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Objective:To investigate the change and clinical significance of serum alkaline phosphatase (ALP) level in patients with acute spontaneous intracerebral hemorrhage(AICH).Methods:81 patients with AICH admitted to the Neurosurgery Department of Tianjin Third Central Hospital from January 2019 to October 2020 were retrospectively analyzed. 81 patients with non cerebral hemorrhage who came from the health examination center or complained of dizziness and had no hepatobiliary and skeletal diseases were selected as the control group. The clinical data of all the patients were recorded, including gender, age, Glasgow Coma Scale (GCS) score, hemorrhage location, liver function indexes, the history of hypertension, diabetes, heart disease, smoking, drinking, and so on. The differences in clinical data between the two groups were compared. Pearson correlation was used to analyze the correlation between liver function indexes and GCS score. The independent risk factors for AICH were screened by binary logistic regression, and the receiver operating characteristic (ROC) curve was used to evaluate the value of serum ALP in predicting intracerebral hemorrhage.Results:Serum ALP level in AICH group was significantly higher than that in the control group [85.0(70.0, 103.0) U/L vs 65.0(54.5, 71.5)U/L, Z=6.740, P<0.001]. Pearson correlation analysis showed that serum ALP had a negative correlation with GCS score ( r=0.255, P=0.022). Binary logistic regression analysis showed that hypertension ( OR=20.440, 95% CI 8.572-48.737) and ALP ( OR=1.077, 95% CI 1.049-1.105) were risk factors for intracerebral hemorrhage. Serum ALP level was an independent risk factor ( OR=1.069, 95% CI 1.038-1.101) for AICH after adjusting for confounding variables including age, AST, history of hypertension. ROC curve showed that the area under the curve (AUC) of serum ALP in predicting intracerebral hemorrhage was 0.807 (95% CI 0.740-0.873, P<0.001), with sensitivity of 67.9% and specificity of 81.5%. Conclusions:Serum ALP level may be related to the occurrence and severity of AICH. Therefore, serum ALP level can be used as a reference index to evaluate the occurrence, severity of patients with AICH.
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Objective@#To determine the diagnostic value of serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with liver cirrhosis.@*Methods@#Serum Cys C levels in 150 liver cirrhosis patients (88 AKI and 62 non-AKI patients) were measured by the Particle-Enhanced Nephelometric Immuno-Assay. The accuracy of serum Cys C for the diagnosis of AKI in liver cirrhosis was evaluated by the ROC curve.@*Results@#Liver cirrhosis patients with AKI had significantly higher serum Cys C levels [2.37 (1.75-2.83) mg/L] than those without AKI [0.97 (0.85-1.09) g/L] (P <0.001). Serum Cys C level was highest in the acute tubular necrosis group [5.41 (2.77-6.19) mg/L], followed by the hepatorenal syndrome group [2.55 (2.28-3.59) mg/L] and prerenal azotemia group [2.07 (1.70-2.41) mg/L], and the serum Cys C level was significantly different between the three groups (P <0.001). In addition, patients with AKI were further divided into infection group and non-infection group. Serum Cys C level was significantly higher in the infection group than in the non-infection group (P <0.05). The area under the ROC curve of serum Cys C for the diagnosis of AKI in liver cirrhosis was 0.99 (0.98-1.00) at a cut-off value of 1.36 mg/L, and the sensitivity and specificity were 97% and 95%, respectively.@*Conclusion@#Serum Cys C is a good marker for detecting AKI in liver cirrhosis, and the different levels of increase in Cys C may be useful in differentiating the different types of AKI.
