BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsi...BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsis and 20 age-matched healthy controls were enrolled in the study.Patients with sepsis were further subdivided into a sepsis group and a septic shock group.nCD64 expression,serum procalcitonin(PCT)level,C-reactive protein(CRP)level,and white blood cell(WBC)count were obtained for each patient,and Sequential Organ Failure Assessment(SOFA)scores were calculated.RESULTS:nCD64 expression was higher in the sepsis group with confirmed infection than in the control group.The receiver operating characteristic(ROC)curve of nCD64 was higher than those of SOFA score,PCT,CRP and WBC for diagnosing infection.The area under the curve(AUC)of nCD64 combined with SOFA score was the highest for all parameters.The AUC of nCD64 for predicting 28-day mortality in sepsis was signifi cantly higher than those of PCT,CRP,and WBC,but slightly lower than that of SOFA score.The AUC of nCD64 or PCT combined with SOFA score was signifi cantly higher than that of any single parameter for predicting 28-day mortality.CONCLUSION:nCD64 expression and SOFA score are valuable parameters for early diagnosis of infection and prognostic evaluation of sepsis patients.展开更多
In this work,the impact of internal heat integration upon process dynamics and controllability by superposing reactive section onto stripping section,relocating feed locations,and redistributing catalyst within the re...In this work,the impact of internal heat integration upon process dynamics and controllability by superposing reactive section onto stripping section,relocating feed locations,and redistributing catalyst within the reactive section is explored based on a hypothetical ideal reactive distillation system containing an exothermic reaction:A + BC + D.Steady state operation analysis and closed-loop controllability evaluation are carried out by comparing the process designs with and without the consideration of internal heat integration.For superposing reactive section onto stripping section,favorable effect is aroused due to its low sensitivities to the changes in operating condition.For ascending the lower feed stage,somewhat detrimental effect occurs because of the accompanied adverse internal heat integration and strong sensitivity to the changes in operating condition.For descending the upper feed stage,serious detrimental effect happens because of the introduced adverse internal heat integration and strong sensitivity to the changes in operating condition.For redistributing catalyst in the reactive section,fairly small negative influence is aroused by the sensitivity to the changes in operating condition.When reinforcing internal heat integration with a combinatorial use of these three strategies,the decent of the upper feed stage should be avoided in process development.Although the conclusions are derived based on the hypothetical ideal reactive distillation column studied,they are considered to be of general significance to the design and operation of other reactive distillation columns.展开更多
Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with ou...Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with out-of-hospital cardiac arrest(OHCA)after return of spontaneous circulation(ROSC)by observing the changes in circulating CD14^(+)monocytes and the expression of human leukocyte antigen D–related(HLA-DR)and programmed cell death ligand 1(PD-L1)in CD14^(+)monocytes.Methods:Adult patients admitted to the emergency department of Beijing Chao-Yang Hospital after OHCA between January 2017 and March 2018 were included in this study.Thirty control subjects,10 patients with OHCA,and 37 patients with OHCA who received 72 hours of TTM therapy were enrolled.Peripheral blood samples of patients in the OHCA and TTM groups were collected on Days 1 and 3(D1 and D3)after ROSC and evaluated for HLA-DR and PD-L1 expression on CD14^(+)monocytes using flow cytometry.Results:Compared with control subjects,the percentage of circulating CD14^(+)monocytes,HLA-DR+/CD14^(+)monocyte ratios,and mean fluorescence intensity were significantly decreased in patients with OHCA.After ROSC,HLA-DR expression in CD14^(+)monocytes in the TTM group was lower than that in patients with OHCA.However,there were no significant differences in the percentage of PD-L1+/CD14^(+)monocytes or the mean fluorescence intensity between patients with OHCA and healthy volunteers.Conclusion:After ROSC,circulating CD14^(+)monocytes and HLA-DR+/CD14^(+)monocyte ratios decreased significantly in patients with OHCA.Human leukocyte antigen D–related expression in CD14^(+)monocytes was lower in patients treated with TTM.展开更多
