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Efficacy and Safety Study of CA330 Hemadsorption Device on IL-6 Removal in Septic Patients: Study Protocol of a Multicenter Randomized Controlled Trial

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Open Journal of Epidemiology 2021年第4期11卷 517-524页

作者： Yao Nie Zhiyi Jiang Zimeng Liu xiangdong guan Department of Critical Care Medicine The First Affiliated Hospital of Sun Yat-sen University Guangzhou China

Background: Sepsis persists to be the leading cause of morbidity and mortality worldwide with the huge cost of health care resources. Besides adequate antibiotics and infectious source control, definitive therapy is still being studied. The activation of multiple pro- and anti-inflammatory mediators plays a key role in the sepsis process. The application of adsorption may help deactivate and decrease the peak elevation of these mediators in the earlier course of sepsis, when levels of endotoxins and cytokines are extremely high. However, the clinical evidence to support hemadsorption for removing endotoxins and/or pro-inflammatory mediators in sepsis remains incompetent and controversial. In this study protocol, we aimed to test the efficacy of removing cytokines and the safety of a new hemadsorption device, CA330, in septic patients. Design: This is a multicenter randomized controlled clinical trial enrolling 8 tertiary hospitals in China. A total of 144 patients will be randomly divided into the experimental group and the control group according to the ratio of 1:1. The primary endpoint is the reduction rate of IL-6 serum concentration between the initiation of the first adsorption and end with the second adsorption. Discussion: To our knowledge, this clinical trial is the first to evaluate the efficacy and safety of the CA330 hemadsorption device in sepsis patients. Our study will raise the level of evidence for the treatment of sepsis patients with hemadsorption.

关键词： Sepsis Hemadsorption CA330 Inflammatory Mediators IL-6

Meta-Analysis of Ventilated versus Spontaneously Breathing Patients in Predicting Fluid Responsiveness by Inferior Vena Cava Variation

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International Journal of Clinical Medicine 2018年第10期9卷 760-777页

作者： Xiang Si Daiyin Cao Hailin Xu xiangdong guan Department of Surgical Intensive Care Unit The First Affiliated Hospital of Sun Yat-sen University Guangzhou China Department of Critical Care Medicine The Sixth Affiliated Hospital of Sun Yat-sen University Guangzhou China Transplantation Department The Second Affiliated Hospital of Guangzhou Medical University Guangzhou China

Purpose: Respiratory variation in inferior vena cava (ΔIVC) has been extensively studied in predicting fluid responsiveness, but the results are conflicting. We performed a systemic review and meta-analysis of studies aiming at investigating the diagnostic accuracy of ΔIVC in predicting fluid responsiveness. Methods: MEDLINE, EMBASE, Cochrane Database and Web of Science were screened for relevant original and review articles from inception to July 2016. The meta-analysis determined the pooled sensitivity, specificity, diagnostic odds ratio (DOR) and area under the ROC curve (AUROC). In addition, subgroup analyses were performed in mechanically ventilated patients and spontaneously breathing patients. Results: A total of 20 studies involving 635 patients were included. Cutoff values of ΔIVC varied from 12% to 42%, the pooled sensitivity and specificity was 0.68 (0.62 - 0.75) and 0.80 (0.75 - 0.85), respectively. The DOR was 14.2 (6.0 - 33.6) and the AUROC was 0.86 (0.78 - 0.93). Subgroup analysis showed better diagnostic performance in patients on mechanical ventilation than in spontaneously breathing patients with higher sensitivity (0.75 vs. 0.56), specificity (0.82 vs. 0.78), DOR (22.9 vs. 7.9) and AUROC (0.90 vs. 0.80). The best threshold of ΔIVC in patients on mechanical ventilation was IVC distensibility index (ΔIVC ≥17% ±4%), compared to IVC collapsibility index (ΔcIVC ≥33% ±12%) in spontaneously breathing patients. Conclusion: ΔIVC is not an accurate predictor of fluid responsiveness in patients with acute circulatory failure. In patients on mechanical ventilation, the predicting ability of ΔIVC was moderate with acceptable sensitivity and specificity;in spontaneously breathing patients, the specificity remains acceptable but its sensitivity is poor.

