Hydrothermal treatment of pearl millet grains:Effects on nutritional composition,antinutrients and flour properties

Pearl millet(Pennisetum glaucum)is one of the major millets with high nutritional properties.This crop exhibits exceptional resilience to drought and high temperatures.However,the processing of pearl millet poses a significant challenge due to its high lipid content,enzyme activity,and presence of antinutrients.Consequently,it becomes imperative to enhance the quality and prolong the shelf life of pearl millet flour by employing suitable technologies.Hydrothermal treatment in the food industry has long been seen as promising due to its potential to reduce microbial load,inactivate enzymes,and improve nutrient retention.This study aims to investigate the effects of hydrothermal treatment on the quality characteristics of pearl millet.The independent variables of the study were soaking temperature(35,45,55℃),soaking time(2,3,4 h),and steaming time(5,10,15 min).Treatment conditions had a statistically significant effect on nutrient retention.Major antinutrients like tannins and phytates were reduced by 0.99% to 5.94% and 0.36% to 6.00%,respectively,after the treatment.Lipase activity decreased significantly up to 10% with the treatment conditions.The findings of this study could potentially encourage the use of pearl millet flour in the production of various food items and promote the application of hydrothermal treatment in the field of food processing.

Gene expression profiles in early leaf of rice(Oryza sativa)and foxtail millet(Setaria italica)

Plant anatomy is patterned early during leaf development which suggests studying the spatial–temporal transcriptomes of primordia will help identify critical regulative and functional genes.We successfully isolated the leaf primordia tissues from the C3grass rice and the C4grass foxtail millet by laser capture microdissection(LCM)and studied the gene expression throughout leaf developmental stages.Our data analysis uncovered the conserved expression patterns of certain gene clusters both in rice and foxtail millet during leaf development.We revealed genes and transcription factors involved in vein formation,stomatal development,and suberin accumulation.We identified 79 candidate genes associated with functional regulation of C4anatomy formation.Screening phenotype of the candidate genes revealed that knock-out of a putative polar auxin transport related gene NAL1 resulted significantly reduced veinal space in rice leaf.Our present work provides a foundation for future analyses of genes with novel functions in grasses and their role in leaf development,in particular the role in leaves with a contrasting C3vs.C4biosynthetic pathway.

Novel Rifle Number Recognition Based on Improved YOLO in Military Environment

Deep neural networks perform well in image recognition,object recognition,pattern analysis,and speech recog-nition.In military applications,deep neural networks can detect equipment and recognize objects.In military equipment,it is necessary to detect and recognize rifle management,which is an important piece of equipment,using deep neural networks.There have been no previous studies on the detection of real rifle numbers using real rifle image datasets.In this study,we propose a method for detecting and recognizing rifle numbers when rifle image data are insufficient.The proposed method was designed to improve the recognition rate of a specific dataset using data fusion and transfer learningmethods.In the proposed method,real rifle images and existing digit images are fusedas trainingdata,andthe final layer is transferredto theYolov5 algorithmmodel.The detectionand recognition performance of rifle numbers was improved and analyzed using rifle image and numerical datasets.We used actual rifle image data(K-2 rifle)and numeric image datasets,as an experimental environment.TensorFlow was used as the machine learning library.Experimental results show that the proposed method maintains 84.42% accuracy,73.54% precision,81.81% recall,and 77.46% F1-score in detecting and recognizing rifle numbers.The proposed method is effective in detecting rifle numbers.

Study of the Constraints of Millet Production (Pennisetum glaucum (L.) R. Br.) and the Peasant Perception of Biological Control in the Tahoua Region

Millet (Pennisetum glaucum (L.) R. Br.) is the Sahelian crop par excellence due to its adaptation to the particular production conditions in this region. Unfortunately, in recent years this crop has been threatened by very strong parasitic pressure and drought during the production period. The objective of this study is to analyze the main constraints of millet production and the solutions known to producers. A survey was carried out in November 2022 with a sample of 298 producers in five municipalities in the Tahoua region. The main constraints are drought and pressure from crop pests (locust, millet ear miner, floricultural insects) according to 57.9% of respondents. The millet ear miner is the most formidable pest according to 55% of respondents. Thus, the average yield obtained in a year of good production without the leafminer is 194 kg/ha and that obtained in a year of millet ear leafminer is around 27 kg to 43 kg/ha depending on the municipality. The yield obtained this last campaign after the attack of this leafminer varies from 64 to 77 kg/ha depending on the municipalities compared to a potential yield of over 1000 kg/ha. More than half of producers (58.1%) are unaware of the existence of biological control compared to only 12.5% who are aware of this alternative method. Work to popularize this technology is necessary in the five municipalities and the entire region in general.

