BACKGROUND:An increase in high-density lipoprotein(HDL)is well associated with a decreased cardiovascular risk,especially atherosclerosis.Recent studies suggest that lower levels of HDL may also be associated with an ...BACKGROUND:An increase in high-density lipoprotein(HDL)is well associated with a decreased cardiovascular risk,especially atherosclerosis.Recent studies suggest that lower levels of HDL may also be associated with an increased risk of sepsis and an increased rate of mortality in septic patients.However,this conclusion remains controversial.METHODS:MEDLINE,EMBASE,and CENTRAL databases were searched from inception to September 30,2019.All studies were conducted to evaluate the correlation of lipoprotein levels and the risk and outcomes of sepsis in adult patients.The primary outcomes were the risk and mortality of sepsis.RESULTS:Seven studies comprising 791 patients were included.Lower levels of HDL had no marked relevance with the risk of sepsis(odds radio[OR]for each 1 mg/dL increase,0.94;95%CI 0.86–1.02;P=0.078),whereas lower HDL levels were related to an increased mortality rate in septic patients(OR for below about median HDL levels,2.00;95%CI 1.23–3.24;P=0.005).CONCLUSION:This meta-analysis did not reveal a signifi cant association between lower HDL levels and an increase in the risk of sepsis,whereas it showed that lower HDL levels are associated with a higher mortality rate in septic adult patients.These findings suggest that HDL may be considered as a promising factor for the prevention and treatment of sepsis in the future.展开更多
BACKGROUND:There are confl icting results regarding whether corticosteroids have better effi cacy than placebo in acute respiratory distress syndrome(ARDS)patients.Therefore,we aim to further evaluate the effi cacy an...BACKGROUND:There are confl icting results regarding whether corticosteroids have better effi cacy than placebo in acute respiratory distress syndrome(ARDS)patients.Therefore,we aim to further evaluate the effi cacy and safety of corticosteroids in adult ARDS patients.METHODS:The databases,including Medline,EMBASE,and Cochrane Central Register of Controlled Trials(CENTRAL)in the Cochrane Library,were searched from their inception to May 2,2020.Randomized controlled trials(RCTs)and observational cohort studies were selected to assess the use of corticosteroids in adult ARDS patients.The quality of the results was judged by the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)methodology.The inverse-variance method with random or fixed effects modeling was used to compute pooled odds ratio(OR),standardized mean diff erence(SMD),and their 95%confi dence interval(CI).RESULTS:Eight eligible RCTs and six cohort studies were included.The use of corticosteroids was associated with reduced mortality(OR 0.57,95%CI 0.43-0.76,I2=35.1%,P=0.148)in ARDS patients,and the result was confirmed in the included cohort studies(OR 0.51,95%CI 0.27-0.95,I2=66.7%,P=0.010).The subgroup analysis stratified by the initiation time and duration of corticosteroid use showed that early ARDS and prolonged corticosteroid use had signifi cant survival benefits in the RCTs.The low-dose corticosteroid use was also associated with significantly more ventilator-free days and a reduced rate of new infections in ARDS patients.CONCLUSIONS:The low-dose corticosteroid therapy may be safe and reduce mortality,especially in patients with prolonged treatment and early ARDS.展开更多
Objective: To investigate the effect of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia. Methods: From January 2017 to...Objective: To investigate the effect of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia. Methods: From January 2017 to June 2018, 82 patients with severe pneumonia were randomly divided into observation group and control group (all 41 cases). Patients in the control group received conventional anti-infective treatment, and the observation group was treated with fiberoptic bronchoscopy combined with mucosolvan on the basis of the control group. Respiratory function, inflammatory response and stress status were compared between the two groups. Results: Before treatment, there was no significant difference in Cdyn, WOB and PaO2/FiO2 between the two groups. After treatment, Cdyn and PaO2/FiO2 in the observation group were (36.28±4.28) mL/cmH2O and (376.23±24.21) mmHg respectively, while those in the control group were (26.89±3.76) mL/cmH2O and (322.12±23.16) mmHg, respectively. The levels of Cdyn and PaO2/FiO2 in the observation group were higher than those in the control group. After treatment, the WOB in the observation group was (7.81±0.72) J/L, and the WOB in the control group was (8.33±1.23) J/L. WOB of both groups was lower than that before treatment, and in observation group WOB was lower than that of control group, the difference was statistically significant. In CRP, PCT and sTREM-1 levels, there was no significant difference between the two groups before treatment. After treatment, CRP, PCT and sTREM-1 in the observation group were (39.10±6.03) mg/L, (14.57±2.05) ng/L, (15.02±3.02) ng/L respectively, while those in the control group were (59.72±8.81) mg/L, (20.03±3.09) ng/L, (34.21±5.28) ng/L, respectively. CRP, PCT, sTREM-1 in both groups were lower than those before treatment, and CRP, PCT, sTREM-1 in observation group were lower than those in control group. Before treatment, there was no significant difference with Cor, Ang-I and Ang-II in two groups. After treatment, the levels of Cor, Ang-I and Ang-II in the observation group were (114.76±15.85) ng/mL, (6.72±0.64) ng/mL, (27.28±3.43) ng/mL respectively, while those in the control group were (193.15±22.64) ng/mL, (12.10±1.68) ng/mL, (43.02±5.57) ng/mL, respectively. In the observation group, the levels of Cor, Ang-I and Ang-II were lower than those in the control group. Conclusion: Mucosolvan combined with fiberoptic bronchoscopy can effectively improve the respiratory function of patients with severe pneumonia, and reduce inflammation and stress state of the body.展开更多