Background:Cardiac arrest(CA)is a terminal event that results in a range of pathophysiological changes in the body,most notably,systemic ischemia-reperfusion injury.The hypothalamic-pituitary-adrenal(HPA)axis is an im...Background:Cardiac arrest(CA)is a terminal event that results in a range of pathophysiological changes in the body,most notably,systemic ischemia-reperfusion injury.The hypothalamic-pituitary-adrenal(HPA)axis is an important neuroendocrine system that modulates adrenocortical hormone release.This study was designed to investigate the changes in HPA-related hormone levels after successful cardiopulmonary resuscitation(CPR)and to explore possible etiologies to provide a basis for relevant clinical research.Methods:We collected the clinical data of 96 patients with CA admitted to the Emergency Department of Beijing Chaoyang Hospital,Capital Medical University,between January 2016 and May 2017.Serum samples were collected 6,24,and 72 hours after restoring spontaneous circulation(ROSC).The data were compared with those of the healthy control group(n=50).An enzyme-linked immunosorbent assay(ELISA)was performed to measure copeptin,adrenocorticotropic hormone(ACTH),corticotropin-releasing hormone(CRH),and total cortisol.Demographic data were collected for both groups.For the CPR group,clinical data and the end-of-study cerebral performance category(CPC)were analyzed.Patients were followed up through day 28.Death or survival after day 28 was used as the study endpoint.Simple values were expressed as medians and quartiles or ratios(%)for statistical analysis.Continuous variables are expressed as mean±standard deviation.Categorical variables were expressed as frequencies and percentages.The mean values of normally distributed measurement data were analyzed using 1-way analysis of variance(ANOVA)for among-group comparisons and the least significant difference(LSD)test for between-group comparisons.SPSS v17(SPSS,Chicago,IL,USA)was used for statistical analysis,and P<0.05 was considered statistically significant.Results:No significant between-group differences were observed in terms of age or sex.The 28-day mortality rate in the CPR group was 71%.ACTH and CRH levels were significantly lower in the CPR group than in the healthy control group(P<0.001).Copeptin and cortisol levels 6 hours after ROSC were significantly higher in the CPR group than in the healthy control group(P<0.001).No significant changes in any indicator were observed over time(6,24,and 72 hours after ROSC)(P>0.05).The CPC score was 1–2(good cerebral performance group)in 13 patients,3–4(poor cerebral performance group)in 17 patients,and 5(brain death or clinical death)in 66 patients.Patients with significantly declining ACTH and CRH levels had higher CPC scores(P<0.05);however,no significant differences were found in other indicators(P>0.05).Conclusion:After post-CA ROSC,ischemia-reperfusion injury may cause brain damage and HPA axis damage and dysfunction,the severity of which is associated with CPC score.展开更多
Objective:Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest.The evidence for the use of adrenaline in out-of-hospital cardiac arrest (OHCA) and in-h...Objective:Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest.The evidence for the use of adrenaline in out-of-hospital cardiac arrest (OHCA) and in-hospital resuscitation is inconclusive.We conducted a systematic review on the clinical efficacy of adrenaline in adult OHCA patients to evaluate whether epinephrine provides any overall benefit for patients.Data Sources:The EMBASE and PubMed databases were searched with the key words &quot;epinephrine,&quot; &quot;cardiac arrest,&quot; and variations of these terms.Study Selection:Data from clinical randomized trials,meta-analyses,guidelines,and recent reviews were selected for review.Results:Sudden cardiac arrest causes 544,000 deaths in China each year,with survival occurring in 〈1% of cases (compared with 12% in the United