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At present, most of the common medical clothes in clinic are uniform medical clothes, but there is no special clothes for patients in intensive care unit (ICU). In recent years, with the extensive application of critical ultrasound in the field of critical medicine, it is obviously difficult to meet the clinical needs on traditional patients' clothes. Guangdong Provincial People's Hospital designed a patient's clothing for critical ultrasound examination. The left/right chest, lateral chest, groin and abdomen of the patient's clothing body were covered with cloth and marked areas. When critically ill patients need to be examined by ultrasound and electrocardiogram, the site can be quickly located only by removing the cloth. At the same time, it can protect patients' privacy, avoid aggravating the condition due to cold, increase patients' comfort in clothing, and also facilitate medical care. It is worthy popularizing in clinic because of its practicability and novel design.
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OBJECTIVE:To observe the effects of Alprostadil dried emulsion for injection combined with Butylphthalide soft capsules on nerve function,inflammatory factor and coagulation function of patients with severe ischemic stroke. METHODS:A total of 66 patients with severe ischemic stroke selected from our hospital during Jun. 2015-Oct. 2017 were divided into control group and observation group according to random number table,with 33 cases in each group. On the basis of routine treatment, control group was additionally given Butyphthalide soft capsules 0.2 g/time,orally at fasting state,tid. On the basis of control group,observation group was additionally given Alprostadil dried emulsion for injection 10 μg added into 0.9% Sodium chloride injection 10 mL,via slow infusion or slow dripping with pipkin,qd. Both groups were treated for 14 days. NIHSS and Barthel index scores,the levels of serum inflammatory factors(CRP,PCT)and coagulation function indexes(D-D,TT,PT,APTT, FIB)were observed in 2 groups before and after treatment,and the occurrence of ADR was also recorded. RESULTS:Before treatment,there was no statistical significance in above indexes between 2 groups(P>0.05).After treatment,NIHSS scores,the levels of CRP,PCT,D-D and FIB in 2 groups were deceased significantly,while Barthel index scores were increased significantly,TT,PT,APTT were prolonged significantly;observation group was significantly better than control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Alprostadil dried emulsion for injection combined with Butylphthalide soft capsules can effectively improve nerve function and coagulation function of patients with severe ischemic stroke,and reduce the levels of inflammatory factor with good safety.
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OBJECTIVE:To investigate risk factors of multidrug-resistant organisms (MDROs) infection in elderly patients of ICU,and to provide reference for formulation and implementation of MDROs prevention and control measures.METHODS:A total of 146 elderly patients were selected from ICU of our hospital during Dec.2013-Jun.2016.Throat swab,sputum swab and anal swab specimens (1 copy,respectively) were collected to conduct active screening of MRSA and ESBLs-producing Enterobacteriaceae.Risk factors of MDROs infection,pathogen distribution and drug resistance were analyzed.RESULTS:Among samples of 146 patients,there were 34 MRSA positive samples in throat swab with positive rate of 23.3％;there were 30 MRSA positive samples in sputum swab with positive rate of 20.5％;there were 99 ESBLs-producing bacteria positive samples in anal swab (containing 50 ESBLs-producing Escherichia coli positive samples and 49 ESBLs-producing Klebsiella pneumoniae positive samples) with positive rate of 67.8％.The positive rate of throat swab MRSA screening was not correlated with patient's gender,age,tracheal intubation or mechanical ventilation (P＞0.05),but it was related with hospitalization time in ICU (P＜0.05).The positive rate of sputum swab MRSA screening was not correlated with patient' s gender,tracheal intubation or mechanical ventilation;the positive rate of anal swab ESBLs-producing bacteria screening were not related with patient's gender(P＞0.05).But they were related with age and hospitalization time in ICU (P＜0.05).Compared with negative patients,there was no statistical significance in the times of fiberoptic bronchoscopy in throat/sputum swab MRSA screening positive patients (P＞0.05).The times of enema,the times of bladder irrigation,the times of urethral catheterization and the duration of indwelling catheter in anal swab ESBLs-producing bacteria screening positive patients were significantly more or longer than negative patients,with statistical significance (P＜0.05).Binary Logistic regression analysis showed that hospitalization time in ICU was risk factor of positive active screening of throat swab in elderly patients of ICU[OR=1.119,95 ％ CI (1.071,1.385),P=0.021];age was risk factor of positive active screening of sputum swab[OR=1.893,95 ％ CI (1.232,4.042),P=0.032];age and hospitalization time in ICU were risk factors of positive active screening of anal swab [OR were 1.046,1.022,95％CI were (1.005,1.088) (1.006,3.283),P were 0.027,0.031].A total of 163 strains of MDROs were detected,among which there were 64 strains of MRSA,50 strains of ESBLs-producing E.coli and 49 strains of ESBLs-producing K.pneumoniae.They were generally highly resistant to compound preparation containing enzyme inhibitors.CONCLUSIONS:The results of MDROs active screening in elderly patients of ICU are related with age,hospitalization time in ICU,the times of enema,the times of bladder irrigation,the times of urethral catheterization and the duration of indwelling catheter.Age and hospitalization time in ICU were risk factors of MDROs infection.The pathogens are mainly ESBLs-producing Enterobacteriaceae,and drug resistance is severe.For elderly critical patients with MDROs infection,clinical prevention and intervention measures should be taken to prevent and control the prevalence and spread of MDROs in ICU.
