Because existing anticoagulants may have contraindications and side effects, continuous renal replacement therapy (CRRT) without anticoagulants is nevertheless widely used. Although it does not produce major adverse effects without anticoagulant CRRT, it can raise the risk of clotting, which can lead to treatment cessation. Extracorporeal circulation lines with saline flush are frequently utilized as a non-pharmaceutical anticoagulation strategy. However, in the absence of anticoagulant CRRT, its clinical efficacy remains debatable. Therefore, this article reviews the specific procedures, flushing frequency, flushing effect, and adverse events of flushing extracorporeal circulation lines with normal saline when CRRT is free anticoagulant, generating fresh ideas for future research.
Objective?To compare the effect of continuous subcutaneous insulin infusion (CSII) with that of multiple daily insulin injections (MDI) in the patients with newly-diagnosed type 2 diabetes, and to provide evidence for clinical treatment. Methods?We searched MEDLINE and Chinese Science and Technology Full-text Database up to Dec. 2009 to identify randomized controlled trials (RCTs) that had been conducted with patients with newly diagnosed type 2 diabetes mellitus. The selection of studies, data extraction and assessment of methodological quality were performed independently by two reviewers. Meta-analyses were performed using RevMan 5.0.23 software. The following outcomes were assessed: glycaemic control, insulin requirements, HOMA-IR, HOMA-β, hypoglycaemia and diabetic remission after follow-up. Results?Eight RCTs involving 597 newly-diagnosed type 2 diabetic patients were included. The methodological quality of the most studies was lower. The funnel plot comparing insulin requirement of CSII therapy with that of MDI therapy showed asymmetry, indicating that there was publication bias. The results of meta-analyses showed that: CSII had the same effect on improving fasting blood glucose (WMD= –0.21, 95%CI –0.42 to 0.00, P=0.05) and postprandial blood glucose (WMD= –0.24, 95CI% –0.57 to 0.08, P=0.14) as MDI in newly-diagnosed type 2 diabetes. CSII therapy took 2.74 days fewer than MDI therapy (WMD= –2.74, 95CI% –3.33 to –2.16, Plt;0.000 01) and needed lower insulin requirements (reducing 7.78 units per day) (WMD= –7.78, 95CI% –9.25 to –6.31, Plt;0.000 01) to get target glucose control. The rate of hypoglycaemia of CSII therapy decreased 69% (OR= 0.31, 95%CI 0.12 to 0.80, P=0.01) compared with that of MDI. The rate of diabetes remission after short-term intensive insulin therapy increased 46% (OR=1.46, 95%CI 1.01 to 2.10, P=0.04) in CSII therapy compared with that in MDI therapy. Conclusion?In newly-diagnosed type 2 diabetes, CSII therapy is better than MDI therapy. But because of the low quality of the included studies, the conclusion should be combined with patients and physicians’ experience, advantages and disadvantages in the clinical application.
ObjectiveTo investigate the effect of pulsed colloid infusion combined with continuous blood purification (CBP) for treatment of severe capillary leak syndrome (CLS).
MethodsAccording to random principle,61 patients were divided into a control group(n=21),a CBP1 group(n=18) and a CBP2 group(n=22). All patients of three groups received routine treatment according to international guidelines 2008 for management of severe sepsis. The patients in the control group also received pulsed infusion colloid combined lasix. The patients in the CBP1 and CBP2 groups also received continuous veno-venous hemofiltration(CVVH) for 72 hours. The patients in the CBP1 group received concentrated colloid infusion combined lasix,and the patients in the CBP2 group received concentrated colloid infusion combined removing fluid. Blood gas analysis and Impedance Cardiography was performed before and 24,48 and 72 hours after therapy. The angiopoietin-2(Ang-2) was measured. Also the length of ICU stay,duration of mechanical ventilation,and death rate of patients in 28 days were observed.