States).The American Heart Association recommends the use of epinephrine in patients with cardiac arrest,as part of advanced cardiac life support.There is a clear evidence of an association between epinephrine and increased return of spontaneous circulation (ROSC).However,there are conflicting results regarding long-term survival and functional recovery,particularly neurological outcome,after CPR.There is currently insufficient evidence to support or reject epinephrine administration during resuscitation.We believe that epinephrine may have a role in resuscitation,as administration of epinephrine during CPR increases the probability of restoring cardiac activity with pulses,which is an essential intermediate step toward long-term survival.Conclusions:The administration of adrenaline was associated with improved short-term survival (ROSC).However,it appears that the use of adrenaline is associated with no benefit on survival to hospital discharge or survival with favorable neurological outcome after OHCA,and it may have a harmful effect.Larger placebo-controlled,double-blind,randomized control trials are required to definitively establish the effect of epinephrine.展开更多
Background: Immune disorder is an important feature of patients with out-of-hospital cardiac arrest (OHCA) after the return of spontaneous circulation (ROSC). We investigated the expression of circulatory T helpe...Background: Immune disorder is an important feature of patients with out-of-hospital cardiac arrest (OHCA) after the return of spontaneous circulation (ROSC). We investigated the expression of circulatory T helper type (Th)1, Th2, and Th 17 cells to explore the early immune alteration in OHCA patients after ROSC. Methods: During July-September 2016 and March-September 2017, 65 consecutive OHCA patients with ROSC 〉 12 h and 30 healthy individuals were enrolled in this study. Clinical and 28-day survival data were collected. Peripheral blood samples were analyzed to evaluate the expression of Th1/Th2/Th 17 cells by flow cytometry from OHCA patients after ROSC on days l and 3 and from healthy individuals. Results: Compared with healthy individuals, T lymphocyte counts and Thl cell counts decreased on days 1 and 3 after ROSC (1464 [1198, 2152] vs. 779 [481, 1140] vs. 581 [324, 1118/μl,χ^2= 30.342, P 〈 0.001; 154 [90, 246] vs. 39 [19, 78] vs. 24 [12, 53]μl, χ^2 = 42.880, P〈 0.001), and Th2 and Th17 cell counts decreased on day 3 (17.0 [10.8, 24.0] vs. 9.0 [3.0, 15.5]μl, Z= -3.228, P= 0.001; 4.7 [2.7, 9.1] vs. 2.7 [1.0, 6.5]μl, Z = -2.294, P = 0.022). No change in CD4+/CD3+ lymphocyte ratio was seen on day 1 or day 3 (57.9 [49.4, 63.0] vs. 55.4 [46.5, 66.5] vs. 55.4 [50.2, 67.0]%, χ^2 = 0.171, P = 0.918). Th1/CD4+ lymphocyte ratio decreased on days 1 and 3 (19.0 [14.0, 24.9] vs. 9.3 [4.6, 13.9] vs. 9.5 [4.9, 13.6]%, χ^2= 25.754, P 〈 0.001), and Th2/CD4+ lymphocyte ratio increased on day 1 and decreased on day 3 (1.9 [1.2, 2.5] vs. 2.5 [1.6, 4.0] vs. 1.9 [1.6, 3.81%,χ^2= 6.913, P = 0.032). Thl/Th2 cell ratio also decreased on both clays (9.4 [7.3, 13.5] vs. 3.1 [1.9, 5.6] vs. 4.2 [2.8, 5.9], χ^2 = 44.262, P 〈 0.001 ). Despite an upward trend in the median of Th 17/CD4+ lymphocyte ratio in OHCA patients, there was no significant difference compared with healthy individuals (0.9 [0.4, 1.2] vs. 0.7 [0.4, 1.2] vs. 0.6 [0.3, 1.01%, χ^2= 2.620, P = 0.270). The dynamic expression of Th1/Th2/Th 17 cells on days 1 and 3 were simultaneously analyzed in 28/53 OHCA patients who survived 〉3 days; patients were divided into survivors (n = 10) and nonsurvivors (n = 18) based on 28-day survival. No significant differences in Th1/Th2/Th 17 cell counts, ratios in CD4+ lymphocytes, and Th1/Th2 cell ratio were seen between survivors and nonsurvivors on both days (all P 〉 0.05). There was no difference over time in both survivors and nonsurvivors (all P 〉 0.05). Conclusion: Downregulated T lymphocyte counts, including Th1/Th2/Th17 subsets and Th1/Th2 cell ratio imbalance, occur in the early period after ROSC, that may be involved in immune dysfunction in OHCA patients.展开更多
