Oxygen delivery-guided perfusion for the prevention of acute kidney injury: A randomized controlled trial

ObjectivesThe reduction of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery using an oxygen delivery-guided perfusion strategy (oxygen delivery strategy) for cardiopulmonary bypass management compared with a fixed flow perfusion (conventional strategy) remains controversial. The purpose of this study was to determine whether a oxygen delivery strategy would reduce the incidence of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery.MethodsWe randomly enrolled 300 patients undergoing cardiopulmonary bypass surgery. Patients were randomly assigned to a oxygen delivery strategy (maintaining a oxygen delivery index value >300 mL/min/m² through pump flow adjustments during cardiopulmonary bypass) or a conventional strategy (a target pump flow was determined on the basis of the body surface area). The primary end point was the development of acute kidney injury. Secondary end points were the red blood cell transfusion rate and number of red blood cell units, intubation time, postoperative length of stay in the intensive care unit and the hospital, predischarge estimated glomerular filtration rate, and hospital mortality.ResultsAcute kidney injury occurred in 20 patients (14.6%) receiving the oxygen delivery strategy and in 42 patients (30.4%) receiving the conventional strategy (relative risk, 0.48; 95% confidence interval, 0.30-0.77; P = .002). The secondary end points were not significantly different between strategies. In a prespecified subgroup analysis of patients who had nadir hematocrit less than 23% or body surface area less than 1.40 m², the oxygen delivery strategy seemed to be superior to the conventional strategy and the existence of quantitative interactions was suggested.ConclusionsAn oxygen delivery strategy for cardiopulmonary bypass management was superior to a conventional strategy with respect to preventing the development of acute kidney injury.     

Analysis of landing performance and ankle injury in elite British artistic gymnastics using a modified drop land task: A longitudinal observational study

ObjectivesTo determine whether differences in landing force and asymmetry of landing force exist between gymnasts at the time of data collection versus those that subsequently experienced an ankle injury 12-months later.Study designProspective longitudinal observational design with baseline measures and 12 month follow up.SettingBritish Gymnastics National Training Centre.ParticipantsThirty-two asymptomatic elite level gymnasts from three artistic gymnastic squads (n = 15 senior female, n = 10 junior female and n = 7 senior male).Main outcome measuresA modified drop land task was used to quantify measures of landing performance. Peak Vertical Ground Reaction Force (PVGRF) was used to measure landing force. The level of inter-limb asymmetry of landing force was calculated using the Limb Symmetry index (LSI). Other measures included injury incidence and percentage coefficient of variation (% CV).ResultsThere was no statistical difference for landing force (p = 0.481) and asymmetry of landing force (p = 0.698) when comparing injured and non-injured gymnasts. Most participants (69%) demonstrated inter-limb asymmetry of landing forces.ConclusionsOur findings observed inter-limb asymmetry of landing force in injured gymnasts, although uninjured gymnasts also exhibited asymmetry of landing force. Both magnitude of landing force and inter-limb asymmetries of landing force failed to identify the risk of ankle injury.     

急性心肌梗死患者D二聚体质量浓度与远期预后的关系

目的 探讨急性心肌梗死(acute myocardial infarction,AMI)患者D二聚体(D-dimer)质量浓度与病情严重程度和远期心源性死亡的关系。方法 选取2013年1月至2020年1月收入首都医科大学附属北京友谊医院的AMI患者3 990例,根据D-dimer质量浓度分为3组:≤0.50 mg/L、0.51～0.80 mg/L、≥0.81 mg/L,平均随访时间为2.1 (1.0～4.0) 年。应用Cox比例风险回归模型评估D-dimer对心源性死亡的影响。结果 D-dimer≥0.81 mg/L组患者年龄较大、女性居多、体质量指数较低,既往合并高血压、糖尿病者较多,3支病变较为多见,住院期间肾小球滤过率较低,N末端B型利钠肽原峰值明显升高,左室射血分数<50%患者比例明显升高。D-dimer≥0.81 mg/L组患者在随访期间累计心源性病死率(18.7%)高于D-dimer≤0.50 mg/L组(2.3%)和D-dimer 0.51～0.80 mg/L组(6.1%),且校正其他危险因素后,D-dimer能独立预测AMI患者的心源性死亡(HR=1.71,95%CI:1.34~2.18,P<0.001)。结论 D-dimer能反映AMI患者病情的严重程度,且D-dimer升高可在一定程度上预测AMI患者远期心源性死亡事件发生率升高。     

