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Objective:To analyze the mechanism of Danpi-Chishao in treatment of sepsis based on network pharmacology.Methods:The corresponding targets of Danpi-Chishao and sepsis were carried out through TCMSP database, OMIM database and Genecards database. Cystoscope 3.8.2 software was used to construct the " Chinese medicine-active components-target-disease" network diagram. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were carried out by DAVID database. Weisheng cloud platform was used to draw bubble map.Results:A total of 36 effective components of Danpi-Chishao was obtained, mainly including quercetin, kaempferol, baicalin, β-sitosterol, stigmasterol, paeoniflorin and so on. There were 96 potential common key targets between Danpi-Chishao and sepsis, such as prostaglandin-endoperoxide synthase 2 (PTGS2), transcription factor p65 (RELA), phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit gamma (PIK3CG), B-cell lymphoma 2 (BCL-2)-associated X (BAX), BCL-2, Caspase-3 (CASP3) with a degree value>4.9. The result of protein-protein interaction (PPI) network analysis showed that there were 10 important target proteins, including alpha serine/threonine-protein kinase (AKT1), interleukin-6 (IL-6), tumor necrosis factor (TNF), interleukin-1β (IL-1β), vascular endothelial growth factor A (VEGFA), cellular tumor antigen p53 (TP53), matrix metalloproteinase-9 (MMP9), CASP3, PTGS2, C-C motif chemokine ligand 2 (CCL2). The pathways obtained by GO and KEGG enrichment analysis included atherosclerosis pathway, advanced glycation end products (AGE)-receptor for advanced glycation end products (RAGE) signal pathway, cancer pathway, tumor necrosis factor signal pathway, hypoxia-inducible factor (HIF) signal pathway, IL-17 signal pathway and other pathway.Conclusions:The mechanism of the intervention effect of Danpi-Chishao on sepsis may be that the active components such as quercetin, kaempferol, paeoniflorin act on target proteins such as PTGS2, RELA, PIK3CG, BAX, BCL2, CASP3, and through TNF-related signal pathway, HIF-1 signal pathway, IL-17 signal pathway, etc. Nonetheless, the conclusion needs further experimental verification.
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Objective:The changes of serum inflammatory factors in patients with chronic obstructive pulmonary disease (COPD) with different traditional Chinese medicine (TCM) syndrome types were compared, and the characteristics and significance of inflammatory factors in COPD were discussed from the perspective of traditional Chinese and western medicine.Methods:A total of 100 patients with COPD who met the inclusion criteria and were admitted to Dongzhimen Hospital of Beijing University of Chinese Medicine from September 2021 to September 2022 were selected and divided into phlegm turbation obstructing lung group ( n=50) and lung and kidney qi deficiency group ( n=50) according to TCM syndrome types. Twenty healthy subjects in the same period were selected as control group. Serum levels of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and other inflammatory factors were compared in each group. Results:The MCP-1, IL-6, ESR, CRP, white blood cell count (WBC) and procalcitonin (PCT) of COPD patients in phlegm turbation obstructing lung group were significantly higher than those in lung and kidney qi deficiency group (all P<0.05). The WBC, MCP-1, MIP-1α, IL-6, ESR and CRP of COPD patients in the lung and kidney qi deficiency group were significantly higher than those in the control group (all P<0.05). In the phlegm turbation obstructing lung group, the MIP-1α, MCP-1, IL-6, ESR, CRP, WBC, and PCT were significantly higher than those in the control group (all P<0.05). Conclusions:Patients with COPD have inflammatory reactions, and the inflammatory reactions of patients with phlegm turbation obstructing lung syndrome are more obvious than those with lung and kidney qi deficiency syndrome. The inflammatory factors MCP-1, MIP-1α, IL-6, ESR, CRP, WBC, PCT and other indicators could be used to judge the degree of COPD inflammation, which had certain clinical guiding significance for different syndrome types of COPD patients.
