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Critical Care Medicine 2017： Bigger Picture, Better Future

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Chinese Medical Journal 2017年第10期130卷 1135-1136页

作者： xiang-dong guan Li Tong Department of Critical Care Medicine The First Affiliated Hospital Sun Yat-sen University Guangzhou Guangdong 510080 China

A lot of new progress has been made in critical care medicine during 2016, including the new definition of Sepsis-3, the tburth revision of the SttrvivhTg Sepsis Guidelines presenting, increasing using of point-of-car... 详细信息

关键词： ARDS Critical Care Medicine ECMO EGDT： Sepsis

Effect of Systolic Cardiac Function on Passive Leg Raising for Predicting Fluid Responsiveness： A Prospective Observational Study

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Chinese Medical Journal 2018年第3期131卷 253-261页

作者： xiang Si Dai-Yin Cao Juan Chen Jian-Feng Wu Zi-Meng Liu Hai-Lin Xu Min-Ying Chen Yong-Jun Liu xiang-dong guan Department of SICU The First Affiliated Hospital of Sun Yat-sen University Guangzhou Guangdong 510080 China Department of Critical Care Medicine The Sixth Affiliated Hospital of Sun Yat-sen University Guangzhou Guangdong 510655 China

Background：Passive leg raising （PLR） represents a ＂self-volume expansion （VE）＂ that could predict fluid responsiveness,but the influence of systolic cardiac function on PLR has seldom been reported.This study aimed to investigate whether systolic cardiac function,estimated by the global ejection fraction （GEF） from transpulmonary-thermodilution,could influence the diagnostic value of PLR.Methods：This prospective,observational study was carried out in the surgical Intensive Care Unit of the First Affiliated Hospital of Sun Yat-sen University from December 2013 to July 2015.Seventy-eight mechanically ventilated patients considered for VE were prospectively included and divided into a low-GEF （〈20%） and a near-normal-GEF （〉20%） group.Within each group,baseline hemodynamics,after PLR and after VE （250 ml 5% albumin over 30 min）,were recorded.PLR-induced hemodynamic changes （PLR-△） were calculated.Fluid responders were defined by a 15% increase of stroke volume （SV） after VE.Results：Twenty-five out of 38 patients were responders in the GEF 〈20% group,compared to 26 out of 40 patients in the GEF 〉20% group.The thresholds of PLR-△SV and PLR-△ cardiac output （PLR-△CO） for predicting fluid responsiveness were higher in the GEF 〉20% group than in the GEF 〈20% group （△SV：12% vs.8%;△CO：7% vs.6%）,with increased sensitivity （△SV：92% vs.92%;△CO：81% vs.80%） and specificity （△SV：86% vs.70%;△CO：86% vs.77%）,respectively PLR-△ heart rate could predict fluid responsiveness in the GEF 〉20% group with a threshold value of-5% （sensitivity 65%,specificity 93%） but could not in the GEF 〈20% group.The pressure index changes were poor predictors.Conclusions：In the critically ill patients on mechanical ventilation,the diagnostic value of PLR for predicting fluid responsiveness depends on cardiac systolic function.Thus,cardiac systolic function must be considered when using PLR.Trial Registration：Chinese Clinical Trial Register,ChiCTR-OCH-13004027;http：//***/showproj.aspx？proj=5540.

关键词： Fluid Responsiveness Passive Leg Raising Systolic Cardiac Function Volume Expansion

Inhibition of c-Jun N-terminal Kinase Signaling Pathway Alleviates Lipopolysaccharide-induced Acute Respiratory Distress Syndrome in Rats

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Chinese Medical Journal 2016年第14期129卷 1719-1724页

作者： Jian-Bo Lai Chun-Fang Qiu Chuan-Xi Chen Min-Ying Chen Juan Chen xiang-dong guan Bin Ouyang Department of Critical Care Medicine First Affiliated Hospital of Sun Yat-Sen University Guangzhou Guangdong 510080 China

