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The step-up approach is the most important modality in the treatment of infected pancreatic necrosis (IPN) and has been recommended by several national and international guidelines. Screening patients with low success rates of percutaneous drainage for timely treatment using the step-up approach and selecting appropriate escalation approach based on IPN staging are expected to improve the overall cure rate of IPN. The open debridement in the step-up approach should be carried out under reasonable indications and timing. When the patient's overall condition is poor and the condition of disease is complex, it is not necessary to adhere to a fixed treatment mode and choose a leapfrogging treatment strategy in a timely manner after thorough evaluation.When following the step-up approach in the treatment of IPN, endoscopic and surgical interventions are advocated in parallel, and escalating and leapfrogging strategies are promoted to establish an integrated, disease-centric, multidisciplinary treatment platform, with the aim of improving clinical prognosis. The authors review relevant literature and combine with team's treatment experience to explore the escalating strategies of surgical intervention for IPN, with a view to further improving the overall cure rate of IPN patients.
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Volume dynamics is a two-compartment dynamical model using hemoglobin (Hb) derived plasma diluted level as input data and urine output as input variable through consecutive repeated measurements of Hb concentration in the blood during infusion. It could be applied to evaluate and guide crystalloid fluid rehydration for patients with dehydration or hypovolemia and during anesthesia or surgery. Volume dynamics could be also used to quantificate of strains, hypovolume, and the change of fluid distribution and elimination caused by anesthesia or surgery. The factors which influence the volume resuscitation are complex, including gender, age, hemodynamic state [mean arterial pressure (MAP)], health and stress state, renal function, consciousness, surgical or anesthesia state and so on, which may affect the half-life, distribution, and volume of the fluid. This article summarizes and analyzes the pathophysiological changes of crystalloids fluid in vivo, in order to provide reference for volume management in critically ill patients.
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Objective To investigate the effect of different appropriate modes of weaning from mechanical ventilation (MV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Patients with AECOPD and mechanically ventilated by orotracheal intubation, suitable for continuous positive airway pressure+proportional pressure support (CPAP+PPS) and CPAP+assisted spontaneous breath (ASB) ventilation mode for weaning from MV, admitted to intensive care unit (ICU) of Tianjin Third Central Hospital form January 1st, 2016 to December 31st, 2017 were enrolled. When the patients recovered to spontaneous respiration and down regulation of ventilator support frequency to 10 bpm, they were taken ventilator weaning in CPAP+PPS and CPAP+ASB mode according to the random number table method, respectively. Basic characteristics, ventilator parameters, the incidence of high man-machine confrontation (man-machine confrontation index > 10%) and clinical outcomes (ventilator weaning time, which was defined as the time from randomization to successful weaning from MV, ventilator weaning failure times, the duration of MV, the length of ICU stay and the length of hospital stay) were compared between the two groups. Results Eighty-seven AECOPD patients were selected, 44 in CPAP+ASB group and 43 in CPAP+PPS group. There was no significant difference in gender, age, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure score (SOFA), Glasgow coma score (GCS), Charsen index and the highest arterial blood carbon dioxide partial pressure (PaCO2), the lowest arterial oxygen partial pressure (PaO2) and tidal volume (VT) at the time of onset between the two groups. Compared with CPAP+ASB group, incidence of high man-machine confrontation was significantly decreased in CPAP+PPS group [9.30% (4/43) vs. 27.27% (12/44), P =0.027], and the airway occlusion pressure (P0.1) was significantly decreased [cmH2O (1 cmH2O = 0.098 kPa): 2.21±0.83 vs. 2.63±0.94, P = 0.032], and the failure rate of the first spontaneous breathing trial (SBT) was significantly decreased [6.98% (3/43) vs. 22.73% (10/44), P = 0.039], ventilator weaning time, the length of ICU stay and the length of hospital stay were significantly shortened [ventilator weaning time (hours): 12.73±14.23 vs. 50.64±38.11, the length of ICU stay (hours): 254.53±108.06 vs. 344.93±124.95, the length of hospital stay (days): 18.53±7.59 vs. 26.64±11.22, all P < 0.05]. However, there was no significant difference in PaCO2, duration of MV, ICU mortality and hospital mortality between the two groups. Conclusion Compared with CPAP+ASB ventilation mode, CPAP+PPS ventilation mode can reduce respiratory muscle load, promote respiratory function recovery, and reduce the occurrence of man-machine confrontation, which is beneficial to AECOPD patients taking ventilator weaning, and can significantly shorten the ventilator weaning time of patients and further shorten the hospitalization time.
