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Objective:To investigate the dynamic changes of mitochondrial fission and fusion in the heart of cardiac arrest (CA) rats after return of spontaneous circulation (ROSC), and to explore the role of mitochondrial fission and fusion in the myocardial injury after ROSC.Methods:Healthy male SD rats were randomly random number assigned into the post-resuscitation (PR) 4 h ( n=12), PR 24 h ( n=12), PR 72 h ( n=12), and sham groups ( n=6). The rat CA model was induced by asphyxia, and cardiopulmonary resuscitation (CPR) was performed 6 min after CA. The protein expressions of mitochondrial Drp1, Fis1, Mfn1, and Opa1 were determined by Western blot in each group at 4, 24 and 72 h after ROSC. The mRNA expressions of Drp1, Fis1, Mfn1, and Opa1 were determined by RT-PCR. Myocardial ATP content and mitochondrial respiratory function were measured. The histopathologic changes of myocardial tissue were observed under light microscope. One-way analysis of variance (ANOVA) was use to compare quantitative data, and LSD- t test was used for comparison between groups. Results:Compared with the sham group, the protein and mRNA expressions of Drp1 and Fis1 were increased (all P<0.05) and the protein and mRNA expressions of Mfn1 and Opa1 were decreased (all P<0.05) in the PR 4 h and PR 24 h groups. However, there were no statistical differences in the protein and mRNA expressions of Drp1, Fis1, Mfn1, and Opa1 in the PR 72 h group compared with the sham group (all P>0.05). Compared with the sham group, the levels of ATP content [(4.53±0.76) nmol/g protein vs. (8.57±0.44) nmol/g protein and (5.58±0.58) nmol/g protein vs. (8.57±0.44) nmol/g protein] and mitochondrial respiratory control rate [(2.47±0.38) vs. (3.45±0.32) and (2.97±0.24) vs. (3.45±0.32)] were obviously decreased in the PR 4 h and PR 24 h groups (all P<0.05). There were no statistically significant differences in the ATP content [(7.73±0.95) nmol/g protein vs. (8.57±0.44) nmol/g protein] and mitochondrial respiratory control ratio [(3.39±0.34) vs. (3.45±0.32)] between the PR 72 h group and the sham group (all P>0.05). The pathological damage of myocardial tissue was obvious in the PR 4 h group, and was improved significantly in the PR 72 h group. Conclusions:The imbalance of mitochondrial fission and fusion is probably involved in the pathological process of myocardial injury after ROSC, which may be related to mitochondrial dysfunction.
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Objective:To investigate the risk factors of systolic dysfunction early complicated in patients with isolated traumatic brain injury (iTBI) and to evaluate the influence of complicated systolic dysfunction on the prognosis of iTBI patients.Methods:From January 2017 to October 2018, 123 patients with moderate or severe iTBI admitted to Trauma Centre in our hospital were included in the study, and patients with previous cardiovascular diseases were excluded. Left ventricular systolic function was assessed by transthoracic echocardiography within 24 h after admission. The patients were divided into normal systolic function group ( n=100) and systolic dysfunction group ( n=23) according to the results of echocardiography. Data were collected from all patients on admission, including GCS score, systolic blood pressure, heart rate, high-sensitivity cardiac troponin T (hs-cTnT), clinical treatment variables (use of sedative drugs, vasoactive drugs, etc.), craniotomy or not and clinical outcomes (survival or death) during hospitalization. Logistic regression analysis was used to analyze the related factors for iTBI patients complicated with systolic dysfunction, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each index for iTBI patients complicated with cardiac insufficiency. Results:The systolic blood pressure (147.3±23.3) mmHg, the heart rate (96.1±26.3) beats/min and the hs-cTnT level (16.48±8.17) pg/mL in the systolic dysfunction group were higher than those in the normal systolic function group on admission (all P<0.05); and the GCS score in the systolic dysfunction group was lower than that in the normal systolic function group ( P<0.05). Logistic regression analysis showed that the heart rate ( OR=1.129, 95% CI: 1.001-1.516; P=0.038), the GCS score ( OR=0.640, 95% CI: 0.445-0.920; P=0.016) and the hs-cTnT level ( OR=1.054, 95% CI: 1.009-1.101; P=0.002) on admission were independent risk factors for iTBI patients complicated with systolic dysfunction. The area under the ROC curve (AUC) of the hs-cTnT levelon admission was the largest (AUC=0.863, P<0.01). The in-hospital mortality of patients in the systolic dysfunction group was higher than that of patients in the normal systolic function group (52.5% vs 22%, P=0.004). Conclusions:The heart rate, the GCS score and the serum hs-cTnT level on admission were independent risk factors for iTBI patients complicated with systolic dysfunction. The hs-cTnT level could better predict the occurrence of cardiac systolic dysfuncion, and higher in-hospital mortality was found in iTBI patients complicated with systolic dysfunction. Therefore, early detection and timely intervention may improve the prognosis of these patients.
