The effects of early hemofiltration on the serum levels of cytokines, pro- and anti-inflammatory balance and organ function in pigs with severe acute pancreatits (SAP) were studied. SAP pig model was induced by retrog...The effects of early hemofiltration on the serum levels of cytokines, pro- and anti-inflammatory balance and organ function in pigs with severe acute pancreatits (SAP) were studied. SAP pig model was induced by retrograde injection of artificial bile into the pancreatic duct. The pigs were randomly divided into SAP hemofiltration treatment group (HF group, n=8) and SAP non-hemofiltration treatment group (NHF group, n=8). In the HF group, the animals were subjected to high-volume and zero-balance hemofiltration therapy. The results showed that as compared with NHF group, MAP, CVP and PaO 2/FiO 2 were significantly increased (P<0.01), while HR, urinary protein content, serum ALT level, pulmonary coefficient and lung wet/dry ratio obviously decreased (P<0.05) in HF group. Under a light microscope, the pulmonary histologic scoring was lower that in HF group (P<0.01) and the lesions of renal and liver tissues were milder. However, there was no significant difference in the pancreatic histologic scoring between the two groups. Six h after establishment of the model, the serum levels of TNF-α, IL-1β were lower, while the IL-10/TNF-α ratio was higher in HF group (all P<0.05). It was suggested that early hemofiltration could effectively remove the serum cytokines TNF-α and IL-1β in SAP pigs, elevate the ratio of IL-10/TNF-α, improve hemodynamics and alleviate the lesions of lung, kidney and liver tissues.展开更多
AIM: To better define the efficacy and the safety of intra-arterial infusion performed with or without hemofiltration for recurrent limb melanoma. METHODS: Patients with the following characteristics were included in ...AIM: To better define the efficacy and the safety of intra-arterial infusion performed with or without hemofiltration for recurrent limb melanoma. METHODS: Patients with the following characteristics were included in the study: recurrent limb melanoma not indicated for surgical resection, measurable disease in the extremity, > 18 years, performances status(Eastern Cooperative Oncology Group) was 0-1 and life expectancy of at least 6 mo. Twenty nine consecutive patients were enrolled in the study. Patients underwent fluoroscopic placement of angiographic arterial and venous catheters to infuse the drug in the artery [isolated limb infusion(ILI)], and to stop the out flow(venous). Melphalan was rapidly infused into the isolated limb via the arterial catheter after the inflation of venous balloon catheter. Then the circulation of the limb was completely blocked with a pneumatic cuff at the root of the limb. Haemofiltration(HF) was available only in the main center, and was performed with an extracorporeal perfusion system, in order to reduce high systemic toxic peaks of drug.RESULTS: Thirty seven ILI were done in 29 cases(31 ILI-HF and 6 ILI) between 2001 and 2014 at Ancona and Pesaro Hospitals, Italy. Clinical outcomes were monitored 30 d after treatment. Eleven patients(38%) received infusion of melphalan alone, 7(24%) melphalan associated to mitomicin C and 7(24%) melphalan associated to cisplatin, the remaining 4 were treated with cisplatin, melphalan and epirubicin or cisplatin and mitomicin C. The overall response rate was 66%, in particular, 3 patients(10%) were complete responders and 16(56%) were partial responders; whereas 7 patients(24%) had stable disease, and 3(10%) showed progressive disease. Limb toxicity was assessed adopting Wieberdink scale, with evidence of 90% of low grade(I and II) toxicity.CONCLUSION: ILI-HF and ILI are effective and safe treatments for recurrent non-resectable limb melanoma. They present evidence of favorable clinical benefit and is effective in delaying progression.展开更多
BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsor...BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsorption combined CWH(HP+CWH) has higher ability of mediator clearance,and can improve clinical outcomes in theory.This study aimed to investigate the effect of blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration(HP+CWH) on plasm cytokines like TNF-α,IL-1β,IL-6,cellular immunity and prognosis in patients with multiple organ dysfunction syndrome(MODS).METHODS:This was a prospective,randomized clinical trial.A total of 30 patients who had been diagnosed with MODS were enrolled in this study.Patients were randomly allocated to routine treatment+HP+CWH group(treatment group) and routine treatment+only CWH group(control group).In the treatment group,patients received blood hemoperfusion with resin adsorption for 2hours,and then received CWH for 10 hours every day.In the control group,patients received CWH for 12 hours only every day.The patients in the two groups received blood purification therapy for three days.The plasma of patients in the treatment group was obtained at 0,2,12,24,26,36,48,50,60 hours,5th day,7th day and 10 th day,respectively.The plasma of patients in the control group was obtained at 0,12,24,36,48,60 hours,5th day,7th day and 10 th day,respectively.APACHE Ⅱscore,T-lymphocytes subpopulations,blood lactate acid concentration,heart rate,breathing rate,and oxygenation index were observed.RESULTS:Plasma cytokines like TNF-α,IL-1β,IL-6 decreased markedly after HP(P<0.01);T-lymphocytes subpopulations CD3+,CD4+,CD8+,CD4+/CD8+ increased after HP+CWH or only CWH.The plasma concentrations of TNF-α,IL-1β and IL-6 in the two groups were not markedly different at 12,36,and 50 hours.But on the 5th day,the plasma concentrations of TNF-α,IL-1β and IL-6 in the treatment group were lower than those in the control group(P<0.05).On the 28 th day,5patients died in the treatment group,and 6 patients in the control group.CONCLUSIONS:Both HP+CWH and CWH can clean plasma cytokines like TNF-α,IL-1β,and IL-6,and improve cellular immunity and clinical symptoms and signs of patients.Compared with only CWH,the plasma concentrations of TNF-α,IL-1β and IL-6 were lower on the 5th day,and patients have an increased survival rate on the 28 day in the HP+CWH group.展开更多
AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP).METHODS: SAP model was produced by intraductal i...AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP).METHODS: SAP model was produced by intraductal injection of sodium taurocholate [4%, 1 mL/kg body weight (BW)] and trypsin (2 U/kg BW). Animals were allocated either to untreated controls as group 1 or to one of two treatment groups as group 2 receiving a low-volume CWH [20 mL/(kg·h)], and group 3 receiving a high-volume CVVH [100 (mL/kg·h)]. Swan-Ganz catheter was inserted during the operation. Heart rate, arterial blood pressure, cardiac output, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, central venous pressure, systemic vascular resistance, oxygen delivery, oxygen consumption,oxygen extraction ratio, as well as survival of pigs were evaluated in the study.RESULTS: Survival time was significantly prolonged by low-volume and high-volume CWHs, which was more pronounced in the latter. High-volume CWH was significantly superior compared with less intensive treatment modalities (low-volume CWH) in systemic inflammatory reaction protection.The major hemodynamic finding was that pancreatitis-induced hypotension was significantly attenuated by intensive CVVH (87.4±12.5 kPa vs 116.3±7.8 kPa, P<0.01). The development of hyperdynamic circulatory failure was simultaneously attenuated, as reflected by a limited increase in cardiac output,an attenuated decrease in systemic vascular resistance and an elevation in oxygen extraction ratio.CONCLUSION: CVVH blunts the pancreatitis-induced cardiovascular response and increases tissue oxygen extraction. The high-volume CWH is distinctly superior in preventing sepsis-related hemodynamic impairment.展开更多
AIM: To investigate whether continuous veno-venous hemofiltration (CWH) in different filtration rate to eliminate cytokines would result in different efficiency in acute pancreatitis, whether the saturation time of fi...AIM: To investigate whether continuous veno-venous hemofiltration (CWH) in different filtration rate to eliminate cytokines would result in different efficiency in acute pancreatitis, whether the saturation time of filter membrane was related to different filtration rate, and whether the onset time of CWH could influence the survival of acute pancreatitis.METHODS: Thirty-seven patients were classified into four groups randomly. Group 1 underwent low-volume CVVH within 48 h of the onset of abdominal pain (early CVVH,n = 9). Group 2 received low-volume CVVH after 96 h of the onset of abdominal pain (late CVVH, n = 10). Group 3underwent high-volume CWH within 48 h of the onset of abdominal pain (early CWH, n = 9). Group 4 received high-volume CWH after 96 h of theonset of abdominal pain (late CVVH, n = 9). CVVH was sustained for at least 72 h. Blood was taken before hemofiltration, and ultrafiltrate was collected at the start of CWH and every 12 h during CVVH period for the purpose of measuring the concentrations of TNF-α, IL-1β and IL-6. The concentrations of TNF-α, IL-1β and IL-6 were measured by swine-specific El ISA. The Solartron 1 255 B frequency response analyzer (British) was used to observe the resistance of filter membrane.RESULTS: The survival rate had a significant difference (94.44% vs68.42%, P<0.01) high-volume and low-volume CVVH patients. The survival rate had also a significant difference (88.89% vs 73.68%, P<0.05) between early and late CWH patients. The hemodynamic deterioration (MAP, HR, CVP) was less severe in groups 4 and 1 than that in group 2, and in group 3 than in group 4. The adsorptive saturation time of filters membranes was 120-180 min if the filtration rate was 1 000-4 000 mL/h. After the first, second and third new hemofilters were changed,serum TNF-α concentrations had a negative correlation with resistance (r: -0.91, -0.89, and -0.86, respectively in group 1; -0.89, -0.85, and -0.76, respectively in group 2;-0.88, -0.92, and -0.82, respectively in group 3; -0.84,-0.87, and -0.79, respectively in group 4). The decreasing extent of TNF-α, IL-1β and IL-6 was significantly different between group 3 and group 1 (TNF-α P<0.05, IL-1β P<0.05,IL-6 P<0.01), between group 4 and group 2 (TNF-α P<0.05,IL-1β P<0.05, IL-6 P<0.01), between group 1 and group 2(TNF-α P<0.05, IL-1β P<0.05, IL-6 P<0.05), and between group 3 and group 4 (TNF-α P<0.01, IL-1β P<0.01, IL-6P<0.05),respectively during CVVH period. The decreasing extent of TNF-α and IL-1β was also significantly different between survival patients and dead patients (TNF-αP<0.05, IL-1β P<0.05).In survival patients, serum concentration of TNF-α and IL-1β decreased more significantly than that in dead patients.CONCLUSION: High-volume and early CWH improve hemodynamic deterioration and survival in acute pancreatitis patients. High-volume CVVH can eliminate cytokines more efficiently than low-volume CWH. The survival rate is related to the decrease extent of TNF-α and IL-1β.The adsorptive saturation time of filter membranes are different under different filtration rate condition. The filter should be changed timely once filter membrane adsorption is saturated.展开更多
