ABSTRACT
Objective@#This study aimed to examine the effects of microcirculatory dysfunction and 654-1 intervention after cardiopulmonary resuscitation on myocardial injury.@*Methods@#Landrace pigs were divided into a sham operation group (S group, n= 6), ventricular fibrillation control group (VF-C group, n= 8) and 654-1 intervention group (VF-I group, n= 8). Hemodynamics was recorded at baseline, at recovery of spontaneous circulation (ROSC), and 1 h, 2 h, 4 h and 6 h thereafter. Sidestream dark field (SDF) technology was used to evaluate and monitor the microcirculation flow index, total vessel density, perfusion vessel ratio, De-Backer score, and perfusion vessel density in animal viscera at various time points.@*Results@#After administration of 654-1 at 1.5 h post-ROSC, the hemodynamics in the VF-I group, as compared with the VF-C group, was significantly improved. The visceral microcirculation detected by SDF was also significantly improved in the VF-I group. As observed through electron microscopy, significantly less myocardial tissue injury was present in the VF-I group than the VF-C group.@*Conclusion@#Administration of 654-1 inhibited excessive inflammatory by improving the state of visceral microcirculation.
Subject(s)
Animals , Cardiopulmonary Resuscitation , Microcirculation , Swine , Ventricular Fibrillation/therapyABSTRACT
Objective:To explore the change of serum 25-hydroxyvitamin D [25(OH)D] and prediction for outcome of acute ischemic stroke in emergency. Methods:From October, 2017 to September, 2019, 224 patients with acute ischemic stroke in emergency and 240 healthy controls were detected serum 25(OH)D within 24 hours after enrollment. The patients were assessed with National Institute of Health Stroke Scale (NIHSS) and Nutritional Risk Screening 2002 (NRS2002), and measured biochemics within 24 hours after admission. They were assessed with modified Rankin Scale (mRS) 180 days after stroke, and divided into favourable group (mRS ≤ 2, n = 106) and unfavourable group (mRS > 2, n = 118). The factors related with the outcome were analyzed with Logistic regression, and the prediction of 25(OH)D for the outcome were analyzed with receiver operator characteristic (ROC) curve. Results:Serum 25(OH)D was less in the patients than in the controls (Z = 4.296, P < 0.001), and less in the unfavourable group than in the favourable group (Z = 5.876, P < 0.001). Serum 25(OH)D (OR = 0.925, P < 0.05) was related with the outcome even controlling the impacts of age, sex, nutritional risk, infarct volume, scores of NIHSS, etc. The area under curve for serum 25(OH)D predicting outcome was 0.795 (P < 0.001). The cut-off point of prediction was 13.17 ng/ml, with the Yoden index of 0.548, which yielded a sensitivity of 0.746 and a specificity of 0.802. Conclusion:Serum 25-hydroxyvitamin D may predict the outcome 180 days after acute ischemic stroke, which may help for risk stratification in emergency.
ABSTRACT
@#Though notorious for its tendency to induce recurrent neck abscess, pyriform sinus fistula is of importance despite its rarity. It usually presents diagnostic and therapeutic challenges. Because of post-infectious fibrosis, the embryologic origin of pyriform sinus fistula is difficult to appreciate in certain cases. Here we present a case with empyema and mediastinal abscess caused by pyriform sinus fistula and share our experience in the treatment of this patient.
ABSTRACT
Heart failure is a serious condition with high prevalence and mortality. The application of the novel big data analysis in heart failure can improve the management of this condition,especially in terms of diagnosis,classification,and prognostic prediction. This articles reviews relevant literature and validates the role of big data analysis for heart failure patients.
