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Objective:To evaluate the association between the use of emergency medical services (EMS) and the severity of disease among patients admitted to the emergency room, to analyze the characteristics of the patients, and to build prediction model providing evidence-based use of EMS resources.Methods:The data of patients admitted to the Emergency Room of the First Affiliated Hospital of University of Science and Technology of China from January 2020 to July 2021 were extracted from the Chinese Emergency Triage Assessment and Treatment (CETAT) database. Patients were divided into the EMS use group (AB+ group) and self-seeing group (AB-group) according to whether they used EMS. The patients’ general condition, vital signs and laboratory tests results were recorded. The severity of patients’ condition was judged based on whether the patient was admitted to the department of critical medicine, specialized care unit, emergency operation and/or emergency percutaneous intervention. A 9-variable model that did not require laboratory inspection and 22-variable model that required laboratory inspection were established to correct the propensity score to analyze the correlation between the severity of disease and the EMS use. In the subgroup analysis, the correlation between the EMS use and severity of the patients was analyzed according to the reason of the patient’s visit.Results:During the study period, 16 489 patients were admitted to the emergency room, and 6975 patients were finally enrolled in this study. There were 2768 patients (39.7%) in the AB+ group and 4207 patients (60.3%) in the AB-group. In the AB+ group 522 patients (18.9%) were in high risk, and in the AB-group 563 patients (13.4%) were in high risk. Compared with the AB-group, patients in the AB+ group were older and had a higher proportion of coma, a faster autonomic heart rate, and a lower diastolic blood pressure and peripheral oxygen saturation (SpO 2). In the 9-variable model, sex, consciousness, temperature, heart rate and diastolic blood pressure were associated with the EMS use. In the 22-variable model, consciousness, SpO 2, neutrophils, and albumin were the relevant factors for patients using EMS. Before the correction of propensity score, the EMS use was an independent risk factor for critically ill patients ( OR=1.5, 95% CI 1.32-1.72, P<0.001). After adjusted using 9-variable propensity score, the EMS use ratio decreased significantly compared with that without correction ( OR=1.24,95% CI 1.08-1.42, P<0.001). Interestingly, after adjusted with propensity score match with 22-variable model, there was no association between the severity of disease and t the EMS use ( OR=1.10,95% CI 0.95-1.28, P=0.195). In subgroup analysis, patients’ chief complaint of central nervous system, cardiovascular system, and trauma were the top three reasons at admission. Before the propensity score correction, the EMS calling patients with chief complaint of central nervous system, digestive system, and trauma were related to the severity of the patients. After adjusted with 9-variable model the EMS use was associated with the severity of the disease only in trauma patients, and after adjusted with 22-variable model there was no statistical difference considering the severity of the disease in all subgroups. Conclusions:The EMS use is common. However, the association of the EMS use with the severity of disease is decreased with variable models using propensity score. These findings indicate that the EMS use should be based on multivariable models, which may be important in detecting critically ill patients, optimizing the EMS use, and avoiding unnecessary call in the future.
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Objective To investigate the immune reaction mechanism of NLRP3 inflammsome in the Escherichia coli bloodstream infection. Methods C57BL/6 mouses were injected by caudal vein with Escherichia coli and phosphate buffer ( PBS) respectively as injected group and control group. The infected group mice were executed after 24 hours and 48 hours,and the control group mice were executed at the beginning of experiment,taking the tis-sue samples of the two groups and detecting the changes of each index. The changes of the indexes were detected by enzyme-linked immunosorbent assay( ELISA) , real-time quantitative PCR ( RT-qPCR) , Western blot and HE stai-ning. Results Significant inflammatory cell infiltration and tissue necrosis were observed by HE staining in 24 h and 48 h after infection with Escherichia coli. The IL-1β and IL-18 cytokines in tissue homogenate and serum of bloodstream infection group were all increased significantly. The mRNA expression of NLRP3, ASC and caspase-1 in liver and lung homogenate increased significantly at 24 h after infection, while NLRP3, ASC and caspase-1 mR-NA in kidney homogenate increased significantly at 48 h after infection. The expression of NLRP3 protein and ASC protein in the liver, lung and kidney tissues of the 48 h group was significantly higher than that in the 24 h group, but there was no significant difference in pro-caspase-1 expression of liver and kidney tissues between three groups. The expression of NLRP3 protein and ASC protein in liver, lung and kidney tissues in 48 h group was significantly higher than that in 24 h group,the expression of pro-caspase-1 protein in liver and kidney tissue in three groups dis-played no significant difference,the expression of caspase-1 protein in lung and kidney tissues was increased with time. Conclusion Escherichia coli bloodstream infection is associated with the activation of NLRP3 inflammatory, and the expression level of NLRP3 inflammasome was related to the severity of infection, with the increase of infec-tion, NLRP3 inflammatory expression increased. The findings may provide a new idea for the treatment of sepsis caused by Escherichia coli bloodstream infection.
