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Objective:To explore the value of Glasgow coma score (GCS) combined with optic nerve sheath diameter (ONSD) in predicting the death risk of patients with cerebrocardiac syndrome (CCS).Methods:From January 2021 to September 2021, 83 patients with CCS secondary to severe traumatic brain injury (sTBI) in our hospital were collected and divided into a survival group ( n = 37) and death group ( n = 46) according to CCS-related death. The clinical data including age, sex, underlying diseases, head CT imaging manifestations, electrolytes, blood glucose, C-reactive protein (CRP), neuron-specific enolase (NSE), lactate dehydrogenase (LDH), creatine kinase (CK), creatine phosphokinase isoenzyme (CKMB), intracranial pressure (ICP), ONSD, cardiac color ultrasound, acute physiology and chronic health evaluationII (APACHEⅡ ) and GCS were analyzed and compared between the two groups. The proportion and dosage of vasoactive drugs used at admission, daily fluid balance volume during hospitalization, total amount of sedative and analgesic drugs, and average daily dose were analyzed and compared between the two groups. The independent risk factors for CCS-related death were analyzed using multivariate logistic regression. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the independent risk factors in CCS-related death. Results:In this study, 55.4% of the patients died of CCS. The ONSD, ICP change rate, right ventricular Tei index and NSE in the death group were higher than those in the survival group, with statistically significant differences ( P < 0.05), while the GCS in the death group was significantly lower than that in the survival group, with a statistically significant difference ( P < 0.01). ONSD ( OR = 23.890, 95% CI: 5.526-103.286, P < 0.001), GCS ( OR = 17.066, 95% CI: 1.476-197.370, P = 0.023) and ICP change rate ( OR = 0.060, 95% CI: 0.007-0.477, P = 0.008) were the independent risk factors for CCS-related death. The area under the ROC curve (AUC = 0.897) of ONSD combined with GCS in evaluating CCS-related death was larger than that of ONSD, ICP change rate alone and the corresponding AUC of 1/GCS (0.876, 0.785, 0.800, respectively), with the advantages of non-invasive, dynamic monitoring and low inspection costs. Conclusions:The mortality rate of CCS is high. ONSD, GCS and ICP change rates are independently correlated with the death of CCS patients. ONSD combined with GCS is an ideal indicator for clinical prediction of CCS-related death.
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Objective To explore the effects of sepsis on the ultrastructure and function of thyroid in rats.Methods This study was performed in the Animal Department of Fujian Medical University,the Key Laboratory of Fujian Provincial Cardiovascular Institute and the Electron.Microscopic Department of Fujian Medical University.Thirty-two pathogen-free male Sprague-Dawley rats weighing 180-220 g selected,and were randomly (random number) divided into control group (C group,n =8),12 hour group (n =8),24 hour group (n =8) and 36 hour group (n =8).The 12 h group,24 h group and 36 h group were established to be sepsis groups.The sepsis model was made by cecal ligation and puncture (CLP).The samples of blood and thyroid tissue of rats in 12 h group were taken 12 hours after modeling,and then the same procedure was done in the rats of 24 h group and 36 h group separately 24 hours and 36 hours after modeling.Blood serum was obtained by centrifugation to detect the thyroid function using measurement of different of kinds of hormones (T3,T4,fT3,fT4,TSH).Thyroid tissue was available to determine the expression of caspase-3,cell apoptosis and change of ultra-microstructure.Raw data were analyzed using SPSS19.0 software.Caspase-3 grey value was determined by Image J software.Thyroid hormone levels were presented as mean ± standard deviation.The differences in levels of different kinds of thyroid hormone among all the groups were determined by one-way ANOVA.TUNEL positive staining and caspase-3 expression were presented as median (P25,P75).Results Compared to the control group,the T4 decreased significantly (P＜0.05) in the 12 h group,the 24 h group and the 36 h group,both the tT3 and the fT4 decreased significantly in the 24 h group and the 36 h group (P ＜0.05),and the T3 decreased significantly in the 36 h group (P ＜ 0.05).The expression of caspase-3 in the 24 h group was higher than that in the C group (P ＜ 0.05).There was significant difference in rate of celt apoptosis in thyroid tissue among those four groups,and both the 24 h group and the 36 h group had higher rate of cell apoptosis than the C group significantly (P ＜0.05).In those sepsis groups,a series of pathological ultrastructural changes were found in thyroid follicular epithelial cells as following:the nucleus became smaller and more distinctly stained,and quite a few vacuoles were visualized in cell.Furthermore,the cell membrane was broken,and nuclei showed pyknosis.Conionclus In sepsis rats,the significant changes of different kinds of thyroid hormone in serum are similar to those found in the thyroidal illness syndrome,the expression of caspase-3 and cell apoptosis in thyroid tissue increase,and pathological change of thyroid follicular epithelial cells can be observed under electron microscopy.
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Objective To explore the clinical characteristics of multiple organs dysfunction syndrome (MODS) complicated with injury of pancreas.Methods A prospective study was carried out.From January 2011 to December 2012,a total of 69 patients with MODS in Department of Medical Intensie Care Unit,Fujian Provincial Hospital,Fujian Medical University were divided into 2 groups at admission.Patients of group A were suffered from MODS complicated with pancreas injury while patients of group B had MODS without complicatios.They were compared and evaluated by acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,6-hour clearance rate of lactic acid,incidence of shock,fluid resuscitation in the first 24 and 48 hours,bladder pressure and 28-day accumulative mortality.Results APACHE Ⅱ score in group A was significantly higher than that in group B (P ＜ 0.01).Compared with group B,the 6-hour clearance rate of lactic acid was lower,the incidence of shock increased obviously,and larger volume of fluid resuscitation was needed in the first 24 and 48 hours in the group A (P ＜ 0.05).Bladder pressure,incidence of feeble bowel sounds and the mortality in the group A were higher than those in group B,but the difference had no statistical significance (P＞0.05).Conclusions MODS complicated with pancreas injury is more severe than MODS without complications thereby resulting in higher incidence of shock and the poorer response to fluid resuscitation.