Subject(s)
Humans , Big Data , Heart Failure , Diagnosis , Therapeutics , PrognosisABSTRACT
<p><b>Background</b>The quick Sequential Organ Failure Assessment (qSOFA) score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism (PE) by combining with electrocardiography (ECG).</p><p><b>Methods</b>Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low - risk groups by imaging and biomarkers. The ECG scores consisted of tachycardia, McGinn-White sign (SQT), right bundle branch block, and T-wave inversion of leads V-V. A new combination of qSOFA scores and ECG scores by logistic regression for predicting high-risk stratification patients with acute PE was evaluated by a receiver operating characteristic curve.</p><p><b>Results</b>Totally 1318 patients were enrolled, including 271 in the high-risk group and 1047 in the low-risk group. A combination predictive scoring system named qSOFA-ECG = qSOFA score + ECG score was created. The optimal cutoff value for qSOFA-ECG was 2, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.5%, 72.3%, 43.2%, and 93.8%, respectively. For predicting high-risk stratification and reperfusion therapy, the qSOFA-ECG is superior to PE Severity Index (PESI) and simplified PESI.</p><p><b>Conclusions</b>The qSOFA score contributes to identify acute PE patients with potentially hemodynamic decompensation that need monitoring and possible reperfusion therapy at the emergency department arrival when used in combination with ECG score.</p>
ABSTRACT
<p><b>BACKGROUND</b>Shock is a life-threatening condition in emergency departments (EDs) and is associated with a high mortality; however, its clinical characteristics and current interventions in China are seldom reported. This study investigated the clinical characteristics and current interventions of shock patients in Chinese EDs.</p><p><b>METHODS</b>This multicenter prospective cohort study was conducted in the EDs of 33 academic hospitals in 16 Chinese provinces. Adult shock patients were enrolled from December 2013 to April 2014. Age, sex, comorbidities, shock subtype, and vital signs were recorded on ED arrival; details of subsequent interventions and treatments were added. We compared those data between survivors and nonsurvivors. All patients were followed up for 3 days. The primary outcome was 3-day mortality. Binary logistic regression analysis identified the independent predictors of that mortality.</p><p><b>RESULTS</b>We enrolled 1095 shock patients. The 3-day mortality was 27.5%, 36.3%, and 29.0%, respectively, in the whole cohort and for cardiogenic and septic shock. Within the first 24 h, 1039 patients (94.9%) were admitted to the Intensive Care Unit. Use of bicarbonate, epinephrine, and dopamine is an independent predictor for mortality. Hemorrhage and trauma (39.1%), along with sepsis (40.4%) were the most commonly observed causes of shock in the ED. In nondiabetic patients with cardiogenic shock, 3-day mortality was 69.2% for patients needing glucose control - much higher than in those not needing glucose control (30.0%, P= 0.01). Hydroxyethyl starch (HES) was applied in 29.6% of septic shock patients, and the mortality of septic patients who received HES was much higher than those who did not (38.2% vs. 25.1%, P = 0.006).</p><p><b>CONCLUSIONS</b>In China, short-term mortality of shock patients in EDs is still high, especially among those with cardiogenic and septic shock. HES application needs to be restricted - particularly in septic shock patients.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cohort Studies , Emergency Service, Hospital , Intensive Care Units , Logistic Models , Prospective Studies , Risk Factors , Sepsis , Epidemiology , Mortality , Shock, Septic , Epidemiology , MortalityABSTRACT