Background： An acute respiratory distress syndrome （ARDS） is still one of the major challenges in critically ill patients. This study aimed to investigate the effect of inhibiting c-Jun N-terminal kinase （JNK） on ARDS in a lipopolysaccharide （LPS）-induced ARDS rat model. Methods： Thirty-six rats were randomized into three groups： control, LPS, and LPS ＋ JNK inhibitor Rats were sacrificed 8 h alter LPS treatment. The lung edema was observed by measuring the wet-to-dry weight （W/D） ratio of the lung. The severity of ptdmonary inflammation was observed by measuring myeloperoxidase （MPO） activity of lung tissue. Moreover, the neutrophils in bronchoalveolar lavage fluid （BALF） were cotinted to observe the airway inflammation. In addition, lung collagen accumulation was quantified by Sircol Collagen Assay. At the same time, the pulmonary histologic examination was perlbrmed, and lung injury score was achieved in all three groups. Results： MPO activity in lung tissue was found increased in rats treated with LPS comparing with that in control （I.26 ＋ 0.15 U in LPS vs. 0.77 ± 0.27 U in control, P 〈 0.05）. Inhibiting ,INK attenuated LPS-induced MPO activity upregulation （0.52 ± 0. 12 U in LPS ＋ JNK inhibitor vs. 1.26 ± 0.15 U in LPS, P 〈 0.05）. Neutrophils in BALF were also found to be increased with LPS treatment, and inhibiting ,INK attenuated LPS-induced neutrophils increase in BALF （255.0 ± 164.4 in LPS vs. 53 （44.5-103） in control vs. 127.0 ± 44.3 in LPS JNK inhibitor, P 〈 0.05）. At the same time, the lung injury score showed a reduction in LPS ＋ JNK inhibitor group comparing with that in LPS group （ 13.42 ± 4.82 vs. 7.00 ± 1.83, P 0.001 ）. However, the lung W/D ratio and the collagen in BALF did not show any difl＇erences between LPS and LPS ＋ JNK inhibitor group.Conclusions： Inhibiting JNK alleviated LPS-induced acute lung inflammation and had no effects on pulmonary edema and fibrosis..INK inhibitor might be a potential therapeutic medication in ARDS, in the context of reducing lung inflammatory.

关键词： Acute Respiratory Distress Syndrome： c-Jun N-terminal Kinase Inhibitor Lung lnflalnmation C14HsN20

Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

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Military Medical Research 2023年第3期10卷 281-298页

作者： Fei Pei Ren‑Qi Yao Chao Ren Soheyl Bahrami Timothy RBilliar Irshad HChaudry De‑Chang Chen Xu‑Lin Chen Na Cui xiang‑Ming Fang Yan Kang Wei‑Qin Li Wen‑Xiong Li Hua‑Ping Liang Hong‑Yuan Lin Ke‑Xuan Liu Ben Lu Zhong‑Qiu Lu Marc Maegele Tian‑Qing Peng You Shang Lei Su Bing‑Wei Sun Chang‑Song Wang Jian Wang Jiang‑Huai Wang Ping Wang Jian‑Feng Xie Li‑Xin Xie Li‑Na Zhang Basilia Zingarelli xiang‑dong guan Jian‑Feng Wu Yong‑Ming Yao Department of Critical Care Medicine the First Affiliated Hospital of Sun Yat-Sen University58 Zhongshan Er RoadYuexiu DistrictGuangzhou 510080GuangdongChina Translational Medicine Research Center Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital28 Fuxing RoadHaidian DistrictBeijing 100853China Department of Burn Surgery the First Affiliated Hospital of Naval Medical UniversityShanghai 200433China Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology 1200 ViennaAustria Department of Surgery University of Pittsburgh Medical CenterPittsburghPA 15213USA Center for Surgical Research and Department of Surgery University of Alabama at BirminghamBirminghamAL 35294USA Department of Critical Care Medicine Ruijin HospitalShanghai Jiaotong UniversityShanghai 200025China Department of Burns the First Affiliated Hospital of Anhui Medical UniversityHefei 230022China Department of Critical Care Medicine Peking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China Department of Anesthesiology the First Affiliated HospitalZhejiang University School of MedicineHangzhou 31003China Department of Critical Care Medicine West China Hospital of Sichuan UniversityChengdu 610041China Department of Critical Care Medicine General Hospital of Eastern Theater Command of Chinese PLANanjing 210002China Department of Surgical Intensive Critical Unit Beijing Chao‑Yang HospitalCapital Medical UniversityBeijing 100020China State Key Laboratory of Trauma Burns and Combined InjuryResearch Institute of SurgeryDaping HospitalArmy Medical UniversityChongqing 400042China Department of Critical Care Medicine Fourth Medical Center of the Chinese PLA General HospitalBeijing 100048China Department of Anesthesiology Nanfang HospitalSouthern Medical UniversityGuangzhou 510515China Department of Critical Care Medicine and Hematology the Third Xiangya HospitalCentral South UniversityChangs

Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis.To provide clinical practice recommendations on the immune function in sepsis,an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed.Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed,Web of Science,and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire.Then,the Delphi method was used to form consensus opinions,and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions.This consensus achieved satisfactory results through two rounds of questionnaire survey,with 2 statements rated as perfect consistency,13 as very good consistency,and 9 as good consistency.After summarizing the results,a total of 14 strong recommended opinions,8 weak recommended opinions and 2 non-recommended opinions were produced.Finally,a face-to-face discussion of the consensus opinions was performed through an online meeting,and all judges unanimously agreed on the content of this consensus.In summary,this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.

