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OBJECTIVE@#To investigate the value of maximal rate of left ventricular pressure (dp/dtmax) in evaluating the changes of cardiac function before and after heart rate reduction in patients with sepsis-induced cardiomyopathy (SIC).@*METHODS@#A single-center, prospective randomized controlled study was conducted. Adult patients with sepsis/septic shock admitted to the department of intensive care unit (ICU) of Tianjin Third Central Hospital from April 1, 2020 to February 28, 2022 were enrolled. Speckle tracking echocardiography (STE) and pulse indication continuous cardiac output (PiCCO) monitoring were performed immediately after the completion of the 1 h-Bundle therapy. The patients with heart rate over 100 beats/minutes were selected and randomly divided into esmolol group and regular treatment group, 55 cases in each group. All patients underwent STE and PiCCO monitoring at 6, 24 and 48 hours after admission in ICU and calculated acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA). Primary outcome measure: change in dp/dtmax after reducing heart rate by esmolol. Secondary outcome measures: correlation between dp/dtmax and global longitudinal strain (GLS); changes of vasoactive drug dosage, oxygen delivery (DO2), oxygen consumption (VO2) and stroke volume (SV) after the administration of esmolol; proportion of heart rate reaching the target after the administration of esmolol; 28-day and 90-day mortality in two groups.@*RESULTS@#Baseline data on age, gender, body mass index, SOFA score, APACHE II score, heart rate, mean arterial pressure, lactic acid, 24-hour fluid balance, sepsis etiology and prior comorbidities were similar between esmolol group and regular treatment group, there were no significant differences between the two groups. All SIC patients achieved the target heart rate after 24 hours of esmolol treatment. Compared with regular treatment group, parameters reflecting myocardial contraction such as GLS, global ejection fraction (GEF) and dp/dtmax were significantly increased in esmolol group [GLS: (-12.55±4.61)% vs. (-10.73±4.82)%, GEF: (27.33±4.62)% vs. (24.18±5.35)%, dp/dtmax (mmHg/s): 1 312.1±312.4 vs. 1 140.9±301.0, all P < 0.05], and N-terminal pro-brain natriuretic peptide (NT-proBNP) significantly decreased [μg/L: 1 364.52 (754.18, 2 389.17) vs. 3 508.85 (1 433.21, 6 988.12), P < 0.05], DO2 and SV were significantly increased [DO2 (mL×min-1×m-2): 647.69±100.89 vs. 610.31±78.56, SV (mL): 49.97±14.71 vs. 42.79±15.77, both P < 0.05]. The system vascular resistance index (SVRI) in esmolol group was significantly higher than that in regular treatment group (kPa×s×L-1: 287.71±66.32 vs. 251.17±78.21, P < 0.05), even when the dosage of norepinephrine was similar between the two groups. Pearson correlation analysis showed that dp/dtmax was negatively correlated with GLS in SIC patients at 24 hours and 48 hours after ICU admission (r values were -0.916 and -0.935, respectively, both P < 0.05). Although there was no significant difference in 28-day mortality between esmolol group and regular treatment group [30.9% (17/55) vs. 49.1% (27/55), χ2 = 3.788, P = 0.052], the rate of esmolol use in patients who died within 28 days was lower than that in patients who survived [38.6% (17/44) vs. 57.6% (38/66), χ2 = 3.788, P = 0.040]. In addition, esmolol has no effect on the 90-day mortality of patients. Logistic regression analysis showed that after adjusting for SOFA score and DO2 factors, patients who used esmolol had a significantly lower risk of 28-day mortality compared with patients who did not use esmolol [odds ratio (OR) = 2.700, 95% confidence interval (95%CI) was 1.038-7.023, P = 0.042].@*CONCLUSIONS@#dp/dtmax in PiCCO parameter can be used as a bedside indicator to evaluate cardiac function in SIC patients due to its simplicity and ease of operation. Esmolol control of heart rate in SIC patients can improve cardiac function and reduce short-term mortality.
Subject(s)
Adult , Humans , Prospective Studies , Ventricular Pressure , Sepsis/complications , Shock, Septic/drug therapy , Cardiomyopathies/etiology , PrognosisABSTRACT
Objective:To study the evaluation method of protein energy wasting (PEW) in maintenance hemodialysis patients.Methods:A total of 166 maintenance hemodialysis patients were selected. Their medical records, physical indicators, as well as NS2002, PG-SGA, and MUST nutrition scale scores were also collected. The patients were divided into PEW and non-PEW groups according to whether PEW occurred or not, and the differences in each index between the two groups were compared to analyze the diagnostic efficacy of each index and nutrition score scale results on the occurrence of PEW.Results:The differences in body mass, body mass index(BMI), body surface area, abdominal circumference, triceps skinfold thickness, upper arm circumference, and calf circumference between the PEW and non-PEW groups were statistically significant(all P<0.05). The diagnostic efficacy of a single physical index or nutrition score for PEW was limited. A simplified formula for the PEW risk was obtained by logistic model analysis. The formula had a sensitivity of 67.7% and a specificity of 94.4% for the diagnosis of PEW, as analyzed by the subject's working characteristic curve. Conclusions:Four indicators, including abdominal circumference, primary hand grip strength, BMI, and upper arm circumference, can be combined to comprehensively assess the presence of PEW to improve the diagnostic efficacy of the occurrence of malnutrition in maintenance hemodialysis patients.