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Objective To evaluate the diagnostic value of contrast-enhanced ultrasound in acute kidney injury (AKI) caused by sepsis. Methods The sepsis patients admitted to intensive care unit of Tianjin Third Central Hospital from January 2015 to June 2017 were enrolled. All of the patients were completed the 6-hour Bundle treatment and the bilateral renal contrast-enhanced ultrasound within 24 hours, and the peak signal intensity (PSI), peak intensity time (PIT), wash internal rate (WIR) and renal function parameters were measured at the same time. The patients were divided into AKI 24 hours group and non-AKI 24 hours group according to Kidney Disease: Improving Global Outcomes (KDIGO)-AKI diagnostic criteria, and the parameters differences were compared between the two groups. The receiver operating characteristic (ROC) curve were used to analyze the diagnostic value of the parameters. Renal function of the non-AKI group patients was measured again 7 days after hospital admission, and patients were divided into AKI 7 days group and non-AKI 7 days group, and the related parameters of the two groups measured within 24 hours were compared. Results ① Ninety-six patients were enrolled, with 39 cases of AKI occurred within 24 hours after admission, and with an incidence of 40.6%. Contrast-enhanced ultrasound showed that the time-intensity curve (TIC) of non-AKI patients manifested as a slow down after rapid rise to the peak, but the AKI patients showed as slow rise to the peak and more slow decrease. Compared with non-AKI 24 hours group, AKI 24 hours group performance as PSI weakened, PIT extended and WIR decreased [PSI (dB): 114.41±19.38 vs. 141.24±24.65, PIT (s): 22.86±4.29 vs. 17.39±3.68, WIR (dB/s): 5.53±4.17 vs. 7.85±1.84, all 1 < 0.01]. ROC curve analysis showed that area under the ROC curve (AUC) of WIR, PIT, PSI was 0.85, 0.84, 0.82 respectively (all 1 < 0.01), the cut-off value of WIR was 7.18 dB/S, the sensitivity, specificity and accuracy were 82.05%, 80.70% and 81.25% respectively; the cut-off value of PIT was 18.45 s, the sensitivity, specificity and accuracy were 74.35%, 73.68% and 73.95% respectively;the cut-off values of PSI was 121.21 dB, the sensitivity, specificity and accuracy were 71.79%, 87.72% and 81.25% respectively. ② The incidence of AKI within 7 days in non-AKI patients was 26.3% (15/57). There were significant differences in PIT, WIR and PSI between AKI 7 days group and non-AKI 7 days group [PSI (dB): 124.97±26.64 vs. 147.02±21.51, PIT (s): 20.61±3.27 vs. 16.24±3.13, WIR (dB/s): 6.81±1.76 vs. 8.22±1.75, all 1 < 0.05]. However, there was no significant difference in serum creatinine (SCr), blood urea nitrogen (BUN) and creatinine clearance rate (CCr). Conclusion Compared to SCr and BUN, contrast-enhanced ultrasound parameters can early response to renal dysfunction, and contribute to early diagnosis of sepsis induced AKI.