关键词： Sepsis Immune function monitoring Immunomodulatory therapy Immunosuppression

Epidemiological Study of Sepsis in China： Protocol of a Cross-sectional Survey

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Chinese Medical Journal 2016年第24期129卷 2967-2973页

作者： Yi Yang Jian-Feng Xie Kai-Jiang Yu Chen Yao Jian-Guo Li xiang-dong guan Jing Yan Xiao-Chun Ma Yan Kang Cong-Shan Yang Xiao-Qing Yao Hong-Cai Shang Hai-Bo Qiu Department of Critical Care Medicine Zhongda Hospital School of Medicine Southeast University Nanjing Jiangsu 210009 China Department of Critical Care Medicine The Third Affiliated Hospital of Harbin Medical University Harbin Heilongjiang 150040 China Clinical Research Center Peking University First Hospital Beijing 100034 China Department of Critical Care Medicine Zhongnan Hospital Wuhan University Wuhan Hubei 430071 China Department of Surgical Critical Care Medicine The First Affiliated Hospital of Sun Yat-sen University Guangzhou Guangdong 510080 China Department of Critical Care Medicine Zhejiang Hospital Hangzhou Zhejiang 310030 China Department of Critical Care Medicine The First Affiliated Hospital of China Medical University Shenyang Liaoning 110001 China Department of Critical Care Medicine West China Hospital Sichuan University Chengdu Sichuan 610041 China Tianjin Chase Sun Pharmaceutical Co. Ltd. Tianjin 300170 China Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing Dongzhimen Hospital Beijing University of Chinese Medicine Beijing 100700 China

Background： Sepsis is the leading cause of death among critically ill patients. Herein, we conducted a national survey to provide data on epidemiology and treatment of sepsis in the clinical practice in China, which has no detailed epidemiological data available on sepsis. Methods： This was a prospective cross-sectional survey from December 1, 2015 to January 31, 2016 in all provinces/municipalities of the mainland of China. The primary outcome of this study was the incidence of sepsis, and the secondary outcome was its etiology in China. Patients with sepsis admitted to the Intensive Care Units were included in this study. The demographic, physiological, bacteriological, and therapeutic data of these patients were recorded. The incidence of sepsis was estimated using the data from the sixth census in China, reported by the Chinese National Health and Family Planning Commission and the National Bureau of Statistics as the standard population. The independent risk factors for increased mortality from sepsis were calculated. Conclusions： This study indicated the incidence and outcome of sepsis in China. It also showed the most common etiology of different sites and types of infection, which could guide empiric antibiotic therapy. Moreover, it provided information on the independent risk factors for increased mortality due to sepsis. The findings provide evidence to guide clinical management and may help improve the outcome in septic patients.

关键词： Epidemiology Incidence National Survey Outcome Sepsis

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 China.This guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill patients.This 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 surgery.The 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 supply.Each question was analyzed according to the Population,Intervention,Comparison,and Outcome(PICO)principle.In addition,interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value.The 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)

Applying dynamic light scattering to investigate the self-assembly process of DNA nanostructures

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Chinese Chemical Letters 2024年第3期35卷 316-320页

作者： Wei Yuan Gui-Zhi dong Hui Ning xiang-xiang guan Jia-Feng Cheng Zi-Wei Shi Xiu-Ji Du Si-Wen Meng dong-Sheng Liu Yuan-Chen dong CAS Key Laboratory of Colloid Interface and Chemical ThermodynamicsInstitute of ChemistryChinese Academy of SciencesBeijing 100190China University of Chinese Academy of Sciences Beijing 100049China Dandong Bettersize Instruments Ltd. Dandong 118000China Key Laboratory of Organic Optoelectronics&Molecular Engineering of the Ministry of Education Department of ChemistryTsinghua UniversityBeijing 100084China Department of Chemistry Renmin University of ChinaBeijing 100872China

Understanding the dynamic assembly process of DNA nanostructures is important for developing novel strategy to design and construct functional devices.In this work,temperature-controlled dynamic light scattering(DLS)strategy has been applied to study the global assembly process of DNA origami and DNA bricks.Through the temperature dependent size and intensity profiles,the self-assembly process of various DNA nanostructures with different morphologies have been well-studied and the temperature transition ranges could be observed.Taking advantage of the DLS information,rapid preparation of the DNA origami and the brick assembly has been realized through a constant temperature annealing.Our results demonstrate that the DLS-based strategy provides a convenient and robust tool to study the dynamic process of forming hieratical DNA structures,which will benefit understanding the mechanism of self-assembly of DNA nanostructures.

