively. The difference was statistically significant between the two groups (χ2=3.786, t=2.861, -7.565, 3.792, P 0.05). Conclusions In patients with heart failure treated with CBP, especially in those treated with CBP therapy within 24 hours, blood return with blood bag may avoid the recurrence of heart failure. Key words: Heart failure; Continuous blood purification; Blood return

Differential clinical benefits of continuous blood purification treatment in critically ill patients with variable APACHE II scores.

The present study aimed to assess whether the Acute Physiology And Chronic Health Evaluation (APACHE) II score may be used to predict whether critically ill patients benefit from continuous blood purification (CBP) treatment. A total of 115 critically ill patients were retrospectively reviewed and grouped according to their baseline APACHE II scores. Each group was further divided into 2 groups based on whether they received CBP or not. At 72 h after CBP treatment, clinical indicators comprising the plasma levels of inflammatory cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8, as well as endotoxin and procalcitonin (PCT), and severity scores (APACHE II, multiple organ dysfunction syndrome and systemic inflammatory response syndrome), were analyzed in all patients. It was observed that while CBP slightly reduced the severity scores in all patients, it significantly improved those in patients with an APACHE II score of 20-29 (P<0.05). Similarly, the plasma levels of TNF-α, IL-6, IL-8, endotoxin and PCT were significantly lower in patients receiving CBP than in those without CBP when the APACHE II score was 20-29 (P<0.05). Furthermore, CBP treatment significantly decreased the fatality rate and length of stay at the intensive care unit (ICU) for critically ill patients with an APACHE II score of 20-29 (P<0.05). In conclusion, CBP significantly decreases the inflammatory response, shortens the length of stay at the ICU and improves the prognosis for critically ill patients with an APACHE II score of 20-29 points. This observation suggests that the APACHE II score is an important clinical indicator to determine the potential benefit of CBP therapy in critically ill patients.

The effect of continuous blood purification on P38MAPK signaling pathway in patients with multiple organ dysfunction syndrome.

ObjectiveThe aim of the study was to investigate the role of p38MAPK signaling pathway in patients with multiple organ dysfunction syndrome treated with continuous blood purification.MethodsBlood samples were obtained to analyze the protein level of inflammatory factors (IL‐1, IL‐8, IL‐10, and TNF‐α) and phosphorylated p38MAPK by utilizing ELISA assay and Western blotting, respectively. The relative mRNA level of iNOS was detected by using RT‐PCR. In vitro study was conducted in Caco‐2 cells, which were treated with serum from patients subjected to continuous blood purification. Serum‐induced inflammatory factors and phosphorylated p38MAPK were also analyzed in Caco‐2 cells.ResultsThe protein levels of IL‐1, IL‐8, IL‐10, and TNF‐α were significantly decreased in Caco‐2 cells treated with serum obtained from patients who were subjected to continuous blood purification therapy at the time course of 12 and 24 hours. A drastic decrease (P < 0.05) was observed in the level of IL‐8 and TNF‐α after continuous blood purification therapy in the patients treated with continuous blood purification therapy compared with control group.ConclusionOur study conducted in vivo and in vitro demonstrated that the continuous blood purification therapy could ameliorate the inflammatory response via activating the p38MAPK signaling pathway.

An investigation of coagulation/fibrinolysis biomarkers as predictors of circuit coagulation in continuous blood purification therapy

An investigation of coagulation/fibrinolysis biomarkers as predictors of circuit coagulation in continuous blood purification therapy

Safety and efficacy of heparin free anticoagulant continuous blood purification in treatment of sepsis patients in intensive care unit