文摘BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsis and 20 age-matched healthy controls were enrolled in the study.Patients with sepsis were further subdivided into a sepsis group and a septic shock group.nCD64 expression,serum procalcitonin(PCT)level,C-reactive protein(CRP)level,and white blood cell(WBC)count were obtained for each patient,and Sequential Organ Failure Assessment(SOFA)scores were calculated.RESULTS:nCD64 expression was higher in the sepsis group with confirmed infection than in the control group.The receiver operating characteristic(ROC)curve of nCD64 was higher than those of SOFA score,PCT,CRP and WBC for diagnosing infection.The area under the curve(AUC)of nCD64 combined with SOFA score was the highest for all parameters.The AUC of nCD64 for predicting 28-day mortality in sepsis was signifi cantly higher than those of PCT,CRP,and WBC,but slightly lower than that of SOFA score.The AUC of nCD64 or PCT combined with SOFA score was signifi cantly higher than that of any single parameter for predicting 28-day mortality.CONCLUSION:nCD64 expression and SOFA score are valuable parameters for early diagnosis of infection and prognostic evaluation of sepsis patients.
基金Supported by the National Natural Science Foundation of China(21076015,21376018,21576014)the Fundamental Research Funds for the Central Universities(ZY1503)
文摘In this work,the impact of internal heat integration upon process dynamics and controllability by superposing reactive section onto stripping section,relocating feed locations,and redistributing catalyst within the reactive section is explored based on a hypothetical ideal reactive distillation system containing an exothermic reaction:A + BC + D.Steady state operation analysis and closed-loop controllability evaluation are carried out by comparing the process designs with and without the consideration of internal heat integration.For superposing reactive section onto stripping section,favorable effect is aroused due to its low sensitivities to the changes in operating condition.For ascending the lower feed stage,somewhat detrimental effect occurs because of the accompanied adverse internal heat integration and strong sensitivity to the changes in operating condition.For descending the upper feed stage,serious detrimental effect happens because of the introduced adverse internal heat integration and strong sensitivity to the changes in operating condition.For redistributing catalyst in the reactive section,fairly small negative influence is aroused by the sensitivity to the changes in operating condition.When reinforcing internal heat integration with a combinatorial use of these three strategies,the decent of the upper feed stage should be avoided in process development.Although the conclusions are derived based on the hypothetical ideal reactive distillation column studied,they are considered to be of general significance to the design and operation of other reactive distillation columns.
基金the National Natural Science Foundation of China(Grant No.81372025).
文摘Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with out-of-hospital cardiac arrest(OHCA)after return of spontaneous circulation(ROSC)by observing the changes in circulating CD14^(+)monocytes and the expression of human leukocyte antigen D–related(HLA-DR)and programmed cell death ligand 1(PD-L1)in CD14^(+)monocytes.Methods:Adult patients admitted to the emergency department of Beijing Chao-Yang Hospital after OHCA between January 2017 and March 2018 were included in this study.Thirty control subjects,10 patients with OHCA,and 37 patients with OHCA who received 72 hours of TTM therapy were enrolled.Peripheral blood samples of patients in the OHCA and TTM groups were collected on Days 1 and 3(D1 and D3)after ROSC and evaluated for HLA-DR and PD-L1 expression on CD14^(+)monocytes using flow cytometry.Results:Compared with control subjects,the percentage of circulating CD14^(+)monocytes,HLA-DR+/CD14^(+)monocyte ratios,and mean fluorescence intensity were significantly decreased in patients with OHCA.After ROSC,HLA-DR expression in CD14^(+)monocytes in the TTM group was lower than that in patients with OHCA.However,there were no significant differences in the percentage of PD-L1+/CD14^(+)monocytes or the mean fluorescence intensity between patients with OHCA and healthy volunteers.Conclusion:After ROSC,circulating CD14^(+)monocytes and HLA-DR+/CD14^(+)monocyte ratios decreased significantly in patients with OHCA.Human leukocyte antigen D–related expression in CD14^(+)monocytes was lower in patients treated with TTM.