Technological advancements in millet dehulling and polishing process: An insight into pretreatment methods, machineries and impact on nutritional quality

Millets are widely recognized for their nutritional significance;however, the methods employed for their processing are currently lacking. This article primarily focuses on the advanced technologies and progressions in millet dehulling and polishing. These technologies operate based on the fundamental principles of compression-shearing, abrasion-friction, and centrifugal-impact forces. Processing of millets can be challenging because of the physical characteristics and tight attachment of hull and bran to the endosperm. However, several dehullers have been designed to solve this problem for different kinds of millets. In addition, the nutritional and anti-nutritional characteristics undergo alterations due to both dehulling and polishing processes. These alterations are thoroughly examined and discussed in this article. Specifically, anti-nutrients such as tannins and phytate are predominantly found in the outer pericarp of the grain and experience a reduction after undergoing dehulling and polishing. The nutritional properties are also subjected to a reduction;however, this reduction can be mitigated by subjecting the grains to certain pretreatments before dehulling and polishing. These treatments serve to enhance dehulling efficiency and nutrient digestibility while simultaneously reducing the presence of anti-nutrients. Novel thermal and non-thermal methodologies such as microwave, hydrothermal, high-pressure processing, and ohmic heating can be employed for processing millets, thereby diminishing the loss of nutrients. Additional research can be carried out to investigate their impact on the dehulling and polishing of millets.

Gut microbiota remodeling drived by dietary millet protein prevents the metabolic syndrome

Metabolic syndrome(Met S)is a chronic disease associated with the disturbance of gut microbiota homeostasis.Metabolites derived from gut microbes play essential roles in Met S prevention and therapy.Here,we focused on the inhibitory effect of the extract of millet bran protein(EMBP)on a high-fat diet(HFD)-induced Met S,aiming to identify gut microbiota and their metabolites that involve in the anti-Met S activity of EMBP.The obesity,chronic inflammation,insulin resistance in Met S mouse models were abolished after EMBP treatment.The protective mechanism of EMBP against HFD-induced Met S may depend on improved gut barrier function.Using microbiome analysis,we found that EMBP supplementation improved gut microbiome dysbiosis in Met S mice,specifically upregulating Bacteroides acidifaciens.The fecal microbiota transplantation(FMT)also demonstrated this phenomenon.In addition,metabolomic analysis showed that EMBP mediates metabolic profiling reprogramming in Met S mice.Notably,a microbiota-derived metabolite,gamma-aminobutyric acid(GABA),is enriched by EMBP.In addition,exogenous GABA treatment produced a similar protective effect to EMBP by improving NRF2-dependent gut barrier function to protect HFDinduced Met S.The results suggest that EMBP suppress host Met S by remodeling of gut microbiota as an effective candidate for next-generation medicine food dual purpose dietary supplement to intervene in MetS.

SiRAP2-12,a Positive Regulatory Factor,Effectively Improves the Waterlogging Tolerance of Foxtail Millet(Setaria italica)