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Objective To investigate the risk factors of ventilator-associated pneumonia (VAP) and the distribution and drug resistance of pathogens in intensive care unit (ICU) of county hospital. Methods 234 patients on mechanical ventilation for more than 48 hours admitted to ICU of Shexian People's Hospital of Huangshan City from January 2016 to June 2018 were enrolled. The clinical data of all patients including gender, age, past medical history, exposure to antibiotics, medication, the duration of mechanical ventilation, the length of ICU stay, serum albumin, tracheotomy, re-intubation, prognosis, and pathogenic bacteria and drug sensitivity test of VAP patients were collected. The patients were divided into VAP group and non-VAP group according to the occurrence of VAP. The differences of each index between the two groups were compared. The risk factors of VAP were analyzed by multivariate Logistic regression. The distribution and drug resistance of pathogenic bacteria in sputum culture of lower respiratory tract of VAP patients were analyzed. Results Among the 234 patients on mechanical ventilation, 95 patients had VAP, and the incidence of VAP was 40.60%. ① Risk factors of VAP: it was shown by univariate analysis that there were significant differences between VAP patients and non-VAP patients in past history, the duration of mechanical ventilation, the length of ICU stay, albumin < 28 g/L, antibiotic exposure and tracheotomy, but there were no significant differences in gender, age, glucocorticoid, sedative, gastric motility and coma between the two groups. It was shown by multivariate Logistic regression analysis that brain injury and cerebrovascular accident, the duration of mechanical ventilation > 7 days, albumin < 28 g/L and tracheotomy were independent risk factors for VAP occurrence [brain injury: odds ratio (OR) =41.40, 95% confidence interval (95%CI) = 2.14-799.60, P = 0.014; cerebrovascular accident: OR = 36.07, 95%CI =1.86-699.64, P = 0.018; the duration of mechanical ventilation > 7 days: OR = 1.23, 95%CI = 1.11-1.36, P < 0.001;albumin < 28 g/L: OR = 2.27, 95%CI = 1.03-5.01, P = 0.042; tracheotomy: OR = 3.33, 95%CI = 1.30-8.56, P = 0.012].② Distribution and drug resistance of VAP pathogens: a total of 108 strains of pathogens were isolated from sputum samples of 95 patients with VAP. Gram-negative (G-) bacteria accounted for 86.11% (93/108). The isolation rate of Klebsiella pneumoniae was the highest, reaching 31.48% (34/108); the isolation rates of Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii were 22.22% (24/108), 8.33% (9/108) and 9.26% (10/108), respectively. Gram-positive (G+) bacteria accounted for 6.48% (7/108), of which Staphylococcus aureus was 4.63% (5/108); and fungi was 7.41% (8/108). Drug resistance analysis showed that Klebsiella pneumoniae was 100% sensitive to amikacin (AMK), meropenem (MEM) and polymyxin (POL), and were suggested as the preferred drug. Pseudomonas aeruginosa was 100% sensitive to AMK, tobramycin (TOB) and POL, but 100% resistant to compound trimethoprim (PCST). Stenotrophomonas maltophilia was 100% sensitive to PCST and 100% resistant to AMK, piperacillin (PIP), piperacillin tazobactam (TZP) and TOB. Acinetobacter baumannii was 100% sensitive to cefoxitin (FOX), cefuroxime (CXM) and POT. Staphylococcus aureus was 100% sensitive to gentamicin (GEN), furantoin (NIT), rifampicin (RIF), vancomycin (VAN) and teicoplanin (TEC), while the drug resistance to clindamycin (CLI) and penicillin (PEN) was high (both 80.00%). Most pathogens were multidrug-resistant. The mortality of patients with multidrug resistant bacteria infection was significantly higher than that of non-multidrug resistant bacteria infection [51.85% (28/52) vs. 30.56% (11/36), χ2= 4.240, P = 0.046]. Conclusions VAP was associated with brain injury and cerebrovascular accident, duration of mechanical ventilation > 7 days, albumin < 28 g/L and tracheotomy. VAP patients were infected mainly with G- bacteria and showed multiple drug resistance.