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Objective To observe the effects of Ulinastatin on pulmonary vascular endothelium permeability and respiratory function in patients with extrapulmonary acute respiratory distress syndrome(ARDS exp). Methods The data of 39 patients with ARDS exp were retrospectively analyzed.According to whether treated with Ulinastatin or not, all patients were divided into Ulinastatin group(n = 21)and control group(n = 18); The level of extravascular lung water index (EVLWI), pulmonary vascular permeability index(PVPI) and respiratory function were measured before and after the treatment. Results The mortality rate of Ulinastatin group was lower than that of control group (28.6% vs 38.9%). The time of decreasing EVLWI, PVPI and improving PaO2/FiO and respiratory function in Ulinastatin group was shorter than that of control group, and the effect was superior. Conclusion Ulinastatin could reduce EVLWI and PVPI, improve pulmonary compliance and oxygenation, and reduce mortality rate in patients with extrapulmonary acute respiratory distress.
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Ojective To determine the risk factors and the clinical distribution of multiple drug resistant bacteria in stroke- associated pneumonia (SAP) patients with multiple drug-resistant bacterial infections from in-tensive care unit, providing guidance for clinical treatment of SAP. Methods A retrospective study was de-signed to analyze the clinical data of the SAP patients from January 2012 to December 2015. Univariate analysis and multivariable regression analysis were taken for risk factors of MDR infections , and investigated the distribu-tion and drug resistance of MDR. Results There were 183 SAP patients, of which 131patients (71.6%) had MDR infection. There are 193 MDR strains in the 131 patients , the first 5 MDR strains were Acinetobacter bau-mannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Escherichia coli. MDR in-fection is highly associated with sever unconsciousness , time of stay in ICU longer than 7 days , ventilator time longer than 7 days and late-onset pneumonia and the difference was significant (P < 0.05). Conclusion SAP patients with MDR bacterial infections are in association with the following risk factors: sever unconsciousness , time of stay in ICU longer than 7 days, ventilator time longer than 7 days and late-onset pneumonia. The rate of MDR bacterial infections was high , and these MDR strains were widely different degrees of resistance to many antibiotics.
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<p><b>OBJECTIVE</b>To assess the effects of continuous blood purification (CBP) on extravascular lung water and respiratory function in patients with extrapulmonary acute respiratory distress syndrome (ARDSexp).</p><p><b>METHODS</b>The data of 31 patients with ARDSexp admitted in our department were retrospectively analyzed.Sixteen of the patients received CBP, and the other 15 patients did not (control group). The level of extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and respiratory function were measured before and after CPB.</p><p><b>RESULTS</b>The mortality rate was significantly lower in CBP group than in the control group (12.5% vs 33.3%, P<0.05). The patients in CPB group showed markedly earlier and significantly greater improvements in EVLWI, PVPI, PaO2/FiO, and respiratory function than the control patients (P<0.05).</p><p><b>CONCLUSION</b>CBP can reduce EVLWI and PVPI, improve pulmonary compliance and oxygenation, and reduce mortality rate in patients with ARDSexp.</p>
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Humans , Capillary Permeability , Extravascular Lung Water , Hemofiltration , Lung , Monitoring, Physiologic , Respiration , Respiratory Distress Syndrome , Retrospective StudiesABSTRACT
ObjectiveTo assess the clinical value of procalcitonin (PCT) in the diagnosis of sepsis in adults.Methods An extensive search for related literature from the Wanfang data, CNKI, VIP, Medline/PubMed, Embase/OvidSP and the Cochrane Library up to December 2014 was performed. The articles, including prospective observational studies or randomized controlled trials, regarding PCT for the diagnosing of sepsis were enrolled. Only patients older than 18 years were included. Patients with sepsis, severe sepsis, or septic shock served as the experimental group, and those with a systemic inflammatory response syndrome (SIRS) of non-infectious origin as control group. The language of literature included was English or Chinese. