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Objective:To investigate the changes of plasma prolactin (PRL) and cortisol (Cor) in the head up tilt test (HUT) in children with vasovagal syncope (VVS), and their correlation with VVS.Methods:From May 2019 to May 2020, 75 children diagnosed as VVS through positive HUT in the Children′s Hospital, Capital Institute of Pediatrics were retrospectively recruited as VVS group, while 29 healthy children with negative HUT during the same period were collected in healthy control group.Heart rate (HR) and blood pressure [systolic and diastolic blood pressure (SBP, DBP)] were monitored using a noninvasive continuous blood pressure monitor.The changes of HR, SBP and DBP were analyzed and their differences between the supine position and positive reaction of HUT were compared.The contents of PRL and Cor in the supine position and positive reaction of HUT were measured using the electrochemiluminescence, and their changes (ΔPRL and ΔCor) were calculated.Differences between groups were analyzed by the two-tailed Student′s t-test or the Mann- Whitney test.Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of ΔPRL on VVS. Results:There were no significant differences in the age, gender, body mass index, blood electrolyte, syncope frequency and syncope course between VVS group and healthy control group (all P>0.05). There was no significant difference in syncope frequency and course of syncope among subtypes of VVS group (vasodepressor syncope, mixed syncope, cardioinhibitory syncope)(all P>0.05). Compared with healthy control group, PRL after HUT was significantly higher in VVS group[36.23 (22.08, 61.97) μg/L vs.11.47 (8.00, 23.25 ) μg/L, Z=-5.40, P<0.01]. Both ΔPRL [25.36( 9.92, 48.93) μg/L vs.-0.10(- 2.67, 9.32) μg/L, Z=-5.39, P<0.01] and ΔCor [(84.4±43.6) μg/L vs.(57.6±64.6) μg/L, t=-2.44, P<0.05 ] were significantly higher in VVS group than those of healthy control group.PRL at HUT positive reaction was negatively correlated with SBP and DBP ( r=- 0.46, -0.45, all P<0.01). In VVS group, PRL at HUT positive reaction was negatively correlated with SBP ( r=-0.38, -0.24, all P<0.05). In VVS group, ΔCor after HUT was negatively correlated with SBP ( r=-0.25, P<0.05). ROC curves revealed that the cut-off value of ΔPRL in predicting HUT was 4.03 μg/L, with the sensitivity of 89.3% and specificity of 72.4%. Conclusions:Plasma PRL and Cor increase during syncope in VVS children, and plasma PRL is correlated with blood pressure drop.The increased plasma level of PRL in VVS children with positive HUT is correlated with blood pressure, and ΔCor is correlated with SBP.Plasma PRL and Cor may be involved in the pathogenesis of VVS and ΔPRL presents the diagnostic potential of VVS in children.
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Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on function of lung ventilation in the patients undergoing laparoscopic cholecystectomy using electrical impedance tomography (EIT).Methods:Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, with body mass index of 18.5-24.9 kg/m 2, undergoing elective laparoscopic cholecystectomy, were divided into 2 groups ( n=30 each) using a random number table method: control group (CON group) and TEAS group.EIT was carried out after entering the operating room.In group TEAS, bilateral Feishu (BL13) and Chize (LU5) acupoints were stimulated, while stimulation electrodes were only placed without electricity in group CON.The percentages of area in center of ventilation and tidal volume in the dependent areas were determined on admission to the operating room (T 1), at 5 min after tracheal intubation (T 2), at 5 min after CO 2 pneumoperitoneum (T 3), at 5 min after CO 2 was exhausted (T 4), and at 5 and 30 min after removal of the tracheal tube (T 5, 6). Radial artery blood samples were collected for blood gas analysis at T 1, T 3 and T 6, and the oxygenation index (OI) and alveolar-arterial oxygen difference (A-aDO 2) were calculated.Blood samples were taken from the peripheral vein at T 1, T 3 and T 6 for determination of the serum concentrations of Clara cell secretion protein (CC16), interleukin (IL)-6 and tumor necrosis factor (TNF)-α. Results:Compared with the baseline at T 1, the percentages of area in center of ventilation and tidal volume in dependent areas at T 2-6 and OI and A-aDO 2 at T 6 were significantly decreased, and the serum concentrations of TNF-α, IL-6 and CC16 were increased at T 3 and T 6 in two groups ( P<0.05). Compared with group CON, the percentage of tidal volume in dependent areas at T 5, 6 and OI at T 6 were significantly increased, and A-aDO 2 and serum concentrations of TNF-α, IL-6 and CC16 were decreased at T 6 in group TEAS ( P<0.05). Conclusions:TEAS can improve the function of lung ventilation in the patients undergoing laparoscopic cholecystectomy.