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Objective To investigate the predictive value of central venous-to-arterial carbon dioxide difference (Pcv-aCO2) on the prognosis of elderly patients with sepsis.Methods 208 elderly patients who met the diagnostic criteria of the Sepsis-3 and with the age of more than 60 years old, and admitted to intensive care unit (ICU) of Guangdong General Hospital from January to December in 2017 were enrolled. According to the prognosis, the patients were divided into death group (n = 46) and survival group (n = 162). The Pcv-aCO2, central venous oxygen saturation (ScvO2), serum procalcitonin (PCT), C-reactive protein (CRP), sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluationⅡ (APACHEⅡ) were collected for all patients. The differences of each index between the two groups were compared. The correlations between Pcv-aCO2 and ScvO2, PCT, CRP, SOFA, APACHEⅡscores were analyzed respectively with Pearson correlation. The prognostic value of Pcv-aCO2 in elderly patients with sepsis was assessed by receiver operating characteristic curve (ROC).Results Compared with survival group, the Pcv-aCO2, PCT, CRP, SOFA and APACHEⅡscores in death group were significantly increased [Pcv-aCO2 (mmHg, 1 mmHg = 0.133 kPa): 6.13±3.33 vs. 4.40±2.65, PCT (μg/L): 31.41±12.83 vs. 3.01±2.69, CRP (mg/L): 130.51± 42.23 vs. 104.46±50.12, SOFA: 12.01±2.25 vs. 9.05±2.06, APACHEⅡ: 29.52±5.03 vs. 20.01±3.21, allP < 0.05], and ScvO2 in death group was significantly decreased (0.571±0.136 vs. 0.685±0.106,P < 0.01). Correlation analysis showed that the Pcv-aCO2 was negatively correlated with ScvO2 (r = -0.762,P = 0.001) and was positively correlated with PCT, CRP, SOFA and APACHEⅡscores (r value was 0.737, 0.625, 0.738, 0.713, respectively, allP < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of Pcv-aCO2 prediction of death in patients with sepsis was 0.826, the cut-off was 6.62 mmHg, the sensitivity was 84.7％, the specificity was 77.5％, the positive likelihood ratio was 3.76, and the negative likelihood ratio was 0.19.Conclusion Pcv-aCO2 has a great value in evaluating the prognosis of elderly patients with sepsis and can accurately determine the prognosis of sepsis.