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC) and subgroup analysis were analyzed with the software of Metadisc 1.4.Results A total of 6 385 published reports were collected, and among them 24 met the inclusion criteria, including a total of 3 107 patients. The studies showed substantial heterogeneity (I2 = 69.4%), and random effect model was used for Meta analysis, showing that the pooledDOR was 10.37 [95% confidence interval (95%CI) = 7.10-15.17]. No evidence of a threshold effect was found (Spearman correlation coefficient = 0.27, calculated by logarithm of sensitivity and logarithm of 1-specificity,P = 0.20). TheDOR values of pooled and each study were not distributed along the same line in forest plots, and Cochran-Q = 78.33,P = 0.000 0, showing that there was heterogeneity in result from non threshold effect. Except for partial heterogeneity caused by non threshold effect, the result of Meta regression analysis including PCT detection method, categories of disease, research location and so on showedP values were all higher than 0.05. Thus, the heterogeneity could not be explained by Meta regression analysis. The pooled sensitivity was 74% (95%CI = 72%-76%), the pooled specificity was 70% (95%CI = 67%-72%), the pooled positive likelihood ratio was 2.79 (95%CI = 2.31-3.38), the pooled negative likelihood ratio was 0.34 (95%CI = 0.28-0.41), and the pooled AUC was 0.83 (95%CI = 0.79-0.87). AUC in medical patients was 0.80 (95%CI = 0.75-0.85), which was higher than that in surgical patients [0.71 (95%CI = 0.65-0.81)].Conclusions Our results indicate a moderate degree of value of PCT for diagnosis of sepsis in adult patients. The diagnostic accuracy in medical patients is higher than that in surgical patients. PCT is a good auxiliary biomarker for diagnosis of sepsis.
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Objective To compare inter-hospital transport and clinical outcome in severe acute respiratory distress syndrome(ARDS)patients whom were transported either on extracorporeal membrane oxygenation(ECMO) or on conventional ventilation,and to investigate the optimal means of inter-hospital transport. Methods Eleven patients with severe ARDS who were invalid under conventional ventilation and were transported from other hospitals to Tianjin Third Central Hospital from November 2009 to January 2014 were analyzed. Five patients were transported on ECMO(observation group)and 6 on conventional ventilation(control group). The clinical characteristics,outcomes, transportation,vital signs before and after transportation,respiratory parameters,and Murray score between two groups were compared. Results Patients in observation group were significantly older than those in control group〔years:73(46,77)vs. 34(23,46),Z=-2.293,P=0.022〕. There was no significant difference between observation group and control group in acute pathologic and chronic health evaluationⅡ(APACHEⅡ)score,Murray score,oxygenation index(PaO2/FiO2)before transportation,transit time,and transit distance〔APACHEⅡscore:36(33,39)vs. 27(23,35),Z=-1.830,P=0.067;Murray score:3.5±0.3 vs. 3.4±0.2,t=0.667,P=0.524;PaO2/FiO2(mmHg, 1 mmHg=0.133 kPa):61±14 vs. 63±14,t=-0.249,P=0.809;transit time(minutes):24(18,74)vs. 79(41, 86),Z=-1.654,P=0.098;transit distance(km):12.9(8.3,71.8)vs. 72.4(39.5,86.8),Z=-1.651,P=0.099〕. There was no significant difference between two groups in vital signs and respiratory parameters before transportation. When arrived in ECMO centre,heart rate,respiratory rate,fractional inspired oxygen,inspiratory pressure and Murray score in observation group were significantly lower than those in control group〔heart rate(beat/min):102±16 vs. 136±8, t=-4.374, P=0.002;respiratory rate(beat/min):23±3 vs. 37±2,t=-7.967,P=0.000;fractional inspired oxygen:0.40±0.05 vs. 0.96±0.09,t=-12.152,P=0.000;inspiratory pressure(cmH2O, 1 cmH2O=0.098 kPa):21±1 vs. 34±4,t=-6.887,P=0.000;Murray score:2.7±0.2 vs. 3.8±0.2,t=-8.573, P=0.000〕,but PaO2/FiO2 was higher than that of control group(mmHg:278±65 vs. 41±5 ,t=8.075,P=0.001). Four patients were survived in observation group,and one died from the shortage of oxygen induced lung injury deterioration during transportation. Three patients died in control group,which was directly associated with lung injury deterioration. Conclusion For patients with severe ARDS who need the support of ECMO,ECMO-assisted transfer is safer than conventional ventilation,but transfer should be implemented by experienced team.
