Effect of Systolic Cardiac Function on Passive Leg Raising for Predicting Fluid Responsiveness: A Prospective Observational Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Passive leg raising (PLR) represents a "self-volume expansion (VE)" that could predict fluid responsiveness, but the influence of systolic cardiac function on PLR has seldom been reported. This study aimed to investigate whether systolic cardiac function, estimated by the global ejection fraction (GEF) from transpulmonary-thermodilution, could influence the diagnostic value of PLR.</p><p><b>METHODS</b>This prospective, observational study was carried out in the surgical Intensive Care Unit of the First Affiliated Hospital of Sun Yat-sen University from December 2013 to July 2015. Seventy-eight mechanically ventilated patients considered for VE were prospectively included and divided into a low-GEF (<20%) and a near-normal-GEF (≥20%) group. Within each group, baseline hemodynamics, after PLR and after VE (250 ml 5% albumin over 30 min), were recorded. PLR-induced hemodynamic changes (PLR-Δ) were calculated. Fluid responders were defined by a 15% increase of stroke volume (SV) after VE.</p><p><b>RESULTS</b>Twenty-five out of 38 patients were responders in the GEF <20% group, compared to 26 out of 40 patients in the GEF ≥20% group. The thresholds of PLR-ΔSV and PLR-Δ cardiac output (PLR-ΔCO) for predicting fluid responsiveness were higher in the GEF ≥20% group than in the GEF <20% group (ΔSV: 12% vs. 8%; ΔCO: 7% vs. 6%), with increased sensitivity (ΔSV: 92% vs. 92%; ΔCO: 81% vs. 80%) and specificity (ΔSV: 86% vs. 70%; ΔCO: 86% vs. 77%), respectively. PLR-Δ heart rate could predict fluid responsiveness in the GEF ≥20% group with a threshold value of -5% (sensitivity 65%, specificity 93%) but could not in the GEF <20% group. The pressure index changes were poor predictors.</p><p><b>CONCLUSIONS</b>In the critically ill patients on mechanical ventilation, the diagnostic value of PLR for predicting fluid responsiveness depends on cardiac systolic function. Thus, cardiac systolic function must be considered when using PLR.</p><p><b>TRIAL REGISTRATION</b>Chinese Clinical Trial Register, ChiCTR-OCH-13004027; http://www.chictr.org.cn/showproj.aspx?proj=5540.</p>

Inhibition of c-Jun N-terminal Kinase Signaling Pathway Alleviates Lipopolysaccharide-induced Acute Respiratory Distress Syndrome in Rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>An acute respiratory distress syndrome (ARDS) is still one of the major challenges in critically ill patients. This study aimed to investigate the effect of inhibiting c-Jun N-terminal kinase (JNK) on ARDS in a lipopolysaccharide (LPS)-induced ARDS rat model.</p><p><b>METHODS</b>Thirty-six rats were randomized into three groups: control, LPS, and LPS + JNK inhibitor. Rats were sacrificed 8 h after LPS treatment. The lung edema was observed by measuring the wet-to-dry weight (W/D) ratio of the lung. The severity of pulmonary inflammation was observed by measuring myeloperoxidase (MPO) activity of lung tissue. Moreover, the neutrophils in bronchoalveolar lavage fluid (BALF) were counted to observe the airway inflammation. In addition, lung collagen accumulation was quantified by Sircol Collagen Assay. At the same time, the pulmonary histologic examination was performed, and lung injury score was achieved in all three groups.</p><p><b>RESULTS</b>MPO activity in lung tissue was found increased in rats treated with LPS comparing with that in control (1.26 ± 0.15 U in LPS vs. 0.77 ± 0.27 U in control, P < 0.05). Inhibiting JNK attenuated LPS-induced MPO activity upregulation (0.52 ± 0.12 U in LPS + JNK inhibitor vs. 1.26 ± 0.15 U in LPS, P < 0.05). Neutrophils in BALF were also found to be increased with LPS treatment, and inhibiting JNK attenuated LPS-induced neutrophils increase in BALF (255.0 ± 164.4 in LPS vs. 53 (44.5-103) in control vs. 127.0 ± 44.3 in LPS + JNK inhibitor, P < 0.05). At the same time, the lung injury score showed a reduction in LPS + JNK inhibitor group comparing with that in LPS group (13.42 ± 4.82 vs. 7.00 ± 1.83, P = 0.001). However, the lung W/D ratio and the collagen in BALF did not show any differences between LPS and LPS + JNK inhibitor group.</p><p><b>CONCLUSIONS</b>Inhibiting JNK alleviated LPS-induced acute lung inflammation and had no effects on pulmonary edema and fibrosis. JNK inhibitor might be a potential therapeutic medication in ARDS, in the context of reducing lung inflammatory.</p>