The polymyxins are important antimicrobial agents against antibiotic-resistant gram-negative bacilli.In 2020,the Clinical and Laboratory Standards Institute modified the clinical breakpoints for polymyxin susceptibili...The polymyxins are important antimicrobial agents against antibiotic-resistant gram-negative bacilli.In 2020,the Clinical and Laboratory Standards Institute modified the clinical breakpoints for polymyxin susceptibility test by eliminating the"susceptible"interpretive category,only reporting intermediate(≤2 mg/L)and resistant(≥4 mg/L).However,the European Committee on Antimicrobial Susceptibility Testing recommended the use of clinical breakpoints of W2 mg/L as susceptible and>2 mg/L as resistant.The first-line laboratorians and clinicians in China have been perplexed by the inconsistence of international polymyxin clinical breakpoints and discouraged by the difficulty of conducting polymyxin susceptibility testing.Therefore,it is urgently needed to make it clear for the laboratorians in China to know how to accurately carry out polymyxin susceptibility testing and standardize the interpretation of susceptibility testing results.To this end,the experts from relevant fields were convened to formulate this consensus statement on the testing and clinical interpretation of polymyxin susceptibility.Relevant recommendations are proposed accordingly for laboratorians and clinicians to streamline their daily work.展开更多
Background:Sepsis is a serious disease caused by infection.Aminophylline has anti-asthma and anti-inflammatory effects.We aimed to explore the safety and effect of aminophylline in sepsis.Methods:We conducted a clinic...Background:Sepsis is a serious disease caused by infection.Aminophylline has anti-asthma and anti-inflammatory effects.We aimed to explore the safety and effect of aminophylline in sepsis.Methods:We conducted a clinical randomized controlled trial involving 100 patients diagnosed with sepsis within 48 h after intensive care unit(ICU)admission in two sites.All patients were randomized in a 1:1 ratio to receive standard therapy with or without aminophylline.The primary clinical outcome was all-cause mortality at 28 days.Results:From September 27,2018 to February 12,2020,we screened 277 septic patients and eventually enrolled 100 patients,with 50 assigned to the aminophylline group and 50 to the usual-care group.At 28 days,7 of 50 patients(14.0%)in the aminophylline group had died,compared with 16 of 50(32.0%)in the usual-care group(P=0.032).Cox regression showed that the aminophylline group had a lower hazard of death(hazard ratio=0.312,95%confidence interval:0.129–0.753).Compared with the usual-care group,patients in the aminophylline group had a longer survival time(P=0.039 by the log-rank test).The effects of aminophylline on vasopressor dose,oxygenation index,and sequential organ failure assessment score were timedependent with treatment.There were no significant differences in total hospitalization days,ICU hospitalization days,and rates of serious adverse events(all P>0.05).No adverse events were observed in the trial.Conclusions:Aminophylline as an adjunct therapy could significantly reduce the risk of death and prolong the survival time of patients with sepsis.Trial registration:ChiCTR.org.cn,ChiCTR1800019173.展开更多
Vitamin C-based cluster therapy,which involves the combined application of hydrocortisone,vitamin C,and thiamine(HAT),is a recently proposed new treatment option for sepsis on top of conventional treatment.This therap...Vitamin C-based cluster therapy,which involves the combined application of hydrocortisone,vitamin C,and thiamine(HAT),is a recently proposed new treatment option for sepsis on top of conventional treatment.This therapy has a strong theoretical basis,but its clinical efficacy remains inconclusive.This review summarizes the rationale for HAT therapy for sepsis and describes the evaluation of its efficacy in clinical observational studies and randomized controlled trials,with the aim of providing a reference for the future clinical practice application of HAT therapy in sepsis.展开更多
文摘BACKGROUND:An increase in high-density lipoprotein(HDL)is well associated with a decreased cardiovascular risk,especially atherosclerosis.Recent studies suggest that lower levels of HDL may also be associated with an increased risk of sepsis and an increased rate of mortality in septic patients.However,this conclusion remains controversial.METHODS:MEDLINE,EMBASE,and CENTRAL databases were searched from inception to September 30,2019.All studies were conducted to evaluate the correlation of lipoprotein levels and the risk and outcomes of sepsis in adult patients.The primary outcomes were the risk and mortality of sepsis.RESULTS:Seven studies comprising 791 patients were included.Lower levels of HDL had no marked relevance with the risk of sepsis(odds radio[OR]for each 1 mg/dL increase,0.94;95%CI 0.86–1.02;P=0.078),whereas lower HDL levels were related to an increased mortality rate in septic patients(OR for below about median HDL levels,2.00;95%CI 1.23–3.24;P=0.005).CONCLUSION:This meta-analysis did not reveal a signifi cant association between lower HDL levels and an increase in the risk of sepsis,whereas it showed that lower HDL levels are associated with a higher mortality rate in septic adult patients.These findings suggest that HDL may be considered as a promising factor for the prevention and treatment of sepsis in the future.