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Objective:To evaluate the value of age-adjusted Charlson comorbidity index (aCCI) in the clinical prognosis of sepsis and septic shock in the elderly, and to further explore the role of aCCI in evaluating the timing of Shenfu injection in elderly patients with septic shock.Methods:Clinical data of elderly patients with sepsis and septic shock in Dongzhimen Hospital of Beijing University of Chinese Medicine from January 1, 2019 to January 1, 2022 were retrospectively analyzed. With the median aCCI score of all samples as the cutoff value, the patients were divided into the low aCCI score group and high aCCI score group. The prognosis of elderly patients with septic shock and the application timing of Shenfu injection with aCCI score and sequential organ failure assessment (SOFA) were compared.Results:A total of 61 patients were included, including 31 patients in the high aCCI score group. The proportion of septic shock in elderly sepsis patients was lower in the low aCCI score group ( P < 0.05). The aCCI score (95% CI: 1.229-2.615; P< 0.01) was more valuable than SOFA score (95% CI: 1.035-1.607; P< 0.05) in predicting septic shock in elderly patients with sepsis. The 28-day survival rate in the low aCCI score group was higher than that in the high aCCI score group ( P < 0.05). Both the SOFA score (95% CI: 1.010-1.364) and the aCCI score (95% CI: 1.072-10.501) were independent factors affecting the 28-day survival rate. The use of Shenfu injection was associated with 28-day survival outcome in elderly patients with septic shock (95% CI: 0.012-0.788; P < 0.05). Conclusions:aCCI score is more effective than SOFA score in assessing the risk of shock in elderly patients with septic shock, and has a certain predictive value for the survival and prognosis of elderly patients with sepsis. Shenfu injection may be beneficial to the survival and prognosis of elderly patients with septic shock, but it needs to be further verified by large-scale prospective studies.
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Objective:Animal models of sepsis are mainly established by cecal ligation and puncture which causes mixed bacterial infections in the abdominal cavity. However in internal clinic, sepsis is more common to be caused by respiratory bacterial infections. Therefore, it is necessary to establish animal models of sepsis caused by lung Infection.Methods:According to the concentration of Staphylococcus aureus (S. aureus) suspension and Pseudomonas aeruginosa (P. aeruginosa) suspension, Sprague Dawley (SD) rats were equally divided into 10 groups, including S-Cont group, S-0.75 group, S-1.5 group, S-3 group, S-6 group and P-Cont group, P-1 group, P-2 group, P-4 group, P-8 group. Rats in the control group were treated with normal saline nasal drip. Rats in each experimental group were infected by nasal dripping bacterial suspension with 0.75×10 8 CFU/ml, 1.5×10 8 CFU/ml, 3×10 8 CFU/ml, 6×10 8 CFU/ml of S. aureus suspension or 1×10 8 CFU/ml, 2×10 8 CFU/ml, 4×10 8 CFU/ml, 8×10 8CFU/ml P. aeruginosa suspension. Our study detected the body temperature (T), blood pressure (BP), heart rate (HR) of rats in each group before and after infection, as well as blood lactic acid (Lac) and procalcitonin (PCT) level after infection. The lung infections of rats in each group were observed by hematoxylin-eosin (HE) staining. Results:The blood pressure(BP) of S-1.5 group, S-3 group, S-6 group and P-8 group was lower than before infection (all P<0.05). The Lac and PCT of each S. aureus experimental group were higher than that of the S-Cont group (all P<0.01); and they showed an increasing trend with the increase of the bacterial suspension concentration ( P<0.05), except for the S-3 and S-6 group ( P>0.05). The Lac and PCT of each P. aeruginosa experimental group were higher than that of the P-Cont group (all P<0.01); and they showed an increasing trend with the increase of the bacterial suspension concentration (all P<0.05), except for the Lac in the P-4 group and P-8 group ( P>0.05). HE staining showed that different degrees of inflammatory infiltration can be seen in the lungs of the experimental rats in each group. Conclusions:Infection of rats by nasal dripping with 3×10 8 CFU/ml of S. aureus suspension or 4×10 8 CFU/ml of P. aeruginosa suspension could establish relatively stable rat sepsis model induced by lung bacterial infection, of which the former could also establish a relatively stable septic shock model.