ResultsCompared with the control group and the CBP1 group,the length of ICU stay(days) and duration of mechanical ventilation (days) in the CBP2 group were significantly shorter(P<0.05),and the death rate in 28 days was lower(P<0.05). The patients in the CBP2 group showed more reduction in the APACHEⅡ score compared with the CBP1 group after therapy(P<0.05). The oxygenation index in the CBP2 group respectively increased at 24,48 and 72 hours after therapy(P<0.05). Compared with the control group and the CBP1 group,the oxygenation index in the CBP2 group respectively increased at the same time(P<0.05). The thoracic fluid content (TFC) in the CBP2 group respectively decreased at 24,48 and 72 hours(P<0.05) after therapy,and decreased compared with the control group and the CBP1 group at the same time(P<0.05). The serum levels of Ang-2 in the CBP2 group respectively decreased at 24,48 and 72 hours after therapy(P<0.05),and decreased compared with the control group and the CBP1 group at the same time(P<0.05).
ConclusionPulsed colloid infusion combined with continuous blood purification can reduce the severity of capillary leak and improves the outcome of patients with severe sepsis.
Objective To assess the effectiveness of the auto-continuous positive airway pressure (Auto-CPAP) versus the fixed-continuous positive airway pressure (Fixed-CPAP) in patients with obstructive sleep Apnea syndrome (OSAS). Methods Such databases as PubMed (1990 to 2010), SpringerLink (1995 to 2010), CNKI (1990 to 2010), WanFang Data (1995 to 2010), and Google academic (1994 to 2010) were searched, the relevant conference theses were retrieved, and the experts in this field were enquired to collect the randomized controlled trials (RCTs) on Auto-CPAP versus Fixed-CPAP for patients with OSAS. Two reviewers independently screened the trials according to inclusion and exclusion criteria, abstracted the data, and assessed the methodology quality. Meta-analyes was performed using RevMan 5.0 software. Results A total of 11 RCTs involving 327 patients were included. The results of meta-analyses showed that, compared with the Fixed-CPAP group after treatment, the Auto-CPAP group significantly reduced the mean effective therapeutic pressure (WMD=-1.79, 95%CI -3.39 to -0.20), won much better treatment adherence (WMD=0.43, 95%CI 0.30 to 0.56), but got much higher scores of the Apnea-hypopnea index (AHI) (WMD=1.17, 95%CI 0.25 to 2.08) and Epworth Sleepiness Scale (ESS) (WMD=0.88, 95%CI 0.42 to 1.33) as well. There was no significant difference between those two groups in patients’ subjective preference for treatment (OR=2.06, 95%CI 0.46 to 9.10). Conclusion Compared to the Fixed-CPAP, the Auto-CPAP significantly reduces the mean effective therapeutic pressure and improves the treatment adherence of the patients, but is inferior in decreasing AHI and ESS. However, more high-quality and large-scale RCTs are required to verify the above conclusion because of the limitation of research quality and sample at present.
Objective To summarize and analyze the clinical outcomes and experiences of continuous renal replacement therapy(CRRT) in patients with acute renal insufficiency after heart transplantation. Methods There were 39 patients received orthotopic heart transplantation from September 2007 to September 2008 in Fu Wai hospital. Seven cases required the use of PRISMA CRRT machine (Gambro Healthcare,Inc.) because of acute renal insufficiency after heart transplantation, and received continuous venovenous hemodiafiltration(CVVHDF) treatment via M100 blood filter (hemofilters). Activated coagulation time (ACT) was maintained in 160200 s. Results Six survivals with New York Heart Association (NYHA)Ⅰdischarged ，1 case died of multiple system organ failure (MSOF) and severe infection. The time of CRRT was 48658 h, with an average of 252 h. Seven patients were oliguric or anuric during CRRT, but hemodynamics and internal environment were stable. After stopping CRRT, the creatinine level rose to 267.1±68.5 μmol/L， then the creatinine level decreased to normal range with urine increasing gradually. Postoperative glomerular filtration rate (GFR) was 56.5±19.0 ml/min， and there was no statistical significance compared with preoperative GFR（Pgt;0.05）. Six survivals were followed up for 513(9.7±3.8)months，and their creatinine level was in normal range(90.6±26.7 μmol/L). There was no statistical significance compared with the creatinine level at discharge (83.2±26.5 μmol/L, Pgt;0.05）. Conclusion The prognostic outcomes of patients with acute renal insufficiency after heart ransplantation are excellent after using CRRT. No significant renal dysfunction is found.