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Objectives This research explored the characteristics of changes in the serum metabolic profile of preeclampsia pregnancy(PE) to establish the disease distinguish model and screen characteristic metabolic markers with potential diagnostic value for preeclampsia.Methods From August 2014 to January 2016,samples in three groups were collected at Tianjin Third Central Hospital.Thirty-one clinically diagnosis patients with preeclampsia,25 normal pregnancy women and 29 healthy volunteers of childbearing age were enrolled.Ultraperformance liquid chromatography-mass spectrometry (UPLC-MS) was used to analyze serum metabolites of PE group (31 patients with preeclampsia),P group (25 normal pregnancy women) and Normal group (29 healthy volunteers of childbearing age).Nonparametric test analyzes were used to analyze the data and find the specific metabolites.Results This research established the principal component analysis (PCA) and orthogonal partial least squares-discriminant analysis (OPLS-DA) disease distinguish model for PE group,P group and Normal group.To distinguish PE group,P group and Normal group,15 characteristic metabolites were identified.Eight kinds of glycerol phospholipid (including 7 kinds of hemolysis phosphatidyl choline and 1 kind of lysophospholipids acid) and 1 kind of sphingomyelin in PE group were higher than that of normal pregnancy group.The difference had statistically significant(Z of the metabolites were 2.32,3.34,3.21,2.60,2.22,3.40,3.58,5.84,2.70 respectively,all P<0.05).1,25-Dihydroxyvitamin D3-26,23-lactone and 24-Oxo-1alpha,23,25-trihydroxyvitamin D3 in PE group were higher than that of P group and Normal group,which had a statistics difference (Z of the metabolites were 2.01,3.89,3.26,2.34 respectively,all P<0.05).Conclusions Metabolomics distinguish model has a good ability to distinguish PE group,P group and Normal group.Serum characteristic metabolites can successfully reflect the status of fat,calcium and phosphorus metabolism of preeclampsia patients and provide high value for prediction,diagnosis and treatment.
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Objective To explore the level of free fatty acid (FFA)in ischemic stroke (IS) patients and its correlation with insulin resistance (IR).Methods This study was case-control study.Patients who were diagnosed with IS were followed up from June,2011 to September,2012 in Tianjin Third Central Hospital.The 180 IS patients were divided into large infarct(57),middle infarct(63)and small infarct (60) according to the area of infarct.At the same time,60 healthy persons were selected as control group.The plasma FFA,fasting insulin (FINS),fasting blood glucose (FBG),homeostasis model assessment (HOMA)-IR,triacylglycerol (TG),total cholesterol (TC),high density lipoprotein cholesterol-C (HDL),low density lipoprotein cholesterol-C(LDL),lipoprotein A1 (APOA1) and lipoprotein B (APOB) in 180 IS patients were measured and compared with that of control group.The correlation between FFA and IR was analyzed by using pearson linear correlation.The relationship between FFA and HOMA-IR was analyzed by using multiple stepwise multivariate analysis.The t test and analysis of variance were used for statistical analysis.Results Compared to normal control,the level of FFA,FINS,FBG,FIB,TG,TC,LDL,APOB and HOMA-IR in IS patients were higher,the difference was statistically.The level of HDL,APOA1 in IS patients were lower than that of normal control.The level of FFA,FINS,HOMA-IR,FBG,TG,TC,HDL,LDL,APOA1 and APOB in IS patients related to the area of infarct.The level of FFA,FINS,HOMA-IR,FBG,TG,TC,LDL,APOB in large infarct were higher than those in middle infarct and small infarct.The level of HDL,APOA1 in large infarct were lower than those in middle infarct and small infarct,the difference were statistically.In IS patients,FFA had positive correlation to FINS,FBG and HOMA-IR (r =0.870,0.497,0.792,P ＜ 0.001),but had no correlation to age (r =0.008,P ＞ 0.05).In IS patients,HOMA-IR was dependent variable,but FFA,FINS,FBG,TG,TC,HDL,APOA1 and APOB were independent variable.FFA was independent risk factor to HOMA-IR,besides FINS,FBG,TC,LDL and APOB.Conclusion FFA elevates in IS patients,FFA has correlation to IR and it is a dependent risk factor to IS patients.