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Objective:To compare the efficacy of conventional Western medicine alone and acupuncture combined with acupoint application in treating intestinal dysfunction secondary to mechanical ventilation in elderly patients with emergency sepsis.Methods:A retrospective analysis was performed on 111 elderly patients with mechanical ventilation for sepsis admitted to the emergency department of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2019 to June 2021. They were divided into two groups according to the time of admission: Western medicine treatment group alone (patients from January 2019 to December 2019, n=47) and acupuncture combined with acupoint application group (patients from January 2020 to June 2021, n=64). Acupuncture combined with acupoint application group was treated with acupuncture combined with acupoint application on the basis of conventional Western medicine. The intestinal dysfunction score, abdominal circumference and mortality after 4 weeks were compared between the two groups. Results:The abdominal circumference and intestinal dysfunction score in acupuncture combined with acupoint application group were significantly lower than those before treatment [(100.56±9.34)cm vs (106.25±9.74)cm; (0.92±0.72)point vs (2.31±0.69)point, all P< 0.05], while there was no significant difference in the above indexes before and after treatment in the Western medicine treatment group (all P>0.05). The abdominal circumference, intestinal dysfunction score and mortality after 4 weeks in the acupuncture combined with acupoint application group were significantly lower than those in the Western medicine treatment group [(100.56±9.34)cm vs (108.09±10.52)cm; (0.92±0.72)point vs (2.43±0.62)point; (29.7%, 19/64) vs (48.9%, 23/47), all P<0.05]. Conclusions:The curative effect of acupuncture combined with acupoint application in the treatment of intestinal dysfunction secondary to mechanical ventilation in elderly patients with sepsis in emergency is better than that of routine treatment of Western medicine alone. The gastrointestinal function and prognosis of patients have been significantly improved, which is worthy of clinical promotion.
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Sepsis is a hot and difficult research topic in the field of acute and critical care all over the world. Sepsis mortality remains high despite ongoing guideline updates. This situation has prompted the research thinking of Western medicine to change from one-sided pursuit of killing pathogenic microorganisms to regulating the body′s immune response, and change from focusing on local pathological changes to focusing on the internal connection of systemic organs. They put forward theories such as liver-renal syndrome, cardio-renal syndrome, and lung-gut axis, which are consistent with the overall concept of traditional Chinese medicine. The research fields, goals, and treatment objects of traditional Chinese medicine and Western medicine are the same, so Integrative traditional Chinese and Western medicine in the treatment of sepsis has important application value and broad development space. In the process of sepsis treatment, we must make full use of modern technology, and at the same time give full play to the advantages of traditional Chinese medicine, to reduce the fatality rate. Only in this way can we contribute to the protection of human health.
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Autophagy is one of the most common protective mechanisms during plant stress response. We studied the effect of exogenous Cd on autophagy in celery, by using transcriptome sequencing technique to analyze the differentially expressed genes under different Cd concentrations (0, 2, 4 and 8 mg/L). Eight differentially expressed autophagy-related genes were screened and identified by qRT-PCR. Cd had obvious toxic effect on celery, in a dose-dependent manner. Eight differentially expressed autophagy-related genes were screened, among which ATG8a, ATG8f, ATG13, AMPK-1 and AMPK-2 were up-regulated, whereas ATG12, VPS30 and VPS34 were first up-regulated and then decreased. The up-regulated expression of differential genes may resist Cd toxicity by increasing autophagosome structures; however, 8 mg/L Cd exceeded the autophagosome tolerance limit of celery, resulting in decreased expression of multiple autophagy-related genes. The above results can provide help for subsequent functional study of autophagy-related genes, and provide a reference for further exploring the tolerance mechanism of celery to Cd toxicity.
