ABSTRACT
Objective To explore the optimization of intubations for severe brain injury patients in ICU. Methods Seventy-six severe brain injury patients were divided into research group and traditional group through the envelop method, with 38 patients in each group. Patients in research group was induced by dexmedetomidine, while patients in traditional group was induced by midazolam or propofol. Throat and intratrachea surface anesthesia was taken with 3 ml of 1%lidocaine on two groups before intubation, and they were intubated through direct laryngoscope. Patients were connected with breathing machines after intubation, and the arterial carbondioxide partial pressure was maintained at 30-35 mmHg (1 mmHg=0.133 kPa). Intubations time, one-time success rate, cardiovascular reaction index, myocardial damage and heart failure biomarkers, adverse reaction, patients comfort and intubationists satisfaction of the two groups were compared. Results The intubation time on research group was significantly shorter than that on traditional group [(27.1 ± 14.2) s vs. (42.2 ± 18.7) s], and there was statistical significance (P0.05). The heart rates and mean arterial pressure (MAP) at pre-intubation, post-intubation, 5 min after intubation and 10 min after intubation in research group were significantly lower than those in traditional group:heart rate:(77.8 ± 8.5) bpm vs. (85.1 ± 7.6) bpm, (85.3 ± 9.1) bpm vs. (106.4 ± 12.5) bpm, (84.4 ± 10.4) bpm vs. (96.4 ± 11.9) bpm, (80.5 ± 12.1) bpm vs. (89.0 ± 10.5) bpm;MAP: (82.6 ± 10.1) mmHg (1 mmHg = 0.133 kPa) vs. (93.2 ± 14.3) mmHg, (88.3 ± 13.2) mmHg vs. (113.7 ± 15.1) mmHg, (85.4 ± 14.0) mmHg vs. (101.3 ± 9.9) mmHg, (83.7 ± 10.7) mmHg vs. (90.3 ± 13.4) mmHg, and there were statistical significances (P0.05). For 6 and 12 h after intubation, creatine kinase isoenzyme MB (CK-MB), cardiac troponin T (cTnT) and brain natriuretic peptide (BNP) levels in research group were significantly lower than those in traditional group:CK-MB:(30.5 ± 7.2) U/L vs. (35.2 ± 10.1) U/L, (25.7 ± 5.7) U/L vs. (27.7 ± 6.5) U/L;cTnT:(0.6 ± 0.2) μg/L vs. (0.8 ± 0.1) μg/L, (0.5 ± 0.2) μg/L vs. (0.6 ± 0.2) μg/L;BNP:(152.6 ± 13.7) pg/L vs. (189.4 ± 19.3) pg/L, (89.7 ± 27.5) pg/L vs. (111.8 ± 20.4) pg/L, and there were statistical significances (P<0.05). There were no significant adverse reactions in two groups after topical anesthesia. The comfort and intubationists satisfaction scores in research group were significantly higher than those in traditional group: (2.5 ± 0.4) scores vs. (1.8 ± 0.5) scores and (8.8 ± 1.1) scores vs. (7.1 ± 0.9) scores, and there were statistical significance (P<0.01). Conclusions Combining dexmedetomidine induction with topical anesthesia to intubate is safe and effective, which is the optimization of tracheal intubations to severe brain injury patients.
ABSTRACT
Phosphoinositide 3-kinase (PI3K)/protein kinase-B (AkT)/mammalian target of rapamycin (mTOR)/70-kDa ribosomal protein S6 kinase (p70S6K), PI3K/Akt/mTOR/p70S6K, is an important signaling pathway in the life activities of cells, and it plays an important role in promoting the growth, proliferation, invasion, and anti-apoptosis of cells and promoting angiogenesis. It was clarified that the PI3K/Akt/mTOR/p70S6K signaling pathway is involved in regulating the activities of hepatic stellate cell(HSC), thus influencing the development and progression of hepatic fibrosis. Analysis demonstrated that blocking any target of the PI3K/Akt/mTOR/p70S6K signaling pathway can inhibit the activation and proliferation of HSC, promote the apoptosis of HSC, inhibit the extracellular matrix secretion from HSC, and delay the progression of hepatic fibrosis. Blocking the pathway is expected to be a treatment strategy for hepatic fibrosis.
ABSTRACT
Hepatitis B virus (HBV) infection seriously threatens human health. Viral, environmental, and host factors can influence the progression, outcome, and prognosis of HBV infection. Accumulating evidence has shown that the host interleukin 28B gene polymorphism is, to a certain degree, associated with host immunity, anti-HBV efficacy of interferon, and HBV infection outcome. However, at present a consistent conclusion has not been reached yet. IL28B may influence the efficacy of interferon therapy and virus spontaneous clearance in patients with chronic hepatitis B (CHB) by affecting the host′s immune status. Examining the immune status for CHB patients before the experimental study may help researchers to draw a more consistent conclusion.
ABSTRACT
Multiple etiological factors are integrally involved in the development of hepatitis B virus (HBV)infection.Interleukin-10 (IL-10)is an essential cytokine of immune regulation,and IL-10 gene promoter polymorphism affects its mRNA transcription and serum level. IL-10 is related to the prognosis of HBV infection.This review briefly discusses the association of IL-10 gene polymorphism and its serum level with the prognosis of HBV infection,and summarizes the role of IL-10,as an anti-inflammatory cytokine,in host immune function, the prognosis and progression of HBV infection,and HBV-related complications.IL-10 gene polymorphism and its serum level are closely associated with inflammatory response after HBV infection,influence HBV clearance,and are related to the severity of HBV-related liver injury,liver cirrhosis,and hepatocellular carcinoma.The determination of IL-10 gene and serum levels may provide a predictive marker for the prognosis of HBV infection.