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Objective To investigate the diagnostic value of dynamic-extended focused assessment with sonography for trauma (D-EFAST) in patients with multiple trauma in intensive care unit (ICU). Methods A prospective clinical study was conducted. Eighty patients with multiple trauma admitted to ICU of Anhui Provincial Hospital from September 1st, 2014 to December 31st, 2016 were enrolled. Extended focused assessment with sonography for trauma (E-FAST) check was conducted at first, for those who had positive findings diagnosis was confirmed by immediately CT examination or surgical exploration. If it was negative, the patients received E-FAST every morning for 7 days (defined as D-EFAST), for those with positive findings, immediately CT or surgery was performed to clarify the diagnosis. The final clinical diagnosis was used as the "gold standard" to calculate the diagnostic accordance rate of EFAST and D-EFAST examination technique for pneumothorax, pleural effusion, spleen injury, kidney damage, liver damage, gastrointestinal injury, pericardial effusion, bladder rupture, and pancreatic injury, as well as their sensitivity, specificity, positive predictive value, negative predictive value, accuracy rate, and missed diagnosis rate, and the difference between EFAST and D-EFAST was compared. Results There were 4 patients excluded because of death and abandoning treatment, and finally 76 patients were included in the study. The total sensitivity of E-FAST examination technique for pneumothorax, pleural effusion, spleen injury, liver damage, gastrointestinal injury, pericardial effusion, and bladder rupture was 75.9% (66/87), and the specificity was 98.3% (587/597), the positive predictive value was 86.8% (66/76), and the negative predictive value was 96.5% (587/608), the accuracy rate was 95.5% (653/684), and the rate of missed diagnosis was 24.1% (21/87). The most of the delayed injury in patients with multiple trauma occurred at 2-7 days after injury with incidence of 4.8% (33/684). The diagnostic sensitivity of D-EFAST for delayed injury was 98.3% (118/120), the specificity was 99.8% (563/564), the positive predictive value was 99.2% (118/119), the negative predictive value was 99.6% (563/565), the diagnostic accuracy rate was 99.6% (681/684), and rate of missed diagnosis was 1.7% (2/120). When the final clinical diagnosis was set as the "gold standard", D-EFAST technology for the detection rate was 98.3% (118/120) for patients with multiple trauma on organ injury while the detection rate of E-FAST was 75.9% (66/87), with statistical significant difference (P < 0.01), indicating that D-EFAST was better than E-FAST in check of multiple trauma patients with organ injury. Conclusion Although the E-FAST technology can quickly diagnose the multiple trauma patients and win the rescue time for critical patients, multiple trauma patients injured after 2-7 days prone to delayed damage and are difficult to detect, and D-EFAST can be used to find delayed damage earlier, and reduce the misdiagnosis rate of multiple trauma patients.
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Objective To explore the effects of two methods of air-impact on clearing the subglottic secretion in patients with intubation.Methods A simple random sampling method was used to select 106 patients underwent mechanical ventilation through oral tracheal intubation in intensive medicine department from September 2016 to October 2017.The recruited patients were divided into two groups by the random number table,53 patients in Group A were treated with breath-holding key of a ventilator,combined with air-bag inflation and deflation,and 53 patients in Group B were treated with simple breathing apparatus combined with manual technique to clear subglottic secretion.The incidence of ventilator-associated pneumonia(VAP),amount of cleared subglottic secretions,difference of vital signs before and after operation,number of coughing,in vitro training time and operation time were compared between groups.Results The intention-to-treat ana]ysis(ITT) showed that the incidence of VAP in Group A and B were 7.55％ and 5.66％,the per-protocol analysis(PP) showed that the incidence of VAP in Group A and B were 3.92％ and 3.85％,and there was no significant difference between groups(P＞0.05);the amount of cleared subglottic secretions in two groups were (8.31±0.82) ml,(7.97±1.12)ml,and there was no significant difference (P＞ 0.05);but vital signs before and after operation,number of coughing,in vitro training time and operation time in Group A were lower than those in Group B,and the differences were statistically significant(P＜0.05).Conclusion Two methods of air-impact can both effectively reduce the incidence of VAP,but using breath-holding key of a ventilator combined with airbag inflation and deflation has less influence on vital signs,which patients can better tolerate and medical staff can master and cooperate more easily.