AIM: To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis (SAP) in China. METHODS: We carried out a search of Pub-Medline and Chinese Biomedical Disk database....AIM: To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis (SAP) in China. METHODS: We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were: continuous or long-term veno-venous hemofiltration (CVVH/LVVH), short-term veno-venous hemofiltration (SVVH), SVVH plus peritoneal dialysis (PD), and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS: The SVVH only technique was the least costly modality, $5809 (44 449 RMB), and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CVVH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION: The role of early veno-venoushemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.展开更多
The issue of concrete carbonation has gained importance in recent years due to the increase use in supplementary cementing materials (SCMs) in concrete mixtures. While there is general agreement that concrete carbonat...The issue of concrete carbonation has gained importance in recent years due to the increase use in supplementary cementing materials (SCMs) in concrete mixtures. While there is general agreement that concrete carbonation progresses at maximum at a relative humidity of about 60%, the rate may differ in the case of cements blended with SCMs, especially with high-volume fly ash replacements. In this study, the effect of high-volume fly ash concrete exposed to low ambient relative humidity (RH) conditions (57%) and accelerated carbonation (4% CO2) is investigated. Twenty-three concrete mixtures were produced varying in cementitious contents (310, 340, 370, and 400 kg/m3), water-to-cementitious materials ratio (0.45 and 0.50), and fly ash content (0%, 15%, 30%, and 50%) using a low and high-calcium fly ash. The specimens were allowed 1 and 7 days of moist curing and monitored for their carbonation rate and depth through phenolphthalein measurements up to 105 days of exposure. The accelerated carbonation test results indicated that increasing the addition of fly ash also led to increasing the depth of carbonation. Mixtures incorporating high-calcium fly ash were also observed to be more resistant against carbonation than low-calcium fly ash due to the higher calcium oxide (CaO) content. However, mixtures incorporating high-volume additions (50%) specimens were fully carbonated regardless of the type of fly ash used. It was evident that the increase in the duration of moist curing from 1 day to 7 days had a positive effect, reducing the carbonation depth for both plain and blended fly ash concrete mixes, however, this effect was minimal in high-volume fly ash mixtures. The results demonstrated that the water-to-cementitious ratio (W/CM) had a more dramatic impact on carbonation resistance than the curing age for mixtures incorporating 30% or less fly ash replacement, whereas those mixtures incorporating 50% showed minor differences regardless of curing age or W/CM. Based on the compressive strength results, carbonation depth appeared to decrease with increase in compressive strength, but this correlation was not significant.展开更多
The aim of this study is to investigate the effect of the hemofiltration-body surface area on mortality and morbidity during cardiopulmonary bypass (CBP). A total of 226 patients were divided into two groups as hemofi...The aim of this study is to investigate the effect of the hemofiltration-body surface area on mortality and morbidity during cardiopulmonary bypass (CBP). A total of 226 patients were divided into two groups as hemofiltration (HF) performed or not performed. The patients to whom hemofiltration was performed were also divided into three subgroups after the distribution analysis which was done according to body surface area. All patients were compared according to the relationship of hemofiltration-body surface area during cardiopulmonary bypass in the interms of mortality and morbidity. There was no statistically significant relationship between the subgroups according to the amount of hemofiltration by square meters (p = 0.818). There was statistically significant difference in total perfusion times and total hospital stay (p = 0.025;p = 0.038) between the subgroups which were divided by the amount of hemofiltration in square meters. As a result, no effect was observed on the mortality of the relationship between the amount of hemofiltration applied during CBP and body surface area.展开更多
Objective:To observe the effect of continuous hemofiltration combined with norepinephrine in the treatment of septic shock,and to explore the value of blood purification in the treatment of septic shock.Methods:From N...Objective:To observe the effect of continuous hemofiltration combined with norepinephrine in the treatment of septic shock,and to explore the value of blood purification in the treatment of septic shock.Methods:From November 2018 to December 2020,100 patients with septic shock in the Intensive care unit of our hospital were selected and randomly divided into observation group and control group,with 50 cases in each group.The control group was given conventional treatment,while the observation group was given continuous hemofiltration combined with norepinephrine intervention.The clinical efficacy,Scv02,MAP and oxygenation index(PO_(2)/FiO_(2))of the two groups were compared.The levels of interleukin-6(IL-6),procalcitonin(PCT)and