Foxtail millet(Setaria italica)growth was inhibited because of waterlogging stress,which has caused yield reduc-tion.ERF family plays an important role to plant adversity tolerance.In our study,we obtained 19,819 differential expressed genes(DEGs)between the two treatments based on the RNA-seq sequencing of foxtail millet of water-logging stress.Furthermore,a total of 28 ERF family members were obtained,which have a complete open read-ing frame.We studied the evolution and function of SiERF family and how they affected the waterlogging tolerance.It was found that SiERF1A/B/C(GenBank ID:OR775217,OR775219,OR775218)and SiRAP2-12(GenBank ID:OR775216)have similar functions to the known waterlogging tolerance genes of other plants.Among them,the SiRAP2-12 expression was obviously significantly up-regulated in foxtail millet after 5d water-logging stress.After SiRAP2-12 was silenced,the activity of defense enzymes in millet decreased significantly.In details,superoxide dismutase(SOD),catalase(CAT)and peroxidase(POD),the osmotic regulator proline(Pro),and the activity of the anaerobic respiratory enzyme alcohol dehydrogenase(ADH)content were decreased by 78.61%,29.52%,79.95%,19.41%and 54.77%,respectively.In contrast,the relative electrical conductivity contents(REC),malondialdehyde(MDA),and hydrogen peroxide(H_(2)O_(2))of the foxtail millet subjected to virus-induced gene silencing clearly increased by 1.03-fold,36.09%,and 15.21%,respectively.The content of sodium(Na^(+))in the SiRAP2-12-silenced foxtail millet also increased,but that of potassium(K^(+))decreased.Interestingly,we found that ethylene content was significantly reduced.Further,the SiAOC1 expression,an essential gene for ethylene synthesis,was inhibited in SiRAP2-12-silenced foxtail millet after waterlogging stress.Taken together,we hypothesized that SiRAP2-12 might be a positive regulator of millet tolerance to waterlogging stress.

Effects of Seeding Date and Density on Yield and Agronomic Traits of Millet : A Case Study of Wangu 098 Variety of Millet

[Objectives]To find out a suitable cultivation technique of Wangu 098 in Nanyang area,speed up the popularization,demonstration and application of Wangu 098,and provide a theoretical and practical basis for adjusting the planting structure and realizing the matching of improved varieties and methods.[Methods]The new self-bred millet variety Wangu 098 was used as the material,and the two-factor split zone experimental design was adopted.The effects of different sowing dates and densities on the yield,growth period and agronomic characters of millet were studied.[Results]The interaction of seeding date and density had a great effect on the yield and plant traits of millet.Millet yield was significantly and positively correlated with plant height,panicle length,single panicle weight,panicle grain weight and tiller number.[Conclusions]The reasonable combination of seeding date and density could give full play to the yield potential of millet.According to the experimental results and cultivation experience,the suitable seeding date of millet in Nanyang area is in the first and middle ten days of June,and the best density is about 750000 plants/ha.However,after June 30,the seeding millet did not tiller,so the density should be increased to more than 900000 plants/ha to obtain higher yield.In terms of cultivation and management,timely seeding,reasonable close planting,and coordination of vegetative growth and reproductive growth can make the plant tall and strong,panicle long and thick,and improve the yield of millet.

Millet Origin Identification Model Based on Near-infrared Spectroscopy

[Objectives]This study was conducted to clarify the difference of millet from different producing areas in near-infrared spectroscopy(NIRS)modeling.[Methods]Millet samples from six different regions were collected for NIRS analysis,and an origin identification model based on BP neural network was established.The competitive adaptive reweighted sampling(CARS)algorithm was used to extract characteristic wavelength variables,and a CARS-BP model was established on this basis.Finally,the CARS-BP model was compared with support vector machine(SVM),partial least squares discriminant analysis(PLS)and KNN models.[Results]The characteristic wavelengths were extracted by CARS,and the number of variables was reduced from 1845 to 130.The discrimination accuracy of the CARS-BP model for the samples from six producing areas reached 98.1%,which was better than SVM,PSL and KNN models.[Conclusions]NIRS can quickly and accurately identify the origin of millet,providing a new method and way for the origin identification and quality evaluation of millet.