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Objective To investigate the clinical experience and associated factors of extracorporeal membrane oxygenation(ECMO)for adult patients with severe acute respiratory distress syndrome(ARDS).Methods The clinical data of 22 adult patients with severe ARDS,which met the criteria for ECMO,were retrospectively collected and analyzed.The ECMO team all receiving VV-ECMO treatment (Veno-venous extracorporeal membrane oxygenation),data collection including the patients,general data,blood gas analysis,hemodynamics,mechanical ventilation parameter before and after the ECMO treatment and the auxiliary complications,etc.The control group were 14 cases of patients with severe ARDS which receiving conventional treatment;We collected the same data as the research team.Results In the research,8 patients treated with VV-ECMO,There were 5 males and 3 females,with an average age of (46.3 ± 14.1)years.Compared with the factors at the same time point in the control group,those of the ECMO group,except MAP (t =-0.872,P =0.357),Respiratory rate (t =-1.670,P =0.357),Heart rate (t =-1.973,P =0.042),PH (t =-1.432,P =0.033),PaCO2 (t =-2.564,P =0.024),PO2 (t =-4.955,P ＜ 0.001),PO2/FiO2 (t =-3.654,P ＜ 0.01),PEEP (t =-1.382,P =0.031),Pplateau (t =-2.785,P ＜ 0.01),Blood lactate (t =-2.564,P =0.024) were significantly improved after ECMO running 24 hours (all P ＜ 0.05).And also the factors such as the length of ICU stay (t =-2.452,P =0.027),the times of mechanical ventilation (t =-1.478,P =0.038),number of organ failure(t =-1.963,P =0.047),the hospital mortality rates(t =-1.970,P =0.045) and treatment costs(t =-1.667,P =0.035) between the ECMO group and the control group were significantly different (P ＜0.05).In the end,we divided the ECMO group into survival group and death group,and compare the time of Mechanical Ventilation before ECMO(P =0.031) the total time of Mechanical Ventilation(P =0.038),the time of ECMO adjutant (P =0.047),the length of ICU stay (P =0.043) and the cost of treatment (P =0.037) between the two groups;and there were also statistically significant difference (P ＜ 0.05).Conclusion ECMO can significantly improve the patients,oxygenation and respiratory physiology indexes which can not sustain under the conventional mechanical ventilation therapy and win the time for rest and repair of lung.Indexes such as age,time of mechanical ventilation before ECMO therapy,the primary cause of ARDS are the important factors influencing the efficacy of ECMO treatment in the patients with severe ARDS.
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Objective:To establish mice models of Staphylococcus aureus bloodstream infections so as to investigate the inflammatory responses and histopathological changes in bloodstream infections (BSIs) mice.Methods:C57BL/6 mice were inoculated with S.aureus intravenously or intraperitoneally to induce BSIs.Survival rate , weight loss and murine sepsis scores ( MSS ) were ob-served.Blood samples and tissue homogenates were plated on agar to determine bacterial burden .Inflammatory proteins ( CRP,PCT) and cytokines ( IL-1β, IL-6 and TNF-α) were determined by ELISA kits.Histopathologic changes were also assessed by pathological inflammation scores(PIS),macroscopic and microscopic examination.Results: About 70% survival rate was observed in 4.5×108 CFU/ml S.aureus induced BSIs mice.Body weight decreased and sepsis scores increased significantly since 24 h post-infection in BSIs mice,and more prominent in IV group.The counts of WBC began to significantly increase at 3 h post-infection,while CRP and PCT levels peaked at 48 hours in IV and IP groups ( 60.80 ±5.63 vs 40.58 ±7.54 for CRP;6.796 ±1.16 vs 2.740 ±0.36 for PCT ) . Moreover,the levels of IL-1β,IL-6 and TNF-αin serum and tissue homogenates ( liver,lungs,and kidneys ) were significantly elevated in BSIs mice.Pathological changes in tissues (liver,lungs and kidneys) and higher pathological inflammation scores (PIS) were also observed in BSIs mice.Conclusion:Our study represents an effective approach for S.aureus BSIs model to mimic human sepsis.Our results demonstrated that inflammation protein (PCT,CRP) and cytokines(IL-6,IL-1βand TNF-α) play an important role in the in-flammatory response and histopathological changes during BSIs caused by S .aureus.