关键词： Fluid Responsiveness Inferior Vena Cava Variation

Phase-separated nucleocapsid protein of SARS-CoV-2 suppresses cGAS-DNA recognition by disrupting cGAS-G3BP1 complex

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Signal Transduction and Targeted Therapy 2023年第5期8卷 2392-2407页

作者： Sihui Cai Chenqiu Zhang Zhen Zhuang Shengnan Zhang Ling Ma Shuai Yang Tao Zhou Zheyu Wang Weihong Xie Shouheng Jin Jincun Zhao xiangdong guan Jianfeng Wu Jun Cui Yaoxing Wu guangdong Province Key Laboratory of Pharmaceutical Functional Genes The First Affiliated Hospital of Sun Yat-sen UniversitySchool of Life SciencesSun Yat-sen UniversityGuangzhouGuangdongChina MOE Key Laboratory of Gene Function and Regulation State Key Laboratory of BiocontrolSchool of Life SciencesSun Yat-sen UniversityGuangzhouGuangdongChina State Key Laboratory of Respiratory Disease Guangzhou Institute of Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina Department of Critical Care Medicine The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouGuangdongChina

Currently,the incidence and fatality rate of SARS-CoV-2 remain continually high ***-19 patients infected with SARS-CoV-2 exhibited decreased type I interferon(IFN-I)signal,along with limited activation of antiviral immune responses as well as enhanced viral *** progresses have been made in revealing the multiple strategies employed by SARS-CoV-2 in impairing canonical RNA sensing ***,it remains to be determined about the SARS-CoV-2 antagonism of cGAS-mediated activation of IFN responses during *** the current study,we figure out that SARS-CoV-2 infection leads to the accumulation of released mitochondria DNA(mtDNA),which in turn triggers cGAS to activate IFN-I *** countermeasures,SARS-CoV-2 nucleocapsid(N)protein restricts the DNA recognition capacity of cGAS to impair cGAS-induced IFN-I ***,N protein disrupts the assembly of cGAS with its co-factor G3BP1 by undergoing DNA-induced liquid-liquid phase separation(LLPS),subsequently impairs the double-strand DNA(dsDNA)detection ability of *** together,our findings unravel a novel antagonistic strategy by which SARS-CoV-2 reduces DNA-triggered IFN-I pathway through interfering with cGAS-DNA phase separation.

关键词： interferon separated cGAS

Tigecycline Use in Surgical Intensive Care Unit for the Treatment of Complicated Intra-Abdominal Infections: A Real-World Study

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International Journal of Clinical Medicine 2021年第1期12卷 1-6页

作者： Yao Nie Fei Pei Luhao Wang Xiang Si xiangdong guan Department of Surgical Intensive Care Unit The First Affiliated Hospital of Sun Yat-sen University Guangzhou China

OBJECTIVES: To describe real-world use of tigecycline in cIAIs patients. METHODS: A retrospective, observational study enrolled cIAIs patients hospitalized in The First Affiliated Hospital, Sun Yat-sen University from January 1, 2013 to June 30, 2017 was conducted. Patients’ data were collected and matched based on age, gender, and Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score according to receiving first-line, later-line, or no tigecycline during hospitalization. RESULTS: Data were collected for 52 patients. 82.6% were male. Mean age was 57.8 years and APACHE II score was 14.8. The incidence of both extended-spectrum beta-lactamase producing and carbapenem-resistant pathogens was high on initial culture;however, few patients received first-line tigecycline. No significant difference in mortality rate was identified among first-line, later-line and no tigecycline users. Of surviving patients, shorter hospital length of stay was observed for patients receiving first- vs later-line or no tigecycline, respectively. ICU length-of-stay was shorter in patients receiving first- vs later-line or no tigecycline. CONCLUSIONS: First-line tigecycline use was rare in our surgical intensive care unit. Resistant organisms were commonly cultured from initial specimens. Although these results are limited by small patient numbers and single center, our results suggest that early tigecycline use may have significant benefits with similar mortality. Further research is warranted to demonstrate the values of early tigecycline use in cIAIs patients.

关键词： Tigecycline Complicated Intra-Abdominal Infection Multidrug-Resistant

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体外膜肺氧合抗凝管理现状和挑战

中华医学杂志 2022年第25期102卷 1864-1869页

作者：司向管向东中山大学附属第一医院重症医学科广东省急危重症临床医学研究中心广州510080

体外膜肺氧合(ECMO)的抗凝管理面临着巨大挑战,出血或栓塞等凝血系统相关并发症是影响患者死亡率的主要因素之一,如何把控血栓形成与出血并发症之间的动态平衡成为ECMO管理的重中之重。本文对ECMO支持期间的凝血改变,如何选用合适的抗... 详细信息

体外膜肺氧合(ECMO)的抗凝管理面临着巨大挑战,出血或栓塞等凝血系统相关并发症是影响患者死亡率的主要因素之一,如何把控血栓形成与出血并发症之间的动态平衡成为ECMO管理的重中之重。本文对ECMO支持期间的凝血改变,如何选用合适的抗凝药物和抗凝监测手段进行论述,旨在对ECMO患者最佳的抗凝策略进行探讨,更好地服务于ECMO患者。