ObjectiveTo study the effects of continuous regional arterial infusion (CRAI) of dexamethasone on plasma inflammatory factors of severe acute pancreatitis (SAP) rabbits. MethodsTwentyfour rabbits were randomly divided into sham operation group, SAP group, intravenous infusion of dexamethasone group and CRAI of dexamethasone group (each group 6 rabbits) by random number table. The serum tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and amylase (AMY) levels in rabbits were tested at hour 0.5, 3, 6, 9, and 12 after modeling succeed. The pathological changes of pancreas and the survival were observed on day 3 after modeling succeed. ResultsCompared with the sham operation group, the serum levels of IL-6 significantly increased at 3 h and reached the peak at 6 h, decreased at 9 h (all Plt;0.05); levels of IL-10 significantly increased at 6 h, continuously elevated at 9 h and 12 h (all Plt;0.001); levels of TNF-α significantly increased at 0.5 h (Plt;0.001), reached the peak at 6 h (Plt;0.001) and decreased at 9 h (Plt;0.05); levels of AMY significantly increased at 9 h, continuously elevated at 12 h (all Plt;0.05) in the SAP group. Compared with the SAP group, the serum levels of IL-6 and IL-10 in the CRAI of dexamethasone group all significantly decreased at 6 h, 9 h, and 12 h (Plt;0.001); levels of IL6 significantly decreased only at 6 h in the intravenous infusion of dexamethasone group; levels of TNF-α in the CRAI of dexamethasone group significantly decreased at 3 h, 6 h, 9 h, and 12 h (all Plt;0.001), which in the intravenous infusion of dexamethasone group significantly decreased only at 6 h (Plt;0.05); levels of AMY in the CRAI of dexamethasone group and intravenous infusion of dexamethasone group all significantly decreased at 12 h (Plt;0.05). Compared with the intravenous infusion of dexamethasone group, the serum levels of IL-6 and IL-10 in the CRAI of dexamethasone group all significantly decreased at 6 h (Plt;0.05) and 12 h (Plt;0.001); levels of TNF-α all significantly decreased at 3 h, 6 h, 9 h, and 12 h (all Plt;0.001); levels of AMY were not significantly different (Pgt;0.05). The pathological changes of pancreas in the CRAI of dexamethasone group were obvious, the death of rabbits reduced on day 3 after modeling succeed. ConclusionCRAI dexamethasone can effectively reduce the systemic inflammatory response and pancreatic inflammation, and reduce mortality.
ObjectiveTo assess postoperative analgesia and early rehabilitation of continuous incision infiltration with ropivacaine in open gastrectomy.
MethodsFrom June 2011 to October 2014, 50 patients underwent open gastrectomy were divided into two groups:standard analgesic therapy group (Abbreviation:standard group, n=25) and continuous incision infiltration with ropivacaine group (Abbreviation:ropivacaine group, n=25). All the patients were also given patient controlled intravenous analgesia (PCIA). Points of visual analog scale (VAS), Bruggrmann comfort scale (BCS), and nausea and vomiting were assessed at different time during the first 48 hours postoperatively. Total sufentanil dosage, the first postoperative ambulation time, bowel recovery time, postoperative hospital stay, and incision infection rate were compared between two groups.