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Objective:To compare the effect of metaraminol and norepinephrine (NA) on elderly patients with septic shock.Methods:In this multicenter prospective cohort study elderly patients with septic shock were divided into the metaraminol group ( n=100) and NA group ( n=100). The 28-day survival and average hospital stay, the hemodynamics and renal function of the patients were observed. Results:The average hospital stay in the metaraminol group was lower than that in the NA group ( P < 0.05). Blood pressure, heart rate, arterial lactate, B-type natriuretic peptide, left ventricular ejection fraction and 28-day survival had no significant differences between the two groups (all P > 0.05). The average urine output at day 3 and 7 after the administration of vasopressor in the metaraminol group were higher than those in the NA group (all P< 0.05), blood urea nitrogen at day 3, 7 and 14 after the administration of vasopressor in the metaraminol group were lower than those in the NA group (all P < 0.05), and the creatinine at day 3, 7 and 14 after the administration of vasopressor and the rate of renal replacement therapy in the metaraminol group were lower than those in the NA group (all P < 0.05). Conclusions:Metaraminol has similar effect to norepinephrine in improving 28-day survival and hemodynamics of elderly patients with septic shock, but is superior to norepinephrine in reducing the average hospital stay and protecting renal function.
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Septic cardiomyopathy is one of the most common complications of sepsis in clinics. Up to now, the pathogenesis of septic cardiomyopathy has not been fully elucidated, and the clinical mortality has been at a relatively high level in patients with organ injury caused by sepsis, so that improving the cardiac dysfunction and myocardial injury of septic patients is of great significance in improving their prognoses. In this article, the related literatures regarding the research and therapeutic progress of septic cardiomyopathy in traditional Chinese and western medicine in recent years were read and summarized.
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Objective To investigate the dynamic change of cardiac function in the patients of septic shock and analyze its influence to prognosis.Methods A total of 129 patients in department of emergency medicine,Beijing Chao-Yang Hospital,Capital Medical University,from January 2014 to January 2016 were enrolled in the investigation using mornitoring the hemodynamics including the contour pulse wave mean artery pressure (MAP),cardiac index (CI) and systemic vascular resistance indes (SVRI).Echocardiography was done 7 days laterenrollment of left ventricular eject fraction (LVEF),E and A peak of mitral blood flow velocity,mitral annulus moving speed (E') were detected changes.E/A and E/E'were calculated.According to the 28-day prognosis,all patients were devided into the survival and death group for detecting the risk factors of death.Results In all patients,hemodynamics detected changes showed the features of septic shock with high output and low vascular risistance.The values of CI in the survival group and death group were (4.30±0.71) L/(min.m2) and (4.52±0.91) L/(min· m2),repectively,and the values of SVRI were (1 477±297) dyn·s · cm-5m2 and (1 488±233) dyn·s · cm-5·m2,repectively.There were no significant differences in CI and SVRI were found between the two groups (both P＞0.05).When 7 days after admission in hospital,CI [(3.88±0.51) L/(min· m2)] was lower and SVRI [(2 044±266) dyn·s · cm-5·m2] was higher compared with those at admission in the survival group with significant differences,between the two intervals (all P＜0.05).In the death group,CI decreased to (2.52±0.87) L/(min · m2) and SVRI increased to (3 201±329) dyn·s · cm5·m2 after admission on the 7th day in hospital,significant differences between the two groups (all P＜0.01).There were significantly differenced with LVEF [(69.1±12.5)％ vs.(69.5±11.2)％] and E/E'(8.43±0.59) vs.(8.89±0.64) found between the two groups on the first day in hospital (all P＞0.05).Compared with survival group,LVEF significantly decreased (64.4％±16.3)％ vs.(54.4±17.6)％ and E/E'(8.73±0.67) vs.(9.97±0.55),all P＜0.01] was significantly decreased in the death group.APACHE Ⅱ (OR=1.667,95％CI:1.322-1.863,P=0.001),LVEF (OR=0.809,95％CI:0.612-0.912,P=0.001) and E/E'(OR=1.219,95％CI:1.030-1.501,P=0.006) were detected to be the risk factors by logistic analysis.Conclusions In septic shock patients,both the systolic,and the diastolic cardiac function were found to be significantly abnormal,resulting poor prognosis.