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Fetal heart rate plays an essential role in maternal and fetal monitoring and fetal health detection. In this study, a method based on Poincare Plot and LSTM is proposed to realize the high performance classification of abnormal fetal heart rate. Firstly, the original fetal heart rate signal of CTU-UHB database is preprocessed via interpolation, then the sequential fetal heart rate signal is converted into Poincare Plot to obtain nonlinear characteristics of the signals, and then SquenzeNet is used to extract the features of Poincare Plot. Finally, the features extracted by SqueezeNet are classified by LSTM. And the accuracy, the true positive rate and the false positive rate are 98.00%, 100.00%, 92.30% respectively on 2 000 test set data. Compared with the traditional fetal heart rate classification method, all respects are improved. The method proposed in this study has good performance in CTU-UHB fetal monitoring database and has certain practical value in the clinical diagnosis of auxiliary fetal heart rate detection.
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Female , Humans , Pregnancy , Databases, Factual , Fetal Monitoring , Fetus , Heart Rate, FetalABSTRACT
Objective:To explore the related factors influencing prognosis of patients with grade Ⅲ cholangitis with myocardial injury.Methods:91 patients with grade III cholangitis complicated with myocardial injury treated in the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from June 2015 to December 2020 were collected retrospectively. They were divided into endoscopic retrograde cholangiopancreatography (ERCP) group ( n=75) and non-ERCP group ( n=16) according to whether ERCP was performed. According to 28-day survival patients were divided into survival group ( n=56) and death group ( n=35). The level of serum cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), N terminal pro-brain natriuretic peptide (NT-proBNP), white blood cell (WBC), platelet (PLT), serum creatinine (Scr), alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), International Standardized Ratio (INR), Glasgow Coma Score (GCS) at different time points were detected and the risk factors influencing the prognosis of patients were analyzed. Results:The cTnT ( P=0.018), NT-proBNP ( P<0.001), PLT ( P=0.016), GCS score ( P=0.07) on day 3 and cTnI ( P=0.027), cTnT ( P=0.002), CK-MB ( P=0.046), NT-proBNP ( P<0.001), PLT ( P=0.041), GCS score ( P<0.001) on day 7 in the ERCP group were significantly different with the non-ERCP group respectively. The survival rate within 28 days of the ERCP group was significantly different from that in the non-ERCP group ( P<0.001). The cTnT ( P=0.006) on day 1, the cTnT ( P=0.021), NT-proBNP ( P=0.02), WBC ( P=0.037), GCS score ( P<0.001) on day 3, and the cTnI ( P=0.029), cTnT ( P=0.008), CK-MB ( P<0.001), PLT ( P=0.008), NT-proBNP ( P=0.004), GCS ( P<0.001) on day 7 in survival group were significantly different from the death group. Logistic regression showed that the mean value of myocardial injury markers and ERCP process were significantly correlated with the 28 days survival rate. Conclusions:In patients with Grade Ⅲ cholangitis-related myocardial injury, the levels of myocardial injury markers, NT-proBNP, platelet (PLT) and Glasgow Coma Score (GCS) are related to mortality. ERCP for patients can significantly improve 28 days survival and prognosis.
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Objective:To evaluate the accuracy of ultrasound-measured pulsatility index (PI) of central retinal arteries in diagnosing low cerebral perfusion pressure (CPP) in the patients with traumatic brain injury.Methods:Fifty-five patients who were admitted to the surgical intensive care unit due to traumatic brain injury with continuous intracranial pressure monitoring were selected.At 72 h after surgery, continuous incracranial pressure and mean arterial pressure were recorded, and peak systolic velocity and end diastolic velocity of central retinal arteries were measured by ultrasound.The invasive CPP and PI were calculated.The correlation between PI and CPP was analyzed.The accuracy of central retinal pulse index in diagnosing low CPP was evaluated by the receiver operating characteristic curve.Results:PI was negatively correlated with CPP ( r=-0.655, P<0.01). The area under the receiver operating characteristic curve of PI in diagnosing low CPP was 0.863 (95% confidence interval 0.761-0.965), and the threshold value was 0.97, sensitivity 92.3%, and specificity 66.7%. Conclusion:Ultrasound-measured PI is more accurate in diagnosing low CPP in the patients with traumatic brain injury.