Polyphenol from foxtail millet bran alleviates experimental colitis in mice by remodulating intestinal fungal community

Inflammatory bowel disease(IBD)is a chronic relapsing-remitting systemic disease of the gastrointestinal tract,characterized by an inflammatory process.Gut mycobiota community dysbiosis has been reported that is closely related to the development of IBD.Our previous findings indicated that polyphenol of the inner shell(BPIS)from foxtail millet bran could restore the gut microbiome and inhibit the progress of colorectal cancer(CRC).In the present study,we studied the anti-inflammatory potential of BPIS in the dextran sodium sulfate(DSS)-induced mouse colitis model.Data suggested that BPIS alleviated experimental colitis by restoring body weight,colonic length and protecting the epithelial architecture from damage by DSS.Moreover,we found that BPIS strengthened the gut barrier function and inhibited the activation of Wnt1/β-catenin pathway.Gene sequence analysis indicated that BPIS remodeled the overall structure of the gut mycobiota from colitis mice toward that of the normal counterparts,including 1 phylum and 9 genera.Interestingly,BPIS significantly increased the abundance of Aspergillus ruber.It further verified that BPIS significantly promoted the growth of A.ruber in vitro.Collectively,BPIS has great potential to develop into an effective against IBD drug.

Performance Evaluation of Novel Eco-Materials Composed of Millet Husks, Rice Husks, and Polystyrene

Managing agricultural waste and expanded polystyrene (EPS) poses significant environmental and economic challenges. This study aims to create composites from millet husks, rice husks, and recycled EPS, using a manufacturing method that involves dissolving the polystyrene in a solvent followed by cold pressing. Various particle sizes and two binder dosages were investigated to assess their influence on the physico-mechanical properties of the composites. The mechanical properties obtained range from 2.54 to 4.47 MPa for the Modulus of Rupture (MOR) and from 686 to 1400 MPa for the Modulus of Elasticity in Bending (MOE). The results indicate that these composites have potential for applications in the construction sector, particularly for wood structures and interior decoration. Moreover, surface treatments could enhance their durability and mechanical properties. This research contributes to the valorization of agricultural and plastic waste as eco-friendly and economical construction materials.

Evaluation of Phytochemical Analysis and Total Phenol Content of Proso Millet and Barnyard Millet

Whole grains of proso and barnyard millets were sequentially extracted using different solvents(hexane,chloroform,ethyl acetate,and methanol).Phytochemical analysis was performed qualitatively,and the total phenolic content in the extracts of proso and barnyard millets was quantified.Alkaloids and cardiac glycosides were identified in all solvent extracts of both millets.Anthraquinone and glycosides yielded negative results in all solvent extracts of both millets.Among all the solvent extracts,methanol extracts of proso and barnyard millets showed the presence of major compounds such as flavonoids,terpenoids,amino acids,tannins,and phenolics compounds.The maximum amount of phenols was found in methanolic extracts of proso and barnyard millets(0.669±0.003 and 0.625±0.003),followed by the chloroform extract of proso and barnyard millets(0.284±0.002 and 0.257±0.003).The minimum amount of phenolics was found in the acetone extract of proso and barnyard millets.The methanol extract of both millets showed the presence of major compounds with high phenolic content.

RIFLE标准和AKIN标准诊断急性肾损伤的对比研究

目的用RIFLE标准和AKIN标准评估急性肾损伤(AKI)的发生率,并比较AKIN标准和RIFLE标准在预测入住ICU危重患者病死率方面的优缺点。方法回顾性分析2003年1月—2008年6月入住ICU的331例患者(终末肾衰竭进行肾脏替代治疗的不包括在内)的临床资料。结果 AKIN标准比RIFLE标准诊断了更多的AKI患者(50.5%vs.43.8%,P=0.049),分类中1期(RIFLE标准中的风险期)患者更多(21.1%vs.14.8%,P=0.004),但是在对2期(RIFLE标准中的损伤期)(10.3%vs.10.9%,P=0.668)和3期(RIFLE标准中的衰竭期)(19.0%vs.18.1%,P=0.712)患者的诊断方面两者没有差异。按RIFLE标准定义的AKI患者的病死率明显高于非AKI患者(42.5%vs.12.4%,P<0.001),按AKIN标准定义的AKI患者的病死率明显高于非AKI患者(40.7%vs.9.8%,P<0.001)。RIFLE标准和AKIN标准在预测住院患者病死率方面差异无统计学意义(P>0.05)。结论和RIFLE标准相比,AKIN标准可以提高AKI诊断的敏感性,但在预测住院危重患者的病死率方面两者无差别。

