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A debate on the role of crystalloids vs colloids for fluid resuscitation has lasted over a century. Obviously, crystalloids were predominantly used in septic patients who were characterized with very complex pathophysiological abnormalities. Meanwhile, it remained controversial whether crystalloids induced an extra pathophysiological alternations while replacing volume depletion. This article was aimed at discussing physiological efficacy and safety of crystalloids for volume replacement through reviewing previous approaches on choice of fluids for septic patients.
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Early adequate fluid loading was the corner stone of hemodynamic optimization for sepsis and septic shock. Meanwhile, recent recommended protocol for fluid resuscitation was increasingly debated on hemodynamic stability vs risk of overloading. In recent publications, it was found that a priority was often given to hemodynamic stability rather than organ function alternation in the early fluid resuscitation of sepsis. However, no safety limits were used at all in most of these reports. In this article, the rationality and safety of early aggressive fluid loading for septic patients were discussed. It was concluded that early aggressive fluid loading improved hemodynamics transitorily, but was probably traded off with a follow-up organ function impairment, such as worsening oxygenation by reduction of lung aeration, in a part of septic patients at least. Thus, a safeguard is needed against unnecessary excessive fluids in early aggressive fluid loading for septic patients.
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Objective To improve the voltage regulator for the traditional X-ray machine to provide heating voltage and current to X-ray tube filament heating circuit.Methods The circuits included the ones for regulator output voltage sampling,desired voltage generation,control voltage generation,synchronous pulse triangular signal generation,phase control,siliconcontrolled rectifier (SCR) and regulator input voltage sampling.Negative feedback control was executed by the sampling,detection and comparison of the regulator output voltage,and the comparison was carried out with the synchronous pulse triangular signal to generate the signal for controlling SCR.The regulator output voltage was kept stable by regulating the modes of SCR conduction angle.Results Installing and debugging of designed circuit for domestic power frequency X-ray machine contributed to realizing voltage regulation for the filament heating circuit.The test also measured voltage waveform distortion in AC circuits,and this kind of adverse effect did not affect the filament heating circuit.Conclusion The improved system has small volume,low heat,little noise and high performance,which can replace the traditional MSVR.
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OBJECTIVE: To investigate the relationship between chemotherapy resistance and cancer stem cells, probe the way to reverse drug resistance, and guide the rational medical treatment. METHODS: Hepatocellular carcinoma cell lines, parent and chemoresistant HepG-2, were cultured with fluorouracil (5-FU). CCK-8 cell proliferation assay was used to determine the inhibition of 5- Fu and all-trans retinoic acid (ATRA), a cell differentiation inducer. The content difference of cancer stem cells between parent and chemoresistant HepG-2 cell lines was examined by flow cytometry. Western blot and realtime PCR were preformed to probe the difference of related gene expression level between parent and chemoresistant HepG-2 cell lines. RESULTS: Our data supported that the inhibitory effect of 5-Fu alone on chemoresistant HepG-2 cells proliferation was lower than on parent HepG-2 cells. After the addition of ATRA, chemoresistant HepG-2 cells proliferation was reduced obviously. Flow cytometry results revealed that compared with parent HepG-2 cells, the ratio of CD44 and CD326 positive cells in chemoresistant HepG-2 cells was much more than that in parent HepG-2 cells. Furthermore, realtime PCR and Western blot suggested that ABCG2, BMI and OCT4 expressions were increased in chemoresistant HepG-2 cells than those in parent HepG-2 cells, while ATRA could attenuate these differences on protein expressions. CONCLUSION: Cancer stem cells enrichment relates to chemotherapy resistance, which can be reversed by ATRA through down-regulation cancer stem cells associated gene expression. This can provide new ideas for clinical rational use of anti-tumor drugs.