基金the United Fund of National Natural Science Foundation of China(U2004110)the Leading Talent Fund in Science and Technology Innovation in Henan Province(194200510017)+3 种基金the Science and Technology People-Benefit Project of Zhengzhou(2019KJHM0001)the Special Fund for Young and Middle-Aged Medical Research from China International Medical Foundation(Z-2018-35)the Integrated Thinking Research Fund from China International Medical Foundation(Z-2016-23-2001)the Fund for Mechanism Study on Gabexate Mesilate in Treating Sepsis and Septic Shock(2019-hx-45).
文摘BACKGROUND:There are confl icting results regarding whether corticosteroids have better effi cacy than placebo in acute respiratory distress syndrome(ARDS)patients.Therefore,we aim to further evaluate the effi cacy and safety of corticosteroids in adult ARDS patients.METHODS:The databases,including Medline,EMBASE,and Cochrane Central Register of Controlled Trials(CENTRAL)in the Cochrane Library,were searched from their inception to May 2,2020.Randomized controlled trials(RCTs)and observational cohort studies were selected to assess the use of corticosteroids in adult ARDS patients.The quality of the results was judged by the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)methodology.The inverse-variance method with random or fixed effects modeling was used to compute pooled odds ratio(OR),standardized mean diff erence(SMD),and their 95%confi dence interval(CI).RESULTS:Eight eligible RCTs and six cohort studies were included.The use of corticosteroids was associated with reduced mortality(OR 0.57,95%CI 0.43-0.76,I2=35.1%,P=0.148)in ARDS patients,and the result was confirmed in the included cohort studies(OR 0.51,95%CI 0.27-0.95,I2=66.7%,P=0.010).The subgroup analysis stratified by the initiation time and duration of corticosteroid use showed that early ARDS and prolonged corticosteroid use had signifi cant survival benefits in the RCTs.The low-dose corticosteroid use was also associated with significantly more ventilator-free days and a reduced rate of new infections in ARDS patients.CONCLUSIONS:The low-dose corticosteroid therapy may be safe and reduce mortality,especially in patients with prolonged treatment and early ARDS.
文摘Objective: To investigate the effect of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia. Methods: From January 2017 to June 2018, 82 patients with severe pneumonia were randomly divided into observation group and control group (all 41 cases). Patients in the control group received conventional anti-infective treatment, and the observation group was treated with fiberoptic bronchoscopy combined with mucosolvan on the basis of the control group. Respiratory function, inflammatory response and stress status were compared between the two groups. Results: Before treatment, there was no significant difference in Cdyn, WOB and PaO2/FiO2 between the two groups. After treatment, Cdyn and PaO2/FiO2 in the observation group were (36.28±4.28) mL/cmH2O and (376.23±24.21) mmHg respectively, while those in the control group were (26.89±3.76) mL/cmH2O and (322.12±23.16) mmHg, respectively. The levels of Cdyn and PaO2/FiO2 in the observation group were higher than those in the control group. After treatment, the WOB in the observation group was (7.81±0.72) J/L, and the WOB in the control group was (8.33±1.23) J/L. WOB of both groups was lower than that before treatment, and in observation group WOB was lower than that of control group, the difference was statistically significant. In CRP, PCT and sTREM-1 levels, there was no significant difference between the two groups before treatment. After treatment, CRP, PCT and sTREM-1 in the observation group were (39.10±6.03) mg/L, (14.57±2.05) ng/L, (15.02±3.02) ng/L respectively, while those in the control group were (59.72±8.81) mg/L, (20.03±3.09) ng/L, (34.21±5.28) ng/L, respectively. CRP, PCT, sTREM-1 in both groups were lower than those before treatment, and CRP, PCT, sTREM-1 in observation group were lower than those in control group. Before treatment, there was no significant difference with Cor, Ang-I and Ang-II in two groups. After treatment, the levels of Cor, Ang-I and Ang-II in the observation group were (114.76±15.85) ng/mL, (6.72±0.64) ng/mL, (27.28±3.43) ng/mL respectively, while those in the control group were (193.15±22.64) ng/mL, (12.10±1.68) ng/mL, (43.02±5.57) ng/mL, respectively. In the observation group, the levels of Cor, Ang-I and Ang-II were lower than those in the control group. Conclusion: Mucosolvan combined with fiberoptic bronchoscopy can effectively improve the respiratory function of patients with severe pneumonia, and reduce inflammation and stress state of the body.