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Objective@#To explore the changes in polymorphonuclear neutrophils (PMN) function in peripheral blood of patients with sepsis and liver injury and its prognostic value.@*Methods@#A prospective observational study was conducted. The patients who met the criteria of Sepsis-3 admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from March to August in 2019 were enrolled as the research objects, and the patients were divided into sepsis without liver injury group and sepsis with liver injury group; non-sepsis patients who were hospitalized at the same time were enrolled as non-sepsis group; and the healthy people in the physical examination center were enrolled as healthy control group. The gender, age, white blood cell (WBC), PMN and procalcitonin (PCT) were recorded when the patients were admitted to ICU as well as the people on the day of physical examination. The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores were calculated. The 28-day mortality was recorded. The quantitative level of neutrophil extracellular traps (NETs) which reflected by circulating free DNA (cf-DNA/NETs) in peripheral plasma was determined by PicoGreen fluorescence quantitative detection; the qualitative level of NETs was detected by immunofluorescence staining. PMN was extracted from the healthy control group, sepsis without liver injury group and sepsis with liver injury group and cultured in vitro, the quantitative level of cf-DNA/NETs in cell supernatant was determined by PicoGreen fluorescence quantitative detection. The patients were divided into two groups according to 28-day outcome of sepsis patients with liver injury. Receiver operating characteristic (ROC) curve was plotted, and the area under ROC curve (AUC) was calculated to analyze the prognostic value of NETs in sepsis patients with liver injury.@*Results@#Finally, 21 sepsis patients without liver injury, 15 sepsis patients with liver injury, 20 with non-sepsis and 20 with healthy examination were enrolled. There was no significant difference in gender or age among the four groups, indicating that the patients in each group were comparable. The levels of cf-DNA/NETs in peripheral blood, WBC and PMN of the sepsis with and without liver injury groups were significantly higher than those of the healthy control group and non-sepsis group, PCT, APACHE Ⅱ score, SOFA score and 28-day mortality were significantly higher than those of the non-sepsis group, and the levels of cf-DNA/NETs in peripheral blood, PCT and 28-day mortality of the sepsis with liver injury group were significantly higher than those of the sepsis without liver injury group [cf-DNA/NETs (μg/L): 481.60±275.86 vs. 169.76±57.05, PCT (μg/L): 11.29 (1.79, 67.10) vs. 1.11 (0.19, 4.09), 28-day mortality: 73.3% (11/15) vs. 38.1% (8/21), all P < 0.05]. The results of PMN in vitro showed that there was no NETs in normal culture of healthy control group, and a small amount of NETs was detected in sepsis with and without liver injury groups. After stimulation of PMN stimulator phorbol-12-myristate-13-acetic acid (PMA), more NETs were produced in neutrophils of three groups compared with normal culture. Quantitative analysis showed that the level of cf-DNA/NETs in cell supernatant of the sepsis with liver injury group was significantly higher than that of the sepsis without liver injury group (μg/L: 1 872.29±258.44 vs. 1 313.55±147.45, P < 0.01). In 15 sepsis patients with liver injury, 4 patients survived for 28 days (26.7%) and 11 died (73.3%). The cf-DNA/NETs level of the dead group on the day of admission was significantly higher than that of the survival group (μg/L: 582.36±160.05 vs. 241.17±96.14, P < 0.05). ROC curve analysis showed that the AUC of NETs level in peripheral blood for predicting 28-day death of sepsis patients with liver injury was 0.932 [95% confidence interval (95%CI) was 0.787-1.000]; when the best cut-off value was 266.81 μg/L, the sensitivity was 90.9%, the specificity was 75.0%, and the approximate index was 0.659.@*Conclusions@#The function of NETs in sepsis patients with liver injury has been further changed. The level of peripheral blood NETs has a certain guiding value for the prognosis of sepsis patients with liver injury.
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Objective@#To explore the correlation and consistency between thromboelastography (TEG) and traditional coagulation tests (CCTs) in ischemic cerebral vascular disease (ICVD).@*Methods@#Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 31 2018 were enrolled. Patients’ TEG parameters (R value, K value, Angle value, MA value, CI value and G value) and CCTs parameters (PT, APTT, TT, and FIB) were collected and analyzed retrospectively. The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters, and Kappa (κ) to explore the consistency in determining the coagulation status of the patients. The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs, and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients.@*Results@#(1) PLT was positively correlated with MA value and G value; PT and APTT were positively correlated with K value; TT was positively correlated with R value and K value; FIB was positively correlated with Angle value, MA value and G value. TT was negatively correlated with Angle value and CI value; FIB was negatively correlated with K value. (2) PT and MA values, PT and G values, FIB and MA values, FIB and G values were accordant in valuing the hypoxic state of ICVD patients. (3) PLT and Angle values, PLT and MA values, PLT and CI values, PLT and G values were accordant in assessing hypercoagulable status of ICVD patients; FIB and Angle values, FIB and MA values, FIB and CI value, and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients. (4) For detecting TT>20 s, the AUC of K value and Angle value were 0.648, 0.651, respectively; For detecting FIB>4 g/L, the AUC of Angle value and MA value were 0.717 and 0.747, respectively; For detecting PLT>300×109/L, the AUC of MA value was 0.808 (all P<0.05).@*Conclusions@#There is weak correlation and consistency between TEG and CCTs parameters in ICVD patients. The TEG parameters have good predictive value in evaluating the abnormal results of CCTs, but cannot replace the CCTs. Combination of these two methods can better reflect the coagulation status of patients, so as to afford assistance.
