A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

BACKGROUND:Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury(SA-AKI)than among patients with sepsis.However,the pathogenesis underlying SA-AKI remains unclear.We hypothesized that the source of infection affects development of SA-AKI.We aim to explore the relationship between the anatomical source of infection and outcome in patients with SA-AKI.METHODS:Between January 2013 and January 2018,113 patients with SA-AKI admitted to our Emergency Center were identifi ed and divided into two groups:those with pulmonary infections and those with other sources of infection.For each patient,we collected data from admission until either discharge or death.We also recorded the clinical outcome after 90 days for the discharged patients.RESULTS:The most common source of infection was the lung(52/113 cases,46%),followed by gastrointestinal(GI)(25/113 cases,22.1%)and urinary(22/113,19.5%)sources.Our analysis showed that patients with SA-AKI had a significantly worse outcome(30/52 cases,P<0.001)and poorer kidney recovery(P=0.015)with pulmonary sources of infection than those infected by another source.Data also showed that patients not infected by a pulmonary source more likely experienced shock(28/61 cases,P=0.037).CONCLUSION:This study demonstrated that the source of infection infl uenced the outcome of SA-AKI patients in an independent manner.Lung injury may influence renal function in an asyet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.

Therapeutic effect of recombinant tissue plasminogen activator on acute cerebral infarction at different times

BACKGROUND:The study aimed to compare the therapeutic effect of recombinant tissue plasminogen activator(rt-PA) on the onset of acute cerebral infarction(ACI) at different time points of the first 6 hours.METHODS:A retrospective analysis was conducted in 74 patients who received rt-PA thrombolysis treatment within 4.5 hours after ACI and another 15 patients who received rt-PA thrombolysis treatment between 4.5-6 hours after ACI.RESULTS:National Institute of Health Stroke Scale(NIHSS) scores were statistically decreased in both groups(P>0.05) at 24 hours and 7 days after ACI.There was no significant difference in modified ranking scores and mortality at 90 days after the treatment between the two groups(P>0.05).CONCLUSIONS:The therapeutic effect and mortality of rt-PA treatment in patients with ACI between 4.5-6 hours after the onset of the disease were similar to those in patients who received rtPA within 4.5 hours after the onset of this disease.Therefore,intravenous thrombolytic therapy for ACI within 4.5-6 hours after ACI was effective and safe.

Ischemia-modified albumin measured with ultra-filtration assay in early diagnosis of acute coronary syndrome

Patients with acute chest pain remain a great diagnostic challenge to emergency physicians. Ischemia-modified albumin （IMA） is a recently developed biomarker of transient myocardial ischemia. IMA has already been licensed by the US Food and Drug Administration for diagnosis of suspected myocardial ischemia. This study aimed to assess the diagnostic value of IMA in treatment of patients with acute coronary syndrome（ACS）. IMA level was detected by ultra-filtration assay combined with albumin-cobalt binding （ACB） test as well as tests of myoglobin （MYO）, creatine kinase-MB （CK-MB） and cardiac troponin I （cTnl） in 169 consecutive patients with acute chest pain onset within 24 hours. Receiver operating characteristic （ROC） curve for IMA in diagnosing ACS was established to determine the cut-off point. The sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of IMA and its combinations with other agents were analyzed. Area under the ROC curve （AUC） was 0.754. As the cut-off point for IMA in this study was 70.4 U/ml, the sensitivity, specificity, PPV and NPV of IMAwere 79.8%, 65.2%±77.7%, and 69.7%, respectively. The sensitivity and NPV of IMA combined with the conventional cardiac marker panel for the diagnosis of ACS were 93.4% and 86.0%, respectively. IMA is a useful biochemical marker for the early diagnosis ofACS. IMA combined with the conventional cardiac marker panel can improve early diagnosis of ACS compared with the traditional combinations of myocardial biochemical markers.

Consensus statement on layout and delivery of automatic external defibrillator in China

1.Introduction Sudden cardiac death(SCD)refers to sudden death due to a variety of cardiac causes.It is manifested as a sudden loss of consciousness,cardiac arrest,and respiratory arrest and generally shows early symptoms that are atypical and not easily detected[1].According to a recent study,nearly 544000 patients suffer from SCD every year in China[2].

Safety awareness and use of child safety seats among parents after the legislation in Shanghai

Purpose:To investigate the changes and underlying mechanisms in parents' safety awareness and the use of child safety seats after the mandatory legislation in Shanghai city,China.Methods:This study was carried out by Shanghai Key Laboratory of Environment and Children's Health using a multi-stage,simple random sampling method.Volunteers with children aged 0-12 months were recruited.Child safety seats were sent to each volunteer's family.Telephone encounters and/or on-site visits were used to collect data from parents using a phased survey on children's safety during car use.Results:Among all respondents,91.2% had heard of motor vehicle accidents involving children,and 97.2% could describe the appropriate use of a safety seat to minimize the risk of child injury in a collision.Among 1078 families with newborns,awareness of child safety seats was 91.9%.There were 86% patients aware that new laws and regulations have been released regarding the use of child safety seats,and 98.5% of them plan to comply with the new laws.Moreover,61% patients think that taxis should be routinely equipped with child safety seats.Conclusion:The parents in Shanghai obtained a high level of awareness of children's traffic safety after the introduction of child safety seats legislation,and had a positive experience related to the use of child safety seats.Taxi may be an important area of focus for implementation of child traffic safety.Traffic safety laws and regulations with further impact should be continuously studied.