ABSTRACT Background: Clinical situations in intensive care units (ICUs) change rapidly, and many factors may prolong the length of stay (LOS) of patients. Objectives: The objectives of the study were to examine the effects of implementing an electronic-ICU (e-ICU) and an informatics system in an ICU on the LOS of patients and quality of care. Methods: We evaluated the implementation of a technology electronic dashboard-ICU (TED-ICU) system to upload automatically physiological information and clinical data within the critical care unit for providing real-time information to the care team. Furthermore, TED-ICU software automatically performed Sequential Organ Failure Assessment (SOFA) every 48 h. If a patient’s SOFA score decreased by more than 2 points, there was an automatic reminder for transferring patients to the general ward. We prospectively collected data for this study from the ICU before and after implementing the e-ICU. Results: In total, 2248 patients were admitted to our ICU during the study period (1147 and 1101 patients before and after TED-ICU implementation, respectively). Demographic characteristics and in-hospital mortality rates did not differ significantly between the two groups, and the LOS decreased from 7.26 to 5.53 days (p < 0.01). Conclusion: Implementing an informatics system (TED-ICU) and care bundle in ICUs can reduce the LOS.

RESUMO Objetivos: Avaliar os estudos de séries de casos e avaliar quantitativamente os efeitos da trombólise dirigida por cateter (TDC) e comparar a eficácia entre TDC e anticoagulação nos pacientes com trombose venosa profunda aguda das extremidades inferiores (TVP) para tratamento futuro. Métodos: Foram pesquisadas as seguintes bases de dados relevantes: PubMed, Embase, Cochrane, Ovid MEDLINE e Scopus. Os critérios de inclusão foram aplicados para pacientes selecionados com TVP aguda de extremidades inferiores tratados com TDC comparada a TDC com anticoagulação. Nos estudos de série de casos, as estimativas agrupadas de resultados de eficácia para a taxa de permeabilidade, lise completa, retrombose e síndrome pós-trombótica (SPT) foram calculadas em todos os estudos. Em estudos comparando TDC com anticoagulação, foi calculada a razão de chance de resumo (summary odds ratio - OR). Resultados: Vinte e cinco artigos (seis comparando TDC com anticoagulação e 19 séries de casos), incluindo 2.254 pacientes, preencheram os critérios de elegibilidade. Nos estudos da série de casos, os resultados agrupados foram: taxa de permeabilidade 0,87 (IC95%: 0,85-0,89), lise completa 0,58 (IC95%: 0,40-0,75), e retrombose 0,11 (IC95%: 0,06-0,17), SPT 0,10 (IC95%: 0,08-0,12). Seis estudos que compararam os resultados de eficácia entre TDC e anticoagulação mostraram que TDC foi associada à redução da SPT (OR 0,38; IC95%: 0,26-0,55; p<0,0001) e maior taxa de permeabilidade (OR 4,76; IC95%: 2,14-10,56; p<0,0001). Conclusão: Pacientes com TVP aguda de extremidades inferiores que recebem TDC estão associados a uma menor incidência de SPT e maior incidência de taxa de permeabilidade. Em nossa metanálise, TDC é um tratamento eficaz para pacientes com TVP aguda de extremidades inferiores.

ABSTRACT Objectives: To evaluate case series studies that quantitatively assess the effects of catheter-directed thrombolysis (CDT) and compare the efficacy of CDT and anticoagulation in patients with acute lower extremity deep vein thrombosis (DVT). Methods: Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE and Scopus, were searched through January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated with CDT or with anticoagulation. In the case series studies, the pooled estimates of efficacy outcomes for patency rate, complete lysis, rethrombosis and post-thrombotic syndrome (PTS) were calculated across the studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated. Results: Twenty-five articles (six comparing CDT with anticoagulation and 19 case series) including 2254 patients met the eligibility criteria. In the case series studies, the pooled results were a patency rate of 0.87 (95% CI: 0.85-0.89), complete lysis 0.58 (95% CI: 0.40-0.75), rethrombosis 0.11 (95% CI: 0.06-0.17) and PTS 0.10 (95% CI: 0.08-0.12). Six studies comparing the efficacy outcomes of CDT and anticoagulation showed that CDT was associated with a reduction of PTS (OR 0.38, 95%CI 0.26-0.55, p<0.0001) and a higher patency rate (OR 4.76, 95%CI 2.14-10.56, p<0.0001). Conclusion: Acute lower extremity DVT patients receiving CDT were found to have a lower incidence of PTS and a higher incidence of patency rate. In our meta-analysis, CDT is shown to be an effective treatment for acute lower extremity DVT patients.