ResultsAt 4 h, 8 h, 16 h, 24 h, 48 h postoperatively, the points of VAS in the ropivacaine group were significantly lower than those in the standard group (P < 0.05), the points of BCS in the ropivacaine group were significantly higher than those in the standard group (P < 0.05). Compared with the standard group, the dosage of sufentanil was significantly less (P < 0.05), the bowel recovery time, the first postoperative ambulation time, and the postoperative hospital stay were significantly shorter (P < 0.05), the point of nausea and vomiting was significantly lower (P < 0.05) at 48 h postoperatively in the ropivacaine group. There was no difference of the incision infection rate between the two groups (P > 0.05).
ConclusionContinuous incision infiltration with ropivacaine is effective and safe to relief postoperative pain and accelerate patient's recovery after open gastrectomy.
Objective
To investigate the therapeutic effect of continuous renal replacement therapy (CRRT) plus hemoperfusion (HP) on patients with diabetes and uremic encephalopathy.
Methods
Fifty-five patients with diabetes and uremic encephalopathy from January 2010 to December 2017 were retrospectively collected in this study and divided into CRRT plus HP (CRRT+HP) group (n=28) and hemodialysis (HD) plus HP (HD+HP) group (n=27). The changes of vital signs, related biochemical indicators before and after treatment and curative effects were compared between the two groups.
Results
The two groups were comparable in general. No significant differences were found in blood pressure or heart rate before and after treatment between the two groups (P>0.05). The incidence of hypotension events in CRRT+HP group was significantly lower than that in HD+HP group (P<0.05), and the effective rate of cardiac function improvement in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). After treatment, the blood urea nitrogen, creatinine, parathyroid hormone, β2-microglobulin, phosphorus, C-reactive protein and brain natriuretic peptide in the two groups were significantly decreased than those before treatment (P<0.05). Parathyroid hormone, β2-microglobulin, C-reactive protein and brain natriuretic peptide were significantly decreased in CRRT+HP group as compared with those in HD+HP group (P<0.05). The remission rate of uremic encephalopathy in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05).
Conclusions
As compared with HD+HP pattern, CRRT+HP pattern is more stable in the hemodynamics, and more effective in the improvement of heart failure and the clearance of inflammatory mediators, middle molecular and macromolecular substances associated with uremic encephalopathy. CRRT+HP pattern is suitable for the treatment of patients with diabetes and uremic encephalopathy.
The existing automatic sleep staging algorithms have the problems of too many model parameters and long training time, which in turn results in poor sleep staging efficiency. Using a single channel electroencephalogram (EEG) signal, this paper proposed an automatic sleep staging algorithm for stochastic depth residual networks based on transfer learning (TL-SDResNet). Firstly, a total of 30 single-channel (Fpz-Cz) EEG signals from 16 individuals were selected, and after preserving the effective sleep segments, the raw EEG signals were pre-processed using Butterworth filter and continuous wavelet transform to obtain two-dimensional images containing its time-frequency joint features as the input data for the staging model. Then, a ResNet50 pre-trained model trained on a publicly available dataset, the sleep database extension stored in European data format (Sleep-EDFx) was constructed, using a stochastic depth strategy and modifying the output layer to optimize the model structure. Finally, transfer learning was applied to the human sleep process throughout the night. The algorithm in this paper achieved a model staging accuracy of 87.95% after conducting several experiments. Experiments show that TL-SDResNet50 can accomplish fast training of a small amount of EEG data, and the overall effect is better than other staging algorithms and classical algorithms in recent years, which has certain practical value.
Blood glucose monitoring has become the weakest point in the overall management of diabetes in China. Long-term monitoring of blood glucose levels in diabetic patients has become an important means of controlling the development of diabetes and its complications, so that technological innovations in blood glucose testing methods have far-reaching implications for accurate blood glucose testing. This article discusses the basic principles of minimally invasive and non-invasive blood glucose testing assays, including urine glucose assays, tear assays, methods of extravasation of tissue fluid, and optical detection methods, etc., focuses on the advantages of minimally invasive and non-invasive blood glucose testing methods and the latest relevant results, and summarizes the current problems of various testing methods and prospects for future development trends.
