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Objective:The hemodynamic parameters of elderly patients with septic shock were measured simultaneously with pulse index continuous cardiac output(PiCCO)and thoracic electrical bioimpedance(TEB)to evaluate the accuracy of TEB and to provide empirical evidence for its clinical use.Methods:A total of 24 elderly patients with septic shock admitted to the intensive care unit of our hospital between July 2021 and December 2021 were retrospectively recruited.TEB and PiCCO hemodynamic monitoring were performed continuously in all patients, and hemodynamic data were collected for statistical analysis.Results:Cardiac output, cardiac index, stroke volume, stroke index and systemic vascular resistance measured by the two methods had no significant difference( P>0.05). The 95% confidence intervals in the Bland-Altman plots for cardiac output, CI, stroke volume, stroke index, and systemic vascular resistance were(-1.18, 1.25), (-0.65, 0.71), (-24.23, 37.00), (-12.93, 19.26)and(397.11, 425.83). In the Bland-Altman plots for cardiac output, cardiac index, stroke volume and systemic vascular resistance, 4.17% of the points(1/24)fell outside of the 95% confidence interval, and in the Bland-Altman plots for stroke index, 8.33% of the points(2/24)fell outside of the 95% confidence interval. Conclusions:TEB and PiCCO have good consistency in evaluating the hemodynamics of elderly patients with septic shock.Therefore, TEB can be recommended for community hospitals and used in elderly patients.
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Exercise rehabilitation is an important method for the prevention and treatment of cardiovascular diseases(CVD). Non-invasive hemodynamic monitoring has the advantage of effectively recording changes in exercise intensity and cardiac function with easy implementation, good compliance, and objective and reliable results.It holds great promise in a wide range of purposes such as helping the formulation of exercise prescriptions and evaluating clinical efficacy for cardiac rehabilitation(CR)in community hospitals.
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Objective:To investigate the immediate and lasting effects of enhanced external counterpulsation(EECP)on blood pressure in elderly patients with hypertension.Methods:In this real-world prospective non-randomized controlled study, the elderly hypertensive patients who were newly diagnosed as hypertension or had poor blood pressure control in the Geriatrics Department of Shandong University Qilu Hospital from May 2019 to December 2019, were enrolled as EECP group, and those with systolic blood pressure(SBP)≥180mmHg(1mmHg=0.133 kPa)or had contraindications for EECP treatment were excluded from EECP group(28 cases). Based on the 1∶1 ratio being consistent with the tendency score-matching method, patients' blood pressure was matched at 3 d before the start of the EECP treatment course, with other matched data of baseline data, coexisting disease, cardiovascular medication were choosed as control group(n=28). The EECP group received an additional 36 hours of EECP treatment(6 times/week, 1 hour/time)including lifestyle improvement and anti-hypertensive drugs.The patient's supine blood pressure was collected 3 minutes before each EECP treatment(baseline), 30 minutes during treatment, and 3 minutes after treatment.In the EECP group, family self-measured blood pressure was collected 3 days before the start of the 6-week treatment course(0w), the 6th week(6w)of the treatment course, and the 2nd week(+ 2w), 4th week(+ 4w)and 12th week(+ 12w)after the end of the treatment course, respectively.And the data of control group were collected at the same time point mentioned above.Results:Compared with baseline, the average immediate SBP of elderly hypertensive patients at the 30th minute of EECP treatment was decreased by(5.5±13.6)mmHg( P<0.001), and the average immediate diabolic blood pressure(DBP)was decreased by(1.1±7.5)mmHg( P<0.001). When the baseline SBP was between 160 and 169 mmHg, the probability of a further increase in SBP during treatment was 2.2%(2/89 cases), and when the baseline SBP was between 170 and 179 mmHg, the probability of a further increase in SBP during treatment was 0%(0/57). At 6 weeks, the decrease in SBP was significantly greater in the EECP group than in the control group[(-17.0±8.7)mmHg vs.(-10.5±7.3)mmHg, P<0.01], and the difference continued to + 2w[(-15.5±6.6)mmHg vs.(-10.6±2.5)mmHg, P<0.01]and + 4w[(-13.3±5.4)mmHg vs.(-10.7±2.1)mmHg, P<0.05]. At + 12w, the blood pressure drop was still greater in EECP group than in the control group, but it did not achieve statistically significant differences.Smoking history, history of diabetes, family history of hypertension, and improvement of comorbidities were the key factors that affect the continuous anti-hypertensive effect of EECP. Conclusions:EECP treatment has an immediate effect on lowering blood pressure in elderly hypertensive patients.A 6-week course of EECP treatment has a sustained effect on lowering blood pressure, and the effect can last from 4 to 12 weeks after the end of the course of treatment.