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Objective To evaluate the accuracy of ultrasound-determined end-diastolic velocity (EDV) of central retinal artery (CRA) in diagnosing postoperative low cerebral perfusion pressure (CPP)in the patients with craniocerebral trauma.Methods Forty-nine patients of both sexes with brain injury,aged 18-64 yr,with body mass index of 18.5-23.9 kg/m2,were enrolled.The peak systolic velocity and EDV of CRA were determined using ultrasound at 1 day after operation.Mean arterial pressure and intracranial pressure were recorded,and CPP was calculated (CPP =mean arterial pressure-intracranial pressure).Results EDV was positively correlated with CPP (r =0.746,P＜0.01),and peak systolic velocity was not correlated with CPP (P＞0.05).The area under the receiver operating characteristic curve for EDV in diagnosing low CPP was 0.938 (95％ confidence interval 0.871-1.000),and the critical value was 3.205 (sensitivity 94.4％,specificity 76.9％).Conclusion Ultrasound-determined EDV of central retinal artery can accurately diagnose postoperative low CPP in the patients with craniocerebral trauma.
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Objective@#To evaluate the accuracy of ultrasound-determined end-diastolic velocity (EDV) of central retinal artery (CRA) in diagnosing postoperative low cerebral perfusion pressure (CPP) in the patients with craniocerebral trauma.@*Methods@#Forty-nine patients of both sexes with brain injury, aged 18-64 yr, with body mass index of 18.5-23.9 kg/m2, were enrolled.The peak systolic velocity and EDV of CRA were determined using ultrasound at 1 day after operation.Mean arterial pressure and intracranial pressure were recorded, and CPP was calculated (CPP=mean arterial pressure-intracranial pressure).@*Results@#EDV was positively correlated with CPP (r=0.746, P<0.01), and peak systolic velocity was not correlated with CPP (P>0.05). The area under the receiver operating characteristic curve for EDV in diagnosing low CPP was 0.938 (95% confidence interval 0.871-1.000), and the critical value was 3.205 (sensitivity 94.4%, specificity 76.9%).@*Conclusion@#Ultrasound-determined EDV of central retinal artery can accurately diagnose postoperative low CPP in the patients with craniocerebral trauma.
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Objective To evaluate the value of the ratio of optic nerve sheath diameter to eyeball transverse diameter (ONSD/ETD) in assessing intracranial pressure using ultrasound in the patients with brain injury.Methods Forty-six patients of both sexes with brain injury in the surgical intensive care unit,were selected.Craniotomy was performed within 24 h after admission to hospital,and the intracranial pressure probe was placed in the lateral cerebral ventricle of the enrolled patients who were aged 18-80 yr,with Glasgow Coma Scale score 3-15.ONSD and ETD were measured within 3 days after operation,three times a day,and the intracranial pressure was simultaneously recorded.The correlation between ONSD/ETD ratio and intracranial pressure were analyzed using the Pearson correlation analysis.The receiver operating characteristic curve was used to evaluate the accuracy of ONSD/ETD ratio in assessing the intracranial hypertension (intracranial pressure＞20 mmHg).Results The ONSD/ETD ratio was positively correlated with intracranial pressure (r =0.720,P＜0.01).The area under the receiver operating characteristic curve was 0.900 (95％ confidence interval 0.854-0.946),and the threshold was 0.248 (sensitivity 89.4％,specificity 77.5％).Conclusion The ONSD/ETD ratio produces higher accuracy in assessing intracranial pressure in the patients with brain injury.
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Objective To explore the relationship between those myocardial markers serum cardiac troponin T (cTNT),serum cardiac troponin I (cTNI),N-terminal pro-brain natriuretic peptide (NT-proBNP),echocardiography and myocardial injury in the oldest-old septic patients,as well as to evaluate prognosis in the oldest-old septic patients.Methods 140 oldest-old septic patients hospitalized in Beijing Friendship Hospital from January 1 st,2015 to Jun 31st,2017 were collected and analyzed retrospectively.They were divided into survival group (90 cases) death group (50 cases)according to their survival time.Serum cTNT,cTNI and NT-proBNP level at 1,3 and 7d post-diagnosis were collected and echocardiography left ventricular diastolic diameter (EDD),left ventricular systolic diameter (ESD),right ventricular diameter (RV),left ventricular ejection fraction (EF) was performed.Results 140 oldest-old septic patients were enrolled in the analysis.There were 90 cases in survival group and 50 cases in death group.Mean values of cTNT,cTNI,NT-proBNP,EDD,ESD in survival group were obviously higher than those in death group (P ＜ 0.05),left ventricular ejection fraction (LVEF) in survival group was lower than that in death group (P ＜ 0.01).But there were no difference in E/A and RV between survival group and death group (P ＞ 0.05).There were positive correlation between cTNT,cTNI,NT-proBNP and EDD,ESD (P ＜ 0.05),negative correlation between cTNT,cTNI,NT-proBNP and LVEF (P ＜ 0.05),and no correlation between cTNT,cTNI,NT-proBNP and E/A,RV (P ＞0.05).There were obviously correlation between cTNT,cTNI,NT-proBNP,EDD,ESD and mortality rate (OR ＞ 1,P ＜ 0.05).It was shown the prognosis value of cTNT,cTNI,NT-proBNP,EDD,ESD to mortality rate in oldest-old septic patient.The prognosis value was cTNT ＞ NT-proBNP ＞ cTNI ＞ EDD ＞ ESD.Conclusions There were obviously correlation between cT NT,cTNI,NT-proBNP,EDD,ESD and myocardium restrain,heart dysfunction as well as mortality rate.cTNT was the best prognosis indicator in sensitivity,and NT-proBNP was the best prognosis indicator in specificity.The combination of cTNT and NT-proBNP can better forecast the prognosis of the oldest-old septic patient.
