ABSTRACT
Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) has a wide range of symptoms, and it is difficult for clinicians to make a quick and correct diagnosis. On November 11, 2021, a 36-year-old male patient with AAV was admitted to the emergency and critical care department of Yichang Central People's Hospital. He was admitted to the emergency intensive care unit (EICU) with gastrointestinal symptoms (abdominal pain, black stool) as the main physical signs, and was initially diagnosed as AAV with gastrointestinal hemorrhage (GIH). No bleeding point was found after repeated gastroscopy and colonoscopy. Abdominal emission CT (ECT) showed diffuse hemorrhage in the ileum, ascending colon and transverse colon. Multi-disciplinary consultation in the whole hospital considered the diffuse hemorrhage caused by small vascular lesions in the digestive tract caused by AAV. Pulse therapy with methylprednisolone 1 000 mg/d and immunosuppressive therapy with cyclophosphamide (CTX) 0.2 g/d were administered. The patient's symptoms quickly relieved and transferred out of the EICU. After 17 days of treatment, the patient finally died of massive gastrointestinal bleeding. A systematic review of relevant literatures combined with the case diagnosis and treatment process found that only a minority of AAV patients present with gastrointestinal symptoms as their first symptoms, and patients with GIH were very rare. Such patients had a poor prognosis. This patient delayed the use of induced remission and immunosuppressive agents due to the treatment of gastrointestinal bleeding, which may be the main cause of life-threatening GIH secondary to AAV. Gastrointestinal bleeding is a rare and fatal complication of vasculitis. Timely and effective induction and remission treatment is the key to survival. Whether patients should receive maintenance therapy, the duration of maintenance therapy, and the search for markers of disease diagnosis and treatment response are directions and challenges for further research.
Subject(s)
Male , Humans , Adult , Gastrointestinal Hemorrhage , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis , Critical Care , Cyclophosphamide , DeathABSTRACT
OBJECTIVE： To evaluate the efficacy and safety of nalbuphine for postoperative analgesia systematically， and to provide evidence-based reference in clinic. METHODS： Retrieved from Embase， Medline， PubMed， CNKI， VIP and Wanfang database， RCTs about nalbuphine hydrochloride （trial group） vs. other analgesics （control group） for postoperative analgesia were collected. After literature screening， data extraction and literature quality evaluation with modified Jadad scale， Meta-analysis was performed by using Rev Man 5.3 statistical software. RESULTS： A total of 10 RCTs were included， involving 796 patients. Results of Meta-analysis showed that there was no statistical significance in satisfaction rate of analgesia [OR＝1.11，95％CI（0.70，1.74），P＝0.66]， the incidence of nausea [OR＝1.20，95％CI（0.79，1.83），P＝0.39]， vomiting [OR＝1.02，95％CI（0.69，1.50），P＝0.92] or narcolepsy [OR＝1.32，95％CI（0.47，3.76），P＝0.06] between 2 groups. The incidence of pruritus [OR＝0.29，95％CI（0.14，0.58），P＝0.000 6]， respiratory depression [OR＝0.21，95％CI（0.08，0.58），P＝0.003] and uroschesis [OR＝0.05，95％CI（0.01，0.37），P＝0.004] in trial group were significantly lower than control group. CONCLUSIONS： Nalbuphine has better efficacy and safety for postoperative analgesia.
ABSTRACT
Objective To investigate the effect of body weight on the induction of mild hypothermia in a rabbit model of asphyxia cardiac arrest. Methods Twenty-four rabbits were randomized into two groups: the ice bag group and the intravenous 4℃ saline group. Cardiac arrest was induced and after 3 minutes of cardiac arrest, cardiopulmonary resuscitation was begun. Simultaneously, mild hypothermia was induced by putting an ice bag over the abdomen or infusion of 4℃ saline via an ear vein. A 2℃ decrease of rectal temperature was considered as the completion of hypothermia induction. Induction times were recorded, compared, and analyzed with respect to body weight. Results All rabbits had restoration of spontaneous circulation (ROSC) and ROSC lasted during the experiment. Induction time in the ice bag group was significantly shorter than that in the intravenous 4℃ saline group (22.8±4.7 min VS 42.5±4.0 min, P< 0.001). Induction time significantly correlated with body weight in the ice bag group (Pearson Correlation: r = 0.725, P = 0.029), but not in the intravenous 4℃ saline group (Pearson Correlation: P = 0.418). Conclusions In a rabbit model, induction of mild hypothermia with an ice bag is faster than with intravenous 4℃ saline; induction time positively correlates with body weight when an ice bag is used, but not when intravenous 4℃ saline used. The effect of body weight should be considered when choosing an appropriate method to achieve early induction of mild hypothermia.