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Von Willebrand Factor (VWF) is a multimeric glycoprotein produced by endothelial cells, which increases in thrombogenicity especially under high shear rates. It bridges between vascular platelets and sub-endothelial collagen. There is abnormal VWF level in ischemic stroke patients, and VWF shows unique significance in valuing the prediction, treatment and prognosis of ischemic stroke. Numerous basic and clinical evidences suggest that VWF is a potential target for ischemic stroke treatment. In recent years, researches on VWF for prevention and treatment of ischemic stroke have been rapidly developed. The findings in this field are reviewed in this paper.
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Objective@#To observe the effects of abnormal body temperature and the area under temperature curve on the prognosis of patients with septic shock.@*Methods@#A retrospective cohort study was conducted. Patients with septic shock admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from September 2013 to June 2019 were enrolled. Data were obtained from the hospital case database, including the gender, age, infection source, the length of ICU stay, sequential organ failure assessment (SOFA) score, 21-day prognosis; within the first 24 hours and throughout the period in ICU, the maximum temperature (24 h Tmax, Tmax), lowest temperature (24 h Tmin, Tmin), and the temperature range (24 h Tmax-min, Tmax-min) were aggregated. The area under temperature curve when body temperature was higher than T (A > T), or lower than T (A < T), and area section between T1 and T2 (AT1-T2) was calculated respectively. Patients were divided into survival group and death group according to 21-day prognosis. Binary Logistic regression was used to analyze the effect of the above temperature indices on the prognosis.@*Results@#635 septic shock patients were enrolled in the study. 476 patients were survived and 159 died within 21 days. Compared with the survival group, the age, SOFA score were higher in the death group, while the length of ICU stay was shorter. There was no significant difference in gender or infection source between two groups. After adjusting for gender, age, the length of ICU stay and SOFA score, binary Logistic regression analysis showed that the increase of Tmax, decrease of Tmin, and increase of Tmax-min were risk factors for 21-day mortality [Tmax: odds ratio (OR) = 2.959, 95% confidence interval (95%CI) was 1.620-5.398, P < 0.001; Tmin: OR = 0.329, 95%CI was 0.140-0.790, P = 0.012; Tmax-min: OR = 3.258, 95%CI was 1.840-5.471, P < 0.001], while 24 h Tmax, 24 h Tmin and 24 h Tmax-min were not related to prognosis. A < 36.0 ℃ (OR = 1.335, 95%CI was 1.102-1.745, P = 0.014), and A > 38.0 ℃ (OR = 1.041, 95%CI was 1.019-1.077, P = 0.001) showed positive correlation with 21-day mortality. When the T level was set at 38.0-40.0 ℃, for every 1 ℃×hour increase in A > T, the 21-day relative risk of death increased by 4.1%-83.2%.@*Conclusion@#When the body temperature of patients with septic shock is lower than 36.0 ℃, or higher than 38.0 ℃, the 21-day relative risk of death rose with the increase of the magnitude and duration of abnormal body temperature.
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Objective To observe the effects of abnormal body temperature and the area under temperature curve on the prognosis of patients with septic shock. Methods A retrospective cohort study was conducted. Patients with septic shock admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from September 2013 to June 2019 were enrolled. Data were obtained from the hospital case database, including the gender, age, infection source, the length of ICU stay, sequential organ failure assessment (SOFA) score, 21-day prognosis; within the first 24 hours and throughout the period in ICU, the maximum temperature (24 h Tmax, Tmax), lowest temperature (24 h Tmin, Tmin), and the temperature range (24 h Tmax-min, Tmax-min) were aggregated. The area under temperature curve when body temperature was higher than T (A > T), or lower than T (A < T), and area section between T1 and T2 (AT1-T2) was calculated respectively. Patients were divided into survival group and death group according to 21-day prognosis. Binary Logistic regression was used to analyze the effect of the above temperature indices on the prognosis. Results 635 septic shock patients were enrolled in the study. 476 patients were survived and 159 died within 21 days. Compared with the survival group, the age, SOFA score were higher in the death group, while the length of ICU stay was shorter. There was no significant difference in gender or infection source between two groups. After adjusting for gender, age, the length of ICU stay and SOFA score, binary Logistic regression analysis showed that the increase of Tmax, decrease of Tmin, and increase of Tmax-min were risk factors for 21-day mortality [Tmax: odds ratio (OR) = 2.959, 95% confidence interval (95%CI) was 1.620-5.398, P < 0.001; Tmin: OR = 0.329, 95%CI was 0.140-0.790, P = 0.012; Tmax-min: OR = 3.258, 95%CI was 1.840-5.471, P < 0.001], while 24 h Tmax, 24 h Tmin and 24 h Tmax-min were not related to prognosis. A < 36.0 ℃ (OR = 1.335, 95%CI was 1.102-1.745, P = 0.014), and A > 38.0 ℃ (OR = 1.041, 95%CI was 1.019-1.077, P = 0.001) showed positive correlation with 21-day mortality. When the T level was set at 38.0-40.0 ℃, for every 1 ℃×hour increase in A > T, the 21-day relative risk of death increased by 4.1%-83.2%. Conclusion When the body temperature of patients with septic shock is lower than 36.0 ℃, or higher than 38.0 ℃, the 21-day relative risk of death rose with the increase of the magnitude and duration of abnormal body temperature.