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Objective:To explore the main risk factors of protein energy expenditure (PEW) in maintenance hemodialysis (MHD) patients.Methods:According to diagnostic criteria, 166 patients with MHD were divided into PEW group and control group. The general clinical data, physical indexes, and physical and chemical analysis results of all patients was collected, and the differences in indexes between the two groups of patients were compared. Logistic analysis was used to find the risk factors of MHD combined with PEW.Results:There were statistically significant differences in blood pressure, protein intake, vitamin intake, and uric acid, creatinine, blood calcium levels between the PEW group and the control group (all P<0.05). Multivariate logistic regression analysis showed that blood pressure, daily sleep time, whether to take vitamins, body mass index (BMI), creatinine and parathyroid hormone (PTH) were the risk factors of MHD combined with PEW. Conclusions:In clinical practice, more attention should be paid to controlling blood pressure, improving sleep, and supplementing vitamins in patients with MHD.
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Objective To estimate effective and organ doses to prostate cancer patients result ing from the whole-body 18F-Choline,11C-Choline and 68Ga-PSMA PET-CT examinations.Methods A total of 150 prostate cancer patients who underwent PET-CT scanning from May 2017 to June 2018 were retrospectively analyzed.They were divided into three groups,each with 50 patients,according to the type of positron radiopharmaceuticals injected.All patients used the same PET-CT scan protocol.PET component dose was calculated by using OLINDA/EXM (version 1.1) software which was based on the MIRD method.The CTDI values were measured by the standard CT phantoms and computed by ImPACT (version 1.0.4) CT,and ImPACT was used for dose calculation from CT.The tissue weighting factors according to ICRP Report 103 were used for effective dose calculation.Results The effective dose and organ equivalent dose from 18F/11C-Choline and 68Ga-PSMA PET/CT examinations were estimated.The voltage and current of Topogram scan were 120 kV and 35 mA,respectively,as well as 120 kV and (135.6±9.4) mA for low-dose CT scan.The injected activity of 18 F-Choline,11 C-Choline and68Ga-PSMA was (279.2±13.2),(350.2±39.9) and (186.8±19.4) MBq,respectively.The effective dose was (5.0±0.2),(1.6±0.2) and (3.0±0.3) mSv,respectively (F=837.0,P＜0.001).The CT effective dose was (11.4±0.2) mSv.The total effective dose for three groups were (16.4±0.3),(13.0±0.3) and (14.4±0.4) mSv,respectively.The mean organ equivalent doses were statistically significantly different among groups (F=381.2-1 637.7,P＜0.001).The highest organ equivalent dose was to kidney for18F-Choline and68 Ga-PSMA PET/CT scans and thyroid for11 C-Choline PET/CT scan.Conclusions The effective dose to the prostate cancer patients who underwent PET-CT scanning was from 13.0 to 16.4 mSv,with vast majority of these doses coming from CT scans.The lowest radiation dose to the patients was caused by 11C-Choline PET-CT examination,suggesting that it would be a potential prostate cancer PET radiotracer.
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Objective To establish a method based on 3D printing radiology equivalent phantom for individual radiotherapy dose verification,and to offer an assurance for the safety of 3D conformal radiotherapy.Methods Two patients' CT data was collected,reconstructing the first patient's skull and brain tissue to generate a skull-brain phantom for the purpose of testing the equivalent material.The second patient's data was used for whole head tissue reconstruction to produce a head phantom with equivalent material.By inserting ionization chamber dosimeters to target region for radiotherapy program,equivalent phantom dose distribution of lesions location was obtained in order to verify and calibrate the actual radiation treatment planning for patients.Results DR,CT images of the phantoms revealed that the difference of X-ray gray value between brain skull phantom and patient's skull was 13 721,CT value difference between equivalent tissue of brain skull phantom and that part of the patient was 35-40 HU,and CT difference between head phantom temporalis and that of the patient tissue was 18-28 HU.The imaging data indicated that the radiation equivalence of 3D printing phantom was similar to that of human body tissue,and the equivalent dose distribution accorded well with the normal range of treatment.The dose verification of phantom model can effectively improve the accuracy of the radiotherapy system.Conclusions The personalized radiotherapy phantom which based on the 3D printing and tissue equivalent technology is suitable for personalized radiation therapy validation.With advantages of easy accessibility,highly-personalized degree and high precision,this technology provides a reliable and safe way for radiation therapy.
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Objective Objective To study the feasibility of direct applying MRI to TPS by measuring the geometric distortion of MRI. Methods Phantom 1 was made by marking radical arrangement of fat pipelines every 15? in foam phantom and Phantom 2 by net arrangement at every 2.7?cm. Coronal and transverse scan parallel with the radial and net fat pipeline in the phantom was performed at sequence of cranial FSE T2WI by Marconi 1.5T superconduct MRI machine. Geometric distortion in 5 different fields of view (FOV) was calculated by measuring the absolute borderline error of direct scan and coronal digital reconstructed radiograph (DRR). Results When FOV was equal or smaller than 11.0?cm?11.0?cm, 22.0?cm?22.0?cm and 27.5?cm?27.5?cm, the geometric distortion was 0.0, 1.1 and 1.4?mm of direct scanning MRI and 1.0,1.4 and 2.0?mm of coronal DRR. Conclusion When the magnetic field of MR is high and the tissue shows uniform density, MRI can be applied on TPS directly.