Objective To investigate the safety and efficacy of heparin free anticoagulant continuous blood purification (CBP) in the treatment of intensive care unit (ICU) sepsis. Methods From October 2015 to October 2017, a total of 80 patients with sepsis treated in ICU with CBP in No.307 Hospital of PLA were included in this study using the random number table. Patients were divided into study group (n=40) and control group (n=40) according to the anticoagulant methods, of which the study group received heparin free anticoagulation, while the control group was given low molecular-weight heparin anticoagulation. The clinical outcome, renal function index and coagulation function were analyzed retrospectively. Paired t test was used to compare acute physiology and chronic health evaluation (APACHE) Ⅲ scores predicted mortality, urea nitrogen level, serum creatinine level, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) between two groups before and after treatment. χ2 test was used in analyzing survival rates in 28 d between two groups after treatment. The procedure of this study is in accordance with the requirements of the revised World Medical Association Declaration of Helsinki in 2013. Informed consent was obtained from all participants. Results ① Before treatment, APACHE Ⅲ scores predicted mortality was (89.6±14.8)% in study group, and was (90.1±13.8)%in control group, and there was no significant difference between two groups (P>0.05). After treatment, 28 d survival rate was 40.0% in study group, and was 47.5% in control group, and there was no significant difference between two groups (P>0.05). ② After treatment, urea nitrogen level was (12.8±1.7) mmol/L, blood creatinine level was (162.5±21.7) μmol/L in study group, and all were significantly lower than those before treatment, which were (22.7±3.8) mmol/L and (276.4±35.8) μmol/L, and the differences were statistically significant (t=8.827, 9.102; P=0.002, 0.000). After treatment, urea nitrogen level was (10.7±2.9) mmol/L, and serum creatinine level was (142.4±37.0) μmol/L in the control group, and all were lower than those before treatment, which were (26.1±3.1) mmol/L, (322.3±38.9)μmol/L respectively, and the differences were statistically significant (t=8.182, 8.992; P=0.006, 0.000). And levels of urea nitrogen and blood creatinine in the 2 groups after treatment were not statistically different (P>0.05). ③ After treatment, platelet count was (67.9±18.7) ×109/L, PT was (19.6±6.7) s, APTT was (28.7±6.1) s and TT was (3.0±1.1) s in study group, and all were significantly lower than those before treatment, which were (117.5±26.8) ×109/L, (28.6±7.9) s, (61.9±15.7) s and (24.2±6.9) s respectively, and the differences were statistically significant (t=7.233, 7.527, 6.232, 7.426; P=0.012, 0.011, 0.037, 0.007). Platelets count was (72.7±16.9) ×109/L, PT was (18.6±6.8) s, APTT was (31.9±7.1) s, and TT was (3.0±1.1) s in the control group, and all were significantly lower than these before the treatment, which were (109.7±25.7) ×109/L, (25.8±6.9) s, (56.7±14.9) s, (24.3±6.9) s respectively, and the differences were statistically significant (t=9.125, 6.728, 6.426, 7.529; P=0.000, 0.029, 0.031, 0.006). Platelet count, PT, APTT and TT levels in the 2 groups after treatment were not statistically different (P>0.05). Conclusions Heparin free and low molecular-weight heparin CBP therapy both can improve the clinical symptoms and renal function index of patients with sepsis in ICU. Heparin free anticoagulation CBP could not lead to abnormal coagulation function and increase platelet consumption, and could improve safety. Key words: Anticoagulant; Heparin, low-molecular-weight; Sepsis; Heparin free anticoagulant; Continuous blood purification

Validation of the recommended safety standards of extracorporeal circuits for continuous blood purification therapy

Validation of the recommended safety standards of extracorporeal circuits for continuous blood purification therapy

Changes in serum cardiac myosin light chain 1 levels in children with fulminant myocarditis during continuous blood purification.

To investigate the changes in serum cardiac myosin light chain 1 (CMLC-1) levels in children with fulminant myocarditis (FM) during continuous blood purification (CBP), as well as to analyze its correlation with other laboratory indexes. Twenty-four (24) children with FM who underwent CBP were enrolled. Before and during treatment (48 and 72 hours after treatment, or death), the optical density value of serum CMLC-1 was measured using enzyme-linked immunosorbent assay, and then the serum CMLC-1 concentration was calculated. The correlations between CMLC-1 OD value change and laboratory indexes including creatine kinase-MB (CK-MB), troponin, myohemoglobin and N-terminal pro-brain natriuretic peptide (NT-proBNP) were analyzed. The serum CMLC-1 concentration significantly increased in the children with FM and decreased obviously during CBP therapy. In the same period, the change of CMLC-1 concentration were positively correlated with creatine kinase-MB (r=0.528), troponin (r=0.726), myohemoglobin (r=0.702), and NT-proBNP levels (r=0.589). The serum CMLC-1 concentration increases significantly in children with FM, but CBP therapy can effectively control this increase.