the total number of leukocytes and other inflammatory factors were compared 72 hours after treatment,and the 28-day mortality of the two groups was counted.Results:The total effective rate of the observation group(92.00%)was significantly higher than that of the control group(86.00%),the difference was statistically significant(p<0.05);the 28-day mortality of the two groups was 8.00%in the observation group and 14.00%in the control group,the difference was statistically significant(χ^(2)=4.629,p=0.038);Before treatment,the Scv02,MAP and PO_(2)/FiO_(2)levels of the two groups were significantly higher than those of post-therapy.There was no significant difference between the two groups(p>0.05);After 48 hours of treatment,the levels of Scv02,MAP and PO_(2)/FiO_(2)in the two groups were significantly increased,while the levels of scv02,map,PO_(2)/FiO_(2)in the observation group were more significantly increased than those in the control group(p<0.05);Before treatment,the levels of IL-6,PCT and total white blood cells in the two groups were significantly higher than those of post-therapy(p<0.05)After 72 hours of treatment,the levels of IL-6,PCT and the total number of white blood cells in the two groups decreased significantly,while the levels of IL-6,PCT and the total number of white blood cells in the observation group decreased more significantly than those in the control group(p<0.05).Conclusion:Continuous blood purification combined with norepinephrine can effectively reduce the level of serum inflammatory factors in patients with septic shock,improve hemodynamic indexes,improve survival rate,which is worthy of clinical application.展开更多
Objective:To investigate effects of hemoperfusion and hemofiltration combination on treating patients with acute organophosphours pesticide poisoning (AOPP) and influence of it on cholinesterase, dopamine and inflamma...Objective:To investigate effects of hemoperfusion and hemofiltration combination on treating patients with acute organophosphours pesticide poisoning (AOPP) and influence of it on cholinesterase, dopamine and inflammatory factors.Methods:A total of 82 cases of AOPP patients treated in our hospital from Sep 2012 to Jul 2016 were selected as subjects. They were randomly divided to be the observation group and the control group, 41 cases for each. For patients in observation group, combined therapy of hemoperfusion (HP) and hemofiltration (HF) were provided. For patients in control group, combined therapy of HP and hemodialysis (HD) were provided. Effects on the two groups of patients were compared. Meanwhile, cholinesterase, dopamine and inflammatory factors levels in different times before and after treatment were compared.Results:Consciousness improvement times and hospitalization times in observation group were significantly lower than in control group. No significant difference showed on fatality rates between the two groups. Before treatment, no significant difference showed on CHE and DE levels between two groups of patients;6 h and 12 h after treatment, CHE average levels in two groups were significantly higher than before treatment in the same group, and levels in observation group at the same phase were significantly higher than in control group;6 h and 12 h after treatment, DA levels in observation group were significantly lower than the same group before treatment, and significantly lower than control group, while 12 h after treatment, DA levels in control group were significantly lower than the same group before treatment. Before treatment, no significant difference showed on serum TGF-β1, TNF-α, IL-6, IL-8 between two groups of patients. After treatment, each index levels in two groups were significantly lower than the same group before treatment, and levels in observation group at the same phase were significantly lower than control group. Conclusion:Effects of blood purification therapy on treating AOPP were worth approving, but effects of HP and HF combined therapy were more significant. In addition, improvement of HP+HF on CHE, DA and inflammatory factors were better than HP+HD.展开更多
Female patients,44 years old,due to'regular peritoneal dialysis5 years,stomach ache 1 week'admission.Previous had 2 times for'Peritoneal dialysis related peritonitis'in hospital,after anti-infection tr...Female patients,44 years old,due to'regular peritoneal dialysis5 years,stomach ache 1 week'admission.Previous had 2 times for'Peritoneal dialysis related peritonitis'in hospital,after anti-infection treatment patients symptoms improved and discharged.1 week ago in patients admitted to hospital because of abdominal pain again.Physical:abdominal tenderness,bowel sounds hyperthyroidism.Laboratory inspection index:CRP:172.22 mg/l,WBC:23.26×10~9/L,NEU%:89.23%,D dimer:3 800 ng/ml,PCT:14.86 ng/ml。展开更多
目的通过Meta分析评价血液灌流联合血液滤过对脓毒症炎症介质及预后的影响。方法检索PubMed、Web of Science、Medline、中国知网(CNKI)、万方数据库、维普数据库,选取血液灌流联合血液滤过对脓毒症治疗的随机对照试验(观察组采用血液...目的通过Meta分析评价血液灌流联合血液滤过对脓毒症炎症介质及预后的影响。方法检索PubMed、Web of Science、Medline、中国知网(CNKI)、万方数据库、维普数据库,选取血液灌流联合血液滤过对脓毒症治疗的随机对照试验(观察组采用血液灌流联合血液滤过治疗,对照组采用单纯血液滤过治疗),检索时间为建库至2023年6月30日。采用RevMan 5.4软件进行Meta分析,采用漏斗图进行偏倚评估。结果共纳入19篇文献,1322例患者。Meta分析结果显示:观察组与对照组患者相比C反应蛋白降低(SMD=-1.60,95%CI:-2.02~-1.18,P<0.001)、肿瘤坏死因子-α水平下降(SMD=-1.60,95%CI:-1.77~-1.43,P<0.001)、白细胞介素-6水平下降(SMD=-1.29,95%CI:-1.43~-1.14,P<0.001)、序贯器官衰竭评分降低(SMD=-0.74,95%CI:-0.98~-0.51,P<0.001)、病死率降低(RR=0.50,95%CI:0.39~0.65,P<0.001)。结论血液灌流联合血液滤过治疗可以下调脓毒症的炎症介质,降低序贯器官衰竭评分及病死率,改善预后。展开更多
