To investigate the relationship between fluid overload and prognosis in elderly patients with sepsis complicated with acute kidney injury (AKI) during the initiation of continuous renal replacement therapy (CRRT).

Enrolled 68 elderly patients with sepsis-induced AKI receiving CRRT who were admitted to Zhejiang Hospital from June 2015 to December 2018. The clinical data collected included baseline data at the time of ICU admission for sepsis diagnosis; AKI staging, laboratory data, sequential organ failure assessment (SOFA) score at the beginning of CRRT, and urine output of the previous day; amount of fluid balance, time elapsed, and use of diuretics and vasopressors from sepsis diagnosis to CRRT initiation. The primary outcome was 28-day death after CRRT initiation. Compared the data at the baseline and at the initiation of CRRT of the survival group and the death group. Compared the data of patients with different fluid volume status and performed Kaplan-Meier survival curve analysis. The indexes with statistical significance in univariate analysis (rank sum test, t test and chi square test) were included in the multivariate logistic regression model to analyze the related factors of death 28 days after CRRT.

Among 68 patients, 22 survived 28 days after CRRT initiation (survival group) and 46 died (death group). There were significant differences in age and mean arterial pressure between the two groups (Z=1.991, t=2.491; P < 0.05). At the start of CRRT, there were significant differences in SOFA, urine volume of the previous day, norepinephrine level, positive fluid balance, and FO > 10% of patients between the two groups (t=0.879, Z=2.343, 2.042, 2.222, 2.229, χ²=6.852; P < 0.05); and there were significant differences in age, blood urea nitrogen, interval time, and positive fluid balance between the two groups with FO > 10% and FO≤10% (Z=4.110, 2.079, 6.101, 6.964, P < 0.05). The mortality of patients with FO > 10% was significantly higher than that of patients with FO≤10% (83.9% vs 54.1%, χ²=6.852; P < 0.01). Logistic regression analysis showed that SOFA at CRRT and FO > 10% were independent related factors for death at 28 d after CRRT (OR=1.354, 16.140; 95%CI=1.069-1.715, 1.883-138.379; P < 0.05).

In elderly patients with sepsis induced AKI, FO > 10% at CRRT initiation is an independent risk factor for 28-day death, CRRT should be initiated as soon as the fluid load continues to increase.

To the predictive value of TEG for formation of Deep vein thrombosis (DVT) in elderly patients with severe thrombelastogram.

59 elderly critically patients admitted to Jiaxing First Hospital from February 2017 to May 2018 were selected, venous blood samples were collected on the 1st, 3rd, 5th and 7th day after admission, and the results of TEG and CCT were recorded. TEG and CCT indexes were compared between DVT group and non DVT group by T-test/rank sum test or chi-square test. ROC curve was used to evaluate the predictive value of TEG and CCT for DVT in elderly patients with severe diseases.

The results of CCT showed that the difference of D-dimer (D-D) level between DVT group and non DVT group was statistically significant (t=2.345, P < 0.05); the results of TEG test showed that the formation speed, maximum amplitude and coagulation index of DVT group were significantly higher than those of non DVT group (t=2.151, 2.614; F=13.750; P < 0.05); and the maximum amplitude difference between the two groups was statistically significant only on the 5th day after admission (P < 0.05). According to the ROC curve analysis results, the indicators that are good at predicting the value of DVT clinically include maximum amplitude, agglutination velocity, coagulation index and D-D, the sensitivity is 94.4%, 50.0%, 44.4% and 95.1%, specificity is 48.8%, 85.4%, 85.4% and 33.3%, respectively, and area under the ROC curve is 0.762, 0.662, 0.656 and 0.651, respectively. Ma was 67.5 on the 5th day after admission into ICU, which was the best clinical diagnostic cut-off value for DVT.

The accuracy of TEG in predicting DVT in elderly critically patients was higher than that of CCT.

To investigate the efficacy and safety of CalliSpheres drug-loaded microsphere through bronchial artery chemoembolization (BACE) for treatment of squamous non-small cell lung cancer in the elderly.

From December 2017 to June 2019, 16 elderly patients with squamous non-small cell lung cancer who were treated by BACE admitted to Linyi Tumor Hospital of Shandong Province were collected. All patients were treated with 40~60 mg epirubicin with callispheres loaded with BACE. After operation, the curative effect of solid tumor was evaluated by improved solid tumor evaluation standard, the function score was evaluated by quality of life core questionnaire (QLQ-C30 version 3.0), and the advanced survival and total survival were counted. Rank sum test was used to measure the non normal distribution between groups.

All the 16 elderly patients were successfully treated by DEB-BACE. One month after operation, the objective remission rate was 75.00%, and the disease control rate was 100%; three months after operation, the objective remission rate was 75.00%, and the disease control rate was 87.5%. The 6-month survival rate was 100%, the 12-month survival rate was 69.8%, the median progression-free survival rate was 7 months, and the total survival rate was 14 months. One month after interventional therapy, the scores of physical function, emotional function, general health status, fatigue, nausea and vomiting, dyspnea and insomnia were significantly better than those before treatment (Z=3.220, 2.484, 3.091, 4.642, 2.250, 6.988, 2.484; P < 0.05 or 0.01). The main adverse reactions were chest pain, fever and irritating cough, which were improved after symptomatic treatment. There were no serious complications such as spinal cord injury and cerebral embolism.

CalliSpheres drug-loaded microsphere through BACE is effective and safe in the treatment of squamous non-small cell lung cancer in the elderly.

To evaluate the effect of transjuaular intrahepatic portosystemic stent shunt (TIPSS) in the treatment of senile cirrhosis and portal hypertension.

A retrospective analysis was reviewed on the 119 elder patients with senile cirrhosis and esophageal varices bleeding and refractory ascites. All of them underwent TIPSS after medical treatment fails. They were strictly followed up for 2 years and their clinical data were analysed. Color doppler imaging and shunt angiography were used to follow up patients to analyze the cases and type of stenosis.

All patients were successfully implanted with stents (75 cases with the fluency stents, 44 cases with bare-metal stents)to establish shunt. Portal venous pressure from before TIPSS (35.00±6.55) cmH₂O to after TIPSS (20.92±6.63) cmH₂O(t=13.43, P<0.01). There is a significant difference. TIPSS after 3 months, 6 months, 12 months and 24 months ascites complete or partial remission rates were 82.35%, 84.85%, 85.19% and 76.00%, rebleeding rates were 5.49%, 12.94%, 22.72% and 33.33%, incidence of shunt stenosis were 4.27%, 10.00%, 14.28% and 24.19%. After 2-year follow-up, the bare stent group had 47.73% stenosis; the covered stent group had 17.33% (χ²=12.55, P<0.01). The difference between two groups was statistically significant.

TIPSS is available and satisfactory in the treatment of senile cirrhosis and portal hypertension, which has high efficacy. TIPSS is less invasive, takes shorter operation tim, causes fewer complications. Stenosis rate can be significantly decreased by the application of covered stent in TIPSS.