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Objective To investigate the effect of Simo decoction oral liquid on inflammatory in acute respiratory distress syndrome (ARDS) mouse serum and the bronchoalveolar lavage fluid (BALF) and to explore the mechanism.Methods Fifty BALB/c mice were divided into normal control group, ARDS model group, small, moderate and large dose Simo decoction oral liquid-treated groups (simplified as Simo groups) according to random number table method (n=10, in each group). The ARDS model mice were replicated by lipopolysaccharide (LPS) tracheal instillation, and the mice in normal control group were given the same amount of normal saline. Immediately after the success of modeling, the mice were gavaged with 1, 2, 4 times the equivalent dose Simo decoction oral liquid of 7.56 mL·kg-1·d-1 in small, moderate or large dose Simo groups respectively, and there was no intervention in the normal control group or ARDS model group. All the mice were sacrificed at 24 hours after the respective drug amount or normal saline was given in various groups. The lung samples were taken for histologic evaluation, and BALF and serum samples were analyzed for the tumor necrosis factor-α(TNF-α), interleukin (IL-1β, IL-6), and in the mean time the level of serum superoxide dismutase (SOD) was detected.Results The pathological observation of lung tissue showed: there was no obvious inflammatory exudation in lung tissue of mice in normal control group; the inflammatory exudation in lung tissue of mice was increased significantly, the level of TNF-α (ng/L: 1759±303 vs. 104±27, 2506±674 vs. 507±46), IL-1β(ng/L: 209±16 vs. 114±11, 7325±826 vs. 3513±498) and IL-6 (ng/L: 144±38 vs. 47±7, 126±38 vs. 15±7) in serum and BALF were significantly increased, and the content of SOD (kU/L: 40.26±2.54 vs. 50.68±3.75) in serum was significantly decreased in ARDS model group (allP < 0.05), indicating that animal model of ARDS was set up successfully. Compared with ARDS model group, in small, moderate and large dose Simo groups, the inflammation exudation in lung tissue of mouse was reduced, the levels of TNF-α, IL-1βand IL-6 in serum and BALF were reduced, and the content of SOD in serum was increased [serum: TNF-α(ng/L) was 1642±276, 1126±154, 817±102 vs. 1759±303, IL-1β(ng/L)was 198±12, 170±11, 141±13 vs. 209±16, IL-6 (ng/L) was 127±22, 82±16, 41±15 vs. 144±38, SOD (kU/L) was 42.11±1.64, 48.09±1.23 vs. 40.26±2.54; BALF: TNF-α(ng/L) was 2479±446, 1632±330, 1067±223 vs. 2506±674, IL-1β(ng/L): 6939±725, 5398±625, 4401±210 vs. 7325±826, IL-6 (ng/L): 106±30, 68±13, 34±10 vs. 126±38, allP < 0.05], showing the Simo decoction inhibiting the lung inflammation and the above levels of indexes inserum and BALF was in a dose-dependent manner, and the changes in large dose Simo group was the most significant 45.18±1.15, .Conclusions Simo decoction oral liquid can inhibit the inflammatory response of ARDS, reduce the oxidative stress and decrease the lung injury of mice with ARDS.
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BACKGROUND:It is unclear about dexamethasone effect on the regulation of microRNA-155 expression in macrophages. OBJCTIVE:To explore whether dexamethasone can regulate the expression of microRNA-155 in macrophages. METHODS:(1) Lipopolysaccharide stimulation of mouse macrophages: mouse macrophage cel lines, Raw264.7 cels, were culturedin vitro and stimulated by lipopolysaccharide. Cultured cels were colected at 0, 0.5, 2, 6 hours after culture to detect the dynamical expression of microRNA-155. (2) Dexamethasone intervention for macrophages: Macrophages were divided into four groups: control group treated with phosphate buffer; lipopolysaccharide group stimulated by lipopolysaccharide; combined group given intervention with dexamethasone and lipopolysaccharide; dexamethasone group cultured with dexamethasone. At 6 hours after culture, cel supernatant was colected to detect the expression of tumor necrosis factor α and interleukin-6 using ELISA method. Real-time fluorescence quantitative PCR was used to detect the expression of microRNA-155 in the Raw264.7 macrophages. RESULTS AND CONCLUSION:Lipopolysaccharide significantly increased the expression of tumor necrosis factor α, interleukin-6 and microRNA-155 after 6 hours of culture (P < 0.05). Combined use of dexamethasone and lipopolysaccharide slightly increased the expression of tumor necrosis factor α, interleukin-6 and microRNA-155 (P< 0.05). Dexamethasone alone had no influence on the expression of tumor necrosis factor α and interleukin-6, but significantly decreased the expression of microRNA-155 (P < 0.05). These findings indicate that dexamethasone can inhibit the expression of microRNA-155 in the macrophages induced by lipopolysaccharide.