文摘The effects of early hemofiltration on the serum levels of cytokines, pro- and anti-inflammatory balance and organ function in pigs with severe acute pancreatits (SAP) were studied. SAP pig model was induced by retrograde injection of artificial bile into the pancreatic duct. The pigs were randomly divided into SAP hemofiltration treatment group (HF group, n=8) and SAP non-hemofiltration treatment group (NHF group, n=8). In the HF group, the animals were subjected to high-volume and zero-balance hemofiltration therapy. The results showed that as compared with NHF group, MAP, CVP and PaO 2/FiO 2 were significantly increased (P<0.01), while HR, urinary protein content, serum ALT level, pulmonary coefficient and lung wet/dry ratio obviously decreased (P<0.05) in HF group. Under a light microscope, the pulmonary histologic scoring was lower that in HF group (P<0.01) and the lesions of renal and liver tissues were milder. However, there was no significant difference in the pancreatic histologic scoring between the two groups. Six h after establishment of the model, the serum levels of TNF-α, IL-1β were lower, while the IL-10/TNF-α ratio was higher in HF group (all P<0.05). It was suggested that early hemofiltration could effectively remove the serum cytokines TNF-α and IL-1β in SAP pigs, elevate the ratio of IL-10/TNF-α, improve hemodynamics and alleviate the lesions of lung, kidney and liver tissues.
文摘AIM: To better define the efficacy and the safety of intra-arterial infusion performed with or without hemofiltration for recurrent limb melanoma. METHODS: Patients with the following characteristics were included in the study: recurrent limb melanoma not indicated for surgical resection, measurable disease in the extremity, > 18 years, performances status(Eastern Cooperative Oncology Group) was 0-1 and life expectancy of at least 6 mo. Twenty nine consecutive patients were enrolled in the study. Patients underwent fluoroscopic placement of angiographic arterial and venous catheters to infuse the drug in the artery [isolated limb infusion(ILI)], and to stop the out flow(venous). Melphalan was rapidly infused into the isolated limb via the arterial catheter after the inflation of venous balloon catheter. Then the circulation of the limb was completely blocked with a pneumatic cuff at the root of the limb. Haemofiltration(HF) was available only in the main center, and was performed with an extracorporeal perfusion system, in order to reduce high systemic toxic peaks of drug.RESULTS: Thirty seven ILI were done in 29 cases(31 ILI-HF and 6 ILI) between 2001 and 2014 at Ancona and Pesaro Hospitals, Italy. Clinical outcomes were monitored 30 d after treatment. Eleven patients(38%) received infusion of melphalan alone, 7(24%) melphalan associated to mitomicin C and 7(24%) melphalan associated to cisplatin, the remaining 4 were treated with cisplatin, melphalan and epirubicin or cisplatin and mitomicin C. The overall response rate was 66%, in particular, 3 patients(10%) were complete responders and 16(56%) were partial responders; whereas 7 patients(24%) had stable disease, and 3(10%) showed progressive disease. Limb toxicity was assessed adopting Wieberdink scale, with evidence of 90% of low grade(I and II) toxicity.CONCLUSION: ILI-HF and ILI are effective and safe treatments for recurrent non-resectable limb melanoma. They present evidence of favorable clinical benefit and is effective in delaying progression.
文摘BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsorption combined CWH(HP+CWH) has higher ability of mediator clearance,and can improve clinical outcomes in theory.This study aimed to investigate the effect of blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration(HP+CWH) on plasm cytokines like TNF-α,IL-1β,IL-6,cellular immunity and prognosis in patients with multiple organ dysfunction syndrome(MODS).METHODS:This was a prospective,randomized clinical trial.A total of 30 patients who had been diagnosed with MODS were enrolled in this study.Patients were randomly allocated to routine treatment+HP+CWH group(treatment group) and routine treatment+only CWH group(control group).In the treatment group,patients received blood hemoperfusion with resin adsorption for 2hours,and then received CWH for 10 hours every day.In the control group,patients received CWH for 12 hours only every day.The patients in the two groups received blood purification therapy for three days.The plasma of patients in the treatment group was obtained at 0,2,12,24,26,36,48,50,60 hours,5th day,7th day and 10 th day,respectively.The plasma of patients in the control group was obtained at 0,12,24,36,48,60 hours,5th day,7th day and 10 th day,respectively.APACHE Ⅱscore,T-lymphocytes subpopulations,blood lactate acid concentration,heart rate,breathing rate,and oxygenation index were observed.RESULTS:Plasma cytokines like TNF-α,IL-1β,IL-6 decreased markedly after HP(P<0.01);T-lymphocytes subpopulations CD3+,CD4+,CD8+,CD4+/CD8+ increased after HP+CWH or only CWH.The plasma concentrations of TNF-α,IL-1β and IL-6 in the two groups were not markedly different at 12,36,and 50 hours.But on the 5th day,the plasma concentrations of TNF-α,IL-1β and IL-6 in the treatment group were lower than those in the control group(P<0.05).On the 28 th day,5patients died in the treatment group,and 6 patients in the control group.CONCLUSIONS:Both HP+CWH and CWH can clean plasma cytokines like TNF-α,IL-1β,and IL-6,and improve cellular immunity and clinical symptoms and signs of patients.Compared with only CWH,the plasma concentrations of TNF-α,IL-1β and IL-6 were lower on the 5th day,and patients have an increased survival rate on the 28 day in the HP+CWH group.