RESUMEN Objetivos: Evaluar estudios de series de casos y evaluar cuantitativamente los efectos de la trombólisis dirigida por catéter (TDC) y comparar la eficacia entre la TDC y anticoagulación en pacientes con trombosis venosa profunda (TVP) aguda de las extremidades inferiores para el tratamiento futuro. Métodos: Se realizaron búsquedas en bases de datos relevantes, incluyendo PubMed, Embase, Cochrane, Ovid MEDLINE y Scopus hasta enero de 2017. Los criterios de inclusión se aplicaron a pacientes seleccionados con TVP aguda de extremidad inferior tratados con TDC o comparados con TDC y anticoagulación. En estudios de series de casos, las estimaciones agrupadas de los resultados de eficacia para la tasa de patencia, la lisis completa, la retrombosis y el síndrome postrombótico (SPT) se calcularon a través de los estudios. En estudios que compararon la TDC con la anticoagulación, se calculó el resumen de las razónes de posibilidades (RP). Resultados: 25 artículos (seis que comparan TDC con anticoagulación y 19 series de casos) que incluyeron 2254 pacientes qienes cumplieron los criterios de elegibilidad. En los estudios de series de casos, los resultados agrupados fueron: tasa de patencia 0,87 (IC 95%: 0,85; 0,89), lisis completa 0,58 (IC 95%: 0,40; 0,75), retrombosis 0,11 (IC 95%: 0,06; 17,0), SPT 0,10 (IC 95%: 0,08; 0,12). Seis estudios que compararon los resultados de eficacia entre la TDC y anticoagulación mostraron que la TDC se asoció con una reducción de SPT (RP 0,38; IC 95%: 0,26; 0,55; p<0,0001) y una mayor tasa de patencia (RP 4,76; IC 95%: 2,14; 10,56; p<0,0001). Conclusión: Los pacientes con TVP aguda de extremidad inferior que reciben TDC se asocian con una menor incidencia de SPT y una mayor incidencia de tasa de patencia. En nuestro metanálisis, la TDC es un tratamiento efectivo para pacientes con TVP aguda de extremidad inferior.

ABSTRACT Objectives: To evaluate case series studies that quantitatively assess the effects of catheter-directed thrombolysis (CDT) and compare the efficacy of CDT and anticoagulation in patients with acute lower extremity deep vein thrombosis (DVT). Methods: Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE and Scopus, were searched through January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated with CDT or with anticoagulation. In the case series studies, the pooled estimates of efficacy outcomes for patency rate, complete lysis, rethrombosis and post-thrombotic syndrome (PTS) were calculated across the studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated. Results: Twenty-five articles (six comparing CDT with anticoagulation and 19 case series) including 2254 patients met the eligibility criteria. In the case series studies, the pooled results were a patency rate of 0.87 (95% CI: 0.85-0.89), complete lysis 0.58 (95% CI: 0.40-0.75), rethrombosis 0.11 (95% CI: 0.06-0.17) and PTS 0.10 (95% CI: 0.08-0.12). Six studies comparing the efficacy outcomes of CDT and anticoagulation showed that CDT was associated with a reduction of PTS (OR 0.38, 95%CI 0.26-0.55, p<0.0001) and a higher patency rate (OR 4.76, 95%CI 2.14-10.56, p<0.0001). Conclusion: Acute lower extremity DVT patients receiving CDT were found to have a lower incidence of PTS and a higher incidence of patency rate. In our meta-analysis, CDT is shown to be an effective treatment for acute lower extremity DVT patients.

RESUMEN Objetivos: Evaluar estudios de series de casos y evaluar cuantitativamente los efectos de la trombólisis dirigida por catéter (TDC) y comparar la eficacia entre la TDC y anticoagulación en pacientes con trombosis venosa profunda (TVP) aguda de las extremidades inferiores para el tratamiento futuro. Métodos: Se realizaron búsquedas en bases de datos relevantes, incluyendo PubMed, Embase, Cochrane, Ovid MEDLINE y Scopus hasta enero de 2017. Los criterios de inclusión se aplicaron a pacientes seleccionados con TVP aguda de extremidad inferior tratados con TDC o comparados con TDC y anticoagulación. En estudios de series de casos, las estimaciones agrupadas de los resultados de eficacia para la tasa de patencia, la lisis completa, la retrombosis y el síndrome postrombótico (SPT) se calcularon a través de los estudios. En estudios que compararon la TDC con la anticoagulación, se calculó el resumen de las razónes de posibilidades (RP). Resultados: 25 artículos (seis que comparan TDC con anticoagulación y 19 series de casos) que incluyeron 2254 pacientes qienes cumplieron los criterios de elegibilidad. En los estudios de series de casos, los resultados agrupados fueron: tasa de patencia 0,87 (IC 95%: 0,85; 0,89), lisis completa 0,58 (IC 95%: 0,40; 0,75), retrombosis 0,11 (IC 95%: 0,06; 17,0), SPT 0,10 (IC 95%: 0,08; 0,12). Seis estudios que compararon los resultados de eficacia entre la TDC y anticoagulación mostraron que la TDC se asoció con una reducción de SPT (RP 0,38; IC 95%: 0,26; 0,55; p<0,0001) y una mayor tasa de patencia (RP 4,76; IC 95%: 2,14; 10,56; p<0,0001). Conclusión: Los pacientes con TVP aguda de extremidad inferior que reciben TDC se asocian con una menor incidencia de SPT y una mayor incidencia de tasa de patencia. En nuestro metanálisis, la TDC es un tratamiento efectivo para pacientes con TVP aguda de extremidad inferior.

