The correlation between platelet parameters and acute rejection after renal transplantation / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the relationship between acute graft rejection early after renal transplantation and the variations of platelet parameters.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 167 renal transplant recipients before and within 2 months after the surgery. Before and at 1-10 days, 15 days, 30 days, 45 days and 60 days after the transplantation, 5 platelet parameters, including platelet count (PLT), platelet hematocrit (PCT), mean platelet volume (MPV), platelet volume distribution width (PDW), and large platelet ratio (P-LCR), were detected in the 35 patients with acute graft rejection within two months (AR group) and in the other 132 recipients with good graft recovery (control group).</p><p><b>RESULTS</b>The AR group and control group showed no significant difference in PLT, PCT, MPV, or P-LCR before the surgery, but the PDW was significantly higher in the AR group (t=2.18, P=0.035). These parameters were similar within 5 postoperative days between the two groups (P>0.05), but in postoperative days 6-15, the AR group showed significantly increased MPV, PDW and P-LCR compared with the control group (P<0.05). In postoperative days 6-9, MPV, PDW and P-LCR became stable in AR group but tended to decrease in the control group, showing obviously different patterns of variation between the two groups (P<0.05).</p><p><b>CONCLUSIONS</b>Preoperative PDW may have a positive correlation with acute graft rejection after renal transplantation. Monitoring the variations of MPV, PDW and P-LCR may help in the diagnosis of acute graft rejection early after renal transplantation.</p>

Clinical value of soluble triggering receptor expressed on myeloid cells-1 in early diagnosis and prognosis of ventilator-associated pneumonia / 中国感染与化疗杂志

Objective This study examined the value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1)in serum and exhaled ventilator condensate (EVC)in early diagnosis and prognosis of ventilator-associated pneumonia (VAP). Methods A total of 37 adult patients undergoing mechanical ventilation were evaluated after treatment,including 24 patients with infection,13 without infection.Of the 24 patients with infection,10 patients were assigned to ineffective subgroup and 14 to effective subgroup.Levels of sTREM-1 in serum and EVC were measured on days 1,3,5,and 7 for all patients.sTREM-1 in serum and EVC were determined in patients by double antibody sandwich enzyme-linked immunosorbant assay (DAS-ELISA).The early diagnostic and prognostic value was assessed by receiver operating characteristic (ROC)curve analysis.Re-sults On Day 1,the sTREM-1 levels in serum and EVC did not show significant difference between the three groups (P>0.05).On Day 3 and Day 5,the level of sTREM-1 in the infection group was higher than that in the non-infection group (P 0.05).For ROC analysis,area under the curve (AUC)of serum sTREM-1 was 0.897,and AUC of EVC sTREM-1 was 0.909 on Day 3.When the cut-off value of EVC sTREM-1 was set at 4.70 ng/mL on Day 3,the sensitivity was 85.8%,specificity was 92.3%.Conclusions The results suggest that the levels of sTREM-1 in serum and EVC are conducive to the early diagnosis of VAP.The levels of sTREM-1 in serum and EVC on Day 7 are helpful for estimating the prognosis.EVC sample is easier to collect than serum.

Continuous intra-tracheal gas insufflation during mechanical ventilation in juvenile piglets with acute lung injury induced by endotoxin / 中华急诊医学杂志

Objective To evaluate the effects of continuous intra-tracheal gas insufflation (TGI) during mechanical ventilation for protecting the juvenile piglets with acute lung injury (ALI) induced by endotoxin. Method Twelve healthy juvenile piglets were anesthetized and mechanically ventilated at 2 cmH2O PEEP with 10 cmH2O peak inspiration pressure. The piglets were challenged with lipopolysaccharide (LPS) and randomly (random number) assigned to two groups (n = 6 each): (1) piglets treated with mechanical ventilation alone (group MV) and (2) piglets treated with TGI by continuous airway flow of 2 L/min (group TGI). FiO2 was set at 0.4 to avoid oxygen toxicity, and the piglets were continuously monitored with an oxygen analyzer. Results Tidal volume, ventilation efficacy index and mean airway pressure were significantly improved in piglets of TGI group (P < 0.01 or P < 0.05). Four hours after ALI, pH decreased to below 7.20 in piglets of MV group, and was higher in piglets of TGI group (P < 0.01). Similarly, PaCO2 was stable and was significantly lower in piglets of TGI group than that in piglets of MV group (P < 0.01). PaO2 and PaO2/FiO2 increased in piglets of TGI group (P < 0.05). There were no significant differences in heart rate, respiraaatory rate, mean arterial pressure, central venous pressure, dynamic lung compliance and mean resistance of airway between two groups. Lung histopathological changes showed severe inflammation,and intra-alveolar hemorrhage and interstitial patchy hemorrhage were ameliorated and the lungs were more homogenously expanded in piglets of TGI group. Conclusions Continuous TGI during MV can significantly improve gas exchange and ventilation efficacy, and may provide a better treatment for acute lung injury.