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Selective extraction of low molecular weight ( LMW) proteins and peptides from complex biological samples plays an important role in the discovery of useful biomarkers and signaling molecules. It is demonstrated that the unique pore structure of mesoporous material makes it efficient to enrich LMW proteins and peptides from complex matrixes. In this study, a mesoporous material, alkyl-diol@ phenyl-SiO2 , with modified exterior ( alkyl-diol group) and interior ( phenyl group) surfaces, was synthesized by co-condensation and post-grafting, and its characteristic was evaluated by FTIR and MS. The LMW proteins and peptides enriched by the alkyl-diol@phenyl-SiO2 mesoporous material could be easily eluted by organic solvents, which was compatible with the following detection by mass spectrometry ( MS ) . This new mesoporous material exhibited good selectivity for the extraction of LMW proteins and peptides ( less than 10 kDa) from complex biological samples.
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@#Objective To explore 64 row volumetric CT 3D reconstruction in the clinical application of severe craniocerebral injury.Methods 60 patients with craniocerebral injury in our hospital were retrospectively analyzed who accept craniocerebral 64 row volumetric CT 6 to 24 hours after injury. Results All cases got timely diagnosis and treatment, especially for the special parts of brain lesions, ventricle base of skull fractures and pool, and various angles show. Conclusion 64 row volumetric CT reconstruction for the diagnosis of craniocerebral injury shows important significance and may estimate the prognosis in diagnosis, guiding treatment and surgery, reducing misdiagnosis.
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BACKGROUND: Poly(ethylene glycol)-b-poly(L-lactide)-b-poly(L-glutamic acid) (PEG-PLA-PGL) tri-block copolymers have good applied foreground in constructing tissue engineering scaffold materials. Whether endothelial cells survive and grow on the materials has a direct influence on the application as a biodegradable material for the scaffold of endothelial cell vector.OBJECTIVE: To explore the cytocompatibility of PEG-PLA-PGL tri-block copolymers with human umbilical vein endothelial cells (HUVECs).DESIGN: Randomized control observation.SETTING: the Second Hospital of Jilin University.MATERIALS: The experiment was carried out in the Department of Pathobiology, School of Basic Medical Sciences, Jilin University from February to October in 2006. Human umbilical cord about 20 cm length came from one neonatal infant who was delivered normally after enough months in the Department of Gynecology and Obstetrics, the Second Hospital of Jilin University. Human umbilical cord was sampled in the informed consents of the infant's family member. The experimentation was authorized by the medical ethic committee of the hospital. PEG-PLA-PGL membranes were provided by Changchun Institute of Applied Chemistry, Chinese Academy of Sciences. Inverted microscope and phase-contrast microscope were bought from Olympus Company (Japan).METHODS: HUVECs cultivated and grew steadily, were inoculated onto PEG-PLA-PGL membranes, serving as the experiment group. While the culture medium without PEG-PLA-PGL membranes were taken as the control group.①Cytocompatibility of PEG-PLA-PGL membranes with HUVECs was evaluated by observing cellular growth through phase-contrast microscope.②The proliferation index of cells was detected by MTT method in 1, 3, 5 and 7 days after inoculation.MAIN OUTCOME MEASURES: ①Cytocompatibility of PEG-PLA-PGL membranes with HUVECs;②The proliferation index of cells in l, 3, 5 and 7 days after inoculationRESULTS: ①Cytocompatibility of PEG-PLA-PGL membranes with HUVECs: The observation result of phase contrast microscopy showed that, endothelial cells planted on the PEG-PLA-PGL membranes began to attach and stretch after being planted 4-6 hours. Three days later, cells grew in colonies rapidly, after 5 days, colonies began to fuse and seemed like cobble-stone. The cells were shuttle or polygon in shape after passages. There were no significant differences between the experiment and control group. Cells cultured on PEG-PLA-PGL membranes for 15 days grew in inserts with membranes, but they didn't grow into patches through scanning electron microscope.②The proliferation index of cells: No significant differences of the proliferation index of cells were detected by MTT method in 1, 3, 5 and 7 days after inoculation between experiment group and control group (P＞0.05).CONCLUSION: Endothelial cells grow well in PEG-PLA-PGL membranes, and the two have good cytocompatibility.