关键词：体外膜氧合作用重症监护凝血抗凝

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氧代谢在外科危重病人中的应用

中国实用外科杂志 2001年第4期21卷 200-202页

作者：管向东中山医科大学第一医院外科ICU 广州510080

外科危重病人如各种休克、呼吸衰竭、低血容量等存在一系列损害氧供和氧利用的因素。在创伤、感染、脓毒症和重症坏死胰腺炎等严重的全身炎症反应综合征(SIRS)状态下，在氧供和氧利用障碍的同时，氧的需求还会成倍增加。这两方面的共同... 详细信息

外科危重病人如各种休克、呼吸衰竭、低血容量等存在一系列损害氧供和氧利用的因素。在创伤、感染、脓毒症和重症坏死胰腺炎等严重的全身炎症反应综合征(SIRS)状态下，在氧供和氧利用障碍的同时，氧的需求还会成倍增加。这两方面的共同作用使外科危重病人出现“氧债”(oxygen debt)状况。目前认为，在外科临床上治疗非常棘手、病死率很高的多器官功能障碍综合征(MODS)是过度的炎症反应，最终导致细胞缺氧和能量代谢衰竭的结果。

关键词：外科危重病氯代谢 PO2 Ozext

Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China

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Journal of Intensive Medicine 2024年第2期4卷 137-159页

作者： xiangdong guan Dechang Chen Yuan Xu Chinese Society of Critical Care Medicine Department of Critical Care Medicine The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina Department of Critical Care Medicine Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina Department of Critical Care Medicine Beijing Tsinghua Changgung HospitalBeijingChina 不详

The Chinese Society of Critical Care Medicine(CSCCM)has developed clinical practice guidelines for nutrition assessment and monitoring for patients in adult intensive care units(ICUs)in *** guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill *** guideline was developed by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough review of the system and a summary of relevant trials or studies published from 2000 to July 2023.A total of 18 recommendations were formed and consensus was reached through discussions and reviews by expert groups in critical care medicine,parenteral and enteral nutrition,and *** recommendations are based on currently available evidence and cover several key fields,including screening and assessment,evaluation and assessment of enteral feeding intolerance,metabolic and nutritional measurement and monitoring during nutrition therapy,and organ function evaluation related to nutrition *** question was analyzed according to the Population,Intervention,Comparison,and Outcome(PICO)*** addition,interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research *** plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3–5 years.

关键词： Adults Critical illness Intensive care unit Nutriti on Nutriti on assessment and monitoring Guideline Recommendations Chinese Society of Critical Care Medicine-Chinese Medical Association(CSCCM-CMA)

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失血性休克

中国实用外科杂志 2006年第12期26卷 916-919页

作者：管向东中山大学附属第一医院外科ICU 广东广州510080

1概述失血性休克(hemorrhagic shock)是临床常见的危重综合征之一。在现代抢救条件下,休克的死亡原因通常是多器官功能衰竭。进入20世纪80年代以来,由于血流动力学监测在临床得到广泛应用,人们逐步认识到休克复苏中组织灌注的改善与否... 详细信息

1概述失血性休克(hemorrhagic shock)是临床常见的危重综合征之一。在现代抢救条件下,休克的死亡原因通常是多器官功能衰竭。进入20世纪80年代以来,由于血流动力学监测在临床得到广泛应用,人们逐步认识到休克复苏中组织灌注的改善与否和氧的供需平衡与预后的密切关系,强调了恢复组织灌注,改善组织细胞供氧,并能被其有效利用的重要性。人们已经认识到,衡量复苏的效果不再是仅仅满足于循环功能稳定,而要深入到细胞水平,即以纠正细胞缺氧和维护正常的细胞功能为最终目标,这是休克复苏监测治疗的重要进展。[第一段]

关键词：失血性休克多器官功能衰竭血流动力学监测休克复苏组织灌注抢救条件死亡原因供需平衡

Lung ultrasound:a valuable tool for assessing COVID-19 patients with different severity

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Chinese Medical Journal 2022年第9期135卷 1114-1116页

作者： Xiang Si Hui Yi Dayue Liu Ruizhi Wang Yumei Liu Jianfeng Wu xiangdong guan Department of Critical Care Medicine The First Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdong 510080China Department of Respiratory and Critical Care Medicine The First Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdong 510080China Institute of Pulmonary Diseases Sun Yat-sen UniversityGuangzhouGuangdong 528406China Department of Healthcare-Associated Infection Management The First Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdong 510080China Department of Laboratory Medicine The First Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdong 510080China Department of Respiratory Medicine Hankou Hospital of WuhanWuhanHubei 430012China.

To the Editor:Lung ultrasound(LUS)may be a promising technique to assess lung injury from coronavirus disease 2019(COVID-19).However,the LUS characteristics and their assessment value have not been well *** aimed to explore the LUS characteristics and their assessment value in COVID-19 patients with different levels of disease severity.

关键词： Lung severity patients