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Objective To characterize myocardial metabolism using positron emission tomography (PET) in porcine models of ventricular fibrillation cardiac arrest (VFCA) and asphyxiation cardiac arrest (ACA) after resuscitation.Methods Thirty-two healthy miniature pigs were randomized into two groups.The pigs of VFCA group (n =16) were subject to programmed electric stimulation to create a ventricular fibrillation cardiac arrest,and the pigs of ACA group (n =16) were subjected to endotracheal tube clamping to establish a cardiac arrest (CA).Once modeling was established,pigs with CA were left untreated for a period of 8 min.Two minutes following initiation of cardiopulmonary resuscitation (CPR),defibrillation was attempted until the restoration of spontaneous circulation (ROSC) was achieved or animals died.To assess myocardial metabolism,PET was performed before modeling,4 hrs and 24hrs after ROSC.To analyze 18F-FDG myocardial uptake in PET,the maximum standardized uptake value (SUVmax)) was measured.Results ROSC was obtained in 100％ of pigs in VFCA group and only 50％ in ACA group.The average survival time in VFCA pigs was significantly longer than that in ACA pigs (22.63 ± 0.95) hvs.(8.75 ± 2.54) h,P ＜0.01.VFCA pigs had better mean arterial pressure and cardiac output after ROSC than ACA pigs.Myocardial metabolism imaging using PET demonstrated that myocardial metabolism injuries after ACA were more severe and widespread than those after VFCA at 4 hrs and 24hrs after ROSC and SUVmax) was much higher in VFCA group than that in ACA group [4 h after ROSC:(1.9 ± 0.3) vs.(1.0 ± 0.4),P ＜ 0.01;24 hafterROSC:(2.4±0.6) vs.(1.2±0.5),P＜0.01].Conclusions Compared with VFCA,ACA causes more severe cardiac metabolism dysfunction associated with less successful resuscitation and shorter survival time;therefore they should be treated as different pathological entities.
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Objective To determine whether left ventricular Tei Index evaluate the cardiac function and prognosis of patients with sepsis-induced cardiomyopathy (SIC).Methods A total of 86 patients with septic shock combined with SIC in the emergency department of Beijing Chaoyang Hospital affiliated to Capital Medical University from July 2014 to June 2016 were recruited and divided into non-survival group (n=35) and survival group (n=51) according to 28-day follow-up.Left ventricular Tei Index, BNP, cTNI and left ventricular ejection fraction within the first 24 h after admisson were detected and compared between the two groups.The correlations of left ventricular Tei Index to BNP, cTNI and ejection fraction were analyzed.The receiver operating characteristic curves (ROC) were constructed to analysize the value of Tei Index in evaluating the cardiac function and prognosis.Results The patientsin the non-survival group had a higher Tei Index compared with that in the survival group [(0.75±0.13) vs.(0.51±0.09), P<0.05].The Tei Index of SIC patients was significantly positively correlated with BNP and cTNI (both P<0.05), and significantly negatively correlated with ejection fraction (P<0.05).The AUC of Tei Index for predicting 28-day mortality in SIC patients was high comapred with that of BNP, cTNI and ejection fraction.Conclusion The left ventricular Tei Index has a reliable value in evaluating the cardiac function and prognosis of patients with SIC.