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<p><b>OBJECTIVE</b>To investigate the feasibility of using the concentration of 1,2-DCE in blood as a biological monitoring indicators and build the determination method of 1,2-DCE in blood.</p><p><b>METHODS</b>Dose-response relationship of the exposure of 1,2-DCE and the level of 1,2-DCE in rat blood were investigated using the Pearson's correlation analysis. The concentration of 1,2-DCE in blood was determined using Headspace Sampler-Gas Chromatography-Mass Spectrometer (HS-GC-MS). 3.0 ml blood sample diluting with 2.0 ml 1,2-DCE standard serial solution was placed in 15 headspace bottles respectively and heated at 80 ℃ for 20 min.The vapor upon the headspace bottle was separated by capillary column and the concentration of 1,2-DCE was determined by massspectrum in SIM mode to draw a standard work curve. The within-run precision and the between-run precision were calculated by the relative standard deviation (RSD) of the concentration of 1,2-DCE in blood which was determined 6 times in a day and 6 times within 3 days respectively. The recovery rate was calculated by P=(C2 -C0)/C1 × 100%.</p><p><b>RESULTS</b>When the treatment groups were exposed at dosage of 1,472, 2,550, 3,093, 3,976, and 4 418 mg/m(3), the average concentration of 1,2-DCE in rat blood was 24.1,231.6,344.3,395.1,538.5 μg/L. There was a positive correlation between the concentration of 1,2-DCE in rat blood and the exposed level of 1,2-DCE.The equation of dose-response relationship was y=0.162x -195.8,r=0.982 2,P=0.003 and the precision of exposure experiments was 7.04% -13.15%. 1,2-DCE contents within 0.259 -2 587 μg/L showed a good linear relationship and the regression equation was y=47 901x -357 446, r= 0.999 8. When the blood containing 0.259 μg/L 1,2-DCE was determined for six times, the average peak/peak signal-to-noise ratio was 56.55. The limit of detection (LOD) was 0.014 μg/L and the limit of quantification (LOQ) was 0.046 μg/L. The within-run precision was 1.23% -2.76% and the between-run precision was 2.21% -4.64%. The average recovery rate was 93.3% - 98.6%.</p><p><b>CONCLUSION</b>The concentration of 1,2-DCE in blood could be used as a biological monitoring indicator. The method of the concentration of 1,2-DCE in blood determining by HS-GC-MS was characterized by high sensitivity, wide linear range, small interference, high precision and easy operation.</p>
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Animals , Rats , Environmental Exposure , Environmental Monitoring , Ethylene Dichlorides , Blood , Gas Chromatography-Mass Spectrometry , Limit of DetectionABSTRACT
<p><b>OBJECTIVE</b>To establish a rat model of 1,2-dichloroethane (DCE)-induced subacute toxic encephalopathy.</p><p><b>METHODS</b>Sixty Sprague-Dawley rats were randomly divided into five groups: negative control, positive control, low-dose DCE (1 472 mg/m(3)), middle-dose DCE (2 550 mg/m(3)), and high-dose DCE (4 418 mg/m(3)). The three DCE groups received static inhalation of DCE 6 hours a day for 6 consecutive days. The positive control group received intraperitoneal injection of lipopolysaccharide (5 mg/kg) and were sacrificed 8 hours after injection. Blood and brain tissue were collected, followed by determination of brain water content and HE staining for pathological examination of brain tissue.</p><p><b>RESULTS</b>The rats in DCE groups suffered decreased body weight with increasing DCE dose (P < 0.01), and brain water content rose with increasing DCEdose. The brain water content of middle-dose DCE group (80.09 ± 0.14%) and high-dose DCE group (80.28±0.10%) increased significantly as compared with that of the negative control group (79.46±0.23%) (P < 0.001). Optical microscopy discovered loose structure and vasodilation in the brain tissue of middle-dose DCE group, indicating obvious brain edema; the high-dose DCE group and positive control group had spongiform and vacuolated brain tissues with severe vascular dilation, indicating severe brain edema.</p><p><b>CONCLUSION</b>A rat model of subacute toxic encephalopathy induced by 1, 2-dichloroethane has been successfully established.</p>