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ObjectiveTo evaluate the influence of different hemoperfusion (HP) intensity on 7-day and 28-day mortality for patients with paraquat (PQ) poisoning, and examine the factors that may affect the decision of the clinicians to prescribe a high intensity HP.Methods A retrospective cohort study was conducted. The patients admitted to the department of critical care medicine of Anhui Provincial Hospital Affiliated to Anhui Medical University with the diagnosis of PQ poisoning from August 2012 to August 2014, fulfilling the following criteria were enrolled in the study: older than 18 years, interval from ingestion PQ to hospital admission shorter than 12 hours, and receiving HP treatment within 24 hours, and expecting surviving time exceeding 24 hours after admission, and data of the patients available for at least 28 days after admission. Depending on the intensity of HP, patients were assigned to either lower intensity HP group (LHP, defined as receiving HP for less than 4 hours, 2 columns) or higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients' data were retrieved from hospital's electronic database after hospital admission, and the results at 7th day and 28th day were recorded. Multiple logistic regression model was used to determine factors with which the clinician decided to choose the intensity of HP for the patients, and Cox regression model was used to evaluate 7-day and 28-day mortality.Results Data of 60 patients was finally available for this study. LHP group consisted of 28 patients, with a 7-day mortality of 53.6%(15 patients) and 28-day mortality of 64.3% (28 patients); 32 patients were assigned to HHP group with 7-day mortality of 43.8% (14 patients) and 28-day mortality of 62.5% (20 patients). Twenty-eight patients constituted as the HHP group, with higher PQ concentration in plasma, higher incidence of respiratory alkalosis and acute kidney injury (AKI), and higher level of lactate (Lac) compared with LHP group. However, a lower 7-day mortality was observed in the HHP group. Multiple logistic regression model indicated that at admission, interval from ingestion PQ to hospital admission longer than 4 hours [odds ratio (OR) = 1.461, 95% confidence interval (95%CI) = 1.132-1.435,P 10×109/L (OR = 1.222, 95%CI = 1.032-1.275, P = 0.018), Lac> 2.0 mmol/L (OR = 2.392, 95%CI = 2.090-2.734,P 50 years old (HR = 1.282, 95%CI = 1.050-1.530,P = 0.043), PQ concentration increased by 1 mg/L (HR = 2.521, 95%CI = 2.371-3.825,P = 0.012), AKI on admission (HR = 3.850, 95%CI = 2.071-5.391,P10×109/L (HR = 1.932, 95%CI = 1.782-2.171,P = 0.006), Lac> 2.0 mmol/L (HR = 2.981, 95%CI =2.210-3.792,P = 0.002), and PaCO2< 35 mmHg (HR = 1.772, 95%CI = 1.483-2.516,P = 0.008; 1 mmHg =0.133 kPa) were independent risk factors for 28-day mortality.Conclusions Though HHP was helpful in lowering mortality rate in patients with PQ poisoning within 7 days, it did not influence on 28-day mortality. Clinicians' decisions on HP intensity need further investigation, and more perfect clinical evaluation system is required for reasonable use of expensive medical resources such as HP.
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Objective To investigate the possible mechanism of natural killer cells(NK cells)in immune dysfunction in sepsis by monitoring the phenotype and function of periphery NK cells in patients with sepsis. Methods A retrospective study was conducted. The patients with systemic inflammatory response syndrome(SIRS,n=59)or sepsis(n=65)admitted to Department of Critical Care Medicine of Anhui Provincial Hospital from August 2011 to August 2013 were enrolled. Blood samples were collected within 48 hours after intensive care unit(ICU)admission,the phenotype and function of periphery NK cells were determined by flow cytometry. Twenty-eight healthy people served as controls. Results The proportion and number of peripheral blood CD3-CD56+NK cells in SIRS and sepsis groups were normal,and no statistical difference was found when compared with those of the healthy control group〔cell proportion:0.102±0.019,0.102±0.108 vs. 0.106±0.018,F=0.018,P=0.982;cell number(×106/L):182.46±65.98, 172.97±63.51 vs. 179.25±60.44,F=0.349,P=0.706〕. It was shown by NK cell degranulation detection that there was no significant difference in the expression of CD107 and interferon-γ(IFN-γ)secretion〔CD107:0.135±0.050,0.140±0.058,0.128±0.070,F=0.583,P=0.560;IFN-γ(kU/L):14.36±4.74,12.49±4.21, 13.45±5.04,F=1.616,P=0.202〕among healthy control group,SIRS group,and sepsis group. It was shown by antibody dependent cytotoxic effect(ADCC)test that there was no difference in the expression of CD107 among healthy control group,SIRS group,and sepsis group(0.574±0.166,0.643±0.165,0.581±0.157,F=0.808,P=0.448). When compared with healthy controls,the secretion of IFN-γwas increased in SIRS patients(kU/L:40.5±13.2 vs. 28.4±9.6,P=0.001),while reduced in sepsis patients(kU/L:19.8±6.7 vs. 28.4±9.6,P<0.01). Compared with SIRS group,only NK cell surface inhibitory receptors CD158e(KIR 3DL1)expression in sepsis group was significantly increased(0.203±0.057 vs. 0.079±0.021,t=15.762,P<0.001),and there were no significant differences in the other phenotype between the two groups. Compared with SIRS group,the IFN-γproduction of the sepsis group was significantly lowered(kU/L:0.280±0.040 vs. 0.310±0.038,t=3.390,P=0.009),and the level of IL-12 was also significantly decreased(ng/L:0.15±0.03 vs. 0.30±0.08,t=32.832,P<0.001). Conclusion It was showed by NK cell phenotype and function assay that the function of NK cells in patients with sepsis was impaired and led to a poor production of IFN-γ. The IFN-γmediated immune dysfunction may be a main reason for the disorder of NK cell function,which laid the foundation of the clinical immune intervention practice to improve to NK cell function.