基金supported by the National Natural Science Foundation of China(no.81372025).
文摘Background:Cardiac arrest(CA)is a terminal event that results in a range of pathophysiological changes in the body,most notably,systemic ischemia-reperfusion injury.The hypothalamic-pituitary-adrenal(HPA)axis is an important neuroendocrine system that modulates adrenocortical hormone release.This study was designed to investigate the changes in HPA-related hormone levels after successful cardiopulmonary resuscitation(CPR)and to explore possible etiologies to provide a basis for relevant clinical research.Methods:We collected the clinical data of 96 patients with CA admitted to the Emergency Department of Beijing Chaoyang Hospital,Capital Medical University,between January 2016 and May 2017.Serum samples were collected 6,24,and 72 hours after restoring spontaneous circulation(ROSC).The data were compared with those of the healthy control group(n=50).An enzyme-linked immunosorbent assay(ELISA)was performed to measure copeptin,adrenocorticotropic hormone(ACTH),corticotropin-releasing hormone(CRH),and total cortisol.Demographic data were collected for both groups.For the CPR group,clinical data and the end-of-study cerebral performance category(CPC)were analyzed.Patients were followed up through day 28.Death or survival after day 28 was used as the study endpoint.Simple values were expressed as medians and quartiles or ratios(%)for statistical analysis.Continuous variables are expressed as mean±standard deviation.Categorical variables were expressed as frequencies and percentages.The mean values of normally distributed measurement data were analyzed using 1-way analysis of variance(ANOVA)for among-group comparisons and the least significant difference(LSD)test for between-group comparisons.SPSS v17(SPSS,Chicago,IL,USA)was used for statistical analysis,and P<0.05 was considered statistically significant.Results:No significant between-group differences were observed in terms of age or sex.The 28-day mortality rate in the CPR group was 71%.ACTH and CRH levels were significantly lower in the CPR group than in the healthy control group(P<0.001).Copeptin and cortisol levels 6 hours after ROSC were significantly higher in the CPR group than in the healthy control group(P<0.001).No significant changes in any indicator were observed over time(6,24,and 72 hours after ROSC)(P>0.05).The CPC score was 1–2(good cerebral performance group)in 13 patients,3–4(poor cerebral performance group)in 17 patients,and 5(brain death or clinical death)in 66 patients.Patients with significantly declining ACTH and CRH levels had higher CPC scores(P<0.05);however,no significant differences were found in other indicators(P>0.05).Conclusion:After post-CA ROSC,ischemia-reperfusion injury may cause brain damage and HPA axis damage and dysfunction,the severity of which is associated with CPC score.
文摘Objective:Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest.The evidence for the use of adrenaline in out-of-hospital cardiac arrest (OHCA) and in-hospital resuscitation is inconclusive.We conducted a systematic review on the clinical efficacy of adrenaline in adult OHCA patients to evaluate whether epinephrine provides any overall benefit for patients.Data Sources:The EMBASE and PubMed databases were searched with the key words &quot;epinephrine,&quot; &quot;cardiac arrest,&quot; and variations of these terms.Study Selection:Data from clinical randomized trials,meta-analyses,guidelines,and recent reviews were selected for review.Results:Sudden cardiac arrest causes 544,000 deaths in China each year,with survival occurring in 〈1% of cases (compared with 12% in the United States).The American Heart Association recommends the use of epinephrine in patients with cardiac arrest,as part of advanced cardiac life support.There is a clear evidence of an association between epinephrine and increased return of spontaneous circulation (ROSC).However,there are conflicting results regarding long-term survival and functional recovery,particularly neurological outcome,after CPR.There is currently insufficient evidence to support or reject epinephrine administration during resuscitation.We believe that epinephrine may have a role in resuscitation,as administration of epinephrine during CPR increases the probability of restoring cardiac activity with pulses,which is an essential intermediate step toward long-term survival.Conclusions:The administration of adrenaline was associated with improved short-term survival (ROSC).However,it appears that the use of adrenaline is associated with no benefit on survival to hospital discharge or survival with favorable neurological outcome after OHCA,and it may have a harmful effect.Larger placebo-controlled,double-blind,randomized control trials are required to definitively establish the effect of epinephrine.