<p><b>Background:</b>Preoperative anatomical scoring system is conducive to comparison between treatment options and evaluation of postoperative outcomes in patients with small renal tumors. This study aimed to evaluate the clinical application efficacy of the R.E.N.A.L. nephrometry score (RNS) in predicting perioperative outcomes in patients with renal tumor who underwent laparoscopic partial nephrectomy (LPN).</p><p><b>Methods:</b>The clinical data of 139 patients with renal tumors who underwent LPN between 2009 and 2015 were collected and analyzed. Patients were divided into three groups according to their RNS (low, moderate, and high). Clinical characteristics including perioperative variables, complications, and RNS were compared to evaluate the differences between the three groups. Multivariable logistic regression analysis was used to analyze the risk factors of postoperative complications.</p><p><b>Results:</b>According to the RNS, there were 74, 50, and 15 patients in the low, moderate, and high RNS groups, respectively. There were significant differences in estimated blood loss (EBL; χ= 7.285, P = 0.026), warm ischemia time (WIT; χ= 13.718, P = 0.001), operation time (OT; χ= 6.882, P = 0.032), perioperative creatinine clearance change (PCCC; χ= 6.206, P = 0.045), and number of patients with complications (NPC; P = 0.002) among the three groups. The values for EBL, WIT, OT, PCCC, and NPC for patients in the high RNS group were higher than those for patients in the low RNS group. After adjustment for OT, WIT, and EBL, RNS was statistically significantly associated with the risk of postoperative complications in a multivariable logistic regression model (odds ratio = 1.541, 95% confidence interval: 1.059-2.242, P = 0.024).</p><p><b>Conclusions:</b>The RNS is a valuable tool for evaluating the complexity of renal tumor anatomy. It can aid surgeons in preoperative decision-making concerning management therapy. Future multicenter, large sample size studies are warranted for evaluating its predicting performance of perioperative outcomes.</p>
ABSTRACT
<p><b>OBJECTIVE</b>Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. In this article, we reviewed the correlation between neutrophil dysfunction and sepsis.</p><p><b>DATA SOURCES</b>Articles published up to May 31, 2016, were selected from the PubMed databases, with the keywords of "neutrophil function", "neutrophil dysfunction", and "sepsis".</p><p><b>STUDY SELECTION</b>Articles were obtained and reviewed to analyze the neutrophil function in infection and neutrophil dysfunction in sepsis.</p><p><b>RESULTS</b>We emphasized the diagnosis of sepsis and its limitations. Pathophysiological mechanisms involve a generalized circulatory, immune, coagulopathic, and/or neuroendocrine response to infection. Many studies focused on neutrophil burst or cytokines. Complement activation, impairment of neutrophil migration, and endothelial lesions are involved in this progress. Alterations of cytokines, chemokines, and other mediators contribute to neutrophil dysfunction in sepsis.</p><p><b>CONCLUSIONS</b>Sepsis represents a severe derangement of the immune response to infection, resulting in neutrophil dysfunction. Neutrophil dysfunction promotes sepsis and even leads to organ failure. Mechanism studies, clinical practice, and strategies to interrupt dysregulated neutrophil function in sepsis are desperately needed.</p>
Subject(s)
Animals , Humans , Cell Movement , Physiology , Neutrophils , Physiology , SepsisABSTRACT
<p><b>OBJECTIVE</b>To determine whether the onset of acute lung injury (ALI) induces the up-regulation of pentraxin 3 (PTX3) expression in mice and whether PTX3 concentration in the biofluid can help recognizing sepsis-induced ALI.</p><p><b>METHODS</b>Wild-type C57BL/6 mice (12-14 weeks old) were randomly divided into 3 groups. Mice in the group 1 (n=12) and group 2 (n=12) were instilled with lipopolysaccharide via intratracheal or intraperitoneal routes, respectively. Mice in the group 3 (n=8) were taken as blank controls. Pulmonary morphological and functional alterations were measured to determine the presence of experimental ALI. PTX3 expression in the lung was quantified at both protein and mRNA levels. PTX3 protein concentration in blood and bronchoalveolar lavage fluid was measured to evaluate its ability to diagnose sepsis-induced ALI by computing area under receiver operator characteristic curve (AUROCC).</p><p><b>RESULTS</b>ALI was commonly confirmed in the group 1 but never in the other groups. PTX3 expression was up-regulated indiscriminately among lipopolysaccharide-challenged mice. PTX3 protein concentration in the biofluid was unable to diagnose sepsis-induced ALI evidenced by its small AUROCC. PTX3 concentration in bronchoalveolar lavage fluid did not correlate with that in serum.</p><p><b>CONCLUSIONS</b>Lipopolysaccharide challenges induced PTX3 expression in mice regardless of the presence of ALI. PTX3 may act as an indicator of inflammatory response instead of organ injury per se.</p>