RIFLE和AKIN标准在评价住院急性肾损伤患者病死率及其相关危险因素中的应用

目的:应用风险期、损伤期、衰竭期、丧失期、终末期肾病(risk,injury,failure,loss,end stage kidney disease,RIFLE)和急性肾损伤网络(acute kidney injury network,AKIN)两种标准评价住院急性肾损伤(acute kidney injury,AKI)患者的病死率及其相关危险因素。方法:分析2006年2月至2011年1月中南大学湘雅二医院各临床科室收治的AKI患者的临床资料,分别采用RIFLE和AKIN标准对已诊断为AKI的病例重新确认AKI诊断并分级,比较两种标准诊断的住院AKI各期患者临床特征、院内病死率及其相关危险因素;应用logistic回归分析筛选出影响AKI院内病死率的相关危险因素。结果:采用RIFLE标准诊断出1020例、AKIN标准诊断出1027例AKI患者。RIFLE和AKIN标准的所有AKI患者及其相对应各期患者的院内病死率、住院天数、完全恢复率两两比较,差异均未见统计学意义(P>0.05)。单因素方差分析显示,死亡组AKI患者的年龄、肾前性疾病、院内AKI、机械通气、低血压、多器官功能衰竭数目、急性肾小管坏死个体严重程度指数(ATN-ISS评分)、血清钾离子浓度与存活组患者比较均差异有统计学意义(P<0.05)。多因素logistic回归分析筛选出年龄≥65岁、院内AKI、低血压、多器官功能衰竭数目、ATN-ISS评分、血清钾离子浓度为影响AKI患者院内病死率的独立危险因素。结论:RIFLE和AKIN标准对住院AKI患者近期预后的评价具有相同科学价值,且AKI分级与住院AKI患者的预后有关。

RIFLE标准对蜂蛰伤并发多器官功能障碍患者行连续性静脉-静脉血液滤过治疗时机选择的价值

目的分析以连续性静脉-静脉血液滤过(CVVH)治疗RIFLE标准不同分期的蜂蛰伤并发多器官功能障碍综合征(MODS)患者的疗效,寻找最佳治疗时机。方法回顾性分析成都军区总医院、第三军医大学西南医院和新桥医院2006年以来收治的61例蜂蛰伤并发MODS患者资料,其中16例未行CVVH治疗,设为对照组;另外45例采用RIFLE标准的急性肾损伤(AKI)分期,按CVVH治疗时机分A组(AKIⅠ期开始CVVH治疗)、B组(AKIⅡ期开始CVVH治疗)、C组(AKIⅢ期开始CVVH治疗),严格按标准CVVH治疗。对比分析各组的死亡率、平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间以及蜂蛰伤至开始CVVH治疗的间隔时间,并将CVVH治疗前和治疗24 h后的APACHEⅡ评分、SOFA评分、血IL-6、氧合指数、血肌酐(Cr)、平均动脉压(MAP)等结果进行比较。结果 (1)对照组的死亡率明显高于行CVVH治疗组(P<0.01)。(2)C组CVVH治疗前APACHEⅡ评分、SOFA评分、血IL-6、死亡率以及蜂蛰伤至开始CVVH治疗的间隔时间均明显高于A、B两组(P<0.05)。(3)A、B两组死亡率及CVVH治疗前APACHEⅡ评分、SOFA评分差异无统计学意义,但B组CVVH治疗前IL-6浓度明显高于A组(P<0.05),平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间以及蜂蛰伤至开始CVVH治疗的间隔时间明显长于A组(P<0.01)。(4)A、B、C三组CVVH治疗24 h后血IL-6、氧合指数、Cr、MAP均明显改善(P<0.01),但C组IL-6仍高于A、B两组(P<0.05);A、B两组CVVH治疗24 h后APACHEⅡ评分、SOFA评分降低(P<0.01),C组治疗24 h后与治疗前相比差异无统计学意义。结论 CVVH是治疗蜂蛰伤并发MODS的一种有效手段,RIFLE标准对判断CVVH的治疗时机有指导意义,AKIⅠ期和Ⅱ期行CVVH可明显改善蜂蛰伤并发MODS的预后,而AKIⅠ期行CVVH的疗效更佳。

