Shibing Zhao

Abstract Massive hemorrhage following tissue trauma has high mortality owing to the lack of timely intervention. However, research on utilizing hemostats for humans is limited; therefore, developing an efficient emergency hemostatic agent is imperative. We developed a hemostatic sponge using natural polysaccharide riclin, theoretically modified with 50% aldehyde content (AR50). The AR50 sponge, with quasi-honeycomb channels and appropriate aldehyde content, exhibits ultra-high blood absorption (59.4 g·g −1 ) and rapidly targets erythrocytes and platelets to form a stable barrier. It surpasses most commercial hemostats in porcine artery scission (reducing hemostasis time and blood loss by 53 s and 4.2 g), hepatic bleeding laceration (68 s and 2.6 g), and perforation models (140 s and 4.9 g). The AR50 sponge is easily removed post hemostasis, exhibits antibacterial properties by destroying bacterial cell walls, and is safely absorbed by day 5, making it an ideal emergency hemostatic agent for massive hemorrhages in humans.

In order to provide an idea dose of polymyxin B in Chinese patients with renal impairment, the present study collected the clinical data of all patients with renal impairment who received polymyxin B therapy in the intensive care unit (ICU) of The First Affiliated Hospital of Bengbu Medical College (Bengbu, China). The clinical data of six patients treated in the ICU between February 2018 and May 2019 were retrospectively analyzed. All patients had renal impairment and were treated with polymyxin B combination therapy. The patients in the current study received polymyxin B and carbapenem, or polymyxin, carbapenem, cefoperazon and sulbactam, or polymyxin B, carbapenems and aminoglycoside treatment. One patient discontinued treatment. The other five patients received polymyxin B at a dosage of 50 mg every 12 h (100 mg/day) through an intravenous drip. During treatment, four of the five patients had deteriorating renal function to varying degrees, and continuous renal replacement therapy (CRRT) was initiated. Polymyxin B was discontinued in all patients when the infection was controlled. After treatment, four of five patients showed improvement in renal function, and had normal kidney function at the 1-month follow-up evaluation, whereas one patient had chronic renal disease. During hospitalization, one patient experienced neurotoxicity, showing decreased limb muscle strength and cognitive impairment, which might have been caused by polymyxin B, according to the Naranjo adverse drug reactions probability scale (also known as the Naranjo algorithm) score. The present report demonstrated that the administration of 100 mg daily dosage of polymyxin B to the five patients weighing between 50 and 75 kg, could control pulmonary infection during the course of treatment of Chinese patients with renal impairment, however, further research is needed to verify this result. Risk factors for nephrotoxicity and neurotoxicity need to be fully assessed before initiating polymyxin B therapy in patients with renal impairment.

OBJECTIVE: To investigate the effects of restrictive fluid management in patients with severe traumatic brain injury (sTBI). METHODS: =26) with conventional fluid management. The data of optic nerve sheath diameter (ONSD), middle cerebral artery pulsatility index (MAC- PI), neuron-specific enolase (NSE) level, inferior vena cava (IVC) diameter, Glascow Coma Scale (GCS) score, mean arterial blood pressure, heart rate, and fluid balance of the patients were collected at ICU admission and at 1, 3 and 7 days after ICU admission, and the duration of mechanical ventilation, ICU stay, and 28-day mortality were recorded. RESULTS: < 0.05). CONCLUSIONS: Restrictive fluid management can reduce cerebral edema and improve the prognosis but does not affect the 28-day mortality of patients with sTBI.