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Objective To observe the effects of abnormal body temperature and the area under temperature curve on the prognosis of patients with septic shock. Methods A retrospective cohort study was conducted. Patients with septic shock admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from September 2013 to June 2019 were enrolled. Data were obtained from the hospital case database, including the gender, age, infection source, the length of ICU stay, sequential organ failure assessment (SOFA) score, 21-day prognosis; within the first 24 hours and throughout the period in ICU, the maximum temperature (24 h Tmax, Tmax), lowest temperature (24 h Tmin, Tmin), and the temperature range (24 h Tmax-min, Tmax-min) were aggregated. The area under temperature curve when body temperature was higher than T (A > T), or lower than T (A < T), and area section between T1 and T2 (AT1-T2) was calculated respectively. Patients were divided into survival group and death group according to 21-day prognosis. Binary Logistic regression was used to analyze the effect of the above temperature indices on the prognosis. Results 635 septic shock patients were enrolled in the study. 476 patients were survived and 159 died within 21 days. Compared with the survival group, the age, SOFA score were higher in the death group, while the length of ICU stay was shorter. There was no significant difference in gender or infection source between two groups. After adjusting for gender, age, the length of ICU stay and SOFA score, binary Logistic regression analysis showed that the increase of Tmax, decrease of Tmin, and increase of Tmax-min were risk factors for 21-day mortality [Tmax: odds ratio (OR) = 2.959, 95% confidence interval (95%CI) was 1.620-5.398, P < 0.001; Tmin: OR = 0.329, 95%CI was 0.140-0.790, P = 0.012; Tmax-min: OR = 3.258, 95%CI was 1.840-5.471, P < 0.001], while 24 h Tmax, 24 h Tmin and 24 h Tmax-min were not related to prognosis. A < 36.0 ℃ (OR = 1.335, 95%CI was 1.102-1.745, P = 0.014), and A > 38.0 ℃ (OR = 1.041, 95%CI was 1.019-1.077, P = 0.001) showed positive correlation with 21-day mortality. When the T level was set at 38.0-40.0 ℃, for every 1 ℃×hour increase in A > T, the 21-day relative risk of death increased by 4.1%-83.2%. Conclusion When the body temperature of patients with septic shock is lower than 36.0 ℃, or higher than 38.0 ℃, the 21-day relative risk of death rose with the increase of the magnitude and duration of abnormal body temperature.
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To explore the changes in polymorphonuclear neutrophils (PMN) function in peripheral blood of patients with sepsis and liver injury and its prognostic value. Methods A prospective observational study was conducted. The patients who met the criteria of Sepsis-3 admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from March to August in 2019 were enrolled as the research objects, and the patients were divided into sepsis without liver injury group and sepsis with liver injury group; non-sepsis patients who were hospitalized at the same time were enrolled as non-sepsis group; and the healthy people in the physical examination center were enrolled as healthy control group. The gender, age, white blood cell (WBC), PMN and procalcitonin (PCT) were recorded when the patients were admitted to ICU as well as the people on the day of physical examination. The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores were calculated. The 28-day mortality was recorded. The quantitative level of neutrophil extracellular traps (NETs) which reflected by circulating free DNA (cf-DNA/NETs) in peripheral plasma was determined by PicoGreen fluorescence quantitative detection; the qualitative level of NETs was detected by immunofluorescence staining. PMN was extracted from the healthy control group, sepsis without liver injury group and sepsis with liver injury group and cultured in vitro, the quantitative level of cf-DNA/NETs in cell supernatant was determined by PicoGreen fluorescence quantitative detection. The patients were divided into two groups according to 28-day outcome of sepsis patients with liver injury. Receiver operating characteristic (ROC) curve was plotted, and the area under ROC curve (AUC) was calculated to analyze the prognostic value of NETs in sepsis patients with liver injury. Results Finally, 21 sepsis patients without liver injury, 15 sepsis patients with liver injury, 20 with non-sepsis and 20 with healthy examination were enrolled. There was no significant difference in gender or age among the four groups, indicating that the patients in each group were comparable. The levels of cf-DNA/NETs in peripheral blood, WBC and PMN of the sepsis with and without liver injury groups were significantly higher than those of the healthy control group and non-sepsis group, PCT, APACHE Ⅱ score, SOFA score and 28-day mortality were significantly higher than those of the non-sepsis group, and the levels of cf-DNA/NETs in peripheral blood, PCT and 28-day mortality of the sepsis with liver