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Objective To investigate the effect of esmolol on myocardial apoptosis and cardiac function in rats with sepsis .Meth‐ods Ninety six SD rats were randomly divided into sham group (n= 32 ,for sham operation) ,sepsis group (n= 32 ,sepsis model) and treatment group (n= 32 ,intravenous infusion with esmolol after sepsis modeling) .At 3 h ,6 h ,12 h ,24 h after operation ,sam‐ples were conserved to measure serum cardiac troponin I (cTnI) ,caspase‐3 ,cardiomyocytes apoptosis index ,and myocardial patho‐morphology was observed by optical microscope .At 24 h after operation ,echocardiography was performed .Results The serum cT‐nI ,caspase‐3 ,cardiomyocytes apoptosis index were increased significantly in sepsis group and treatment group compared with sham group (all P< 0 .05) .After using esmolol ,cTnI and cardiomyocytes apoptosis index were relatively decreased in treatment group compared with sepsis group at the four time‐points(all P < 0 .05) .Caspase‐3 of treatment group decreased at 12 h after operation compared with sepsis group (P< 0 .05) .Treatment group had a higher LVEF than sepsis group at 24 h(P< 0 .05) .Conclusion Es‐molol could inhibit myocardial apoptosis and mitigate the damage of cardiac function in rats with sepsis .The decrease in caspase‐3 may be the mechanism of anti‐apoptosis .
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Objective To investigate the effects of Sini decoction on function of hypothalamic-pituitary-adrenal axis in patients with sepsis.Methods A prospective single-blind randomized controlled trial was conducted.60 septic patients were divided into three groups with the method of random number table,20 cases in the control group,20 in the Chinese herb group,and 20 in corticoid group.All of them received routine treatment.Patients in Chinese herb group were given Sini decoction in addition (decoction of monkshood 15 g,dried ginger 15 g,honey-fried licorice 10 g) 100 mL/d orally or by nasal feeding,while patients in corticoid group were given hydrocortisone 200 mg/d intravenously instead,both for 7 days.Before the treatment,3 days and 14 days after treatment,blood was collected to determine the levels of adrenocorticotropic hormone (ACTH) and cortisol,and the result of ACTH stimulating test was observed.At the same time,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was recorded,and 3-day shock recovery rate and 28-day death rate were also compared among these groups.Results None of the three groups showed different result in ACTH stimulating test (x2=1.101,P=0.605).ACTH in three groups was gradually decreased.Compared with that before treatment,ACTH in Chinese herb group and corticoid groups began to decrease obviously on day 3 (ng/L:29.90 ± 3.31 vs.33.10 ±.3.31,28.20 ±.2.45 vs.33.30 ± 3.84,both P＜0.01),while in control group declined ACTH appeared later (on day 14) compared with before treatment (ng/L:29.40 ±5.63 vs.33.50 ±4.89,P＜0.05).No obvious difference in ACTH level was showed between the Chinese herb group and the cortical group (both P＞0.05).Cortisol level in both Chinese herb and cortical groups showed a raise-fall biphase trend while there was no change in the control.The cortical levels on day 3 in Chinese herb and cortical groups were much higher than that before treatment (μg/L:343.04 ± 31.20 vs.294.70 ±42.10,331.25 ±42.80 vs.280.36 ± 38.10,both P＜0.01) and that of control group (μg/L:291.61 ± 41.50,both P＜0.01),though no significant statistical difference was observed between two groups (both P＞0.05).APACHE Ⅱ score on day 14 in control,Chinese herb and cortical groups was significantly lower than that before treatment (16.8 ± 5.1 vs.20.1 ± 4.3,13.4 ± 3.2 vs.18.3 ± 3.8,15.1 ± 2.5 vs.19.5 ± 4.0,all P＜0.01),and the score was much lower in Chinese herb group comparing with that of control group (P＜0.05).No statistical difference was observed among control,Chinese herb and cortical groups in lowering 28-day death rate [35.0％ (7/20),25.0％ (5/20),20.0％ (4/20)] and improving 3-day shock recovery rate [40.0％ (8/20),70.0％ (14/20),60.0％ (12/20),all P＞0.05].Conclusions Sini decoction could elevate cortisol while lower ACTH at the early stage of sepsis.Sini decoction could also effectively improve symptoms and hypothalamic-pituitary-adrenal axis function in septic patients without affecting death rate.