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Objective To study the difference in post-resuscitation lung injury between cardiac arrest induced by anoxia and ventricular fibrillation in porcine model.Methods WuZhiShan inbred miniature pigs were randomly (random number) divided into the asphyxia (AS,n =24) and ventricular fibrillation group (VF,n =24).Cardiac arrest (CA) was induced by endotracheal tube clamping or programmed electric stimulation.Cardiopulmonary resuscitation (CPR) or defibrillation was performed for returning of spontaneous circulation (ROSC).Pulmonary perfusion/ventilation measured with isotope scanand positron emission tomography-computed tomography (PET-CT) scanning were done before and 4hrs after ROSC.The oxygenation index (OI),respiratory index (RI),oxygen delivery (DO2),blood lactic acid,and dynamic pulmonary compliance (Cdyn),airway resistance (Raw),extra-vascular lung water index (EVLWI),pulmonary vascular permeability index (PVPI),were measured before cardiac arrest,ROSC 0 h,ROSC15 min,ROSC 30 min,ROSC 1 h,ROSC 2 h,ROSC 4 h and ROSC 6 h.All pigs were sacrificed with euthanasia at ROSC 6 h and the lungs were dissected for observing histopathological changes.The level of Na +-K +-ATPase,Ca2+-ATPase,superoxide dismutase (SOD),Methane Dicarboxylic Aldehyde (MDA),Bcl-2,Bax,Caspase3 and apoptosis index (AI％) in lung were measured.Results The ROSC rate and ROSC 6hrs survival rate of in AS group was lower (P ＜0.01) than those of the VF group.The damages of lung in AS group were more severe than that in VF group by the results of enzymology and protein detection (Na +-K +-ATPase,Ca2 +-ATPase,SOD,MDA,Bax,Bcl-2 and Caspase3).AI％ was higher in AS group (P＜0.01).The deterioration of the indexes (OI,RI,DO2,Lac,Cdyn,Raw,EVLWI,PVPI) at all time points were more severe in AS group than those in VF group.Obvious filling-defect was found by the PET-CT scan of both groups,but not revealed by the isotope scan.Conclusions The lung injury after CA was closely related to the cause of CA rather than the external chest compression.Asphyxia induced more serious lung injury than ventricular fibrillation.
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Objective To determine the protective effect of isosorbidemononitrate (IM) on myocardial injury after restoration of spontaneous circulation (ROSC)in swine models of cardiac arrest induced by ventricular fibrillation.Methods The experiment was carried out in Animal Lab of Beijing Chao-Yang Hospital,Capital Medical University.Ventricular fibrillation was induced and untreated for 8 min in twenty WhuZhiShan piglets.CPR was performed until ROSC occurred.The animals were randomized (random number)into two groups:IMgroup (n =10)and control group (n =10).IM [2 μg/(kg· min)]or the equivalent volume in saline was administered respectively for 6 h after ROSC.Hemodynamics and post-resuscitation cardiac function were monitored until 24 h after ROSC. Echocardiography and transmission electron microscopy were useed at 72 h after ROSC.Results There was no significant difference in survival rate between the two groups.No significant differences in mean arterial pressures (mmHg)at ROSC 6 h (88.5 ±5.6 vs.87.8 ±6.0,P =0.790)and ROSC 24 h (89.3 ±3.8 vs.86.9 ± 5.0,P =0.245)between the two groups were found.Cardiac outputs (L/min)were significantly increased at ROSC 6 h (2.40 ±0.17 vs.1.60 ±0.14,P <0.01)and ROSC 24 h (2.49 ±0.17 vs.2.09 ±0.21,P<0.01);and ejection fraction at ROSC 72 h (0.67 ±0.08 vs.0.56 ±0.09,P =0.044)was improved too,and significant differences were found between the two groups.The ultra-structural myocardial injury was ameliorated in the MI group at 72 h after CPR observed by using electron microscopy.Conclusions IM can ameliorate post-resuscitation cardiac dysfunction in porcine models of cardiac arrest induced by ventricular fibrillation.