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Objective To study the diagnostic accuracy of bedside lung ultrasound examination in chronic obstructive pulmonary disease (COPD) and cardiac pulmonary edema.Methods A prospective pilot and single-blind trial was conducted.A total of 89 patients with respiratory failure admitted to the Department of Critical Care Medicine of Anhui Provincial Hospital from September 2012 to September 2013 were enrolled.There were 32 patients with COPD,31 patients with cardiac pulmonary edema,8 patients with interstitial lung disease,12 with lung infection,and 6 patients with other diseases.Another group of 30 patients without respiratory disease were enrolled as the control group.Bedside lung ultrasound examinations were performed in all patients within 24 hours,and chest radiograph was performed at the same time.The signs to be revealed were the A lines or horizontal lines arising from the pleural line,and the comet-tail artifact (B lines) arising from the lung wall interface.Results Of 89 patients,33 patients were shown a mean of 2.94 ± 1.87 A lines per case with the bedside lung ultrasound,and 38 patients with a mean of 3.27 ± 1.72 B lines per patient.1.94 ± 0.96 A lines a case and 1.74 ± 0.82 B lines a case in control group.There were significant difference between the test group and control group (Aline:t=3.835,P=0.000; B line:t=6.540,P=0.000).Among 32 cases with COPD,28 patients had a positive result of A line with a coincidence rate of 81.2％.In the 31 patients with cardiac pulmonary edema,25 patients presented B line,with a coincidence rate of 80.6％.The A lines or horizontal lines arising from the pleural line showed a sensitivity of 81.30％ and a specificity of 87.70％ with a positive predictive value (PPV) 78.80％ and a negative predictive value (NPV) 89.30％ of in the diagnosis of COPD,and the B lines showed a sensitivity of 80.60％ and a specificity of 77.60％ with a PPV of 65.80％ and a NPV of 88.20％ in the diagnosis of cardiac pulmonary edema.However,X-ray examination showed a sensitivity of 65.50％,a specificity of 86.00％,a PPV of 72.40％ and a NPV of 81.70％ in the diagnosis of COPD,and it showed a sensitivity of 74.20％,a specificity of 69.00％,a PPV of 56.10％ and a NPV of 83.30％ in the diagnosis of cardiac pulmonary edema.Bedside ultrasound was highly consistent with X-ray in diagnosis of COPD [area under receiver operating characteristic curve (AUC):0.833 vs.0.816,P＞0.05],but Kappa value of ultrasound technology A line in the diagnosis of COPD was greater than the value of X-ray imaging techniques (0.685 vs.0.527).There was little diagnostic value of ultrasound A line in cardiac pulmonary edema (AUC was 0.305),while the B line was superior to X-ray (AUC:0.888 vs.0.747,P＜0.001),and had a higher Kappa value than the value of X-ray imaging techniques (0.553 vs.0.481) in cardiac pulmonary edema.Conclusions We conclude that bedside ultrasound is cost-effective,easy for repeated examination,and suitable for differential diagnosis of lung diseases.It might be useful in screening for COPD and cardiac pulmonary edema.
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Objective To establish mild cognitive dysfunction (MCI) models in elderly rats,and to investigate the pathophysiological features.Methods Totally 40 SD rats (14 to 18-month-old) were randomly divided into 2 groups:the model group (n=20) and the sham operation group (n=20).Bilateral carotid artery stenosis was prepared in the model group while bilateral carotid artery was seperated with no bilateral narrowing in the sham operation group.30 days after the operation,Morris water maze test was performed,pathomorphological and electron microscopic observations of the cerebral tissue were examined and the expression of G protein-coupled receptor kinase 2(GRK2) in hippocampus tissue w detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blottin.Results The mortality in model group was only 10％.Pathological morphology and ultrastructure showed that hippocampal tissue structure was almost normal in sham operated group,but in model group group,hippocampal CA1 pyramidal cells were in ischemic demyelination,arranged loose,and part of the cells showed nucleus pyknosis,deeply stained; there was no obvious infarct in white matter,part of the white matter fiher hecame thinner and disorder,nucleolus became smaller and steped aside,cytoplasmic electron density increased,lipofuscin appeared occasionally.Rough endoplasmic reticulum and Golgi were expanded,cytosolic free ribosomes increased,part of mitochondria became swelled,vacuolated.Morris water maze test results showed that the average escape latency in model group was longer than in sham group (P＜0.05).In spatial probe test,the average time of crossing the first original platform in model rats was significantly longer than the sham operated group [(36.80±7.68) s vs.(20.87±6.16)s,P＜0.05].The average number of crossing the original platform in 60 seconds in model group was significantly less than in sham group(1.43±0.51 vs.3.10±1.45,P＜0.05).The expressiones of GRK2 mRNA and protein in the hippocampus were significantly increased in model group rats than in sham group (P＜0.05).Conclusions The model of severe CCA stenosis in elderly rats can be applied for MCI animal models with good stability and repeatability.Compared with sham group,the cells morphology and ultrastructure in model group appeare more obvious pathological changes and mild impairments in cognitive function.GRK2 may play an important role in the development of MCI.
