Comparison of the pulmonary dead-space fraction derived from ventilator volumetric capnography and a validated equation in the survival prediction of patients with acute respiratory distress syndrome / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>This prospective observational study aims to evaluate the accuracy of dead-space fraction derived from the ventilator volumetric capnography (volumetric CO₂) or a prediction equation to predict the survival of mechanically ventilated patients with acute respiratory distress syndrome (ARDS).</p><p><b>METHODS</b>Consecutive VD/VT measurements were obtained based upon a prediction equation validated by Frankenfield et al for dead-space ventilation fraction: VD/VT = 0.320 + 0.0106 (PaCO₂-ETCO₂)⁺ 0.003 (RR)⁺0.0015 (age) in adult patients who had infection-related severe pneumonia and were confirmed as having ARDS. Here PaCO₂ is the arterial partial pressure of carbon dioxide in mmHg; ETCO₂, the end- tidal carbon dioxide measurement in mmHg; RR, respiratory rate per minute; and age in years. Once the patient had intubation, positive end expiratory pressure was adjusted and after Phigh reached a steady state, VD/VT was measured and recorded as the data for the first day. VD/VT measurement was repeated on days 2, 3, 4, 5 and 6. Meanwhile we collected dead-space fraction directly from the ventilator volu- metric CO₂ and recorded it as Vd/Vt. We analyzed the changes in VD/VT and Vd/Vt over the 6-day period to determine their accuracy in predicting the survival of ARDS patients.</p><p><b>RESULTS</b>Overall, 46 patients with ARDS met the inclusion criteria and 24 of them died. During the first 6 days of intubation, VD/VT was significantly higher in nonsurvivors on day 4 (0.70 ± 0.01 vs 0.57 ± 0.01), day 5 (0.73 ± 0.01 vs. 0.54 ± 0.01), and day 6 (0.73 ± 0.02 vs. 0.54 ± 0.01) (all p =0.000). Vd/Vt showed no significant difference on days 1e4 but it was much higher in nonsurvivors on day 5 (0.45 ± 0.04 vs. 0.41 ± 0.06) and day 6 (0.47 ± 0.05 vs. 0.40 ± 0.03) (both p=0.008). VD/VT on the fourth day was more accurate to predict survival than Vd/Vt. The area under the receiver-operating characteristic curve for VD/VT and Vd/Vt in evaluating ARDS patients survival was day 4 (0.974 ± 0.093 vs. 0.701 ± 0.023, p = 0.0024) with the 95% confidence interval being 0.857-0.999 vs. 0.525-0.841.</p><p><b>CONCLUSION</b>Compared with Vd/Vt derived from ventilator volumetric CO₂, VD/VT on day 4 calculated by Frankenfield et al's equation can more accurately predict the survival of ARDS patients.</p>

Differential expression of microRNA in chronic hepatitis B patients of pi-wei dampness-heat syndrome and of gan depression Pi deficiency syndrome: a primary research / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore different microRNA expression profiles between chronic hepatitis B (CHB) patients of Pi-Wei dampness-heat syndrome (PWDHS) and Gan depression Pi deficiency syndrome (GDPDS).</p><p><b>METHODS</b>By applying gene chip technology, blood samples from CHB patients of PWDHS (3 cases), GDPDS (3 cases), and healthy volunteers (3 cases) were withdrawn and microRNA detected. The microRNA was screened and functional analyses performed by using SAS system.</p><p><b>RESULTS</b>Totally 77 microRNAs with differential expression were screened from CHB patients of PWDHS and healthy volunteers, including 60 up-regulated microRNAs and 17 down-regulated microRNAs. Functions of target genes were mainly associated with transcription factors, gas exchange, adverse stimulating, regulation of enzyme activities, developing of the immune system, and the process of actin filaments. Totally 41 microRNAs with differential expression were screened from CHB patients of GDPDS and healthy volunteers, including 32 up-regulated microRNAs and 9 down-regulated microRNAs. Functions of target genes were mainly associated with binding to nucleotide or chromatin, inhibition and activation of transcription, biosynthesis, regulation of metabolic process, regulation of enzyme activities, developing of the immune system, the process of actin filaments, and IL-12. Totally 6 microRNAs with differential expression were screened from CHB patients of PWDHS and CHB patients of GDPDS, including 1 up-regulated microRNA and 5 down-regulated microRNAs. Functions of target genes were mainly associated with transmembrane transport, regulation of transcription factors, metabolism of hormones, developing of the immune system, the process of actin filaments, regulation of metabolic process, response to exterior stimulation, and so on.</p><p><b>CONCLUSION</b>There existed differentially expressed microRNAs (spectrum) between CHB patients of PWDHS and CHB patients of GDPDS.</p>

Cluster analysis on TCM syndrome characteristics of chronic hepatitis B / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the characteristics of Chinese medicine (CM) syndromes of chronic hepatitis B (CHB) in Sichuan area, thus providing referential evidence for objective research of CHB.</p><p><b>METHODS</b>According to the CRF chart, 1 064 CHB patients' four diagnostic information from 8 clinical units were recorded in Sichuan region using cross-sectional method. The laws of CHB syndrome characteristics were explored using the K-means clustering analysis method.</p><p><b>RESULTS</b>Based on the K-means cluster analysis, we found 8 categories that fulfill the clinical practice combined professional knowledge with experts' opinions. They were Pi-Wei dampness heat (326 cases, 30.6%), Gan and gallbladder dampness heat (193 cases, 18.1%), Gan and Pi dampness heat (158 cases, 14.8%), Gan depression and Pi deficiency (92 cases, 8.6%), Gan depression transforming into heat (89 cases, 8.4%), Pi deficiency with dampness encumbrance (74 cases, 7.0%), dampness-heat combined with yin deficiency of Gan and Shen (73 cases, 6.9%), yang deficiency mingled with blood stasis (59 cases, 5.5%).</p><p><b>CONCLUSION</b>The results of cluster analysis showed Pi-Wei dampness heat, Gan and gallbladder dampness heat, Gan and Pi dampness heat, Gan depression and Pi deficiency, Gan depression transforming into heat, Pi deficiency with dampness encumbrance, dampness-heat combined with yin deficiency of Gan and Shen, yang deficiency mingled with blood stasis were mainly syndromes of CHB patients in Sichuan area.</p>