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Objective To evaluate the clinical significance of the combined determination of serum procalcitonin (PCT),C reactive protein(CRP),prealbumin(PA)and white blood cell(WBC) in curative effect and prognosis of elderly patients with bacterial infection.Methods Serum PCT,CRP,PA and WBC levels and their dynamic changes of 70 patients with bacterial infection from intensive care unit(ICU)were measured.The patients with bacterial infection were classified into serious infection group and local infection group.And the comparison with virus infection group was made.Results The levels of PCT(18.00±3.20)μg/L and CRP(86.17±10.64)mg/L in serious infection group and local infection group[PCT(2.03±0.46)μg/L,CRP(50.24±7.45)mg/L] were increased.The contents of PA were reduced[(3.214±0.88)mg/L,(12.89± 1.03)mg/L].The levels of WBC were increased mildly[(8.89±1.23) × 109/L,(6.54±0.87) × 109/L].The differences were statistically significant between bacterial infection groups(serious infection group and local infection group) and virus infection group [PCT (0.21 ±0.06)μg/L,CRP (5.21 ±0.84) mg/L,PA (20.14 ±2.57)mg/L,WBC (5.30 ± 0.93) × 109/L] (P＜ 0.01).Serum PCT,CRP.PA and WBC showed significant differences between serious infection group and local infection group(P＜0.01).After antibiotic treatment,the levels of PCT (0.5 ± 0.08) μg/L,CRP (10.32 ± 1.65) mg/L and WBC (6.30± 0.91) × 109/L in bacterial infection group were reduced obviously and the concentration of PA (18.19±2.66)mg/L was elevated compared with before treatment [PCT(11.61±8.27)μg/L,CRP (71.80±20.09)mg/L,WBC(7.95± 1.59) × 109/L,PA(7.08±4.87)mg/L] (P＜0.01).Correlative analysis was performed between PCT and others indicators before and after antibiotic treatment in bacterial infection group and virus infection group.There was positive correlation between PCT and CRP,WBC before(r=0.586,0.445) and after treatment (r=0.688,0.463) in bacterial infection group.PCT and WBC(r=0.432) were positively correlated after treatment,while no correlation existed between PCT and others indexes in virus infection group(r＜0.306).When comparing sensitivity and specificity of PCT and CRP for diagnosis of bacterial infection disease,the sensitivity (95.7％) of PCT was similar to that of CRP.The specificity of PCT(86.7％) was remarkably higher than that of CRP(73.3％).Conclusions The combination of serum PCT,CRP.PA and WBC is valuable for early diagnosis of bacterial infection disease.Monitoring PCT level dynamically would assist an evaluation of curative effect and disease outcome of elderly patients.
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In order to examine whether repeated sciatic nerve blocks showed tachyphylaxis and continuity of sciatic nerve with spinal cord affected development of tachyphylaxis when assayed in vivo by duration of depression compound action potentials (CAP), rats were anesthetized with halothane, ventilated, monitored and supported with stable hemodynamics and temperature. Posterior tibial nerve distally and sciatic nerve in thigh were exposed, placed on bipolar silver electrodes for stimulation and recording respectively. Three sequential sciatic nerve blocks were performed between these electrodes using 0.15 ml of 3% chloroprocaine. Nine rats were chosen to observe the effects of repeated sciatic nerve blocks on CAP. In another 18 rats, a second investigator exposed the sciatic nerve near its origin at spinal cord and randomly performed nerve cut and sham (n=9), and closed the incision blinding the electrophysiologic investigator. The results showed that electrical stimulated tibial nerve induced sciatic nerve Aalpha/beta, Adelta, C fiber mediated CAP waves. CAP amplitudes were remained stable during whole experimental procedure. CAP amplitudes were decreased completely with 3% chloroprocaine blocked sciatic nerve and recovered fully. The duration of CAP depression were reduced with repeated blocks. There were no selective blocked effects on Aalpha/beta, Adelta, C fiber mediated CAP. With sciatic nerve cut proximally, there was no statistical significant tachyphylaxis with 3% chloroprocaine repeated blocked sciatic nerve, and the duration of first and third blocked Adelta fiber mediated CAP was 108+/-20 and 92+/-14 min respectively (P>0.05). In normal rats the duration of first and third blocked Adelta fiber mediated CAP was 110+/-20 and 75+/-16 min respectively (P<0.05). It was suggested that tachyphylaxis to local anesthetics can occur in rats repeated blocked sciatic nerve when assayed in vivo by duration of depression CAP. The continuity of sciatic nerve with spinal cord is one of the important factors affecting the development of tachyphylaxis.