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OBJECTIVE:To study the effects of simvastatin on oxidative stress and cell apoptosis in aged mice with myocardi-al ischemia-reperfusion (IR). METHODS:Aged mice were randomly divided into sham operation group (phosphate buffer solu-tion),model group(phosphate buffer solution)and simvastatin low-dose,medium-dose and high-dose groups(2.5,5 and 20 mg/kg) with 14 mice in each group. Those groups were given relevant medicine intraperitoneally before modeling for 7 d,once a day. IR model was induced in those groups except for sham operation group. The area ratio of myocardial infarction,myocardial cell apop-tosis rate,activity of myocardial tissue apoptosis gene Caspase-3,the protein expression of Bax and Bcl-2,Akt phosphorylation, serum concent of MDA and activity of SOD were all detected. RESULTS:Compared with sham operation group,the area ratio of myocardial infarction,myocardial cell apoptosis rate,Caspase-3 activity,the protein expression of Bax and MDA content were all increased in model group,while the protein expression of Bcl-2,Akt phosphorylation and SOD activity were decreased(P0.05). CONCLUSIONS:Simvastatin can relieve myocardial IR injury in aged mice,and the mechanism of which may be associated with inhibiting myocardial cell apoptosis and the generation of oxidative stress.
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Objective To investigate the clinical application of renal vessel angiography with 256-slice spiral CT in laparoscopic surgery for renals.Methods One hundred and fifty-five cases underwent computed tomograph angiography(CTA) who were all confirmed by operations.According to preoperative renal artery CTA case shown,the initial plan intraoperative renal artery was compared with the situation with the actual surgery.AIl axial images were reconstructed using technique.Results All patients underwent preoperative renal artery CTA operative findings correspond with the actual rate of 100％.CTA stereoscopic images were good at reflecting renal vascular anatomy and ectopic blood vessels line.Conclusion CTA can accurately evaluate out of shape and variation of the renal arteriesvariation.It has important significance of processing of renal arteries intraoperative rapid,dealing with the renal artery accurately and reducing blood loss or damage and other complications.
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Objective To observe any change in the laterality index (LI) in the active volume of the hand motor cortex during rehabilitation after acute cerebral infarction and to analyze the mechanisms involved in the rehabilitation of motor function.Methods Sixteen patients with acute cerebral infarcts were administered standard but individualized rehabilitation training.Blood oxygenation-dependent functional magnetic resonance imaging (BOLD-fMRI) was used to evaluate the active volume of their hand sensorimotor cortex (SMC) and the LI,at admission and after 14 days of rehabilitation.The Fugl-Meyer motor assessment for the hand (FMA) was used to evaluate hand function.Ten healthy volunteers were recruited as a control group and subjected to a single BOLD-fMRI examination to confirm the location and the volume of the active area when performing the same rehabilitation exercises.Results The baseline LI of affected hand SMC activation was significantly smaller than that of the unaffected hand [(0.010 ±0.808) versus (0.789 ± 0.157)],but no significant difference was observed between the affected and the unaffected hands after treatment.Rehabilitation therapy significantly increased the SMC LI of affected hand activation when compared with the baseline,but no such effect was observed with the unaffected hand.In 12 patients with dysfunction of the right hand as evaluated by the FMA,the baseline LI of the affected hand was smaller than that of the unaffected hand and that of the healthy volunteers.Conclusion Rehabilitation after acute infarction can promote functional recovery.The LI of the affected hand reflects cerebral plasticity during rehabilitation after acute cerebral infarction.
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Objective To study the characteristics of the hand motor cortex in ataxia patients during active and passive finger-to-thumb opposition movements using bold oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI). Methods Ten right-handed healthy volunteers and 16 ataxia patients with motor cortex lesions were selected, and whole-brain BOLD-fMRI examinations were made while the subjects were performing the active and passive movements. Activated volume and intensity were recorded from the corresponding motor cortex and analyzed quantitatively. Meanwhile, the patients' coordination was evaluated using the international cooperative ataxia rating scale (ICARS). Results During passive movement of the ataxia patient's affected hands, the ipsilateral supplementary motor area (SMA) activated volume was larger than that during normal ipsilateral hand movement, and the activation intensity was also higher than that in the healthy controls. The ipsilateral cerebellum activated volume and intensity were significantly lower than those in the control group, and the frequency of appearance of the cerebellum was also less. The patients' activated volume and intensity in the ipsilateral cerebellum showed no correlation with ICARS scores. Conclusions When the ataxia patients' affected side cerebellum was dysfunctional, the ipsilateral SMA could compensate for the weak cerebellum function. The ICARS does not reflect cerebellum function.