Subject(s)
Animals , Male , Mice , Acute Lung Injury , Metabolism , Blotting, Western , C-Reactive Protein , Metabolism , DNA Primers , Enzyme-Linked Immunosorbent Assay , Lipopolysaccharides , Mice, Inbred C57BL , Nerve Tissue Proteins , Metabolism , Real-Time Polymerase Chain Reaction , Up-RegulationABSTRACT
<p><b>OBJECTIVE</b>To explore whether the amount of lipocalin-2 in the biofluid could reflect the onset of sepsis-induced acute lung injury (ALI) in mice.</p><p><b>METHODS</b>Lipopolysaccharide (LPS, 10 mg/kg) injection or cecal ligation and puncture (CLP) was performed to induce severe sepsis and ALI in C57 BL/6 male mice randomly divided into 5 groups (n=10 in each group): group A (intraperitoneal LPS injection), group B (intravenous LPS injection via tail vein), group C (CLP with 25% of the cecum ligated), group D (CLP with 75% of the cecum ligated), and the control group (6 sham-operation controls plus 4 saline controls). All the mice received volume resuscitation. Measurements of pulmonary morphological and functional alterations were used to identify the presence of experimental ALI. The expressions of lipocalin-2 and interleukin (IL)-6 in serum, bronchoalveolar lavage fluid (BALF), and lung tissue were quantified at both protein and mRNA levels. The overall abilities of lipocalin-2 and IL-6 tests to diagnose sepsis-induced ALI were evaluated by generating receiver operator characteristic curves (ROC) and computing area under curve (AUC).</p><p><b>RESULTS</b>In both group B and group D, most of the main features of experimental ALI were reproduced in mice, while group A and group C showed septic syndrome without definite evidence for the presence of ALI. Compared with septic mice without ALI (group A+group C), lipocalin-2 protein expression in septic mice with ALI (group B+group D) was significantly up-regulated in BALF (P<0.01) and in serum (P<0.01), and mRNA expression boosted in lung tissues (all P<0.05). Lipocalin-2 tests performed better than IL-6 tests in recognizing sepsis-induced ALI cases, evidenced by the larger AUC of the former (BALF tests, 0.8800 versus 0.6625; serum tests, 0.8500 versus 0.7000). Using a dual cutoff system to diagnose sepsis-induced ALI, BALF lipocalin-2 test exhibited the highest positive likelihood ratio (13.000) and the lowest negative likelihood ratio (0.077) among the tests of lipocalin-2 and IL-6 in blood and BALF. A statistically significant correlation was found between lipocalin-2 concentration in BALF and that in serum (Spearman r=0.8803, P<0.0001).</p><p><b>CONCLUSIONS</b>Lipocalin-2 expression is significantly up-regulated in septic ALI mice compared with those without ALI. Lipocalin-2 tests with a dual cutoff system could be an effective tool in distinguishing experimental ALI cases.</p>
Subject(s)
Animals , Male , Mice , Acute-Phase Proteins , Metabolism , Base Sequence , Bronchoalveolar Lavage Fluid , DNA Primers , Lipocalin-2 , Lipocalins , Metabolism , Lung Injury , Diagnosis , Mice, Inbred C57BL , Oncogene Proteins , Metabolism , Real-Time Polymerase Chain Reaction , SepsisABSTRACT