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Objective To observe the interfering effect of different doses of penehyclidine hydrochloride (PHC) on the mRNA expressions of nuclear factor kappa B (NF-κB) and inducible nitric oxide synthase (iNOS) in the lung tissue of rats with traumatic shock so as to investigate the protective role of PHC in secondary long injury following traumatic shock and the underlying mechanism.Methods The traumatic shock model was established.A total of 104 Wistar rats were randomly divided into four groups:control group,shock group,low dose PHC group ( P1 group) and high dose PHC group ( P2 group).At the beginning of resuscitation,the rats in P1 and P2 groups were given transjugular intravenous injection of 2 ml/kg isotonic saline containing 0.15 mg/kg and 0- 45 mg/kg PHC respectively,while the rats in shock and control groups were injected only isometric isotonic saline.The rats in the four groups were killed at 2 h,6 h,12 h and 24 h after resuscitation respectively to detect the mRNA expressions of NF-κB and iNOS by using RT-PCR and determine the lung wet/dry weight (W/D) ratio,lung permeability index (LPI) and lung injury score (LIS).Results The mRNA expressions of NF-κB and iNOS,lung W/D ratio,LPI and LIS at all the time intervals in the shock,P1 and P2 groups were all significantly increased as compared with those in the control group (P＜0.05).Howerver,the P2 group showed significant reduction in aspects of the mRNA expressions of NF- κB and iNOS,lung W/D ratio,LPI and LIS at all time points and P1 group also had significant decrease regarding the mRNA expressions of NF-κB and iNOS,lung W/D ratio at2 h,6 h,and LPI and LIS at 2 h,6 h,12 h,as compared with the shock group.Meanwhile,P2 group showed evident decrease at 6 h concerning the mRNA expressions of NF-κB and iNOS,lung W/D ratio,LPI and LIS as compared with P1 group (P ＜ 0.05 ).Conclusions PHC,especially at a large dosage,can significantly mitigate the long injury secondary to traumatic shock,and the mechanism may be associated with the inhibition of mRNA expressions of NF-κB and iNOS.
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Objective To develop a tool capable of early and exactly predicting various outcomes in comatose survivors who restore spontaneous circulation after cardiopulmonary resuscitation (CPR) and validate its performance.Methods Variables that were both readily available and predictive of outcomes were identified by systematically reviewing published literature on resuscitation.A value was assigned to these variables.We used these variables in combination with APACHE Ⅱ/score to devise a multifactorial prediction score system,which we called PRCSs Prognostication Score (PRCSs-PS).Outcomes in 115 hospitalized comatose survivors after CPR were retrospectively reviewed using PRCSs-PS.Score of patients with different outcomes was compared.The area under the receiveroperating characteristic (ROC) curve was determined to evaluate performance of this tool to identify patients with a poor outcome (CPC4 and 5) and other outcomes (CPC1,2,and 3).Results There were differences of PRCSs-PS score among multiple groups with five different outcomes (CPC1-5)(F=65.91,P=0.000).Pairwise groups with different CPC were compared:no significant difference was noted between CPC 1 and CPC2 (12.41±6.49 vs 17.38±6.91,P=0.092),but difference between other pairwise CPC groups was statistically significant (CPC2 vs CPC3:17.38±6.91 vs 24.50±5.80,P=0.041,CPC3 vs CPC4:24.50±5.80 vs 32.29±5.24,P=0.006).The performance of PRCSs-PS to discriminate patients with a poor outcome from patients with other outcomes went as follows:it had 100% sensitivity,78.6% specificity,and 178.6 diagnostic index at the score cut-off22.5; it had 77.8% sensitivity,100% specificity and 176.4 diagnostic index at the score cut-off32.5.Score 23 and 33 were two key cut-offpoints.The area under the ROC curve was 0.968,showing excellent discrimination.Conclusions The final outcomes in post-resuscitation comatose survivors can be accurately predicted using PRCSs-PS Score.
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Objective To explore the clinic value of sequential severity evaluation in emergency nursing for stroke patients. Methods 138 of stroke patients were enrolled in study group, which completed sequential severity evaluation in emergency medical and nursing provision drawn up according to the results. Another 207 of stroke patients were enrolled in control group, which emergency nursing provision drawn up according to general procedure. Length of time from emergency call to special therapeutic, mortality compared between the two groups respectively. Results In study group, length of time from emergency call to special therapeutic (48.9?34.1) min was significantly shorter than that of control group (73.1?46.7) min; mortality (11.1%) was significantly lower than that of control group (24.3%),cure rate (34.7%) was significantly higher than that of control group (26.9%). Conclusion Sequential severity evaluation in acute nursing may be a worthy procedure for proving reaction ability of nurse reaction ability in emergency medical and nursing, proving outcome for stroke patients and it should be commended.
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<p><b>OBJECTIVE</b>To investigate changes in renal function, urine N-acetyl-beta-D-glucosaminidase enzyme (N-AG),liver function, myocardial enzymes, the pathology of renal damage and the mechanism of acute renal failure (ARF) associated with fish gall bladder poisoning.</p><p><b>METHODS</b>Eleven patients with acute fish gall bladder poisoning were consecutively admitted to our hospital from September 1997 to October 1999. Renal function, urine N-AG enzyme, liver function, and myocardial enzymes were assayed before and after treatment. One patient consented to a kidney biopsy and the pathology of renal damage was observed under light and electron microscopes.</p><p><b>RESULTS</b>All patients had multiple organ dysfunction syndrome (MODS) and 11 patients suffered from ARF. Ten patients had liver dysfunction, ten patients had poisonous myocarditis, and 8 patients had gastrointestinal dysfunction. Renal function, urine N-AG enzyme, liver function, and myocardial enzymes were significantly improved after treatment compared with those of before treatment (P < 0.05). Kidney biopsy showed that the main damage site was the proximal renal tubule. All eleven patients recovered and were discharged from the hospital.</p><p><b>CONCLUSIONS</b>Ingestion of fish gall bladder leads to kidney damage, as well as liver, heart and gastrointestinal tract injury. The mechanism of acute renal function failure is the serious tubular damage, confirming the location of kidney damage. Necrosis of the proximal tubules plays an important role in the development of ARF. Immediate hemodialysis is the most effective treatment.</p>