急性肾损伤的RIFLE标准在危重病患者中的临床应用

目的使用急性肾损伤（AKI）RIFLE分级标准评估危重患者AKI的发生率和住院病死率。方法回顾性分析2004—07—01～2006—12—31入住ICU的739例患者资料，包括患者性别、年龄、基础疾病、APACHEⅡ评分等，并按照RIFLE分级标准将患者分为四组：即肾功能正常组、RIFLE—R组、RIFLE—I组和RIFLE—F组，比较四组患者的APACHEⅡ评分、住院病死率及ICU入住时间。结果AKI在ICU患者的发生率是15．2％，R、I、F级发生率分别是6．2％、4．2％、4．7％，其中R级患者60例中14例（23．3％）发展为I级或F级，I级患者39例中8例（20．5％）发展为F级。住院期间达最大RIFLE分级R、I、F级的患者病死率分别是45．7％、64．5％、62．9％，而没有发生AKI的患者病死率是19．3％，RIFLE分级越高，APACHEⅡ评分越高，ICU入住时间越长。结论RIFLE分级R级患者有着进展为I或F级的高危险性。与未发生AKI的患者比较，AKI患者有着更高的APACHEⅡ评分，更长的住院时间和更高的住院病死率。

RIFLE、AKIN和KDIGO急性肾损伤诊断标准在肺移植术后的应用比较

目的比较风险、损伤、衰竭、失功能、终末期肾病(risk,injury,failure,loss,end stage renal disease,RIFLE)、急性肾损伤网络(acute kidney injury network,AKIN)和改善全球肾脏病预后组织(kidney disease:improving global outcomes,KDIGO)3种急性肾损伤(acute kidney injury,AKI)诊断标准在肺移植术后AKI评估方面的差异性。方法回顾性分析2017年4月~2019年4月在中日友好医院接受肺移植术的101例患者,对上述患者进行AKI诊断和分期,比较各分期患者在ICU住院天数、机械通气天数、体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持天数和总住院天数的差异,应用受试者工作特征曲线(receiver operating characteristic curve,ROC)比较3种诊断标准对术后1年死亡率的预测能力。结果根据RIFLE、AKIN和KDIGO标准,肺移植术后AKI的发生率分别为73.2%、71.6%和75.3%。3种标准下AKI各分期在ICU住院天数(H值分别为1.933,3.337,1.814;P值分别为0.586,0.343,0.612)、机械通气天数(H值分别为3.226,4.102,2.032;P值分别为0.358,0.251,0.566)、ECMO支持天数(H值分别为2.646,0.638,1.847;P值分别为0.450,0.888,0.605)和总住院天数(H值分别为0.678,0.576,1.151;P值分别为0.878,0.902,0.765)上没有差异性。RIFLE、AKIN和KDIGO标准预测肺移植术后1年死亡率的ROC曲线下面积(area under the curve,AUC)分别为0.744、0.710和0.765,其中AKIN与KDIGO比较,差异有统计学意义(Z=2.009,P=0.044)。结论肺移植患者术后AKI的发生率因采用诊断标准不同而异。KDIGO标准可以诊断更多的AKI患者,对术后1年死亡率预测能力更强。

RIFLE标准在HVHF治疗严重创伤并发MODS的应用研究

目的:探讨以RIFLE标准衡量高容量血液滤过(High-volume hemofiltration,HVHF)治疗严重创伤并发多器官功能障碍综合征(Multiple organ dysfunction syndrome,MODS)的治疗时机及其对预后的影响。方法:回顾性分析成都军区总医院和西南医院自2006年以来行HVHF治疗的47例严重创伤并发MODS的患者,采用RIFLE标准,分A组(AKIⅠ期)、B组(AKIⅡ期)、C组(AKIⅢ期),以AKI分期作为HVHF治疗的时机,对比分析各组的死亡率、平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间,并将HVHF治疗前和治疗24 h后的APACHEⅡ评分、SOFA评分、血浆IL-6、氧合指数、血浆肌酐(Cr)、平均动脉压(MAP)等结果进行比较。结果:①C组HVHF治疗前APACHEⅡ评分、SOFA评分、血浆IL-6及死亡率均明显高于A、B 2组(P<0.01);②A、B 2组HVHF治疗前APACHEⅡ评分、SOFA评分及死亡率差异无统计学意义,但B组HVHF治疗前IL-6浓度以及平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间明显高于或长于A组(P<0.01);③3组HVHF治疗24 h后血浆IL-6、氧合指数、Cr、MAP均明显改善,但C组IL-6仍高于A、B 2组(P<0.01),B组IL-6仍高于A组(P<0.01);A、B 2组HVHF治疗24 h后APACHEⅡ评分、SOFA评分显著降低(P<0.01),C组变化无显著性。结论:HVHF能有效辅助治疗严重创伤并发MODS;RIFLE标准及IL-6对判断预后有指导意义;早期(AKIⅠ期和Ⅱ期)行HVHF可明显改善严重创伤并发MODS的预后,而AKIⅠ期行HVHF的疗效更好。