Cardioprotective effects of sinomenine in myocardial ischemia/reperfusion injury in a rat model

BackgroundIschemia reperfusion (I/R) play an imperative role in the expansion of cardiovascular disease. Sinomenine (SM) has been exhibited to possess antioxidant, anticancer, anti-inflammatory, antiviral and anticarcinogenic properties. The aim of the study was scrutinized the cardioprotective effect of SM against I/R injury in rat.MethodsRat were randomly divided into normal control (NC), I/R control and I/R + SM (5, 10 and 20 mg/kg), respectively. Ventricular arrhythmias, body weight and heart weight were estimated. Antioxidant, inflammatory cytokines, inflammatory mediators and plasmin system indicator were accessed.ResultsPre-treated SM group rats exhibited the reduction in the duration and incidence of ventricular fibrillation, ventricular ectopic beat (VEB) and ventricular tachycardia along with suppression of arrhythmia score during the ischemia (30 and 120 min). SM treated rats significantly (P < 0.001) altered the level of antioxidant parameters. SM treatment significantly (P < 0.001) repressed the level of creatine kinase MB (CK-MB), creatine kinase (CK) and troponin I (Tnl). SM treated rats significantly (P < 0.001) repressed the tissue factor (TF), thromboxane B2 (TXB2), plasminogen activator inhibitor 1 (PAI-1) and plasma fibrinogen (Fbg) and inflammatory cytokines and inflammatory mediators.ConclusionOur result clearly indicated that SM plays anti-arrhythmia effect in I/R injury in the rats via alteration of oxidative stress and inflammatory reaction.     

Examining Acute Coronary Syndrome Across Ethnicity,Sex, and Age

Acute coronary syndrome (ACS) remains one of the leading causes of death in the United States. With its heightened prevalence, considerable variabilities in the disease process exist across ethnicities, sex, and age. This creates substantial disparities in the recognition and management of ACS, which consequently contributes to poor outcomes. It is of utmost importance that nurse practitioners remain vigilant, cognizant, and maintain a high index of suspicion to accurately identify ACS presentations and thus efficaciously intervene to successfully manage the disease process.     

基础疾病负担对药物性肝损伤严重程度及预后的影响

目的探讨基础疾病对药物性肝损伤(drug-induced liver injury,DILI)患者严重程度及预后的影响。方法纳入北京友谊医院肝病中心2016年1月至2019年12月符合入排标准的DILI患者,依据查尔森合并症指数(Charlson Comorbidity Index,CCI)分为显著基础疾病负担组(CCI>2分)和无或轻度基础疾病负担组(CCI≤2分),通过卡方检验及非参数检验分析两组患者临床特征、损伤程度及预后。结果313例DILI患者年龄为(54±14)岁,女性227例(72.5%),其中无或轻度基础疾病负担的患者272例(86.9%),显著基础疾病负担的患者41例(13.1%)。与无或轻度基础疾病负担组相比,显著基础疾病负担组年龄更大[(63±8)岁比(52±14)岁]、体质指数[(24.2±5.2)比(23.1±3.6)kg/m²]及谷氨酰转肽酶[初始值283.0(159.0,404.0)U/L比189.0(100.0,325.0)U/L;峰值335.0(239.0,582.0)U/L比219.0(131.0,360.0)U/L]更高,差异均有统计学意义(均P<0.01);严重程度及临床分型两组相比差异无统计学意义(P>0.05)。在本队列中,250例(79.9%)DILI患者恢复正常,41例(13.1%)发展为慢性DILI,22例(7.0%)需要肝移植或者死亡,显著基础疾病负担组全因病死率及非肝脏相关的病死率均显著高于无或轻度基础病负担组患者(19.5%比3.7%;12.2%比0.7%,均P<0.01)。结论基础疾病负担重的患者预后差,以非肝脏相关死亡为主。