BACKGROUND: Altered mental status (AMS) is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly challenging for emergency physicians. The aim of this study is to provide a framework for the assessment of AMS patients. This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management. METHODS: This is a prospective cohort observational study. We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24 months (June 2009 to June 2011). Demographic characteristics, clinical manifestations, assessment approaches, causative factors, emergency treatments and outcomes were collected prospectively. RESULTS: In 1934 patients with AMS recruited, accounting for 0.93％ of all emergency department (ED) patients, 1026 (53.1％) were male, and 908 (46.9％) female. Their average age was 51.95±15.71 years. Etiologic factors were neurological (n=641; 35.0％), pharmacological and toxicological (n=421; 23.0％), systemic and organic (n=266; 14.5％), infectious (n=167; 9.1％), endocrine/metabolic (n=145; 7.9％), psychiatric (n=71; 3.9％), traumatic (n=38; 2.1％), and gynecologic and obstetric (n=35; 1.9％). Total mortality rate was 8.1％ (n=156). The death rate was higher in elderly patients (≥60) than in younger patients (10.8％ vs. 6.9％,P=0.003). CONCLUSIONS: Patients with AMS pose a challenge for ED physicians. The most frequently encountered diagnostic categories causing AMS were primary CNS disorders, intoxication, organ system dysfunction, and endocrine/metabolic diseases. AMS has a high fatality rate in the ED. AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects. Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the role of gastric mucosa apoptosis in the stress of ischemic stroke, and to discuss the relationship between gastric mucosa apoptosis and gastric barrier.</p><p><b>METHODS</b>Ten dogs were artificially made ischemic stroke by operation (IS group), and another 10 shamly-operated dogs were served as control group. Sucrose permeability were measured after the operation. All dogs were sacrificed 24 hours after operation to measure the gastric mucosal apoptosis index, gastric gross classification, and histological score.</p><p><b>RESULTS</b>The gastric mucosal apoptosis index in the IS group were significantly higher than in the control group (14.83 +/- 4.41 vs. 5.60 +/- 2.61, P < 0.05). The gastric mucosal apoptosis index were correlated with the sucrose permeability (r = 0. 89, P < 0.05) , gastric gross classification (r = 0. 87, P < 0.05), and histological score (r = 0.92, P < 0.05).</p><p><b>CONCLUSIONS</b>Although ischemic stroke will not cause the obvious damage in the respiratory and circulatory system, it is responsible for the apoptosis of epithelial cell in the gastric mucosa and gastric barrier dysfunction. The apoptosis index is closely correlated with the damage of the function and morphology of the gastric barrier, indicating that the epithelial cell apoptosis acceleration in the gastric mucosa may result in the damage of gastric barrier function.</p>
Subject(s)
Animals , Dogs , Apoptosis , Physiology , Epithelial Cells , Pathology , Gastric Mucosa , Pathology , In Situ Nick-End Labeling , Random Allocation , Stroke , PathologyABSTRACT
This article reviews the recent advances in gastrointestinal function research, especially the gastrointestinal dysfunction/failure in critical care medicine.
Subject(s)
Humans , Critical Care , Methods , Gastrointestinal Diseases , Drug Therapy , PathologyABSTRACT
<p><b>OBJECTIVE</b>To develop an oligonucleotide microarray-based method for the simultaneous detection of Helicobacter pylori (Hp) infection, virulence-associated genotypes, and drug resistance.</p><p><b>METHODS</b>Hp was classified into cagA + and cagA- genotypes based on its virulence. Clarithromycin-resistance of Hp was identified by existence of point mutations in 23S rRNA. We constructed an oligonucleotide microarray chip to simultaneously diagnose Hp infection and detect its virulence-associated genotypes and mutations associated with clarithromycin-resistance. The diagnostic accuracy of the constructed microarray was tested with templates of wild type and mutated type.</p><p><b>RESULTS</b>The oligonucleotide chip accurately detected cagA + and cagA- genotypes of Hp, as well as four common point mutations in 23S rRNA related to clarithromycin-resistance.</p><p><b>CONCLUSION</b>Oligonucleotide microarray chip can be used to diagnose Hp infection and test its virulence-associated genotypes and drug resistance simultaneously.</p>