injury group were significantly higher than those of the sepsis without liver injury group [cf-DNA/NETs (μg/L): 481.60±275.86 vs. 169.76±57.05, PCT (μg/L): 11.29 (1.79, 67.10) vs. 1.11 (0.19, 4.09), 28-day mortality: 73.3% (11/15) vs. 38.1% (8/21), all P < 0.05]. The results of PMN in vitro showed that there was no NETs in normal culture of healthy control group, and a small amount of NETs was detected in sepsis with and without liver injury groups. After stimulation of PMN stimulator phorbol-12-myristate-13-acetic acid (PMA), more NETs were produced in neutrophils of three groups compared with normal culture. Quantitative analysis showed that the level of cf-DNA/NETs in cell supernatant of the sepsis with liver injury group was significantly higher than that of the sepsis without liver injury group (μg/L: 1 872.29±258.44 vs. 1 313.55±147.45, P < 0.01). In 15 sepsis patients with liver injury, 4 patients survived for 28 days (26.7%) and 11 died (73.3%). The cf-DNA/NETs level of the dead group on the day of admission was significantly higher than that of the survival group (μg/L: 582.36±160.05 vs. 241.17±96.14, P < 0.05). ROC curve analysis showed that the AUC of NETs level in peripheral blood for predicting 28-day death of sepsis patients with liver injury was 0.932 [95% confidence interval (95%CI) was 0.787-1.000]; when the best cut-off value was 266.81 μg/L, the sensitivity was 90.9%, the specificity was 75.0%, and the approximate index was 0.659. Conclusions The function of NETs in sepsis patients with liver injury has been further changed. The level of peripheral blood NETs has a certain guiding value for the prognosis of sepsis patients with liver injury.
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Objective To explore the correlation and consistency between thromboelastograpby(TEG)and traditional coagulation tests(CCTs)in ischemic cerebral vascular disease(ICVD).Methods Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 31 2018 were enrolled.Patients' TEG parameters(R value,K value,Angle value,MA value,CI value and G value)and CCTs parameters(PT,APTT,TT,and FIB)were collected and analyzed retrospectively.The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters,and Kappa(κ)to explore the consistency in determining the coagulation status of the patients.The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs,and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients.Results(1)PLT was positively correlated with MA value and G value; PT and APTT were positively correlated with K value; TT was positively correlated with R value and K value; FIB was positively correlated with Angle value,MA value and G value.TT was negatively correlated with Angle value and CI value; FIB was negatively correlated with K value.(2)PT and MA values,PT and G values,FIB and MA values,FIB and G values were accordant in valuing the hypoxic state of ICVD patients.(3)PLT and Angle values,PLT and MA values,PLT and CI values,PLT and G values were accordant in assessing hypercoagulable status of ICVD patients; FIB and Angle values,FIB and MA values,FIB and CI value,and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients.(4)For detecting TT＞20 s,the AUC of K value and Angle value were 0.648,0.651,respectively;For detecting FIB＞4 g/L,the AUC of Angle value and MA value were 0.717 and 0.747,respectively; For detecting PLT＞ 300× 109/L,the AUC of MA value was 0.808(all P＜0.05).Conclusions There is weak correlation and consistency between TEG and CCTs parameters in ICVD Patients.The TEG parameters have good predictive value in evaluating the abnormal results of CCTs,but cannot replace the CCTs.Combination of these two methods can better reflect the coagulation status of patients,so as to afford assistance.
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Von Willebrand Factor (VWF) is a multimeric glycoprotein produced by endothelial cells, which increases in thrombogenicity especially under high shear rates. It bridges between vascular platelets and sub?endothelial collagen. There is abnormal VWF level in ischemic stroke patients, and VWF shows unique significance in valuing the prediction, treatment and prognosis of ischemic stroke. Numerous basic and clinical evidences suggest that VWF is a potential target for ischemic stroke treatment. In recent years, researches on VWF for prevention and treatment of ischemic stroke have been rapidly developed. The findings in this field are reviewed in this paper.
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Fluid infusion is one of the most common therapeutic measures in clinical practice.With the development of medical technology,the assessment of fluid responsiveness before fluid infusion has become simpler and less invasive.The assessment of fluid responsiveness is based on three aspects:cardiopulmonary interaction,volume-loading test and endogenous volume-loading test.This article reviews the progress in the assessment of fluid responsiveness with the application of ultrasound and noninvasive continuous cardiac output monitoring,and the prospect of future improvement.