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Objective To analyze the clinical features and the effect of therapy on cutaneous emphysema of chest wall and/or pneumomediastinum complicated in severe acute triphosgene poisoning patients.Methods Among 81 triphosgene poisoning patients,5 complicated with cutaneousemphysema of chest wall and/or pneumomediastinum were analyzed in respect of the clinical data including age,gender,arterial blood gas (ABG),modes of mechanical ventilation support and so on.Results Five patients consisting of 3 males and 2 females,aged (23.20 ± 5.17) years,were complicated with cutaneous emphysema of chest wall and/or pneumomediastium with a prevalence rate of 0.06％.Of them,4 were alleviated completely and 1 died of acute respiratory distress syndrome (ARDS).There was no significant difference in arterial blood gas analysis (ABG) between patients with cutaneousemphysema and/or pneumomediastinum and patients without ( P ＞ 0.05 ).Conclusions Triphosgene-induced acute lung injury treated with mechanical ventilation support with high PEEP is highly suggested as high risk factor for the formation of cutaneous emphysema of chest wall and/or pneumomediastinum in severe acute Triphosgene poisoning patients.It is very important to set the PEEP level of mechanical ventilation support as low as possible for avoidance of alveolar rupture.
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Objective To study the effects of pulse high volume hemofiltration (PHVHF) on the changes of Th17 cells (T helper 17 cells) and CD4 + CD25 + reguratory T cells (Treg cells) in peripheral blood of patients with sepsis and to evaluate the clinical value of this intervention. Methods The patients were included in this prospective study as per the criteria of sepsis set by America Chest Physicians College/America Society for Critic Care Medicine in 1992. The patients were excluded: ① immune system disorder, ② acute stroke, ③ myocardial infarction, ④ virus hepatitis,⑤ human immunodeficiency virus infection, ⑥ under immunosuppressive therapy. Forty patients (24 males, 16 females, aged from 25 to 75years) with sepsis in ICU were enrolled from January. 2008 to November. 2010. According to the severity of disease, the patients were divided into three groups; moderate sepsis group (n = 14, 8 males, 6 females) , severe sepsis group (n = 15, 9 males, 6 females) , and septic shock group (n = 11, 7 males, 4 females). The initially clinical data of three groups were comparable. Twenty healthy individuals served as controls. According to the mode of treatment, forty patients were also divided into two groups: conventional treatment group (group A, n= 15) in which patients were treated without PHVHF within 5 days after admission and trial group (group B, n=25) in which patients were treated with pulsed high volume hemofiltration (PHVHF) within 5 days after admission. In group B, high volume hemofiltration (70 mL · kg-1 · h-1) was given to patients for 6 ～ 8 hours, and then conventional continuous vein - vein hemofiltration (35 mL · kg-1 · h-1) for 16 ~ 18 hours. The total length of period for continuum blood scavenging was 24 hours as one cycle. The interval between two cycles of blood scavenging was 24 hours. The changes of Th17 cells and CD4+ CD25 + Treg cells of 40 patients were detected with flow cytometry on the 1st day and the 5th day after admission. The data were analyzed by using SPSS version 13. 0 software. Measurement data were analyzed with Paired-samples t-test, independent-samples t-test or one way ANOVA . Ratio of small samples was compared with fisher's exact test, and the correlation was analyzed by using Pearson correlation analysis. Results The rates of Th17 cells were( 0.91 ±0.38)%, (2.09 ±0. 53)% , (3.90 ±0. 80)% , and ( 1. 85 ±0.35)% in control, moderate sepsis, severe sepsis, and septic shock groups, respectively, while the rates of CD4+ CD25+ Treg cells were (0.39 ±0.23)%, (1. 72 ±0. 59)% , (2.72 ±0. 22)% , and (3. 55 ±0. 51)% , respectively. The rate of Thl7 cells on the 1st day was higher in severe sepsis group than that in other two groups ( P 0. 05). Moreover , the rate of CD4+ CD25 + Treg cells was up - regulated on the 1st day in the following order from high to low: septic shock group > severe sepsis group > sepsis group (P < 0.05). The rates of Th17 cells and CD4 + CD25 + Treg cells in patients of group B decreased in greater degree than that did in patients of group A (P < 0.05 ). Conclusions The changes of Th17 cells and CD4 + CD25 + Treg cells may play an important role in pathogenesis of sepsis, and the pulsed high volume hemofiltration may be one of the effective treatments for the patients with sepsis by regulating the rates of Thl7 cells and CD4 + CD25 + Treg cells.