OBJECTIVE: To investigate the changing laws of rest energy expenditure (REE) in intensive care unit (ICU) patients and the intervention effect for nutritional support. METHODS: A prospective randomized control trial was conducted. Fifty-eight critically ill patients who were expected to be able to receive sustained enteral and (or) parenteral nutrition for more than 7 days admitted to ICU of the First Affiliated Hospital of Bengbu Medical College from December 2016 to June 2017 were enrolled. The patients were divided into REE group (n = 29) and HBREE group (n = 29) according to the random number table. On the 1st to 7th day after ICU admission, the indirect calorimetry and the Harris-Benedict (HB) formula were used to obtain the REE and HBREE values, and nutritional support was given according to REE and HBREE values respectively. The data of hemoglobin (Hb), albumin (Alb), prealbumin (PA), C-reactive protein (CRP), oxygenation index (OI) on 1st, 3rd, 5th, 7th and discharged day, and insulin dosage, vasopressor time, mechanical ventilation time, the length of ICU stay, and 28-day mortality were collected. RESULTS: (1) At the beginning, the REE level was high, and then decreased gradually with the extension of hospitalization, and the decline was obvious on the 2nd to 3rd day (kJ/d: 7 088.38±559.41, 6 751.34±558.72 vs. 7 553.44±645.55, both P < 0.05), and was stable from the 5th day, the changing laws showed high at first, then the low, the first rapid decline, then the slow decline, and then reached the steady, there was a 2-day plateau in the middle. During the first 2 days, the REE value was significantly higher than the HBREE value (kJ/d: 7 553.44±645.55 vs. 6 759.21±668.14, 7 088.38±559.41 vs. 6 759.21±668.14, both P < 0.01); on the 3rd, 4th day, the REE value was almost the same as the HBREE value (kJ/d: 6 751.34±558.72 vs. 6 759.21±668.14, 6 568.03±760.19 vs. 6 759.21±668.14, both P > 0.05). After that, the REE value was significantly lower than the HBREE value (kJ/d: 6 089.55±560.70 vs. 6 759.21±668.14, 5 992.55±501.82 vs. 6 759.21±668.14, 5 860.84±577.59 vs. 6 759.21±668.14, all P < 0.01). (2) After the initiation of nutritional support, Hb in the REE group (the first 3 days) and HBREE group (the first 7 days) all increased slowly in the early stage. It increased obviously on the 5th day in the REE group. Compared with the REE group, Hb increased more slowly in the HBREE group, however, there was no difference between the two groups at the time of discharge (g/L: 113.75±17.28 vs. 110.86±15.35, P > 0.05). PA and OI all enhanced significantly on the 3rd day since the nutritional support was initiated, but the daily increase of the REE group was significantly higher than that of the HBREE group [3rd day, PA (mg/L): 110.38±27.65 vs. 96.28±18.06, OI (mmHg, 1 mmHg = 0.133 kPa): 259.29±49.36 vs. 231.74±28.02, both P < 0.05]. The Alb and CRP in the REE group began to improve on the 3rd day, while the index in the HBREE group was delayed on the 5th day, overall, at the time of discharge, the PA, CRP and OI were lower in the HBREE group than in the REE group [PA (mg/L): 252.28±56.94 vs. 295.86±57.26, CRP (mg/L): 73.14±17.63 vs. 56.52±14.91, OI (mmHg): 353.59±70.36 vs. 417.52±71.58, all P < 0.01]. (3) The vasopressor was used in both groups for less than 3 days, but the REE group was shorter (days: 2.26±0.82 vs. 2.95±1.22, P < 0.05), the insulin dosage in the HBREE group was much more than that in the REE group (U: 101.97±21.05 vs. 84.59±22.21, P < 0.01); compared with the REE group, the time of mechanical ventilation and the length of ICU stay in the HBREE group were longer (hours: 113.07±25.96 vs. 93.41±27.25, days: 10.41±3.11 vs. 8.45±2.44, both P < 0.01). There was no significant difference in the 28-day mortality between the REE group and HBREE group (17.24% vs. 24.14%, P > 0.05). CONCLUSIONS: Indirect calorimetry can more accurately grasp the changing laws of REE in critically ill patients. Nutritional support with REE value can make relevant nutritional indicators as good as possible, and reduce insulin dosage, shorten vasopressor use time, the length of ICU stay and mechanical ventilation time, but does not change the 28-day mortality.

OBJECTIVE: This study investigated the risk factors for acute kidney injury (AKI) occurrence in patients with spontaneous intracerebral hemorrhage. METHODS: The clinical data of patients with spontaneous intracerebral hemorrhage who were hospitalized in the Department of Intensive Care Medicine of Mingguang People's Hospital from January 2016 to August 2020 were retrospectively analyzed. The patients were divided into AKI group and non-AKI group according to whether the patient had secondary AKI, and the clinical data of the two groups were compared. Logistic regression analysis was used to screen out the risk factors for secondary AKI in patients with spontaneous intracerebral hemorrhage. RESULTS: Three hundred thirty-seven patients were included in this study, whereby 186 males (55.2%) and 151 females (44.8%). A total of 65 patients developed AKI, of whom 44 patients were (67.69%) in stage 1, 12 patients (18.46%) in stage 2, and 9 patients (13.85%) in stage 3. Univariate logistic regression analysis showed that Acute Physiology, Age and Chronic Health Evaluation (APACHE II score), diabetes, chronic kidney disease, fasting blood glucose level and amount of mannitol used were risk factors for AKI in patients with intracerebral hemorrhage. Multivariate logistic regression analysis showed APACHE II score (OR: 1.846, 95% CI: 1.319 to 2.585, p < 0.001), diabetes (OR: 3.609, 95% CI: 1.596 to 8.163, p=0.002) and amount of mannitol use (OR: 3.495, 95% CI: 1.910~3.395, p < 0.001) are the independent risk factors for AKI after intracranial hemorrhage. CONCLUSION: In summary, APACHE II score, diabetes, and total mannitol use are independent risk factors for AKI in patients with spontaneous intracerebral hemorrhage. It is necessary to monitor renal function frequently in patients with high APACHE II scores and control the amount of mannitol administrated in the prevention of AKI after intracranial hemorrhage. The intervention of the above factors is expected to reduce the risk of secondary AKI.