RESUMO Objetivos: Avaliar os estudos de séries de casos e avaliar quantitativamente os efeitos da trombólise dirigida por cateter (TDC) e comparar a eficácia entre TDC e anticoagulação nos pacientes com trombose venosa profunda aguda das extremidades inferiores (TVP) para tratamento futuro. Métodos: Foram pesquisadas as seguintes bases de dados relevantes: PubMed, Embase, Cochrane, Ovid MEDLINE e Scopus. Os critérios de inclusão foram aplicados para pacientes selecionados com TVP aguda de extremidades inferiores tratados com TDC comparada a TDC com anticoagulação. Nos estudos de série de casos, as estimativas agrupadas de resultados de eficácia para a taxa de permeabilidade, lise completa, retrombose e síndrome pós-trombótica (SPT) foram calculadas em todos os estudos. Em estudos comparando TDC com anticoagulação, foi calculada a razão de chance de resumo (summary odds ratio - OR). Resultados: Vinte e cinco artigos (seis comparando TDC com anticoagulação e 19 séries de casos), incluindo 2.254 pacientes, preencheram os critérios de elegibilidade. Nos estudos da série de casos, os resultados agrupados foram: taxa de permeabilidade 0,87 (IC95%: 0,85-0,89), lise completa 0,58 (IC95%: 0,40-0,75), e retrombose 0,11 (IC95%: 0,06-0,17), SPT 0,10 (IC95%: 0,08-0,12). Seis estudos que compararam os resultados de eficácia entre TDC e anticoagulação mostraram que TDC foi associada à redução da SPT (OR 0,38; IC95%: 0,26-0,55; p<0,0001) e maior taxa de permeabilidade (OR 4,76; IC95%: 2,14-10,56; p<0,0001). Conclusão: Pacientes com TVP aguda de extremidades inferiores que recebem TDC estão associados a uma menor incidência de SPT e maior incidência de taxa de permeabilidade. Em nossa metanálise, TDC é um tratamento eficaz para pacientes com TVP aguda de extremidades inferiores.

OBJECTIVE: This study investigated the correlation between the albumin-to-creatinine ratio in the urine and 24-hour urine proteinuria and whether the ratio can predict chronic kidney disease progression even more reliably than 24-hour proteinuria can, particularly in primary IgA nephropathy. METHODS: A total of 182 patients with primary IgA nephropathy were evaluated. Their mean urine albumin-to-creatinine ratio and 24-hour proteinuria were determined during hospitalization. Blood samples were also analyzed. Follow-up data were recorded for 44 patients. A cross-sectional study was then conducted to test the correlation between these parameters and their associations with chronic kidney disease complications. Subsequently, a canonical correlation analysis was employed to assess the correlation between baseline proteinuria and parameters of the Oxford classification. Finally, a prospective observational study was performed to evaluate the association between proteinuria and clinical outcomes. Our study is registered in the Chinese Clinical Trial Registry, and the registration number is ChiCTR-OCH-14005137. RESULTS: A strong correlation (r=0.81, p<0.001) was found between the ratio and 24-hour proteinuria except in chronic kidney disease stage 5. First-morning urine albumin-to-creatinine ratios of ≥125.15, 154.44 and 760.31 mg/g reliably predicted equivalent 24-hour proteinuria ‘thresholds’ of ≥0.15, 0.3 and 1.0 g/24 h, respectively. In continuous analyses, the albumin-to-creatinine ratio was significantly associated with anemia, acidosis, hypoalbuminemia, hyperphosphatemia, hyperkalemia, hypercholesterolemia and higher serum cystatin C. However, higher 24-hour proteinuria was only associated with hypoalbuminemia and hypercholesterolemia. Higher tubular atrophy and interstitial fibrosis scores were also associated with a greater albumin-to-creatinine ratio, as observed in the canonical correlation analysis. Finally, the albumin-to-creatinine ratio and 24-hour proteinuria were associated with renal outcomes in univariate analyses. CONCLUSION: This study supports the recommendation of using the albumin-to-creatinine ratio, rather than 24-hour proteinuria, to monitor proteinuria and prognosis in primary IgA nephropathy.