Immunotherapy improves immune homeostasis and increases survival rate of septic patients / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the efficacy of immunotherapy on septic patients with Ulinastatin plus Thymosin-alpha(1).</p><p><b>METHODS</b>Seventy postoperative septic patients were divided into two groups at random: the immunotherapy group (n equal to 36) and the conventional therapy group (n=34). Patients in the immunotherapy group received intravenous Ulinastatin of 200 000 U, 3 times per day for 3 days, Ulinastatin of 100 000 U, 3 times per day for 4 days, and subcutaneous injection of Thymosin-alpha(1) of 1.6 mg, twice per day for 3 days, then once per day for 4 days. While conventional therapies such as antibiotics and fluid resuscitation were undertaken in both groups. The expression levels of serum tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10), IgG, C3, T lymphocyte subsets, CD14+ monocyte human leukocyte antigen (locus) DR (HLA-DR) and patients'28-day survival rate of the two groups were observed and evaluated.</p><p><b>RESULTS</b>The survival rate was significantly higher in the immunotherapy group (63.9%; 23/36) compared with the conventional therapy group (41.2%; 14/34). The serum TNF-alpha levels [(1.38+/-0.50) ng/ml in the immunotherapy group vs (1.88+/-0.53) ng/ml in the conventional group, P less than 0.05] and the serum IL-10 levels [(217.52+/-15.71) ng/ml vs (101.53+/-16.57) ng/ml, P less than 0.05] were significantly different between the two groups. The serum IgG levels in the immunotherapy group [(17.65+/-6.81) g/L] were significantly higher than in the conventional group [(11.94+/-5.32) g/L]. There were also significant differences in the expression levels of CD4+ T lymphocyte (35%+/-13% in the immunotherapy group vs 21%+/-7% in the conventional group, P less than 0.05) and CD14+ monocyte HLA-DR (50%+/-5% in the former vs 35%+/-4% in the latter, P less than 0.05).</p><p><b>CONCLUSIONS</b>Immunotherapy with Ulinastatin plus Thymosin-alpha(1) can enhance the inflammatory response, improve the immune homeostasis, and increase the survival rate of septic patients.</p>

Evaluation of the effect of maxillary anterior teeth morphology on torque using cone beam dental computed tomography / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study was undertaken to evaluate the influence of labial surface contours and collum angles of the maxillary anterior teeth on torque.</p><p><b>METHODS</b>206 extracted maxillary teeth were selected, including 77 central incisors, 68 lateral incisors and 61 canines. All specimens were scanned by cone beam dental computed tomography (CT). Three-dimensional reconstructed images were made by using the CT software. The median sagittal planes of all teeth were selected and then analyzed by the Auto CAD software. For each tooth, the angles between tangent lines to the labial surface at four different heights along the surface and the longitudinal axis of the crown were measured. The collum angle was also measured.</p><p><b>RESULTS</b>Between 3.5 mm and 5.0 mm level of bracket heights, for the variation of 0.5 mm, the torque differed by 1.5 degrees for the maxillary central incisors and 2 degrees for the maxillary lateral incisors and canines. The mean collum angle values for the maxillary central incisors, lateral incisors and canines were 0.88 degree, 3.87 degrees and -3.30 degrees.</p><p><b>CONCLUSION</b>The biological variation in tooth morphology would influence the torque after orthodontic treatment in different ways.</p>

Evaluation of the implant sites of palatal implants using cone beam computed tomography / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the vertical bone height and the bone density of the palate for implants placement using cone beam CT(CBCT) and to provide references to the safe and stable placement of palatal implants.</p><p><b>METHODS</b>Three-dimensional reformatting images were reconstructed with the selected CBCT scanning data of 34 patients aged 18 to 35 yeras, by means of EZ implant software. The vertical bone height was measured at 20 interesting sites of palate. Bone density was measured at 10 sites that could support 3.0 mm long implants. The data of the vertical bone height and bone density were analyzed by K-means cluster analysis.</p><p><b>RESULTS</b>According to the cluster analysis results, the 10 sites were classified into 3 clusters. There were statistical differences among these three clusters in bone height and bone density (P < 0.05). The LSD result showed that the greatest mean value of vertical bone height was obtained in cluster 2, followed by cluster 1 and cluster 3; the highest bone density was founded in cluster 3, followed by cluster 1 and cluster 2.</p><p><b>CONCLUSIONS</b>Evaluation of the sites for palatal implant placement with cone beam CT would be helpful in safe and stable implantation.</p>

The drug resistance of pathogenic bacteria of nosocomial infections in surgical intensive care unit / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the drug resistance of pathogenic bacteria of nosocomial infections in the surgical intensive care unit.</p><p><b>METHODS</b>The drug resistance of pathogenic bacteria of nosocomial infections in the SICU in our hospital from January 2001 to December 2004 were analyzed.</p><p><b>RESULTS</b>The average nosocomial infections rate was 11.3%. The major sites of nosocomial infections were respiratory tract (30.9%), abdominal cavity (29.0%), bloodstream (9.7%) and biliary ducts (7.2%). The most common pathogens were pseudomonas aeruginosa (11.6%), methicillin-resistant coagulase negative staphylococci (11.1%) and candida albicans (9.7%). ESBLs-producing strains accounted for 66.2% and 58.5% of escherichia coli and klebsiella spp. respectively. Methicillin-resistant staphylococcus aureus accounted for 94.7% and methicillin-resistant coagulase negative staphylococci accounted for 88.2% in staphylococcus aureus and coagulase negative staphylococci. Carbapenems were the most powerful antibiotics against enterobacteriaceae. The non-fermenters were high resistant to antimicrobial agents. Vancomycin was the most potent antimicrobial against gram positive cocci. Amphotericin B was the most active antibiotic against fungi.</p><p><b>CONCLUSIONS</b>Most strains of pathogens were antibiotic resistant in SICU. The main pathogenic bacteria of each infection site were different. So it is essential to establish nosocomial infections surveillance system in order to prevent, control and treat nosocomial infections effectively.</p>