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Objective To evaluate the effect of global end diastolic volume index (GEDVI) on fluid resuscitation in elderly patients with septic shock. Methods A prospective randomized controlled trial (RCT) was conducted. Septic shock patients over 65 years admitted to intensive care unit (ICU) of Shandong Province, Zibo Central Hospital from January 2013 to December 2015 were enrolled. The patients were randomly divided into control group and observation group, 20 cases in each group. In accordance with the guidelines for the treatment of septic shock, early goal-directed therapy (EGDT), rehydration in the control group was treated with the guide of central venous pressure (CVP); observation group was received pulse indicator continuous cardiac output (PiCCO) monitoring, and rehydration was treated according to the GEDVI and extravascular lung water index (EVLWI), i.e. GEDVI was maintained in 650-800 mL/m2, EVLWI was not obviously increased compared with the basic value and without the emphasis of CVP. Initial acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score, sequential organ failure score (SOFA), procalcitonin (PCT), mean arterial pressure (MAP), lactic acid (Lac) and oxygenation index (PaO2/FiO2); serial Lac, central venous to arterial carbon dioxide pressure (Pcv-aCO2), fluid balance, the amount of noradrenaline accumulation, PaO2/FiO2 after 6, 24 and 48 hours resuscitation; mechanical ventilation time, incidence of acute heart failure, ICU hospitalization time and 28-day mortality were recorded. Results There was no significant difference in gender,age, APACHE Ⅱ score, SOFA score, primary disease, infection site and basal PCT, MAP, Lac, PaO2/FiO2 between the two groups. Compared with the control group, 6 hours Lac, Pcv-aCO2 recovery, positive fluid balance, noradrenaline accumulation and PaO2/FiO2 of the observation group showed no significant difference; positive fluid balance 24 hours in the recovery was significantly reduced (mL: 2919.80±986.44 vs. 3991.40±933.53), Pcv-aCO2 significantly decreased [mmHg (1 mmHg = 0.133 kPa): 5.55±1.43 vs. 7.10±2.38], PaO2/FiO2 significantly improved (mmHg: 194.80±28.57 vs. 177.65±23.46), and noradrenaline accumulation was increased significantly (mg: 40.99±20.69 vs. 27.31±19.34) with statistically significant difference (all P < 0.05); the blood level of Lac 48 hours in the recovery was significantly decreased (mmol/L: 1.16±0.89 vs. 1.85±1.01), Pcv-aCO2 (mmHg: 5.35±1.18 vs. 6.70±2.34), and PaO2/FiO2 (mmHg: 215.75±33.84 vs. 190.60±32.89) were further improved, the positive fluid balance was significantly reduced (mL: 3141.55±1245.69 vs. 4533.85±1416.67, all P < 0.05). Compared with the control group, mechanical ventilation time (days: 3.65±1.31 vs. 4.50±1.19), ICU hospitalization time (days: 5.80±1.67 vs. 7.15±2.30) was significantly shorter in the observation group (both P < 0.05), acute heart failure rate was decreased significantly (5.0% vs. 30.0%, P < 0.05), but the 28-day mortality showed no statistical significance (25.0% vs. 40.0%, P = 0.311). Conclusions Compared to the conventional EGDT methods, fluid resuscitation under the guidance of GEDVI in elderly patients with septic shock with less liquid loading, can achieve better oxygenation and reduce heart failure, shorten the duration of mechanical ventilation and ICU stay, and play an important significant guidance for elderly patients' fluid resuscitation with septic shock.