基金the National Key Research&Development Program(2018YFC1200100,2018YFC1200105)the Major Research and Development Project of Innovative Drugs,Ministry of Science and Technology of China(2017ZX09304005).
文摘The polymyxins are important antimicrobial agents against antibiotic-resistant gram-negative bacilli.In 2020,the Clinical and Laboratory Standards Institute modified the clinical breakpoints for polymyxin susceptibility test by eliminating the"susceptible"interpretive category,only reporting intermediate(≤2 mg/L)and resistant(≥4 mg/L).However,the European Committee on Antimicrobial Susceptibility Testing recommended the use of clinical breakpoints of W2 mg/L as susceptible and>2 mg/L as resistant.The first-line laboratorians and clinicians in China have been perplexed by the inconsistence of international polymyxin clinical breakpoints and discouraged by the difficulty of conducting polymyxin susceptibility testing.Therefore,it is urgently needed to make it clear for the laboratorians in China to know how to accurately carry out polymyxin susceptibility testing and standardize the interpretation of susceptibility testing results.To this end,the experts from relevant fields were convened to formulate this consensus statement on the testing and clinical interpretation of polymyxin susceptibility.Relevant recommendations are proposed accordingly for laboratorians and clinicians to streamline their daily work.
基金the United Fund of National Natural Science Foundation of China(No.U2004110)the National Natural Science Foundation of China(No.82172129)the Medical Science and Technology Tackling Plan Provincial and Ministerial Major Projects of Henan Province(No.SBGJ202101015).
文摘Background:Sepsis is a serious disease caused by infection.Aminophylline has anti-asthma and anti-inflammatory effects.We aimed to explore the safety and effect of aminophylline in sepsis.Methods:We conducted a clinical randomized controlled trial involving 100 patients diagnosed with sepsis within 48 h after intensive care unit(ICU)admission in two sites.All patients were randomized in a 1:1 ratio to receive standard therapy with or without aminophylline.The primary clinical outcome was all-cause mortality at 28 days.Results:From September 27,2018 to February 12,2020,we screened 277 septic patients and eventually enrolled 100 patients,with 50 assigned to the aminophylline group and 50 to the usual-care group.At 28 days,7 of 50 patients(14.0%)in the aminophylline group had died,compared with 16 of 50(32.0%)in the usual-care group(P=0.032).Cox regression showed that the aminophylline group had a lower hazard of death(hazard ratio=0.312,95%confidence interval:0.129–0.753).Compared with the usual-care group,patients in the aminophylline group had a longer survival time(P=0.039 by the log-rank test).The effects of aminophylline on vasopressor dose,oxygenation index,and sequential organ failure assessment score were timedependent with treatment.There were no significant differences in total hospitalization days,ICU hospitalization days,and rates of serious adverse events(all P>0.05).No adverse events were observed in the trial.Conclusions:Aminophylline as an adjunct therapy could significantly reduce the risk of death and prolong the survival time of patients with sepsis.Trial registration:ChiCTR.org.cn,ChiCTR1800019173.
基金supported by the United Fund of the National Natural Science Foundation of China (grant number:U2004110)the National Natural Science Foundation of China (grant number:82172129)+3 种基金the Central Government Guides Local Science and Technology Development funds (grant number:Z20221343037)the Medical Science and Technology Tackling Plan Provincial and Ministerial Major Projects of Henan Province (grant number:SBGJ202101015)the special fund for young and middle-aged medical research of China International Medical Exchange Foundation (grant number:Z-2018-35)the integrated thinking research fund of China International Medical Exchange Foundation (grant number:Z-2016-23-2001).
文摘Vitamin C-based cluster therapy,which involves the combined application of hydrocortisone,vitamin C,and thiamine(HAT),is a recently proposed new treatment option for sepsis on top of conventional treatment.This therapy has a strong theoretical basis,but its clinical efficacy remains inconclusive.This review summarizes the rationale for HAT therapy for sepsis and describes the evaluation of its efficacy in clinical observational studies and randomized controlled trials,with the aim of providing a reference for the future clinical practice application of HAT therapy in sepsis.