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Objective To investigate the role of underlying diseases in predicting the length of stay for observation in emergency department of internal medicine by the Charlson weighted index of comorbidities (WIC).Methods A single-center retrospective analysis of clinical data of 2 836 patients admitted in emergency observation room of the Beijing Chaoyang Hospital from January 1 to June 30 in 2013 was carried out.The patients were divided into two groups according to the length of observation time:Group A (time of observation ≥72 h,n =1908) and Group B (time of observation ＜ 72 h,n =928).The data of the length of observation time were recorded,and the WIC and the APACHE Ⅱ score were calculated.Logistic regression analysis was used to determine the independent predictors for 72-hour observation.Receiver operating characteristics (ROC) curve was used to evaluate the value of WIC in predicting 72-hour observation.Results Of 2836 patients,1176 (41.5％) suffered from respiratory disease,709 (25.0％) had cardiovascular and cerebrovascular diseases,423 (14.9％) were contracted digestive system disease,251 (8.8％) had renal and endocrinology system diseases and 277 (9.8％) had diseases arisen from physicochemical factor and miscellaneous causes.Compared with patients in Group B,the average age,the number of elderly patients residing in apartment exclusively for elderly,the WIC and the APACHE Ⅱ score were higher in patients in Group A.The one-variable and multi-variable Logistic regression analyses showed that age,the WIC score,the APACHE Ⅱ score and residing in apartment for elderly people were related with 72-hour observation in emergency observation room.The area under the ROC curve in predicting 72-hour observation was 0.701 for the WIC score,0.788 for APACHE Ⅱ score and 0.853 for their combination.Conclusions The WIC scoring system can be a good predicting method for 72-hour observation in patients in emergency observation room.
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Objective To study the effects of sodium bicarbonate (SB) on resuscitation in swine model of asphyxiation cardiac arrest (CA).Methods Thirty-two healthy miniature pigs were randomized (ramdom number) into two groups,the SB group (n =16) and the control group (n =16).Animals in both groups underwent endotracheal tube clamping to induce CA.Once induced,CA left untreated for a period of 8 minutes.At the beginning of initiation of cardiopulmonary resuscitation (CPR),SB (1.0 mEq/kg,diluted to 40 mL) was injected in central venous in SB group and isopyknic normal saline solution was injected in control group.Two minutes following initiation of CPR,defibrillation was attempted until return of spontaneous circulation (ROSC) was achieved or animals died.To assess the SB effects on myocardial metabolism,positron emission tomography (PET) was performed at baseline and 6 after ROSC.To analyze 18F-FDG myocardial uptake identified in PET,the maximum standardized uptake value (SUV) was measured.Results ROSC was 10/16 successful in SB group and only 8/16 successful in control group.The average survival time of SB group was (3.63 ± 0.76) h and that of control group was (2.45 0.70) h.Myocardial metabolism imaging using PET demonstrated that myocardial metabolism injuries in control group were more severe than in SB group at 6 h after ROSC and SUVmax was more higher in SB group than in control group (6 hrs after ROSC:1.32 ± 0.20 vs.1.10 ± 0.14,P =0.035).Conclusions In swine model of asphyxiation CA,SB improve the myocardial metabolism and might raise the possibility of ROSC and have no hypernatronemia.
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Objective To investigate the prognosis evaluation of acute kidney injury (AKI) by kidney disease staging of Improving Global Outcomes Organization (KDIGO) criteria and neutrophil gelatinase-associated lipocalin (NGAL) in severe sepsis patients treated with continuous blood purification (CBP).Methods In this prospective study, 84 severe sepsis patients treated with venous-venous CBP were selected from January 2013 to December 2014 in emergency intensive care unit of Medical University of China, Shun Yi Hospital and were divided into 3 groups based on the KDIGO staging criteria.Blood NGAL, ICU survival rate and renal function outcome of survivals were compared among groups.Results Compared with KDIGO stage 3, KDIGO stages 1 and 2 hospitalized patients had significantly lower NGAL [(453.9 ± 74.4) ng/mL vs.(789.1 ±86.8) ng/mL, P ＜0.01];Hospitalized survival rate was 92.3％ (24/26) in KDIGO stages 1 and 2 which was significantly higher than 69.0％ (40/58) in KDIGO stage 3 (P =0.026).Renal function improvement rate in KDIGO stages 1 and 2 was significantly higher than that in KDIGO stage 3 [83.3％ (20/24) vs.27.5％ (11/40), P ＜0.01].When the reliability of combination of KDIGO criteria and NGAL for prognosis evaluation was analyzed by ROC curve, the area under curve of survival was 0.703 (95％ confidence interval: 0.648-0.759, P ＜0.01) and area under curve of renal function improvement was 0.679 (95％ confidence interval: 0.627-0.731, P ＜ 0.01).Conclusions In severe sepsis patients complicated with AKI, CBP in KDIGO stages 1 and 2 might improve survival rate and renal function of sepsis patients.Combination of KDIGO criteria and NGAL maybe acted as an indicator of the prognosis in severe sepsis patients with complication of AKI.