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Objective To investigate the effect of concentrated suture fixation in subdermal vascular network flap method for treatment of axillary osmidrosis in reducing postoperative complications,increase the wound dressing effect of comfort.Methods Ninety-six cases of bilateral axillary osmidrosis patients were randomly divided into concentrated suture group (group A) and 8 bandage compression group (group B),48 cases in each group.They were cleared of sweat gland retaining subdermal vascular network skin flap method in treatment of axillary osmidrosis.Group A was treated with concentrated suture fixation after the separation of the subdermal vascular network flap by in situ,group B was treated by routine compression bandage fixation after the separation of the subdermal vascular network flap.Observation of subcutaneous hematoma,infection,necrosis of skin after operation and understood dressing comfort.To observe the peculiar smell and axillary scar,operation area 6 months postoperative growth.Results The postoperative observation:group A subcutaneous hematoma complication rate was lower in group B,the incidence of 1.04％ (1/96) vs.19.79％ (19/96),the difference was statistically significant (P ＜ 0.01).Group A postoperative dressing comfort satisfaction rate was 93.75％ (45/48),group B po or comfort,satisfaction rate was only 10.42％(5/48),the difference had statistically significant (P ＜ 0.01).After 6 months of postoperative,the total efficiency of two groups were 100.00％,no significant difference (P ＞ 0.05).Group A district scar formation rate was higher than that in group B [3.12％(3/96) vs.21.88％(21/96)] (P ＜ 0.05).The armpit hair and sweat in the two groups was significantly reduced,there was no significant difference (P ＞ 0.05).Conclusion Concentrated suture fixation method in the treatment of axillary osmidrosis by subdermal vascular network is a reliable fixation of the axillary free after the subdermal vascular network flap,and have flap high healing rate,scar,low rate of complications; postoperative dressing is simple,comfortable,living freely,overall is better than 8 bandage compression method.
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Objective To analyze the correlations between acute respiratory distress syndrome ( ARDS) and extravascular lung water(EVLW),tumor necrosis factor alpha (TNF-α),E-selectin,vasostatin-2.To discuss the value of EVLW, TNF-α, E-selectin and vasostatin-2 in evaluating the severity of ARDS and prognosis of this disease . Methods There are thirty-six patients with ARDS were selected .According to the level of EVLWI shown by pulse indicator continuous cardiac output ( PiCCO) monitor,they were divided into the two groups:EVLWI≥14mL/kg group (n=18) and EVLWI0.05).EVLWI had positive correlation with PVPI,TNF-αand E-selectin (r=0.605,0.649, 0.549,all P0.05).Conclusion There were significant correla-tions between EVLWI and TNF-α,E-selectin in patients with ARDS.The levels of EVLWI,TNF-α,E-selectin were higher,and the mortality rate was higher,the the stay time in ICU was longer.The levels of EVLWI,TNF-αand E-selectin can provide a good reference value to the judgement of the severity of disease and prognosis in patients with ARDS.The level of vasostatin-2 had no correlation with EVLWI .
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ObjectiveTo assess the effect of modified minimally-invasive transverse-vertical epicanthoplasty in double-eyelid plastic with three points at the same period.Methods87 cases with mild or moderate epicanthus and oriental eyelid were involved in our research.Epicanthoplasty was performed based on the principle of transversevertical plasty.The curvilinear incision of epicanthoplasty was made between the desired point of the new medial canthus and the lower lacrimal point,the malpositioned orbicularis oculi muscle excised after skin undermining,the superficial head of the medial canthal tendon plicated or anchored to the lateral nasal aponeurosis and the incision closed after skin redraping.Double-eyelid plastic with three points was performed as usual,however,the incision of eyelid plastic was connected with the incision of epicanthoplasty by skin tunnel in which a strip of orbicularis oculi muscle was excised.Results87 cases were followed-up for 3 to 24 months.The cosmetic results of the new medial canthi were satisfactory with new figure and inconspicuous scar.The contours of the double eyelids were natural.No incisional scar presented between the medial canthi and the upper eyelids.No recurrence of epicanthus was observed.ConclusionThe modified mini-incisional transverse-vertical epicanthoplasty together with double-eyelid plastic with three points is a simple and effective feasible surgical approach for correction of epicanthus and oriental eyelid.