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Objective To discuss the main complication and death cause of VLBWI,and enhance survival rate. Methods We summarized our experience and analyzed distribution of respiratory disease diseases of 68 cases of VLBWI. Results 51 cases were cured and 9 cases were died. Conclusion The respiratory disease was the main complication and death cause of VLBWI. The survival rate of VLBWI could be improved by being in NICU,intervening early with medicine and strengthening management of respiratory tract.
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Objective To research the method and effect about the bronchoscopic lung volume reduction by ?-cyanoac- rylate in the therapy of chronic obstructive pulmonary disease (COPD).Methods The 14 patients had been examined bosoms by CT before the operation and determined the type of emphysema and the distributing of pneumatocele,had blood gas analyzed and pulmonary function checked.The operation was carried through trachea cannula and intravenous anesthe- sia.When the bronchoscope came to the goal bronchia,we infused the meglumine diatrizoate through the biopsy orifice and approved the location of pneumatocele forward。Then,we infused erythromycin and ?-cyanoacrylate in turn through the biopsy orifice by silica del tube.Results The 3 pneumothorax patients had been removed the drainage tube in 3 days af- ter the operation.8 cases had been counterchecked sternite in one week and the pneumatocele was just like before,among which,1 case developed exudation.1 case had shown pleural thickening in the right-up lung counterchecked sternite 9 months later.1 case been checked the pulmonary function,the FEV_1 enhanced from 24.7% pred before operation to 32. 9% pred after operation one week.3 cases felt polypnea improved greatly and 7 cases felt polypnea improved a little.Con- clusion The bronchoscopic lung volume reduction by ?-cyanoacrylate is a safe,effective and economical method in the therapy of COPD.
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0.05)before treatment.(2)After 6 months' treatment,there was significant difference in PMC and EMC(P0.05).VNDmax and VTmax were significantly lower in group one than in group two(P
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Objective To evaluate the effect of inhalation of furosemide on lung function and airway hyperresponsiveness in asthmatic patients.Methods By double blind randomized controlled trial,the effect of inhalation of furosemide (20mg twice daily) on the lung function and airway hyperresponsiveness in the asthmatics was studied.Results Most of lung function tests of the observation group improved 10 days after inhalation therapy.The improvement of VC,FVC and FEV 1 was significant statistically.There was also slight improvement of lung function in the control group,but not statistically significant.but it was decreaded slass.Conclusion Asthma can be relieved by inhalation of furosemide.
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Objective To evaluate Feridex(superparamagnetic iron oxide,SPIO)enhanced MRI in the diagnosis of hepatic lesions.Methods Feridex-enhanced MRI was performed in 31 patients with CT,or MRI proved or suspected hepatic lesions.T 2WI signal intensity of hepatic parenchyma,lesion and background noise was measured before and after enhancement separately.SNR and CNR of parenchyma and lesion before and after enhancement were calculated.The number of lesions on plain and enhanced scans were observed and alalyzed.Results Post-enhancement SNR of liver significantly decreased (?0.05).Post-enhancement lesion-liver CNR increased significantly (?