Evaluation index in predicting the prognosis of critical patients post cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To assess the early prognosis of 117 patients after carduopulmonary resuscitation (CPR) in ICU by using the markers of inflammation,Glasgow Coma Scale (GCS) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores.Methods A total of 117 CPR patients admitted between 2010 January to 2012 December were enrolled for study.Within 24 h after admission,inflammatory markers,blood routine items,hepatorenal function,electrolytes of blood were measured.The GCS and APACHE Ⅱ scores were recorded.Arterial blood gas analyses were performed at 0,12,and 24 h after hospitalization,and the 12-h and 24-h lactate clearance rates were calculated.Seven days after treatment,according to the outcomes,the patients were divided into survival group and death group,and the clinical data of two groups were analyzed.Results (1) Of them,73 patients died and 44 survived.Factor analysis showed that age,time elapsed from resuscitation to ICU admission,D-dimer,arterial oxygenation index (FiO2),arterial blood pH,arterial blood lactate concentration upon ICU admission,GCS score and APACHE Ⅱ score were significantly different between the two groups (P ＜ 0.05or P ＜ 0.01); (2) Two classification logistic regression analysis showed that D-Dimer,GCS score and APACHE Ⅱ score significantly correlated with the mortality risk of the patients in the wake of CPR with relative odds ratios of 1.000,2.091,and 0.531,respectively (P ＜ 0.05 or P ＜ 0.01) ; (3) Receiver operating characteristic curve analysis indicated that the area under the curve of GCS (0.821) and APACHE Ⅱ (0.869) had higher predictive value than D-dimer (0.655).The highest accuracy (84.6％) in predicting patient survival was achieved when the GCS score was 6.5.Meanwhile,the highest accuracy (82.1％) in predicting patient death was achieved when the APACHE Ⅱ score was 17.5.Conclusions Both GCS score and APACHE Ⅱ score has obvious correlation with the prognosis of the critically ill patients after CPR and could be used to predict prognosis at early stage.

Fluid resuscitation in a patient with severe hypovolemic shock and severe pulmonary capillary leak / 南方医科大学学报

A male patient undergoing extracorporeal ultrasound lithotripsy developed the symptoms of dyspnea, low blood pressure, palpitations, chest tightness, and sweating, and a clinical diagnosis of pulmonary capillary leak and hypovolemic shock was made. Pulse indicator continuous cardiac output (PiCCO) technique was used for resuscitation according to the measurements of extravascular lung water index (EVLWI) and global end-diastolic volume index (GEDI). The patient showed low levels of cardiac output (CO) and GEDI with a peak EVLWI of 32 ml/kg and profuse pink and thin sputum overflow from the trachea. The high ventilator support parameters failed to correct low oxygen saturation. Restricted fluid infusion was used to reduce pulmonary edema. Colloidal solution was given when GEDI was below 500 ml/m(2), and the volume and fluid infusion rate were reduced for a GEDI higher than 500 ml/m(2). Pulmonary edema was gradually reduced after the treatments with improvement of lactic acid level and liver and kidney functions. Vasopressors were withdrawn 6 days later, mechanical ventilation was discontinued 10 days later, and tracheal intubation was removed 25 days later, after which the patient was discharged. In the treatment of the patient, PiCCO monitoring played an important role.

Genetic risk factors of sporadic Alzheimer's disease among Chinese in Beijing / 中华老年医学杂志

Objective To evaluate the genetic factors for sporadic Alzheimer's disease(SAD) among a Chinese population in Beijing. Gene polymorphisms was studied: apolipoprotein E,ps-1 gene E318G missense mutation,alpha(2)-macroglobulin gene Val1000/Ile1000,mtDNA4336G mutation and methylene tetrahydro-fulek reduclase (MTHFR) C677T mutation. Methods The polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)technique was used to analyze the genotype of 127 SAD patients and 138 non-dementia elderly controls. Results There was a significant difference in the frequency of apoE allele gene between SAD and control group. The freguencies with 2 of apoE4 ,1 of apoE4 and none of apoE4 in SAD were 2.4%,18.1%,79.5% respectively,and in normal control were 0.7%,10.1%,89.2% respectively. mtDNA4336 mutation and ps-1 E318G missense mutation were not found in either Alzheimer's disease or age-matched controls. The frequency of A2M Val1000 (GTC)/Ile1000 (ATC),G/G genetype was 0.02 in SAD and 0.01 in NC . The frequency of MTHFR C677T mutation was 46.3% in SAD and 43.8% in NC respectively, The mutation frequency of cases was not significantly increased than that of controls. Conclusions Our study indicates that apoE?4 allele gene is risk factor for SAD.

Study on apolipoprotein E gene polymorphism and mtDAN4336 mutation in patients with Alzheimer's disease / 临床神经病学杂志

Objective To study the distribution of Apolipoprotein E(ApoE) gene polymorphism and mtDAN*!4336 mutation in patients with sporadic Alzheimer's disease(AD),and analyse the difference of frequency of ApoE genotype from some other studies.Methods The polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) technique was used to analyze the ApoE allele genotype and mtDAN mutation of 127 AD patients and 138 healthy elderly controls.Results In AD group, we found 2.4% of the patients with 2 ApoE4 allele gene, 18.1% of the patients with 1 ApoE4 allele gene, and 79.5% of the patients without ApoE4 allele gene. However, in control group, the frequency was 0.7%, 10.1% and 89.2% respectively. There was a significant difference between the two groups( P