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Objective To investigate the effect of hyperbaric oxygen therapy on T-lymphocyte subpopulations in rats with acute pancreatitis. Methods 56 rats were randomly divided into three groups the sham group ( n = 8 ),control group( n = 24) and hyperbaric oxygen therapy group( treatment group, n = 24), then the control group and treatment groups were divided into three subgroups of 8 rats each undergoing euthanasia on days 1,3,7 after the acute pancreatitis induction. The CD4+ ,CD8+ subpopulations of T-lymphocytes in peripheral blood were detected respectively at the fist day and each day of the euthanasia. The sham group was used to make sure that the model was successfully induced. After euthanasia the pancrea was examined using electron microscopy. Results In the control group, the CD4+ cells in AP rats was significantly decreased and the ratio of CD4+/CD8+ also decreased. After 7days of HBO therapy,compared with the control group, the CD4+ lymphocytes of peripheral blood in the treatment group markedly increased( P ＜0.01 ). The CD8+ lymphocytes also increased to a certain extent. And the CD4+/CD8+ ratio of peripheral blood was obviously increased(P ＜0. 01 ). Also more severe pathological changes appeared in the untreated group than in the treatment group. Conclusion Hyperbaric oxygen therapy could improve the oxygen supply in acute panereatitis, regulate T cell immune function.
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OBJECTIVE To investigate the distribution of pathogenic bacteria and the status of drug resistance in intensive care unit(ICU) of Anhui Provinceical Hospital,to provide reference for rational use of the antibiotics in clinical practice and effective control of hospital infection.METHODS From Jan 2007 to Dec 2008,a total of 873 clinical isolates were collected from different samples of infective patients in ICU,drug sensitivity test was conducted based on disk diffusion testing(K-B),to analyze the drug resistance of the pathogenic bacteria.RESULTS The highest isolating rate came from the sample of respiratory tract,which was 68.96%.Among 873 clinical isolates,Gram-negative bacilli and Gram-positive cocci accounted for 65.95% and 19.22%,respectively.Gram positive cocci rised obviously in 2008 compared to 2007.The rate of bacterial drug resistance was relatively high,meticillin-resistant Staphylococcus aureus(MRSA) detection rate was 56.58%;The detection rates Escherichia coli and Klebsiella ESBLs were 75.00% and 57.41%.CONCLUSIONS There is a higher rate of infection for ICU patients,and the condition of drug resistance is serious.To strengthen the pathogen distribution and drug resistance monitoring is of great guiding significance for rational clinical use of drug,reducing multi-drug resistance and nosocomial infection control.
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Objective To investigate the protective effect of Gabexate mesilate(GM)on D-galactosamine- lipopolysaccharide-indneed acute liver failure in rats.Methods The model of acute liver failure in rats was produced by injection of D-galactosamine(D-GalN)and lipopolysaccharide(LPS).The alanine aminotransferase(ALT),aspartate aminotransferase(AST)in serum and malondiadehyde(MDA)content,superoxide dismutase(SOD)and glutathione peroxidase(GSH-PX)activities in liver homogenate were assayed by spectrophotometry.The levels of turnout necrosis factor-?(TNF-?),interleukin-?(IL-?)and interleukin-6(IL-6)were determined by ELISA method.Hepatic pathological examination was observed.Results 25 mg?kg~(-1),50mg?kg~(1),100 mg?kg~(-1) of GM significantly decreased the serum transaminase activities,the infiltration of inflammatory cells,and MDA content,hut didn't reduce SOD and GSH- PX activities in liver homogenate.GM significantly reduced TNF-?,IL-1?and IL-6 levels in serum.Conclusions GM showed significant protective effects on acute liver failure in rats.
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Objective To study the risk factors of severe acute pancreatitis(SAP) complicated with MODS at the early stage.Methods One hundred and seven SAP patients served as A group,who admitted from Janurary 1995 to December 1999.One hundred and thirty patients served as B group who admilted from Janurary 2000 to 2005.Age,sex,Ranson' score,APACHEⅡ ,CT score,biliary tract obstruction,hypoxia,lung infection,shock,abdomen compartment syndrome,hyperlipemia,pleural effusion,and mortality were analyzed.Results Twenty-five in the A group and 28 in B group two were complicated with MODS at the early stage.There existed difference in Ranson's score,APACHEⅡ,CT score between patients with and without MODS(P