Abstract Background: The etiologies of acute respiratory failure (ARF) in critically ill rheumatology patients remain unknown. We aimed to describe the clinical features, etiologies and outcomes of adult patients with systemic rheumatic diseases (SRDs) who were admitted to intensive care unit (ICU). Methods: We performed a retrospective study of all SRD patients with ARF who were admitted to a medical ICU between 2014 and 2018. We collected data on demographics, clinical characteristics, reasons for ICU admission and outcomes. Etiologies of ARF were classified as infection, SRD exacerbation, and undetermined. Independent predictors of ICU mortality were identified with multivariate logistic regression analysis. Results: A total of 259 patients admitted to ICU due to ARF were included in final analysis. Systemic lupus erythematosus, dermatomyositis/polymyositis (DM/PM), vasculitis and rheumatoid arthritis were the most common SRDs (78% of patients). Etiologies of ARF included infection (n = 209, 80.7%), SRD exacerbation (n = 71, 27.4%), and undetermined (n = 21, 8.1%). The most common pathogen was Pneumocystis jirovecii (39.8%), followed by Aspergillus spp. (33.2%), and cytomegalovirus (23.2%). One hundred and fifty-five patients (59.8%) died during ICU. Higher acute physiology and chronic health evaluation II score (odds ratio [OR] 1.118, 95% confidence interval [CI] 1.054 to 1.186, p < 0.001) and PaO2/FiO2 < 100 mmHg (OR 3.918, 95% CI 2.199 to 6.892, p < 0.001), DM/PM (OR 4.898, 95% CI 1.949 to 12.309, p = 0.001), vasculitis (OR 3.007, 95% CI 1.237 to 7.309, p = 0.015) and Pneumocystis pneumonia (OR 2.345, 95% CI 1.168 to 4.705, p = 0.016) were independent predictors of ICU mortality. Conclusions: Opportunistic infections and SRD exacerbation were the most common etiologies of ARF in patients with SRDs requiring ICU admission, with high ICU mortality. Development of a standard protocol for differential diagnosis in this group of immunocompromised patients might help initiate definitive therapy and improve clinical outcome. Keywords: Infection, Systemic rheumatic disease, Acute respiratory failure, Etiology
The ATP-binding cassette transporter A1 (ABCA1) is a membrane transporter that directly contributes to high-density lipoprotein (HDL) biogenesis by mediating the cellular efflux of cholesterol and phospholipids to lipid-poor apolipoprotein A-I.Therefore, identification of a novel upregulator of ABCA1 would be beneficial for atherosclerosis prevention and/or therapy because of its pivotal role in cholesterol homeostasis and HDL metabolism.In this study, a high-throughput assay method for ABCA1 upregulators was developed and used for screening a synthetic and natural compound library.The cellbased high-throughput screen is conducted in a 96-well format using the human hepatoma HepG2 cells stably transfected with ABCA1 promoter-luciferase construct and calibrated with reference ABCA1 upregulators (oxysterols, 9-cis-retinoic acid, thiazolidinediones, cyclic adenosine monophosphate, verapamil, fenofibrate, and oncostatin M).Among 2600 compounds, 4 microbial compounds (pyrromycin, aclarubicin, daidzein, and pratensein) were picked up as hits by the highthroughput screening assay, and those compounds were further identified as upregulators of ABCA1 expression by real-time quantitative reverse transcription-polymerase chain reaction and Western blot analysis.(
The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)
ObjectiveTo study the TCM syndrome differen tiation rules in coronary artery bypass grafting (CABG) patients during peri-operation period. Methods A ccording to the Guideline for Clinical Trail of Traditional Chinese New Drugs an d experience of Professor DENG Tie-tao, the standard of TCM syndrome differenti a tion for CABG patients was established, with which 161 CABG patients were classi fied before and two weeks after CABG operation. Results Before CABG, the qi st agnation and blood stasis syndrome type was the type most commonly seen (46.0%) , the next in turn was the phlegm stagnation type (24.8%), the yang-qi deficien cy type (15.5%), and the yin-blood deficiency type (13.7%). While after CABG, t he phlegm stagnation syndrome type was the most frequently occurred one (35.9%), t h en in turn was the yang-qi deficiency type (30.8%), the yin-blood deficiency typ e (21.2%) and the qi stagnation with blood stasis type (12.2%). Concl usionFor patients before CABG, the pathological characteristic is mostly the deficiency i n root with excess in superficiality, and the commonest syndrome is the qi stagn ation with blood stasis type. For patients after CABG, both deficiency and exces s is the pathological characteristic, the Xin-qi and Xin-yang deficiency syndr ome the commonest type, and with phlegm as the main pathologic factor.
AbstractBackground: Sevoflurane is metabolized in the body to Hexafluoro-isopropanol(HFIP). The aim of this study was to compare the levels of free HFIP in the blood of rats after inhalation of different concentrations of sevoflurane and the effects on the awakening period of rats, and to investigate the related mechanisms. Methods: Seventy-four healthy male rats of 8–10 weeks of age were selected. Six rats were used to determine the blood/gas partition coefficient of HFIP. Forty-eight rats were randomly divided into three groups: 0.5 minimum alveolar concentration (MAC) (group S1), 1.0 MAC (group S2), and 1.5 MAC (group S3), with 16 rats in each group. The free HFIP concentration in blood was measured by gas chromatography. Twenty rats were randomly divided into five groupsof four rats each, anesthetized by inhalation of 1.0 MAC sevoflurane for mine field tests, and immunohistochemistry was used to detect glial changes in cognition-related brain regions of rats. Results: The peak concentration of free HFIP in the blood of rats appeared at an inhalation concentration of 1 MAC (P<0.05), and the total mileage of the mine experiment was the longest in rats anesthetized for 1 h with 1.0 MAC sevoflurane (P<0.05).Expression of glial fibrillary acidic protein (GFAP) and IBA1 in cognitively related brain regions was significantly higher in rats anesthetized for 1 h with 1.0 MAC sevoflurane than the other time points (P<0.05). Conclusions: Free HFIP in the blood of rats reached its peak 1 hour after 1.0 MAC sevoflurane anesthesia was inhaled. Rats showed obvious arousal and excitement at this time, and glial cells and inflammatory factors in cognitively related brain regions were significantly activated.
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