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Objective To investigate the value of strong ion gap (SIG) for predicting acute heart failure (AHF) after acute myocardial infarction. Methods A total of 189 patients with acute myocardial infarction were enrolled from July 2015 to December 2016 in the First Affiliated Hospital of Soochow University. Based on AHF occurrence, the patients were divided into the AHF group (n=76) and the non-AHF group (n=113). General clinical data and laboratory tests were compared between the two groups. The univariate analysis and multivariate logistic regression analysis were performed to estimate the contribution of clinical risk factors to triggering AHF after acute myocardial infarction. Spearman correlation analysis was performed to estimate the correlation between SIG and Killip classification. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of ALB, anion gap (AG) and SIG in AHF after acute myocardial infarction. Results Age, proportion of history of diabetes, the serum level of C-reactive protein (CRP), AG and SIG of the AHF group were higher than those of the non-AHF group (P<0.05). Meanwhile, the serum level of albumin (ALB) of the AHF group were lower than those of the non-AHF group (P<0.05). Univariate analysis showed AHF after acute myocardial infarction was closely associated with age, history of diabetes, serum ALB, AG and SIG (P<0.05). Multivariate logistic regression analysis showed that history of diabetes (OR=2.034, 95％CI:1.075-4.113, P<0.05) and SIG (OR=2.445, 95％CI: 1.538-4.297, P<0.05) were significantly correlated with AHF after acute myocardial infarction. The ROC analysis revealed SIG (AUC=0.837,95％CI:0.781-0.893) had a large area under curve compared to ALB (AUC=0.671,95％CI: 0.593-0.750) and AG (AUC=0.728,95％CI: 0.654-0.802). The optimal diagnostic intercept value was 5.24 mmol/L, and the sensitivity and specificity were 76.32％ and 78.36％, respectively. Conclusions SIG could be used as an independent predictor for AHF secondary to acute myocardial infarction, and was significantly correlated with severity of AHF.
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Objective To investigate the correlation between blood flow velocity and respiratory variability in different parts of left heart of patients with sepsis via measuring the flow velocity of the E-wave of mitral valve (MV), peak flow velocity of left ventricular outflow tract (LVOT), and respiratory variability (ΔVpeak) by ultrasonography. Methods Totally 81 patients with sepsis hospitalized in ICU were chosen consecutively from March 2017 to October 2017. Each patient's flow velocity of the E-wave of mitral valve and peak flow velocity of LVOT was inspected, by apical four-chamber view and apical five-chamber view respectively, to calculate the respiratory variability. Results (1) Of the 81 patients with sepsis, 33 patients (40.7％) had complete control of mechanical ventilation (no spontaneous breathing trigger), and 48 patients (59.3％) had spontaneous breathing and incomplete control of mechanical ventilation (partial spontaneous breathing trigger). (2) There was no significant difference in the mean values of flow velocity of the E-wave of mitral valve and peak flow velocity of LVOT in patients with sepsis. Whereas the flow velocity of the E-wave of mitral valve (0.15±0.05) was greater than the peak flow velocity of LVOT (0.12±0.04) with statistical significance (P<0.01). In sepsis patients with complete control of mechanical ventilation (no spontaneous breathing trigger), respiratory variability in the flow velocity of the E-wave of mitral valve (0.17±0.06) was significantly greater than the peak flow velocity of LVOT (0.11±0.03), P<0.01, whereas in sepsis patients with incomplete control of mechanical ventila tion (partial spontaneous breathing trigger), there was no statistically significant difference between the respiratory variability in flow velocity of the E-wave of mitral valve (0.14±0.04) and in the peak flow velocity of LVOT (0.13±0.03), P=0.102. (3) The respiratory variability in flow velocity of the E-wave of mitral valve was correlated with the peak flow velocity of LVOT (r=0.670, P<0.01). The flow velocity of the E-wave of mitral valve was all correlated with the peak flow velocity of LVOT in both sepsis patients with complete control of mechanical ventilation (no spontaneous breathing trigger) (r=0.894, P<0.01), and sepsis patients with incomplete control of mechanical ventilation (partial spontaneous breathing trigger) (r=0.774, P<0.01), respectively. Conclusions The respiratory variability in flow velocity of the E-wave of mitral valve was correlated with that in the peak flow velocity of LVOT, which may provide a new indicator in evaluating the fluid responsiveness of patients with sepsis.