基金Supported by the Social Development Foundation of Jiangsu Province, No.BS2000051
文摘AIM: To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP).METHODS: SAP model was produced by intraductal injection of sodium taurocholate [4%, 1 mL/kg body weight (BW)] and trypsin (2 U/kg BW). Animals were allocated either to untreated controls as group 1 or to one of two treatment groups as group 2 receiving a low-volume CWH [20 mL/(kg·h)], and group 3 receiving a high-volume CVVH [100 (mL/kg·h)]. Swan-Ganz catheter was inserted during the operation. Heart rate, arterial blood pressure, cardiac output, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, central venous pressure, systemic vascular resistance, oxygen delivery, oxygen consumption,oxygen extraction ratio, as well as survival of pigs were evaluated in the study.RESULTS: Survival time was significantly prolonged by low-volume and high-volume CWHs, which was more pronounced in the latter. High-volume CWH was significantly superior compared with less intensive treatment modalities (low-volume CWH) in systemic inflammatory reaction protection.The major hemodynamic finding was that pancreatitis-induced hypotension was significantly attenuated by intensive CVVH (87.4±12.5 kPa vs 116.3±7.8 kPa, P<0.01). The development of hyperdynamic circulatory failure was simultaneously attenuated, as reflected by a limited increase in cardiac output,an attenuated decrease in systemic vascular resistance and an elevation in oxygen extraction ratio.CONCLUSION: CVVH blunts the pancreatitis-induced cardiovascular response and increases tissue oxygen extraction. The high-volume CWH is distinctly superior in preventing sepsis-related hemodynamic impairment.
基金Supported by the Natural Science Foundation of Shaanxi Province,No. 2002C257
文摘AIM: To investigate whether continuous veno-venous hemofiltration (CWH) in different filtration rate to eliminate cytokines would result in different efficiency in acute pancreatitis, whether the saturation time of filter membrane was related to different filtration rate, and whether the onset time of CWH could influence the survival of acute pancreatitis.METHODS: Thirty-seven patients were classified into four groups randomly. Group 1 underwent low-volume CVVH within 48 h of the onset of abdominal pain (early CVVH,n = 9). Group 2 received low-volume CVVH after 96 h of the onset of abdominal pain (late CVVH, n = 10). Group 3underwent high-volume CWH within 48 h of the onset of abdominal pain (early CWH, n = 9). Group 4 received high-volume CWH after 96 h of theonset of abdominal pain (late CVVH, n = 9). CVVH was sustained for at least 72 h. Blood was taken before hemofiltration, and ultrafiltrate was collected at the start of CWH and every 12 h during CVVH period for the purpose of measuring the concentrations of TNF-α, IL-1β and IL-6. The concentrations of TNF-α, IL-1β and IL-6 were measured by swine-specific El ISA. The Solartron 1 255 B frequency response analyzer (British) was used to observe the resistance of filter membrane.RESULTS: The survival rate had a significant difference (94.44% vs68.42%, P<0.01) high-volume and low-volume CVVH patients. The survival rate had also a significant difference (88.89% vs 73.68%, P<0.05) between early and late CWH patients. The hemodynamic deterioration (MAP, HR, CVP) was less severe in groups 4 and 1 than that in group 2, and in group 3 than in group 4. The adsorptive saturation time of filters membranes was 120-180 min if the filtration rate was 1 000-4 000 mL/h. After the first, second and third new hemofilters were changed,serum TNF-α concentrations had a negative correlation with resistance (r: -0.91, -0.89, and -0.86, respectively in group 1; -0.89, -0.85, and -0.76, respectively in group 2;-0.88, -0.92, and -0.82, respectively in group 3; -0.84,-0.87, and -0.79, respectively in group 4). The decreasing extent of TNF-α, IL-1β and IL-6 was significantly different between group 3 and group 1 (TNF-α P<0.05, IL-1β P<0.05,IL-6 P<0.01), between group 4 and group 2 (TNF-α P<0.05,IL-1β P<0.05, IL-6 P<0.01), between group 1 and group 2(TNF-α P<0.05, IL-1β P<0.05, IL-6 P<0.05), and between group 3 and group 4 (TNF-α P<0.01, IL-1β P<0.01, IL-6P<0.05),respectively during CVVH period. The decreasing extent of TNF-α and IL-1β was also significantly different between survival patients and dead patients (TNF-αP<0.05, IL-1β P<0.05).In survival patients, serum concentration of TNF-α and IL-1β decreased more significantly than that in dead patients.CONCLUSION: High-volume and early CWH improve hemodynamic deterioration and survival in acute pancreatitis patients. High-volume CVVH can eliminate cytokines more efficiently than low-volume CWH. The survival rate is related to the decrease extent of TNF-α and IL-1β.The adsorptive saturation time of filter membranes are different under different filtration rate condition. The filter should be changed timely once filter membrane adsorption is saturated.