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Objective To investigate the prevalence and influential factors of anxiety and depression in patients with non-organic dyspnea.Methods Data of 68 patients with non-organic dyspnea who were in emergency department of ShunYi Hospital China Medical University and department of emergency,Beijing Chaoyang Hospital from January to May in 2014 were collected.All the subjects were assessed with Hospital Anxiety and Depression Scale.Comparative analysis of influencing factors such as age,gender,educational level,type of inhabitant,etc.were conducted.Results Of all the subjects,22 cases (32.4％) were identified as anxiety,14 cases (20.6％) as depression.Patients of non-organic dyspnea with anxiety were more frequently seen in female,with lower education level,rage pre-hospital and nonnative inhabitant.Patients of non-organic dyspnea with depression were more frequently seen in lower education level,rage prehospital and nonnative inhabitant.Univariate and multivariate logistic regression analysis showed lower education level,rage pre-hospital and nonnative inhabitant were the major risk factors on anxiety and depression.Conclusions Patients with non-organic dyspnea had high prevalence of anxiety and depression.More attention should be paid to these patients.
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<p><b>BACKGROUND</b>The two most prevalent causes of sudden cardiac death are ventricular fibrillation cardiac arrest (VFCA) and asphyxiation cardiac arrest (ACA). Profound postresuscitation myocardial dysfunction has been demonstrated in both VFCA and ACA animal models. Our study aimed to characterize the two porcine models of cardiac arrest and postresuscitation myocardial metabolism dysfunction.</p><p><b>METHODS</b>Thirty-two pigs were randomized into two groups. The VFCA group (n = 16) were subject to programmed electrical stimulation and the ACA group (n = 16) underwent endotracheal tube clamping to induce cardiac arrest (CA). Once induced, CA remained untreated for a period of 8 minutes. Two minutes following initiation of cardiopulmonary resuscitation (CPR), defibrillation was attempted until return of spontaneous circulation (ROSC) was achieved or animals died. To assess myocardial metabolism, (18)F-FluoroDeoxyGlucose Positron Emission Tomography was performed at baseline and 4 hours after ROSC.</p><p><b>RESULTS</b>ROSC was 100% successful in VFCA and 50% successful in ACA. VFCA had better mean arterial pressure and cardiac output after ROSC than ACA. Arterial blood gas analysis indicated more detrimental metabolic disturbances in ACA compared with VFCA after ROSC (ROSC 0.5 hours, pH: 7.01 ± 0.06 vs. 7.21 ± 0.03, P < 0.01; HCO3(-): (15.83 ± 2.31 vs. 20.11 ± 1.83) mmol/L, P < 0.01; lactate: (16.22 ± 1.76 vs. 5.84 ± 1.44) mmol/L, P < 0.01). Myocardial metabolism imaging using Positron Emission Tomography demonstrated that myocardial injuries after ACA were more severe and widespread than after VFCA at 4 hours after ROSC (the maximum standardized uptake value of the whole left ventricular: 1.00 ± 0.17 vs. 1.93 ± 0.27, P < 0.01). Lower contents of myocardial energy metabolism enzymes (Na(+)-K(+)-ATPase enzyme activity, Ca(2+)- ATPase enzyme activity, superoxide dismutase and phosphodiesterase) were found in ACA relative to VFCA.</p><p><b>CONCLUSIONS</b>Compared with VFCA, ACA causes more severe myocardium injury and metabolism hindrance, therefore they should be treated as different pathological entities.</p>