Background: Betatrophin is a novel adipokine that provokes pancreatic β-cell proliferation and is involved in lipid metabolism. Aims: This study aims to evaluate the role of serum betatrophin in metabolic syndrome (MetS). Methods: A hospital-based, age-/gender-matched case control study was conducted. The serum betatrophin level was evaluated by enzyme-linked immunosorbent assay. Serum concentrations of 12 adipokines were measured to assess their associations with serum betatrophin, using commercial Adipokine Magnetic Bead Panel kits. Statistical analyses included bivariate correlation, receiver operating characteristic (ROC) curve, and multivariate stepwise linear regression. Results: Serum betatrophin showed a higher level in MetS patients (997.36 ± 475.92 pg/ml, p = 0.001) compared with controls (735.35 ± 526.51 pg/ml). Compared with the lowest tertile, the highest tertile of serum betatrophin level indicated an association with higher risk of MetS (adjusted odds ratio = 3.521, 95% confidence interval [CI] [1.191-10.413], p = 0.023). ROC curve of betatrophin was developed to predict the presence of MetS (area under ROC = 0.682 [95% CI, 0.597-0.767], p < 0.001). Furthermore, betatrophin correlated with several parameters, e.g. age (r = 0.286, p < 0.001), body mass index (r = 0.160, p = 0.046), waist-to-hip ratio (r = 0.241, p = 0.002), high-density lipoprotein cholesterol (r = -0.167, p = 0.037), low-density lipoprotein cholesterol (r = -0.195, p = 0.015), fasting plasma glucose (r = 0.266, p = 0.001), hemoglobin A1C (r = 0.314, p < 0.001), homeostasis model assessment of insulin resistance (r = 0.272, p = 0.001), and various adipokines, e.g. resistin (r = 0. 571, p < 0.001), interleukin-8 (r = 0.435, p < 0.001), tumor necrosis factor-α (r = 0.295, p = 0.011) and lipocalin-2 (r = 0.346, p = 0.003). Conclusions: This study supports that serum betatrophin plays an important role in MetS, involving the regulations of glucose and lipid metabolism and inflammation.

Introducción: la betatrofina es una novedosa adipoquina que provoca la proliferación de células β pancreáticas e interviene en el metabolismo de los lípidos. Objetivos: el propósito de este estudio es evaluar el papel de la betatrofina en el síndrome metabólico. Método: se llevó a cabo un estudio hospitalario de casos y controles según sexo y edad. El nivel de betatrofina en suero fue evaluado mediante ensayo por inmunoabsorción ligado a enzimas. Se midieron las concentraciones en suero de 12 adipoquinas para evaluar las asociaciones con la betatrofina usando los kits comerciales Adipokine Magnetic Bead Panel. Los análisis estadísticos incluyeron correlación bivariada, análisis de curva ROC y análisis de regresión lineal multivariable. Resultados: el nivel de betatrofina en suero fue más elevado en pacientes con síndrome metabólico (997,36 ± 475,92 pg/ml, p = 0,001) que en los controles (735,35 ± 526,51 pg/ml). Frente al tercil más bajo, el tercil más alto del nivel de betatrofina mostró una asociación con mayor riesgo de síndrome metabólico (odds ratio ajustado = 3,521, intervalo de confianza [IC] 95% [1,191-10,413], p = 0,023). Se desarrolló la curva ROC de betatrofina para pronosticar la presencia de síndrome metabólico (área bajo la curva ROC = 0,682 [95% IC, 0,597-0,767], p < 0,001). Además, la betatrofina mostró correlación con distintos parámetros, como edad (r = 0,286, p < 0,001), índice de masa corporal (r = 0,160, p = 0,046), índice cintura-cadera (r = 0,241, p = 0,002), lipoproteína de alta densidad (r = -0,167, p = 0,037), lipoproteína de baja densidad (r = -0,195, p = 0,015), glucosa plasmática en ayunas (r = 0,266, p = 0,001), hemoglobina A1C (r = 0,314, p < 0,001), índice de resistencia a la insulina mediante HOMA (r = 0,272, p = 0,001) y diversas adipoquinas, entre ellas resistina (r = 0,571, p < 0,001), interleucina-8 (r = 0,435, p < 0,001), factor de necrosis tumoral alfa (r = 0,295, p = 0,011) y lipocalina-2 (r = 0,346, p = 0,003). Conclusiones: este estudio demuestra que la betatrofina en suero desempeña una importante labor en el síndrome metabólico, implicando la regulación del metabolismo de la glucosa y los lípidos y la inflamación.