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Objective:To investigate the effect of enhanced external counterpulsation(EECP)on heart failure with preserved ejection fraction(HFpEF)and hemodynamics in elderly patients.Methods:Clinical data of 66 elderly HFpEF patients admitted to the enhanced external counterpulsation center of our hospital from January 2018 to December 2019 were retrospectively analyzed.The primary assessment parameter was the six-minute walk distance, and the secondary parameters included the Minnesota Living with Heart Failure Questionnaire(MLHFQ). Noninvasive hemodynamic parameters including the cardiac index(CI), stroke volume(SV), isovolumic relaxation period(A2-mitral valve opening, A2-O), pulmonary capillary wedge pressure(PCWP)and total peripheral resistance(TPR)were monitored and mean arterial blood pressure(MAP)was calculated.Results:After EECP treatment, the six-minute walk distance increased(372±87 m vs.341±85 m, P<0.05), the score of MLHFQ decreased(47.0±16.0 vs.50.0±17.0, P<0.05), CI increased(2.8±0.7)L·min -1·m -2vs.(2.6±0.6)L·min -1·m -2( P<0.05), SV, PCWP and A2-O did not show significant change(73.3±16.4 ml vs.71.5±17.1 ml, 10.0±3.3 mmHg vs.11.0±3.6 mmHg, 1 mmHg=0.133 kPa, 98.0±29.5 ms vs.91.0±29.1 ms, P>0.05), TPR decreased(1 719.0±427.0 DS/cm 5vs.1 821.0±508.0 DS/cm 5, P<0.05), and there was no significant change in MAP(96.9±10.7 mmHg vs.98.8±13.1 mmHg, P>0.05), compared with pre-EECP treatment levels.Compared with patients without hypertension, MAP decreased in patients with hypertension(14 cases), when stratified by the initial MAP( P<0.05). Conclusions:For elderly patients with HFpEF, EECP can increase the six-minute walk distance, improve the quality of life and hemodynamic parameters, and is a safe adjuvant treatment.
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Objective To investigate the comprehensive improvement of multi-system diseases in elderly patients treated with enhanced external counterpulsation(EECP).Methods Clinical data of an elderly patient with multiple systemic diseases were collected and analyzed.The therapeutic effect of EECP was assessed and EECP-related literatures were reviewed.Results The 62-year-old male patient was diagnosed with coronary atherosclerotic heart disease,unstable angina,New York Heart Association(NYHA)functional class Ⅱ,hypertension(grade 3,very high risk),type 2 diabetes,acute cerebral infarction (recovery period)and benign prostatic hyperplasia.After two courses of EECP treatment,angina in the patient was significantly relieved,cardiac systolic and diastolic function was improved,activity tolerance was increased and the corresponding dosage of therapeutic drugs was reduced.In addition,the patient's blood pressure and blood glucose levels were decreased after versus before treatment and the retinal superficial blood flow was enhanced in both eyes assessed by optical coherence tomography.The frequency and volume of nocturia were reduced.The symptoms of numbness on the left side were improved.Conclusions EECP treatment has shown significant therapeutic effects on multi-system diseases in the elderly patient.EECP is safe,effective and simple and has a broad application prospect in geriatrics.