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<p><b>BACKGROUND</b>Elevating the head of bed (HOB) 30° - 45° has been widely supported as a means of ventilator associated pneumonia (VAP) prevention. However, it was poorly adhered in clinical practice. This observational study aimed to investigate the factors impeding this simple practice at the bedside.</p><p><b>METHODS</b>This prospective study was conducted in 33 Chinese academic hospital intensive care units (ICUs). HOB angle was measured four times daily at 5 - 7 hour intervals. The predefined HOB elevation goal was an angle ≥ 30°.</p><p><b>RESULTS</b>The overall rate of achieving the HOB goal was 27.8% of the 8647 measurements in 314 patients during 2842 ventilation days. The HOB goal of ≥ 3 times/d was consistently achieved only in 15.9% of the cases. Almost 60% of patients had at least one 24 hours period during which the HOB goal was never documented. This low rate of protocol compliance was not associated with acute physiology and chronic health evaluation (APACHE) II score or dependence on vasopressors. In a survey, "nurse workload" was identified as the most important factor for non-compliance with the HOB goal. In addition, the rates of compliance were significantly different (P < 0.001) between physicians self-reporting that they either did or did not know the Institutes of Healthcare Improvement (IHI) ventilator bundle.</p><p><b>CONCLUSIONS</b>Low adherence to a HOB angle of ≥ 30° was found in this nationwide survey. Nursing workload and lack of knowledge on VAP prevention were important barriers to changing this practice.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , China , Guideline Adherence , Intensive Care Units , Pneumonia, Ventilator-Associated , Respiration, ArtificialABSTRACT
Objective To study the trend of infant mortality and the leading cause of the deaths in Sichuan province from 2001 to 2009.Methods Data presented in this report was obtained from the child mortality surveillance network with target population as children under 5 years of age.Rates on infant mortality,neonatal mortality and indirect estimation of infant mortality were calculated.Results The neonatal mortality rate and infant mortality rate in Sichuan dropped from 18.6,25.5 in 2001 to 7.6,12.1 per 1000 live birth in 2009,with rates of decline as 59.1% and 35.0%,from 2001 to 2009.In urban areas of Sichuan,the neonatal and infant mortality rates dropped from 4.7,7.5 in 2001 to 3.7 and 6.5 per 1000 live birth in 2009,with the rates of decline as 22.3% and 13.1%.In the rural areas of Sichuan,the neonatal and infant mortality rates dropped from 25.2 and 34.0 in 2001 to 9.6,14.3 per 1000 live birth in 2009,with rates of decline as 62.0%,57.9% from 2001to 2009.Conclusion In both urban and rural areas,the neonatal and infant mortality rates had decreased drastically from 2001 to 2009,due to the decrease of avoidable deaths as pneumonia and diarrhea in infants.
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<p><b>OBJECTIVE</b>To facilitate early recognition of ominous clinical manifestations, to understand pathophysiology and assess treatment effects in patients with severe enterovirus 71 (EV71) associated hand, foot and mouth disease (HFMD).</p><p><b>METHOD</b>A retrospective analysis was performed based on the clinical records, laboratory data and treatment effects which were collected from twelve severe EV71 infected cases from nine hospitals in 2008, in Hubei province, China.</p><p><b>RESULT</b>Of the 12 severe cases, ten (83.3%) were male and two female. The median age was 1.96 yrs (8 m to 7 yrs). The mean hyperthermic duration was 6 days with the peak temperature over 38.5 degrees C, and mean rash duration was 7 days. Fever and rash emerged simultaneously in 4 of 5 cases with cardiopulmonary failure. The severe complications included encephalitis (10 cases), pulmonary edema or hemorrhage (5 cases). Eleven cases were checked with magnetic resonance imaging (MRI) and four cases showed characteristics of encephalitis or meningitis, two with images of naso sinusitis and ethmoid-mastoid inflammation. Chest X-ray examination showed with pulmonary edema on single or both sides (5 cases), bronchitis (4 cases), and normal image (3 cases). There was no specific finding in the cardiac ultrasound and electrocardiogram in any of the patients, as well as the white blood cell count, blood glucose, prothrombin time, partial thromboplastin time and D-dimer. Cerebrospinal fluid showed aseptic meningitis with the increase of cell count in 7 cases. All patients were treated with antibiotics and/or antivirals, such as cephalosporins, ribavirin etc. Eleven patients were treated with intravenous immunoglobulin (total dose 2 - 4.5 g/kg) for 2 - 5 days, and the highest blood concentration of immunoglobulin was detected increasing at 7 g/L. Seven cases were also treated with methylprednisolone 10 - 30 mg/(kg x d), four with dopamine, dobutamine, or digitalis. In addition, by using continuous positive airway pressure by nasal catheter and maintenance of circulation in the cases with cardiopulmonary failure could not relieve the symptoms of dyspnoea, and mechanical ventilation was required to maintain for a mean of 72 hrs (24 - 96 hrs). Except one case died of pulmonary edema in the early stage, others were cured without sequelae.</p><p><b>CONCLUSION</b>Severe EV71 infection is more common in children younger than 3 years old, in which the profound complications include encephalitis and pulmonary edema. The mechanical ventilation should be critically urged for child with complicating cardiopulmonary failure as soon.</p>