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Objective To investigate the value of strong ion gap (SIG) in predicting the severity of acute pancreatitis (AP) based on the revised Atlanta classification. Methods A total of 133 patients with AP admitted from January, 2015 to December, 2016 were enrolled. Of them, there were 55 with mild AP (MAP), 52 with moderately severe AP (MSAP) and 26 with severe AP (SAP). All patients with AP conformed to the diagnostic criteria of Guidelines or Diagnosis and Treatment of Acute Pancreatitis set in 2014 in China. Patients with other underlying diseases that might influence the clinical outcome were excluded, including those with diabetic ketoacidosis, chronic renal failure and other disorders. The changes in blood SIG levels in each group were observed. The correlations between SIG and acute physiology, chronic health evaluation (APACHE) Ⅱ score, Ranson score and length of hospital stay were analyzed. The receiver operating characteristic curves (ROC) were plotted to determine the efficiency of SIG, Scr, APACHE Ⅱ score, and Ranson score for predicting the severity of acute pancreatitis. Results The level of SIG in the SAP group was the highest, followed by the MSAP group and the lowest in the MAP group.There were significant differences in pairwise comparisons (P<0.01). The correlations between SIG and APACHE Ⅱ score (r=0.567, P<0.01), Ranson score (r=0.502, P<0.01), and length of hospital stay were positive (r=0.589, P<0.01). There was no statistical difference in the area under curve (AUC) between SIG and APACHE Ⅱ score (0.874±0.029 vs.0.895±0.025, P>0.05) and as well as Ranson score (0.874±0.029 vs. 0.890±0.027, P>0.05) for predicting moderately-severe acute pancreatitis, but SIG was superior to Scr (0.874±0.029 vs. 0.735±0.043, P<0.01). There was a significant difference in AUC between SIG and Scr (0.910±0.030 vs. 0.755±0.054, P<0.01), but no statistical differences between SIG and APACHE Ⅱ score (0.910±0.030 vs. 0.867±0.034, P>0.05) and Ranson score (0.910±0.030 vs. 0.871±0.032, P>0.05) for predicting severe acute pancreatitis. Conclusion SIG has important clinical significance for predicting the severity of acute pancreatitis.
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Objective To observe the effects of olprinone on ischemia/reperfusion (I/R) induced myocardial injury in male (Sprague-Dawley, SD rats) and explore its mechanisms. Methods Rats were subjected to a 30-min coronary arterial occlusion followed by 24-hour reperfusion. The survival rats were randomly divided into sham group (n=6), ischemia reperfusion group (I/R group, n=9), ischemia reperfusion+low dose of olprinone group(IR+olprinone-L group, n=6), ischemia reperfusion+medium dose of olprinone group (IR+olprinone-M group, n=6),ischemia reperfusion +high dose of olprinone group (IR+olprinone-H group, n=6). A MAP heart function analysis system was used to measure hemodynamic parameters; TTC staining method was used to detect the myocardial infarct size;24-hour mortality of SD rats was recorded; western blot was used to detect the levels of Caspase-3, Bax,Bcl-2, LC3B/LC3A,Beclin-1. Results Cardiac function in I/R group was lower than that in sham group, which was significantly improved by pretreatment with olprinone (P＜0.01),but systolic arterial pressure (SAP) diastolic arterial pressure (DAP) mean arterial pressure (MAP) mean pressure developed in left ventricle (Pmean) had no significant difference (P＞0.05). The percentage of myocardial infarct size in olprinone-M and olprinone-H group was lower than that in I/R group (P＜0.05).There was no significant difference in mortality among groups within 24 hours. Compared with sham group, the expressions of Caspase-3 and Bax were obviously up-regulated in I/R group (P＜0.01), whereas caspase-3 was down-regulated in olprinone-M group (P＜0.05) and Bax was inhibited by different doses of olprinone (P＜0.05), but the expression of Bcl-2 increased (P＜0.05); furthermore, the ratio of Bcl-2/Bax decreased in I/R group (P＜0.01) and increased with different degrees in different doses of olprinone (P＜0.05). Meanwhile, compared with sham group, the expression of Beclin-1 was up-regulated in I/R group(P＜0.05),and also increased in olprinone-L and olprinone-M groups(P＜0.05), but the ratio of Bcl-2 /Beclin-1 decreased in different doses of olprinone making statistically significant difference only in olprinone-M group (P＜0.05). Moreover, different doses of olprinone elevated the different ratios of LC3B/LC3A (P＜0.05), and this elevated ratio in olprinone-M group at median among groups. Conclusions Olprinone can strengthen the cardiac function after myocardial ischemia/reperfusion injury, without leading to disorders in hemodynamics; by regulating autophagy with anti-apoptotic protein, olprinone can make autophagy to an appropriate level using the mechanism of autophagy to preventing the myocardium from injury.
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First marketed in Japan in the 1990s, olprinone is a newly developed phosphodiesterase Ⅲ (PDE Ⅲ) inhibitor. It can not only increase cardiac contractility and also reduce peripheral vascular resistance without affecting mean arterial pressure and heart rate. At present, olprinone is mainly used in the treatment of acute heart failure and postoperative acute cardiac insufficiency. Through selectively inhibiting the activity of PDEⅢ and increasing the concentration of cyclic adenosine monophosphate (cAMP) by blocking its degradation, olprinone accelerates the influx of Ca2+in cardiac myocytes, leading to enhancement of myocardial contractility; and on the other hand, decreases the influx of Ca2+in vascular smooth muscle cells, resulting in dilation of peripheral blood vessels. Recently, a considerable amount of research has been conducted on olprinone in terms of pulmonary hypertension, myocardial ischemia/reperfusion (I/R) injury, and arrhythmia. In this review, we summarize the application of olprinione in acute heart failure, pulmonary hypertension, myocardial I/R injury, and arrhythmia, and analyze its application value and related progress in cardiovascular diseases.