基金This study was supported by grants from the National Natural Science Foundation of China (No. 81372025) and the 2015 Annual Special Cultivation and Development Project for the Technology Innovation Base of the Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation (No. Z151100001615056).
文摘Background: Immune disorder is an important feature of patients with out-of-hospital cardiac arrest (OHCA) after the return of spontaneous circulation (ROSC). We investigated the expression of circulatory T helper type (Th)1, Th2, and Th 17 cells to explore the early immune alteration in OHCA patients after ROSC. Methods: During July-September 2016 and March-September 2017, 65 consecutive OHCA patients with ROSC 〉 12 h and 30 healthy individuals were enrolled in this study. Clinical and 28-day survival data were collected. Peripheral blood samples were analyzed to evaluate the expression of Th1/Th2/Th 17 cells by flow cytometry from OHCA patients after ROSC on days l and 3 and from healthy individuals. Results: Compared with healthy individuals, T lymphocyte counts and Thl cell counts decreased on days 1 and 3 after ROSC (1464 [1198, 2152] vs. 779 [481, 1140] vs. 581 [324, 1118/μl,χ^2= 30.342, P 〈 0.001; 154 [90, 246] vs. 39 [19, 78] vs. 24 [12, 53]μl, χ^2 = 42.880, P〈 0.001), and Th2 and Th17 cell counts decreased on day 3 (17.0 [10.8, 24.0] vs. 9.0 [3.0, 15.5]μl, Z= -3.228, P= 0.001; 4.7 [2.7, 9.1] vs. 2.7 [1.0, 6.5]μl, Z = -2.294, P = 0.022). No change in CD4+/CD3+ lymphocyte ratio was seen on day 1 or day 3 (57.9 [49.4, 63.0] vs. 55.4 [46.5, 66.5] vs. 55.4 [50.2, 67.0]%, χ^2 = 0.171, P = 0.918). Th1/CD4+ lymphocyte ratio decreased on days 1 and 3 (19.0 [14.0, 24.9] vs. 9.3 [4.6, 13.9] vs. 9.5 [4.9, 13.6]%, χ^2= 25.754, P 〈 0.001), and Th2/CD4+ lymphocyte ratio increased on day 1 and decreased on day 3 (1.9 [1.2, 2.5] vs. 2.5 [1.6, 4.0] vs. 1.9 [1.6, 3.81%,χ^2= 6.913, P = 0.032). Thl/Th2 cell ratio also decreased on both clays (9.4 [7.3, 13.5] vs. 3.1 [1.9, 5.6] vs. 4.2 [2.8, 5.9], χ^2 = 44.262, P 〈 0.001 ). Despite an upward trend in the median of Th 17/CD4+ lymphocyte ratio in OHCA patients, there was no significant difference compared with healthy individuals (0.9 [0.4, 1.2] vs. 0.7 [0.4, 1.2] vs. 0.6 [0.3, 1.01%, χ^2= 2.620, P = 0.270). The dynamic expression of Th1/Th2/Th 17 cells on days 1 and 3 were simultaneously analyzed in 28/53 OHCA patients who survived 〉3 days; patients were divided into survivors (n = 10) and nonsurvivors (n = 18) based on 28-day survival. No significant differences in Th1/Th2/Th 17 cell counts, ratios in CD4+ lymphocytes, and Th1/Th2 cell ratio were seen between survivors and nonsurvivors on both days (all P 〉 0.05). There was no difference over time in both survivors and nonsurvivors (all P 〉 0.05). Conclusion: Downregulated T lymphocyte counts, including Th1/Th2/Th17 subsets and Th1/Th2 cell ratio imbalance, occur in the early period after ROSC, that may be involved in immune dysfunction in OHCA patients.