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Objective To investigate the relationship between the serum levels of retinol-binding protein 4(RBP4),blood lipid level and glycemic control in patients with chronic schizophrenia complicated with type 2 diabetes.Methods The levels of glycated hemoglobin (HbA1c),fasting plasma glucose (FPG),cholesterol (TC),triglycerides (TG),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),apolipoproteinA1 (Apo A1),apolipoprotein B(Apo B),apolipoprotein E(Apo E),lipoprotein(a)[Lp (a)],free fatty acid(FFA),RBP4,fasting insulin (FINS) were determined in 96 patients with chronic schizo-phrenia complicated with type 2 diabetes (schizophrenia group) and 50 healthy subjects (healthy control group),the insulin resistance index (HOMA IR)was calculated.The patients were divided into HbA1c<7.0% group and HbA1c≥7.0% group according to the results of the HbA1c,and the results were statistically analyzed.Results In the HbA1c<7.0% group,the levels of HbA1c,FPG,TG,Apo B,Apo E,Lp(a),RBP4 were significantly higher than those in the healthy control group,the levels of serum Apo A1 and HDL-C was lower than those in the healthy control group (P<0.05).In the HbA1c≥7.0% group,the levels of HbA1c, Body mass index (BMI),FPG,TG,Apo E,FFA,RBP4,FINS,HOMA-IR were significantly higher than those in the HbA1c<7.0% group and the healthy control group,the levels of TC,Apo B,Lp(a)were significantly higher than the healthy control group and the levels of serum Apo A 1 and HDL-C were lower than those in the healthy control group (P<0.05).Single factor Logistic regression analysis showed that BMI,TG,Apo E, FFA,RBP4,FINS and HOMA-IR were risk factors for poor control of blood glucose in type 2 diabetes pa-tients with chronic schizophrenia.Conclusion The levels of RBP4 and blood lipid in patients with chronic schizophrenia complicated with type 2 diabetes may be related to the poor control of blood sugar level.
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Influenza,caused by influenza virus,is a respiratory infectious disease with a serious hazard to human health.Prevention of influenza through vaccine development is the most effective strategy.It is important to build a rapid response platform for research and production of influenza vaccine.As virus vectors,live vaccine provides a new prevention and treatment way for infectious disease.Modified vaccinia virus Ankara(MVA) is a replication-deficient viral vector that is safe and can encode one or more foreign antigens and induce humoral and cellular immune response.MVA holds great promise as a vaccine platform.In this review,we discuss the use of MVA for vaccine development against influenza virus.
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OBJECTIVE@#To explore the distribution of allergen tested by skin prick test (SPT) in about 5,843 allergic rhinitis patients in south Shanghai.@*METHOD@#SPT test was conducted in 5,843 allergic rhinitis patients who came to our clinic from January 2007 to August 2012. The result was analyzed by age, sex and year.@*RESULT@#The top three allergens by percentage are dermatophagoides pteronyssinus, dermatophagoides culinae and fungus among 15 common allergens. Incidence rate between male and female in each year had statistical significance, both of which showed no increasing trend with year. Incidence rates among different age groups aging from 6 to 17 years' old had no statistically significant difference, but statistically significant difference among different age groups existed in other age groups. Incidence rate showed increasing trend with year in age group of 40-65, which was not observed in other groups. The incidence rate showed decreasing trend with age in male and female, while the incidence rate in male was always higher than female.@*CONCLUSION@#In south Shanghai, primary allergens causing allergic rhinitis are dermatophagoides pteronyssinus, dermatophagoides culinae and fungus. Statistically significant difference about allergic rhinitis existed in age and sex. SPT has important significance in diagnosis of allergens.
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Allergens , Allergy and Immunology , China , Epidemiology , Rhinitis, Allergic , Diagnosis , Epidemiology , Allergy and Immunology , Skin TestsABSTRACT
Medical chemistry is one of the important basic medicines.Faced with the rapid development of education,Medical chemical education reform or innovation should also keep vigorous.In this paper,we discuss how to innovate and improve the quality and effect of experiment in the process of medical chemistry experiment and lay a solid foundation for continued study.