Evaluation of exercise response in asthmatics: Impulse oscillometry in measurement of respiratory impedance / 中国组织工程研究

BACKGROUND:Traditionally, forced expiratory volume in one second (FEV1) was used to evaluate exercise response of patients with asthma; however, patients obviously had panting after exercise, so FEV1 was affected commonly. Impulse oscillometry (IOS) is a new technique for measuring respiratory impedance that do not require maximal inspiration and forced expiration.OBJECTIVE: To study airway resistance with IOS before and after exercise in healthy and asthmatic patients and investigate the significance of exercise excitation and IOS assessment.DESIGN: Synchronically non-randomized case contrast study.SETTING: Department of Respiratory Medicine, East Hospital Affiliated to Tongji University.PARTICIPANTS: A total of 14 male patients with bronchial asthma who were regarded as the asthmatic group were selected from Department of Respiratory Medicine of Shanghai East Hospital from January to October 2006. They were in a clinical stationary phase. Another 14 male healthy subjects were selected as the control group and ages of all subjects ranged from 29 to 50 years. All subjects provided the confirmed consent.METHODS: IOS was used to measure basic value of respiratory resistance, and then subjects underwent exercise challenge. Nose of subjects was clipped breathing through mouth. Within 3-4 minutes, heart rate was increased to 90% and maintained for 6 minutes during challenge. Respiratory resistance was repeatedly measured at 1, 5, 10, 15 and 20 minutes after exercise, including airway hyperresponse (AHR), total respiratory resistance, central resistance, peripheral resistance and resonance frequency at 5, 20 and 35 Hz of pulse frequency, elasrtic resistance and inertia resistance (X5 and X35) at 5 and 10 Hz of pulse frequency. In addition, difference of AHR at 5 and 35 Hz was calculated, and change ratios of both Rcentral and Rperipheral were calculated as (highest value after exercise-baseline value)/baseline value × 100%.MAIN OUTCOME MEASURES: Basic value of respiratory resistance by using IOS and exercise challenge test.RESULTS: All 14 patients with bronchial asthma and 14 healthy subjects were involved in the final analysis. Peripheral resistance (Rperiphera) was significantly higher than central resistance (Rcentral) in asthmatic patients (P ＜ 0.01). The maximal increase of respiratory impedance occurred from 5 minutes to 10 minutes after exercise in asthmatics. Resonance frequency (Fres) of asthmatics before and after exercise was significantly increased than that of controls (P ＜ 0.01).Change ratios of Fres from asthmatics were higher than that from control group (P ＜ 0.01). After challenge, R5, R5-R20,Zrespir and X5 from asthmatics changed significantly than that from controls (P ＜ 0.01). The increment change value of After exercise Zrespir increased significantly, because obstruction of small bronchi during expiration and impedance increased abruptly. Air trapping was expressed in VT-Zrespir graph in 57.1% patients. There was no difference in the VT-Zrespir graph of controls before and after exercise.CONCLUSION: The main site of airflow obstruction was in small airways in asthmatics after exercise challenge. The general acceptance of IOS method was good among the asthmatic patients. The airway response of exercise challenge may be assessed more accurately with IOS that do not require a maximal inspiration and forced expiration.

Operative treatment of hypertensive intracerebral hemorrhage / 中国基层医药

Objective To explore the effect of operative treatment of hypertensive intracerebral hemorrhage.Methods 386 cases with hypertensive intracerebral hemorrhage were retrospectively analysed,hematoma was removed through big bone flap and small skull window,or drainage and urokinase infusion with small hole puncture.Results 39 cases died(10.1%),according to ADI grade system:Ⅰ 106 cases(27.4%),Ⅱ 136 cases(35.2%),Ⅲ 50 cases(13%),Ⅳ 43 cases(11.1%),Ⅴ 12 cases(3.2%).Conclusion To increase the cure rate and life quality,and obtain a lower mortality,it is a key to do surgical operation such as microsurgery or drainage and urokinase infusion.

Analysis of the brain tumor operation in cerebello-pontine angle / 中国基层医药

Objective To discuss the microsurgery approaches and the prevention and treatment of complication about the tumors in cerebellopontine angle.Methods The 53 cases with cerebellopontine angle brain tumor were retrospectively analyzed.Results In all 53 patients,the tumor of 23 cases were full-resected,29 cases' tumor were resected more then 3/4,only one cases' tumor was partly treated.Following operation,one case died,5 cases had hearing decreasing,3 cases had severely facial nerve weakness and non hearing,10 cases had facial nerve anaesthesia,futhermore there was one case with long-period coma because of the injury of brain stem.Conclusion The important factors that decrease the complications of cerebellopontine angle tumor surgery include surgery approachs,operating experience and mechanism of complication.