Intestinal mucosal barrier dysfunction in SAP patients with MODS ameliorated by continuous blood purification.

Dysfunction of the intestinal mucosal barrier plays an important role in the pathophysiology of severe acute pancreatitis (SAP). Continuous blood purification (CBP) has been shown to improve the prognosis of SAP patients. In order to investigate the effect of CBP on intestinal mucosal barrier dysfunction in SAP patients with MODS, we conducted in vivo and in vitro experiments to explore the underlying mechanisms. The markers for the assessment of intestinal mucosal barrier function including serum diamine oxidase (DAO), endotoxin and intestinal epithelial monolayer permeability were detected during CBP therapy. The distribution and expression of cytoskeleton protein F-actin and tight junction proteins claudin-1 were observed. In addition, Rho kinase (ROCK) mRNA expression and serum tumor necrosis factor-alpha (TNF-α) levels during CBP were determined. SAP patients with MODS had increased levels of serum DAO, endotoxin and intestinal epithelial monolayer permeability when compared with normal controls. While the distribution of F-actin and claudin-1 was rearranged, and the expression of claudin-1 significantly decreased, but F-actin had no change. Meanwhile, ROCK mRNA expression and serum TNF-α level were increased. However, after CBP treatment, levels of serum DAO, endotoxin and intestinal epithelial monolayer permeability decreased. The F-actin and claudin-1 reorganization attenuated and the expression of claudin-1 increased. At the same time, ROCK mRNA expression and serum TNF-α level were decreased. CBP can effectively improve intestinal mucosal barrier dysfunction. The beneficial effect is associated with the improvement of cytoskeleton and tight junction proteins in stability by downregulation of ROCK mRNA expression through the removal of excess proinflammatory factors.

Clinical characteristics and influencing factors of nosocomial candidemia

To retrospectively explore the clinical features and risk factors of nosocomially acquired candidemia. Retrospective analyses were conducted for general information, underlying diseases, risk factors, clinical features and laboratory tests of blood culture Candida-positive cases at Beijing Hospital from January 1, 2006 to December 31, 2011. Comparisons were made with regards to the clinical features, prognostic factors, risk factors of candidemia pathogen distribution between dead and survival groups and Candida albicans vs non-Candida albicans groups. Statistical analysis was performed with SPSS 19.0. A total of 30 Candida albicans and 35 non-candida albicans cases were recruited. Their mean age was (76±14) years and total in-hospital fatality rate 58.5% (38/65). The acute physiology and chronic health evaluation II (APACHE II) score, ratio of APACHE II score>24 points, ratio of shock, primary diagnosis time (from onset to reporting time of positive outcome of blood culture) and ratio of serum albumin≤30 g/L of death group were (28.7±8.6) score, 55.3% (21/38), 71.1% (27/38), (138.7±50.4) h, 47.4% (18/38) respectively. And the values were significantly higher than those of survival group, i.e. (20.1±8.0) score, 29.6% (8/27), 44.4% (12/27), (127.2±50.2) h and 22.2% (6/27) respectively. Multivariate Logistic regression analysis showed that shock (OR=4.821, P=0.030), primary diagnosis time (OR=1.594, P=0.027) and APACHE II score (OR=1.096, P=0.032) were independent risk factors for death. However continuous blood purification therapy was an independent protective factor (OR=0.014, P=0.004). And diabetes was an independent risk factors for non-Candida albicans infection (OR=4.426, P=0.016). Advanced age, more underlying diseases, severe clinical conditions and high fatality rate are the major clinical characteristics of candidemia. Shock, APACHE II score and primary diagnosis time are independent risk factors for death. Continuous blood purification therapy is a protective factor. And diabetes is an independent risk factor for non-Candida albicans candidemia.