RIFLE与AKIN急性肾损伤诊断标准在心脏手术患者中的应用比较

目的比较RIFLE与AKIN的急性肾损伤(AKI)诊断标准在心脏手术患者中的应用价值。方法收集2004年1月至2007年6月接受心脏手术患者的病史资料,分别采用RIFLE和AKIN标准对心脏手术后AKI(发生于术后7 d内)进行诊断和分期,比较两种标准的诊断敏感性及预测患者院内死亡的精确性。结果共有1 056例患者纳入研究。RIFLE与AKIN标准诊断的心脏手术后AKI发病率比较,差异无统计学意义(29.55%vs31.06%,P>0.05)。RIFLE与AKIN标准诊断的AKI患者的住院病死率以及对应各期患者的住院病死率比较,差异均无统计学意义(P>0.05)。Logistic回归分析显示,根据RIFLE和AKIN分期标准评估对应各期AKI患者发生院内死亡的相对危险度均较为接近。RIFLE和AKIN的AKI分期标准预测患者院内死亡的ROC曲线下面积分别为0.856和0.865(均P<0.001)。结论与RIFLE标准比较,AKIN标准在对心脏手术后AKI诊断的敏感性及患者院内死亡预测的精确性方面未显示出明显的优势。

危重病评分系统预测急性肾损伤患者预后优于RIFLE分级

目的评价并比较序贯性脏器衰竭评分(sequential organ failure assessment,SOFA)、急性生理学与慢性健康状况评分(acute physiology and chronic health evaluation,APACHE)Ⅱ、简明急性生理学评分(simplified acute physiology score,SAPS)Ⅱ和Liano评分4种危重病评分系统及RIFLE标准对急性肾损伤(acute kidney injury,AKI)患者的预后评估价值。方法本研究为前瞻性、单中心研究,收集2008年12月到2009年11月复旦大学附属华山医院各种病因引起的AKI患者。AKI的诊断标准为RIFLE的肌酐标准,除外肾后性、肾小球性、肾血管性和间质性肾炎等引起的急性损伤。研究的主要终点是28d死亡率。比较存活组和死亡组的RIFLE分级、SOFA、APACHEⅡ、SAPSⅡ和Liano评分,并进行各种评分系统对死亡的ROC曲线分析,同时将4种评分方法根据RIFLE分级进行分层分析。结果共入选194例符合入选标准的AKI患者。存活组和死亡组的RIFLE分级、AKI病因、是否需要透析差异无统计学意义(P>0.05)。死亡组的机械通气比例、SOFA、APACHEⅡ、SAPSⅡ和Liano评分显著高于存活组(P<0.001)。SOFA、APACHEⅡ、SAPSⅡ和Liano评分预测死亡的受试者工作特性(ROC)曲线下面积分别为0.900、0.885、0.888、0.875(均P<0.001),而RIFLE的ROC曲线下面积为0.566(P>0.05)。按AKI的RIFLE级别进行分层分析时发现,4个评分方法在衰竭组(Fc)ROC曲线下面积最大,其中又以Liano评分最高。结论 RIFLE分级对AKI患者的预后无明显的判断价值,而危重病评分包括SOFA、APACHEⅡ、SAPSⅡ和Liano评分对AKI的预后具有良好的预测价值。