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ObjectiveTo study the curative effect of axillary osmidrosis,that incision in armpit wrinkle,orthoptic cut off the gland to thick skin flap.MethodsCollected double-sided axillary osmidrosis 163 patients,all of them accepted armpit wrinkle incision,the scope of surgical operation super the armpit hair distribute 1 cm,swelling anaesthesia,orthoptic cut off the armpit organization 5 mm under skin included apocrine sweat gland,kept the operation scope to vessel net flap under skin.Hematischesis thoroughly used a double pole electricity hemostasis,kept drainage after operation,bandaged in pressure,took out sutures after 9 days.The foul smell standard referenced the Tung-Chain standard of axillary osmidrosis curative effect evaluation.ResultsThree hundred and twenty armpits (98.16％,320/326) were cure,6 armpits (1.84％,6/326) were excellence.The armpit hair variety:obvious reduce 322 armpits(98.77％,322/326),general reduce 4 armpits(1.23％,4/326).Perspire condition:obvious reduce 324 armpits(99.39％,324/326),improve but no obvious reduce 2 armpits ( 0.61％,2/326).The average surgical operation recovery time was about 9 days.Complication:necrosis on the edge of the skin was 8 armpits,scar formation on the incision was 3 armpits,hematoma was 1 armpit,shoulder joint limitation of activity was 0 armpit.ConclusionThe method of axillary osmidrosis treatment useing thick skin flap in armpit wrinkle,which has extermination foundation of anatomy and pathology,which can cause axillary osmidrosis,this operation is simple,curative effect is credible,the wound is small,complication is little etc,utmost matching the principle of orthopedic surgery,worthy of clinical application.
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Objective This study was designed to evaluate the correlations between soluble E-selectin (sE-selectin) and intedeukin-8 (IL-8) levels and the condition and prognosis of severe pneumonia. Methods A total of 67 patients with pneumonia were identified at the intensive care unit and the Respiratory Department of Zibo Central Hospital between April 2007 and March 2008. The patients were divided into two groups according to the severity of pneumonia: severe (Group A, n = 35) and non-severe (Group B, n = 32). Group A was also subdivided into two groups of patiems: patients with Multiple Organ Dysfunction Syndrorae(MODS) (Group A_1, n = 13) and pa-tients with severe pneumonia alone (Croup A_2, n= 22). Thirty healthy people whose age and sex matched with the patients were enrolled as a control group (Group C). Patients with cancer, who had undergone surgery within the past 1 month, connective tissue disease or acute conplications of diabetes, for example, were excluded from the study. The serum levels of s-Eselectin and IL-8 were measured by EI.ISA, and correlations with Acute physiol-ogy and chronic Health Evaluation Ⅱ (APACHE-Ⅱ)score, Oxygenation index(PaO_2/FiO_2), percentage of poly-morphonuclear leukocyte (PMN)and high sensitive C-reactive protein (hs-CRP)levels were determined. The data were analyzed using t tests, one-way ANOVA, X~2 tests and linear correlation analysis using SAS 8.2 software. Results The sermn levels of sE-selectin and IL-8 in Croup A and Group B were significant higher than Group C (P < 0.05), and the levels in Group A were higher than those in Group B (P < 0.05). Furthermore, the levels of sE-selectin and IL-8 were higher in Group A_1 than in Group A_2(P < 0.001). The correlation analysis showed a positive correlation between the levels of sE-selectin and IL-8 in patients with pneumonia (r = 0.781,P < 0.01) ; and both were positively correhted with APACHE-Ⅱ score, PMN% and hs-CRP (P < 0.01), and nega-tively correlated with PaO_2/FiO_2 (P < 0.01).Conclusions sE-selectin and IL-8 levels are important indices for the assessment of the severity of pneumonia in tetras of the condition and prognosis.
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Objective To observe the change of plasma neuropeptide Y(NPY) concentration in patients with essential hypertension,and its relevance to target organ damage.Methods The plasma NPY concentration was determined by radioimmunoassay(RIA) in 115 patients with essential hypertension,including 45 patients with single target damage(left ventricle hypertrophy 21,stroke 13,nephropathy 11) and 19 patients with multiple target damage,with 30 normal as controls.Results 1) Plasma NPY concentration in patients with essential hypertension was significantly higher than normal controls(P0.05).Conclusion NPY may involve in the physiopathologic progress of essential hypertension and associate with the development of target organ damage.Evaluation of plasma NPY concentration may be valuable biomarker in estimation the severity of hypertension and target organ damage.