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Objective To identify the neural substrates of three motor tasks (repetitive and sequential fin-get-to-thumb opposition movements in turn, making fates, fingers passive flexion-extension movements in turn) of dominant and subdominant hands by using the whole-brain functional magnetic resonance imaging. Methods Ten right-handed healthy volunteers were scanned while they were performing the movement tasks with their right and left fingers. The motor cortex active volume and intensity was recorded. Quantitive analysis of motor cortex was conducted with paired t test. Results Under the three hand motor tasks, activation volumes in SMC during movements of the subdominant hand were significantly larger than those during movements of the dominant hand (P < 0. 05). Activation volumes during finger-to-thumb opposition movements and passive bendlng-extending fingers movements were significantly larger than those during movements of making fasts (P < 0.05). Activation intensity during passive ben-ding-extending fingers movements was significantly larger than those during movements of making fasts (P < 0.05). Conclusion The representation of the Motor Cortex is related to the complexity of the hand motor exercises. Quantitive criterion as volume and intensity approves the dissymmetry of cortex activation by dominant and subdominant fingers'movements. It is practicable and credible to adopt invariable fingers passive flexion-extension movements in turn in the study on BOLD-fMRI.
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Objective To investigate the metabolic characteristics,clinic values of different tissues in benign prostatic hyperplasia by correlating MR spectroscopy(MRS)with whole pathologic sections.Methods MRS presentation was studied in 16 patients with benign prostatic hyperphsia.The peak values of citrate,choline and creatine were measured,and the mtios of(choline+creatine)/citrate(cc/c)were obtained.After suprapubic transvesical prostatectomy,the specimens of whole pathologic sections were observed.The values of cc/c of different pathologic types were compared statistically with One.way-ANOVA and t test. Results MRS results were obtained in 578 units,which included 233 glandular tissue units.130 matrical tissue units.165 mixed tissue units and 50 tissue units around urethra.The ratios of (choline+creatine)/citrate of glandular,matrical.mixed tissues and units around urethra were 0.59±0.29.1.23±0.38.0.80±0.27 and 0.68±0.33(F=3.49.P＜0.05).The t tests were carried out between every two tissues.The t valUes between glandular tissues and matrical.mixed tissues were 19.60 and 7.09.P＜0.05:the t values between matrical tissues and mixed tissues.units around urethra were 13.22 and 9.42,P＜0.05;the t valUes between mixed tissues and units around urethra was 9.42,P＜0.05.Condusions,The ratios of cc/c ofthree prostate tissues were different in MRS.The metabolic characteristic of the units around urethra Was near to glandular units.MRS may be valuable to the distinctive diagnoses of prostate diseases.
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Objective To observe any change in the active volume of the hand motor cortex during rehabilitation therapy after acute cerebral infarction and analyze the mechanisms involved in motor function rehabilitation.Metbods Of 16 patients with acute brain infarction,8 were administered routine intemal medicine treatment only,while and the other 8 received rehabilitation therapy in addition.Before treatment and after 14 days,the patients were assessed with functional magnetic resonance imaging(fMRI)and the Fugl-Meyer assessment of motor function (FMA).The active volume of the motor cortex was compared between the two groups of patients.Ten healthy volunteers were examined with fMRI to confirm the location and the volume ofthe active area when performing the sanle exercises.Results After treatment,all the 16 patients showed increased motor cortex active volume,and their FMA scores also increased.Those receiving rehabilitation therapy improved tO a significantly greater extent than those treated with internal medicine treatment alone.Conclusion Rehabilitation of patients with acute infarction Can activate a greater volume of the motor cortex and promote functional recovery.