基金Supported by The National Natural Science Foundation of China, No.30500684 and Clinical Research Foundation for Residency Granted by the Cooperative Project of West China Hospital and Daiichi Pharmaceutical Co. Ltd., the level Ⅰ
文摘AIM: To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis (SAP) in China. METHODS: We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were: continuous or long-term veno-venous hemofiltration (CVVH/LVVH), short-term veno-venous hemofiltration (SVVH), SVVH plus peritoneal dialysis (PD), and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS: The SVVH only technique was the least costly modality, $5809 (44 449 RMB), and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CVVH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION: The role of early veno-venoushemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.
文摘The issue of concrete carbonation has gained importance in recent years due to the increase use in supplementary cementing materials (SCMs) in concrete mixtures. While there is general agreement that concrete carbonation progresses at maximum at a relative humidity of about 60%, the rate may differ in the case of cements blended with SCMs, especially with high-volume fly ash replacements. In this study, the effect of high-volume fly ash concrete exposed to low ambient relative humidity (RH) conditions (57%) and accelerated carbonation (4% CO2) is investigated. Twenty-three concrete mixtures were produced varying in cementitious contents (310, 340, 370, and 400 kg/m3), water-to-cementitious materials ratio (0.45 and 0.50), and fly ash content (0%, 15%, 30%, and 50%) using a low and high-calcium fly ash. The specimens were allowed 1 and 7 days of moist curing and monitored for their carbonation rate and depth through phenolphthalein measurements up to 105 days of exposure. The accelerated carbonation test results indicated that increasing the addition of fly ash also led to increasing the depth of carbonation. Mixtures incorporating high-calcium fly ash were also observed to be more resistant against carbonation than low-calcium fly ash due to the higher calcium oxide (CaO) content. However, mixtures incorporating high-volume additions (50%) specimens were fully carbonated regardless of the type of fly ash used. It was evident that the increase in the duration of moist curing from 1 day to 7 days had a positive effect, reducing the carbonation depth for both plain and blended fly ash concrete mixes, however, this effect was minimal in high-volume fly ash mixtures. The results demonstrated that the water-to-cementitious ratio (W/CM) had a more dramatic impact on carbonation resistance than the curing age for mixtures incorporating 30% or less fly ash replacement, whereas those mixtures incorporating 50% showed minor differences regardless of curing age or W/CM. Based on the compressive strength results, carbonation depth appeared to decrease with increase in compressive strength, but this correlation was not significant.
文摘The aim of this study is to investigate the effect of the hemofiltration-body surface area on mortality and morbidity during cardiopulmonary bypass (CBP). A total of 226 patients were divided into two groups as hemofiltration (HF) performed or not performed. The patients to whom hemofiltration was performed were also divided into three subgroups after the distribution analysis which was done according to body surface area. All patients were compared according to the relationship of hemofiltration-body surface area during cardiopulmonary bypass in the interms of mortality and morbidity. There was no statistically significant relationship between the subgroups according to the amount of hemofiltration by square meters (p = 0.818). There was statistically significant difference in total perfusion times and total hospital stay (p = 0.025;p = 0.038) between the subgroups which were divided by the amount of hemofiltration in square meters. As a result, no effect was observed on the mortality of the relationship between the amount of hemofiltration applied during CBP and body surface area.
基金by Scientific research project plan of Weifang Health Committee(Grant No:wfwsjk2019076).