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Objective To investigate the dynamic changes of mean platelet volume (MPV) and platelet distribution width (PDW),and to explore the role of MPV and PDW in the prognosis of patients with acute myocardial infarction (AMI).Methods This retrospective cohort study included 312 patients with AMI during 2012 to 2014 in The First Affiliated Hospital of Soochow University.Patients were divided into ST-elevation myocardial infarction (STEMI) group,non ST-elevation myocardial infarction group and low PDW group,high PDW group.Their clinical data and outcomes were analyzed.MPV and PDW were measured successively from admission to day-7 after AMI.The relationship between PDW,MPV and GRACE risk score was further investigated.Results In the STEMI group,the patients were younger (P =0.005),and with higher rates of hyperlipidemia and smoking (P ＜ 0.01).Patients in STEMI group had higher risk of death during hospitalization,compared to NSTEMI (P =0.014).In the high PDW group,the rates of congestion heart failure,cardiogenic shock and Killip ⅣV were higher (P ＜ 0.01;P =0.026;P ＜ 0.01).PDW was significantly associated with mortality of in-hospital,one-year mortality and the risk of re-infarction in one year (r =0.69,P ＜ 0.01;r =0.68,P ＜0.01;r =0.70,P ＜ 0.01).MPV was associated with one-year mortality (r =0.30,P =0.02).Conclusions PDW related to the severity of AMI could predict the risk of in-hospital mortality,one-year mortality and re-infarction.It was helpful to screen out the high-risk patients,so as to make more suitable treatment to improve the prognosis of patients.
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Objective To observe the effects of Tanshinone Ⅱ A sodium sulfonate (TSS ) on ischemia/reperfusion (I /R) induced cardiac injury in male (Sprague-Dawley,SD ) and explore its mechanisms.Methods Rats were subjected to a 30 min coronary arterial occlusion followed by 24 hours reperfusion.The survival rats were randomly (random number)divided into sham group (Sham group,n =10),ischemia reperfusion group (I /R group,n =10),low dose of TSS group (TSS-L group,n =10), medium dose of TSS group (TSS-Mgroup,n =9),high dose of TSS group (TSS-H group,n =9).A MAP heart function analysis system was used to measure hemodynamic variables,and TTC staining method was used to detect the myocardial infarct size.The levels of Bcl-2,Bax,Caspase-3,Lc3B/Lc3A,Beclin-1 and high mobility group box1 (HMGB1)were detected by western blot method.All data were analyzed by using One-way analysis of variance (ANOVA)(LSD-t test).Results Cardiac function in I /R group was lower than that in Sham group,and that was significantly improved by pretreated with TSS (P 0.05 ).The percentage of myocardial infarct size in TSS pretreatment group was significantly smaller than that in I /R group (P <0.05 ).Compared with Sham group,levels of Caspase-3 and Bax increased,and the Bcl-2 content was reduced obviously in I /R group (P <0.05).TSS pretreatment significantly down-regulated the levels of Caspase-3 and Bax protein (P <0.01).At the same time,the level of Bcl-2 was increased in all TSS pretreatment groups (P <0.01).Compared with Sham group,the ratio of Bcl-2 /Bax in I /R group was lower (P <0.05),and that was elevated in TSS groups (P <0.05 ).The change of autophagy related protein beclin-1 and Lc3B/Lc3A was in similar trend,and the levels of beclin-1 and Lc3B/Lc3A in I /R group were lower than that in Sham group (P <0.05),and those were raised in TSS pretreatment groups (P<0.05).The level of HMGB1 in I /R group was higher than that in Sham group (P <0.05),and compared with I /R group,the level of HMGB1 significantly decreased in TSS pretreatment groups (P <0.01 ). Conclusions The tanshinone ⅡA sodium sulfonate can protect the myocardium from ischemia/reperfusion injury and the mechanism may be attributed to the inhibition of cell apoptosis and activation of cell autophagy.
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Traumatic brain injury (TBI)has been classified as mild,moderate,or severe,on the basis of the Glasgow coma scale (GCS)score.Mild TBI is estimated to account for 90% of all cases of TBI, and it has become a serious public health problem,with morbidity increasing year by year.At present,there is a lack of accepted uniform definition of mild TBI.Clinically,mild TBI and concussion are interchangeable terms.In recent years,advances in brain imaging,biomarkers determination,and neuropathology have encouraged people to revise and update their knowledge about mild TBI.In view of the high prevalence of mild TBI in the emergency and community,and the absence of the data concerning the long-term effects of mild TBI, further research is needed about how to reduce morbidity and costs, alleviate delayed consequences,and develop evidence-based interventions to improve outcomes.