关键词： Dynamic light scattering Self-assembly process DNA nanostructures Temperature transition ranges Rapid preparation

Degradation of iopamidol in the permanganate/sulfite process:Evolution of iodine species and effect on the subsequent formation of disinfection by-products

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Journal of Environmental Sciences 2024年第1期135卷 345-352页

作者： Yimin Lin Hongyu dong Yating Zhu Gongming Zhou Junlian Qiao Xiaohong guan State Key Laboratory of Pollution Control and Resources Reuse College of Environmental Science and EngineeringTongji UniversityShanghai 200092China Department of Environmental Science School of Ecological and Environmental SciencesEast China Normal UniversityShanghai 200241China

Permanganate/sulfite(Mn(VII)/S(IV))process is a promising pre-oxidation technology for sequestering the emerging organic contaminants in drinking water treatment plant.Iopamidol(IPM),a representative of iodinated X-ray contrast media,has been widely detected in water sources and has the risk of forming iodinated disinfection byproducts(I-DBPs)in water treatment system.In this study,we investigated the evolution of iodine species during the IPM degradation by the Mn(VII)/S(IV)process and its effect on the subsequent formation of I-DBPs during chlorination at pH 7.0 and 8.0.IPM could be effectively degraded in the Mn(VII)/S(IV)process at environmentally relevant pH(pH 7.0 and 8.0).The results of quenching and competitive oxidation kinetic experiments revealed that SO^(·-)_(4)was the major reactive oxidizing species contributing to the degradation of IPM whereas the contributions of HO·and reactive manganese species were negligible in the Mn(VII)/S(IV)process.I–and IO–3were generated while no HOI was detected during the degradation of IPM in the Mn(VII)/S(IV)process.The effects of IPM oxidation by Mn(VII)/S(IV)on the subsequent formation of chlorinated disinfection by-products(Cl-DBPs)during chlorination were related to the category of Cl-DBPs.The pre-oxidation of IPM by Mn(VII)/S(IV)resulted in the generation of I-DBPs during the disinfection process although no I-DBPs were detected if no pre-oxidation was applied.The finding of this study suggested that attention should be paid to the toxicity of DBPs when water containing iodinated organic contaminants is treated by Mn(VII)/S(IV)process or other pre-oxidation technologies.

关键词： Permanganate/sulfite Iopamidol Sulfate radical Iodinated disinfection byproducts Pre-oxidation

Causal role of immune cells in obstructive sleep apnea hypopnea syndrome:Mendelian randomization study

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World Journal of Clinical Cases 2024年第7期12卷 1227-1234页

作者： Huang-Hong Zhao Zhen Ma dong-Sheng guan Department of Encephalopathy Henan Provincial Hospital of Traditional Chinese MedicineZhengzhou 450000Henan ProvinceChina Department of Personnel The First Affiliated Hospital of Henan University of Traditional Chinese MedicineZhengzhou 450000Henan ProvinceChina Department of Neurology Henan Provincial Hospital of Traditional Chinese MedicineZhengzhou 450000Henan ProvinceChina

BACKGROUND Despite being one of the most prevalent sleep disorders,obstructive sleep apnea hypoventilation syndrome(OSAHS)has limited information on its immunologic foundation.The immunological underpinnings of certain major psychiatric diseases have been uncovered in recent years thanks to the extensive use of genome-wide association studies(GWAS)and genotyping techniques using highdensity genetic markers(e.g.,SNP or CNVs).But this tactic hasn't yet been applied to OSAHS.Using a Mendelian randomization analysis,we analyzed the causal link between immune cells and the illness in order to comprehend the immunological bases of OSAHS.AIM To investigate the immune cells'association with OSAHS via genetic methods,guiding future clinical research.METHODS A comprehensive two-sample mendelian randomization study was conducted to investigate the causal relationship between immune cell characteristics and OSAHS.Summary statistics for each immune cell feature were obtained from the GWAS catalog.Information on 731 immune cell properties,such as morphologic parameters,median fluorescence intensity,absolute cellular,and relative cellular,was compiled using publicly available genetic databases.The results'robustness,heterogeneity,and horizontal pleiotropy were confirmed using extensive sensitivity examination.RESULTS Following false discovery rate(FDR)correction,no statistically significant effect of OSAHS on immunophenotypes was observed.However,two lymphocyte subsets were found to have a significant association with the risk of OSAHS:Basophil%CD33dim HLA DR-CD66b-(OR=1.03,95%CI=1.01-1.03,P<0.001);CD38 on IgD+CD24-B cell(OR=1.04,95%CI=1.02-1.04,P=0.019).CONCLUSION This study shows a strong link between immune cells and OSAHS through a gene approach,thus offering direction for potential future medical research.

关键词： Obstructive sleep apnea hypopnea syndrome Immunity Causal inference MR analysis Sensitivity