Mean perfusion pressure deficit during the initial management of shock—an observational cohort study

Purpose

It is unclear if blood pressure targets for patients with shock should be adjusted to pre-morbid levels. We aimed to investigate mean deficit between the achieved mean perfusion pressure (MPP) in vasopressor-treated patients and their estimated basal (resting) MPP, and assess whether MPP deficit has any association with subsequent acute kidney injury (AKI).

Materials and Methods

Fifty-one consecutive, non-trauma patients, aged ≥ 40 years, with ≥ 2 organ dysfunction and requiring vasopressor ≥ 4 hours were observed at an academic intensive care unit. Mean MPP deficit [=%(basal MPP − achieved MPP)/basal MPP] and % time spent with > 20% MPP deficit were assessed during initial 72 vasopressor hours (T0-T72) for each patient.

Results

Achieved MPP was unrelated to basal MPP (P = .99). Mean MPP deficit was 18% (95% CI 15-21). Patients spent 48% (95% CI 39-57) time with > 20% MPP deficit. Despite similar risk scores at T0, subsequent AKI (≥ 2 RIFLE class increase from T0) occurred more frequently in patients with higher (> median) MPP deficit compared to patients with lower MPP deficit (56% vs 28%; P = .045). Incidence of subsequent AKI was also higher among patients who spent greater % time with > 20% MPP deficit (P = .04).

Conclusions

Achieved blood pressure during vasopressor therapy had no relationship to the pre-morbid basal level. This resulted in significant and varying degree of relative hypotension (MPP deficit), which could be a modifiable risk factor for AKI in patients with shock.     

Spill Over Effects of Inpatient Bed Capacity on Accident and Emergency Performance in England

The English National Health Service (NHS) has failed to meet the four-hour waiting time target to admit, transfer or discharge 95 per cent of patients attending Accident and Emergency Departments (A&E) since 2013. A growing number of patients requiring inpatient care are waiting on trolleys longer than four hours before admission to a hospital bed. This study examines the role of bed occupancy in the deterioration of A&E performance in the NHS. Longitudinal panel data methods are used to analyse hospital data (n = 72,129,886) for 143 Trusts from 1^st June 2016 to 31^st October 2019. The average bed occupancy rate across the study period was 93.2%. A 1% increase in bed occupancy was associated with a 9.5 percentage point decrease in the Trusts’ probabilitay of meeting the waiting target, and an approximately 6 patient increase in four hours to 12 -hs trolley waits per 1,000 admissions. These relationships became more pronounced with rising bed occupancy levels above a 90% threshold. Bed occupancy is associated with significant negative spill-over effects on A&E performance. We estimate a minimum investment in 3,861 additional inpatient beds across the NHS to improve A&E performance in England. Relevant lessons can be derived for health care systems that have observed similar trends in increasing bed occupancy and deteriorations in A&E performance, including Ireland, Canada and Israel.     

双靶点抗肿瘤疫苗研制项目提升大学生综合能力

以大学生创新训练项目为契机,依托国家级生物制药实验教学示范中心平台,围绕"双靶点抗肿瘤疫苗研制"项目指导大学生进行相关理论知识的学习、科研思路的设计,并完成实验操作、数据整理、专利申请和论文写作等训练。初步选择鼠源粒细胞巨噬细胞集落刺激因子(mGM-CSF)和促胃泌素释放肽(GRP)为双靶点,完成了基因工程菌的构建、目标蛋白的制备、细胞培养、动物肿瘤模型的建立、肿瘤疫苗药效初步分析与探索。通过指导学生申请专利、发表文章、参加药苑论坛、挑战杯等各类比赛完成对学生的训练,提升其自主设计实验、自主完成实验、自主管理实验等综合能力。     

姜黄素联合阿托伐他汀对溃疡性结肠炎小鼠的保护作用及机制研究

目的：探讨桃红四物汤治疗腰椎间盘突出症的作用机制。方法：借助中药整合药理学平台,结合中医药大数据,按照“中药-成分-靶标-通路”关联性研究,探讨其治疗腰椎间盘突出的作用机制。结果：共得到桃红四物汤有效成分69个和腰椎间盘突出症的相关靶点396个,进行映射得到48个共同靶点。进行蛋白质-蛋白质相互作用（PPI）网络及其拓扑分析后得到含有203个节点的PPI网络,可能是桃红四物汤治疗LDH的重要靶点。进行基因本体（GO）和京都基因与基因组百科全书（KEGG）通路富集分析得到各排名前20的生物过程、分子功能、细胞组分和KEGG信号通路,生物过程涉及对脂多糖的反应、对细菌起源分子的反应等;分子功能涉及丝氨酸水解酶活性、细胞因子受体结合等;细胞组分涉及膜筏、膜微区等;KEGG信号通路涉及AGE-RAGE、TNF、IL-17等。结论：桃红四物汤通过多种通路对腰椎间盘突出症产生治疗作用,生物学机制可能与AGE-RAGE、TNF、IL-17等有关。