Efficacy and significance of various scores for pneumonia severity in the management of patients with community-acquired pneumonia in China

Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in the high-risk CAP sub-group.The 30-day mortality of patients who underwent ICU treatment on admission was also higher than for non-ICU treatment,but much lower than for those patients who took ICU treatment subsequent to the failure of non-ICU treatment.Conclusions Each severity score system,CURB-65,sepsis severity score and especially PSI,was capable of effectively predicting CAP mortality.Delayed ICU admission was related to higher mortality rates in severe CAP patients.

Blockade of the OX40/OX40L pathway and induction of PD-L1 synergistically protects mouse islet allografts from rejection

Background OX40/OX40 ligand （OX40/OX40L） and programmed death-1/programmed death ligand-1 （PD-1/PD-L1） co- stimulator/signals play important roles in T cell-induced immune responses. The aim of this study was to investigate the roles of OX40/OX40L and PD-1/PD-L1 costimulatory pathways in mouse islet allograft rejection. Methods Lentiviral vectors containing OX40L siRNA sequences and an adenovirus vector containing the PD-L1 gene were constructed. The streptozotocin-induced model of diabetes was established in C57BL/6 （H-2b） mice. Diabetic C57BL/6 mice were randomly allocated into five groups： group 1, untreated control; group 2, Ad-EGFP treatment; group 3, Ad-PD-L1 treatment; group 4, OX40L-RNAi-LV treatment; group 5, OX40L-RNAi-LV combined with Ad-PD-L1 treatment. Lentiviral vector and the adenovirus vector were injected, singly or combined, into the caudal vein one day before islet transplantation. The islets of DBA/2 （H-2d） mice were transplanted into the renal subcapsular space of the diabetic recipients. Recipient blood glucose and the survival time of the allografts were monitored. Antigen-specific mixed lymphocyte reaction was also evaluated.

The effects of ω-3 fish oil lipid emulsion on inflammation-immune response and organ function in patients with severe acute pancreatitis

Objective To investigate the effects of ω-3 fish oil lipid emulsion via vein on the inflammatory response,immune and organ function in patients with severe acute pancreatitis. Methods A total of 53 patients with severe acute pancreatitis were randomized into

Extracorporeal membrane oxygenation as rescue therapy for H7N9 influenza- associated acute respiratory distress syndrome

To the editor： Infection with the novel H7N9 influenza virus broke out in the mainland and Taiwan Region of China in 2013.

Protective effect of electroacupuncturing Zusanlli(ST36) and umbilical compression with Dachengqi decoction on intestinal barrier function of septic patients

Objective To investigate the effect of the combined therapy of electroacupuncturing Zusanli(ST36)and umbilical compression with Dachengqi Decoction on septic patients with intestinal dysfunction in reducing inflammation index,protecting intestinal mucosal barrier function and improving the prognosis of disease.Methods Totally 70 septic patients with intestinal dysfunction(Yangming visceral syndrome)were randomly assigned to treatment group and control group,35 in each group.Patients in the control group were administered with routine treatment of Western medicine,and as for the treatment group,electroacupuncturing Zusanli(ST36)combined with umbilical compression with Dachengqi Decoction were applied based on routine treatment.All treatment course lasted for 5 days.Before treatment and at 1st,3rd and 7th day of treatment,the levels of procalcitonin(PCT),TNF-α,intestinal fatty acid binding protein(IFABP),citrulline,D-lactic acid and intra-abdominal pressure(IAP)were observed.The duration of mechanical ventilation,stay in ICU and the 28th day survival were recorded.The correlation with the level of inflammatory factors and the serum markers of intestinal function was analyzed.Results Compared with those before treatment,although the level of TNF-α was not significantly decreased in the control group at 1st day of treatment,the levels of PCT,TNF-α,IFABP,D-lactic acid and IAP decreased at all time points after treatment in the two groups,and the level of citrulline increased(P<0.05).Compared with those of the 1st day after treatment,the levels of PCT,TNF-α,IFABP,D-lactic acid and IAP decreased in the two groups at 3rd and 7th day of treatment,and the levels of citrulline were increased at the 3rd and 7th day after treatment,the levels of PCT,TNF-α,IFABP,D-lactic acid,citrulline and IAP were better at the 7th day than the 3rd day in the two groups(P<0.05).Compared with the control group,the levels of PCT,TNF-,IFABP,D-lactic acid and IAP in the treatment group all decreased and the level of citrulline increased at time points after treatment(P<0.05).There were no statistical differences in duration of mechanical ventilation,stay in ICU and the 28th day mortality between the two groups(P>0.05).The plasma level of IFABP,citrulline,D-lactic acid and IAP were pairwise correlated(P<0.01),all of which had significant correlation with the level of serum PCT and TNF-α(P<0.01),and there was no significant correlation with duration of mechanical ventilation and stay in ICU.Conclusion Electroacupuncturing Zusanli(ST36)combined with umbilical compression with Dachengqi Decoction could relieve the inflammatory response and protect their intestinal barrier functions in septic patients with intestinal dysfunction.

A retrospective clinical study of sixty-three cases with persistent inflammation immunosuppression and catabolism syndrome

Objective To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome(PICS)in ICU.Methods A total of 126 patients admitted to ICU(ICU stay of more than 10 days,age≥18 years)between January 2014 and December 2014 were retrospectively studied.Data were collected from electronic medical records including demographics,underlying disease。

Combining relative alpha variability and electroencephalogram reactivity to predict the prognosis of hypoxic-ischemic encephalopathy in adult patients

Objective To evaluate the role of combining relative alpha variability and electroencephalogram(EEG)reactivity to predict the prognosis of hypoxic-ischemic encephalopathy(HIE)in adult patients.Methods A total of 28 adult patients with HIE admitted to general intensive care unit at Xiangya Hospital in Central South University were enrolled in this observational study from January 2016 to April 2017.These patients with body temperature over 35℃after 72-hour admission could be continuously monitored at least 12 hours byEEG.At the same time,each patient was assessed for EEG reactivity.Then we analyzed the correlation between EEG reactivity,relative alpha variability and clinical prognosis.Results EEG reactivity was elicited in 15/28 patients,among whom 12 patients had a good outcome.While in the other 13 patients,EEG reactivity was not elicited,among whom only 3 patients had a good outcome.As to the results of relative alpha variability,11/13 patients with degree 3-4 were of good prognosis;while only 3/15 patients with degree 1-2 were of good prognosis.Glasgow coma scale(GCS),EEG reactivity,and relative alpha variability were correlated with clinical outcome(χ^2=5.073,9.073,-3.626,respectively,all P<0.05).The sensitivity of GCS,EEG reactivity,and relative alpha variability to predict the poor prognosis were 69.2%,76.9%,84.6%,respectively.The specificity were 73.3%,80.0%,73.3%,respectively.The consistency rates were 71.4%,78.6%,78.6%,respectively.The positive predictive values were 69.2%,76.9%,73.3%,respectively.The negative predictive values were 73.3%,80.0%,84.6%,respectively.More importantly,the accuracy of the relative alpha variability combined with EEG reactivity for the prediction of poor prognosis was much higher with the positive predictive value of 90.0%,the specificity of 93.3%,the sensitivity of 69.2%,the consistency rate of 82.1%,and the negative predictive values of 77.8%.Conclusion The combination of relative alpha variability and EEG reactivity is reliable to predict clinical outcome of patients with HIE.