文摘Objective:To observe the effect of continuous hemofiltration combined with norepinephrine in the treatment of septic shock,and to explore the value of blood purification in the treatment of septic shock.Methods:From November 2018 to December 2020,100 patients with septic shock in the Intensive care unit of our hospital were selected and randomly divided into observation group and control group,with 50 cases in each group.The control group was given conventional treatment,while the observation group was given continuous hemofiltration combined with norepinephrine intervention.The clinical efficacy,Scv02,MAP and oxygenation index(PO_(2)/FiO_(2))of the two groups were compared.The levels of interleukin-6(IL-6),procalcitonin(PCT)and the total number of leukocytes and other inflammatory factors were compared 72 hours after treatment,and the 28-day mortality of the two groups was counted.Results:The total effective rate of the observation group(92.00%)was significantly higher than that of the control group(86.00%),the difference was statistically significant(p<0.05);the 28-day mortality of the two groups was 8.00%in the observation group and 14.00%in the control group,the difference was statistically significant(χ^(2)=4.629,p=0.038);Before treatment,the Scv02,MAP and PO_(2)/FiO_(2)levels of the two groups were significantly higher than those of post-therapy.There was no significant difference between the two groups(p>0.05);After 48 hours of treatment,the levels of Scv02,MAP and PO_(2)/FiO_(2)in the two groups were significantly increased,while the levels of scv02,map,PO_(2)/FiO_(2)in the observation group were more significantly increased than those in the control group(p<0.05);Before treatment,the levels of IL-6,PCT and total white blood cells in the two groups were significantly higher than those of post-therapy(p<0.05)After 72 hours of treatment,the levels of IL-6,PCT and the total number of white blood cells in the two groups decreased significantly,while the levels of IL-6,PCT and the total number of white blood cells in the observation group decreased more significantly than those in the control group(p<0.05).Conclusion:Continuous blood purification combined with norepinephrine can effectively reduce the level of serum inflammatory factors in patients with septic shock,improve hemodynamic indexes,improve survival rate,which is worthy of clinical application.
文摘Objective:To investigate effects of hemoperfusion and hemofiltration combination on treating patients with acute organophosphours pesticide poisoning (AOPP) and influence of it on cholinesterase, dopamine and inflammatory factors.Methods:A total of 82 cases of AOPP patients treated in our hospital from Sep 2012 to Jul 2016 were selected as subjects. They were randomly divided to be the observation group and the control group, 41 cases for each. For patients in observation group, combined therapy of hemoperfusion (HP) and hemofiltration (HF) were provided. For patients in control group, combined therapy of HP and hemodialysis (HD) were provided. Effects on the two groups of patients were compared. Meanwhile, cholinesterase, dopamine and inflammatory factors levels in different times before and after treatment were compared.Results:Consciousness improvement times and hospitalization times in observation group were significantly lower than in control group. No significant difference showed on fatality rates between the two groups. Before treatment, no significant difference showed on CHE and DE levels between two groups of patients;6 h and 12 h after treatment, CHE average levels in two groups were significantly higher than before treatment in the same group, and levels in observation group at the same phase were significantly higher than in control group;6 h and 12 h after treatment, DA levels in observation group were significantly lower than the same group before treatment, and significantly lower than control group, while 12 h after treatment, DA levels in control group were significantly lower than the same group before treatment. Before treatment, no significant difference showed on serum TGF-β1, TNF-α, IL-6, IL-8 between two groups of patients. After treatment, each index levels in two groups were significantly lower than the same group before treatment, and levels in observation group at the same phase were significantly lower than control group. Conclusion:Effects of blood purification therapy on treating AOPP were worth approving, but effects of HP and HF combined therapy were more significant. In addition, improvement of HP+HF on CHE, DA and inflammatory factors were better than HP+HD.
基金Guangzhou Development Zone entrepreneurship leading talent project(2017-L153)Guangdong University blood purification technology and Engineering Research Center(GCZX-A1104)+2 种基金Guangzhou entrepreneurial leader talent/LCY201215Guangdong Provincial Center for clinical engineering of blood purification(507204531040)Guangdong Obers Blood Purification Academician Work station(2013B090400004)
文摘Female patients,44 years old,due to'regular peritoneal dialysis5 years,stomach ache 1 week'admission.Previous had 2 times for'Peritoneal dialysis related peritonitis'in hospital,after anti-infection treatment patients symptoms improved and discharged.1 week ago in patients admitted to hospital because of abdominal pain again.Physical:abdominal tenderness,bowel sounds hyperthyroidism.Laboratory inspection index:CRP:172.22 mg/l,WBC:23.26×10~9/L,NEU%:89.23%,D dimer:3 800 ng/ml,PCT:14.86 ng/ml。
文摘目的通过Meta分析评价血液灌流联合血液滤过对脓毒症炎症介质及预后的影响。方法检索PubMed、Web of Science、Medline、中国知网(CNKI)、万方数据库、维普数据库,选取血液灌流联合血液滤过对脓毒症治疗的随机对照试验(观察组采用血液灌流联合血液滤过治疗,对照组采用单纯血液滤过治疗),检索时间为建库至2023年6月30日。采用RevMan 5.4软件进行Meta分析,采用漏斗图进行偏倚评估。结果共纳入19篇文献,1322例患者。Meta分析结果显示:观察组与对照组患者相比C反应蛋白降低(SMD=-1.60,95%CI:-2.02~-1.18,P<0.001)、肿瘤坏死因子-α水平下降(SMD=-1.60,95%CI:-1.77~-1.43,P<0.001)、白细胞介素-6水平下降(SMD=-1.29,95%CI:-1.43~-1.14,P<0.001)、序贯器官衰竭评分降低(SMD=-0.74,95%CI:-0.98~-0.51,P<0.001)、病死率降低(RR=0.50,95%CI:0.39~0.65,P<0.001)。结论血液灌流联合血液滤过治疗可以下调脓毒症的炎症介质,降低序贯器官衰竭评分及病死率,改善预后。