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Anesthetics, Local/administration & dosage , Nerve Block , Procaine/administration & dosage , Procaine/analogs & derivatives , Sciatic Nerve , Tachyphylaxis/physiologyABSTRACT
In order to examine whether repeated sciatic nerve blocks showed tachyphylaxis and continuity of sciatic nerve with spinal cord affected development of tachyphylaxis when assayed in vivo by duration of depression compound action potentials (CAP), rats were anesthetized with halothane, ventilated, monitored and supported with stable hemodynamics and temperature. Posterior tibial nerve distally and sciatic nerve in thigh were exposed, placed on bipolar silver electrodes for stimulation and recording respectively. Three sequential sciatic nerve blocks were performed between these electrodes using 0.15 ml of 3% chloroprocaine. Nine rats were chosen to observe the effects of repeated sciatic nerve blocks on CAP. In another 18 rats, a second investigator exposed the sciatic nerve near its origin at spinal cord and randomly performed nerve cut and sham (n=9), and closed the incision blinding the electrophysiologic investigator. The results showed that electrical stimulated tibial nerve induced sciatic nerve Aalpha/beta, Adelta, C fiber mediated CAP waves. CAP amplitudes were remained stable during whole experimental procedure. CAP amplitudes were decreased completely with 3% chloroprocaine blocked sciatic nerve and recovered fully. The duration of CAP depression were reduced with repeated blocks. There were no selective blocked effects on Aalpha/beta, Adelta, C fiber mediated CAP. With sciatic nerve cut proximally, there was no statistical significant tachyphylaxis with 3% chloroprocaine repeated blocked sciatic nerve, and the duration of first and third blocked Adelta fiber mediated CAP was 108+/-20 and 92+/-14 min respectively (P>0.05). In normal rats the duration of first and third blocked Adelta fiber mediated CAP was 110+/-20 and 75+/-16 min respectively (P<0.05). It was suggested that tachyphylaxis to local anesthetics can occur in rats repeated blocked sciatic nerve when assayed in vivo by duration of depression CAP. The continuity of sciatic nerve with spinal cord is one of the important factors affecting the development of tachyphylaxis.
Subject(s)
Animals , Rats , Anesthetics, Local , Nerve Block , Procaine , Sciatic Nerve , Tachyphylaxis , PhysiologyABSTRACT
Objective To investigate the therapeutic rate and side effects of different doses of Triamcinolone Acetonide to treat prolapsed lumbar disc. Methods 32 patients with prolapsed lumbar disc were randomly divided into two groups ( n =16). Epidural space was punctured at L3-4 interspace at lateral position, then a epidural catheter was inserted 4 cm distally. 5 min after injection of 3 ml of 1.5% lidocaine, group A or B medication was administered epidurally. Group A contrained Triamcinolone Acetonide 20mg + lidocaine 20mg + vitamin B_ 12 1000?g diluted to 8ml with saline, Group B contained Triamcinolone Acetonide 40mg + lidocaine 20mg + vitamin B_ 12 1000?g diluted to 8ml with saline. The patients were allowed to supine position after 10min in lateral position. 3 injections was made at interval of 3 days, patients were kept in bed for 3 weeks. Results The cure rate at group A and B were 100%. Side effects at group A and B were 31% and 75%, there were statistical significant difference ( P
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Objective To compare the effect of acute hypervolemic hemodilution (AHH) and normovolemic hemodilution (ANH) as means of perioperative blood conservation in the patients undergoing hepatic tumor operation. Methods 45 ASA I-II patients with hepatic tumor were randomly divided into three groups, control, AHH and ANH, each group containing 15 cases. After induction of anesthesia, the patients of AHH group were rapidly infused 20 ml/kg fluid intravenously, the patients of ANH group were withdrawn 15ml/kg intravenous blood and simultaneously infused the same volumes of 6% hydroxyethyl starch. BP, HR, ECG, SaO2, urine output, fluid input and blood loss were monitored during operation. Blood samples were collected before and after hemodilution, at end of operation and the first day of postoperation to measure Hb, Hct, Plt, blood biochemical indices, PT and APTT. Results After hypervolemic and normovolemic hemodilution Hct reduced to 30.9?3.3% and 29.6?2.8% from 39.8?3.4% and 40.2?3.5% respectively, and PT and APTT were significantly prolonged in both the AHH and ANH patients (P
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Objective To observe the changes of hemorheology after acute hypervolemic hemodilution (AHH), and provide theoretic basis for clinical rationally using artificial plasma substitutes. Methods 90 patients undergoing hip joint operation were randomly divided into 3 groups (each group containing 30 patients), which received intravenous infusion of 6% hydroxyethyl starch (HES), 4% gelofusine or ringer's solution at 20ml/kg, respectively before operation. The whole blood viscosity, plasma viscosity, Hct, index of RBC aggregation and index of RBC deformation were measured before and after hemodilution. Resutls Hemodynamics was stable after AHH, and the amounts of perioperatively blood transfusion in the patients received colloid solution were obviously less than those in the patients received crystalloid solution. The whole blood viscosity, Hct and index of RBC aggregation significantly decreased after AHH in all the patients, and index of RBC deformation markedly increased in the patients after AHH with 6% HES. Conclusion AHH could effectively maintain hemodynamics stable, improve hemorheological condition and perfusion of microcirculation, enhance the tolerance of blood loss, and reduce homologous blood transfusion. Colloid solution was better than crystalloid solution for AHH.