Observational study on improvement of hypotension in hemodialysis with blood volume feedback control system / 中华肾脏病杂志

Objective:To study the effect of blood volume feedback control system on improving intradialytic-hypotension (IDH) in maintenance hemodialysis (MHD) patients.Methods:It was a prospective cohort study. Thirty MHD patients with recurrent IDH in the Dialysis Center of the First Affiliated Hospital of Zhejiang University School of Medicine from March 2021 to March 2022 were selected. A self-control study was conducted in MHD patients. The patients were treated with routine hemodialysis in both baseline phase (A1) and reversal phase (A2), while with hemodialysis under the blood volume feedback control system in intervention phase (B). Each phase lasted for 4 weeks (12 hemodialysis sessions). The average occurrences of IDH and IDH-related adverse events (IDH-RAE, stopping dehydration for more than 10 minutes or getting off the hemodialysis machine 10 minutes earlier due to IDH) of each patient between phase A1, B, and A2 were calculated and compared. In a total of 1 080 dialysis records, a logistic regression analysis model was established with age, sex and intervention as independent variables and with the occurrence of IDH-RAE as the outcome.Results:A total of 30 eligible patients were included in the study, including 14 males (46.7%) and 16 females (53.3%), aged 63.0 (56.5, 72.5) years old, with a median dialysis age of 84.0 (37.2, 120.0) months. The average times of IDH in 30 MHD patients decreased from 1.17 (0.83, 1.67) in stage A1 (before intervention) to 0.33 (0.25, 0.58) in stage B (after intervention) ( P<0.05). The frequency of IDH-RAE decreased significantly from 0.29 (0.19, 0.47) in stage A1 to 0.17 (0,0.25) in stage B ( P<0.05). Logistic regression analysis results indicated that the use of blood volume feedback control system reduced the risk of IDH-RAE by 53% ( OR=0.47, 95% CI 0.34-0.64, P<0.001). Conclusions:The application of blood volume feedback control system can effectively reduce the occurrences of IDH and the risk of IDH-RAE in MHD patients.

Application of our self-made Kirschner wire connecting rod in difficult extraction of intramedullary implants / 中华创伤骨科杂志

Objective:To report the application of our self-made Kirschner wire connecting rod combined with a conventional intramedullary nail extractor in difficult extraction of intramedullary devices.Methods:From January 2012 to August 2017, 10 patients with a hard-to-remove intramedullary device were treated at Department of Orthopaedics, The Fifth Hospital Affiliated to Xinjiang Medical University. They were 7 males and 3 females with a mean age of (40.0±9.0) years. In cases where no relevant extractor was available for the intramedullary device or it was impossible to connect the extractor connecting rod to the tail of the intramedullary device, the Kirschner wire was bent and pulled through the screw hole or the hole newly drilled at the tail of the intramedullary device to be tied or fixed with a conventional extractor connecting rod to form an effective connection. Next, our self-made Kirschner wire connecting rod was used to pull out the intramedullary device. In this cohort, 7 intramedullary nails in the tibia, 1 femoral intramedullary nail, 1 humeral intramedullary nail, and 1 tibial elastic nail were removed. The difficult extraction was due to "cold welding" of the tail cap of the intramedullary nail in 3 cases, mismatch between the screw rod of the extractor and the tail screw hole of the intramedullary nail in 4 cases, and unavailability of relevant removal tools in 3 cases. The time for intramedullary device removal, blood loss and postoperative adverse reactions were recorded.Results:Of this cohort, 9 patients underwent simple removal of the intramedullary device and 1 patient replacement of the intramedullary device. The total time for removal of an intramedullary device was (2.3±0.8) h, ranging from 1.0 to 3.2 h. The amount of blood loss was (159.0±61.0) mL, ranging from 80 to 250 mL. The follow-up was (14.5±2.2) months, ranging from 11 to 18 months. There was no infection or fracture associated with implant removal.Conclusion:Application of our self-made Kirschner wire connecting rod in combination with a conventional intramedullary nail extractor is an easy operation to successfully extract hard-to-remove intramedullary implants, requiring no more special instruments.

Cardiovascular Responses to Commonly Used Tests In and Outside of the Laboratory Settings

Several tests are available for assessing cardiovascular response to various interventions which may be given in the laboratory, or outside of it in the field. The tests are meant to excite or deactivate cardiovascular and other sensory receptors which signal the central mechanisms. They have been found useful in generating data to study cardiovascular effects on subjects exposed to specialized physical training (e.g., athletes), in the evaluation of people engaged in special occupations such as pilots, astronauts, and other military personnel, and in training undergraduate and postgraduate students. If the response does not fit into the physiological norm, it may reflect a temporary aberration, or a more serious defect in the cardiovascular control mechanism because of disease. Interpretation of data generated may vary between various operators/observers. Here, an attempt has been made to bring out responses of the cardiovascular system to the commonly used tests, and their applicability in clinical situations.

Effects of large-volume versus restrictive-volume fluid resuscitation on hemodynamics and prognosis in patients with severe acute pancreatitis / 中国基层医药

Objective:To explore the effect of large-volume versus restrictive fluid resuscitation on hemodynamics and prognosis in patients with severe acute pancreatitis (SAP). Methods:A total of 102 patients with severe acute pancreatitis who received treatment in The Second People's Hospital of Hefei, China between March 2018 and December 2020 were included in this study. They were randomly assigned to undergo large-volume fluid resuscitation (control group, n = 51) or restrictive-volume fluid resuscitation (study group, n = 51). Hemodynamic indexes, intra-abdominal pressure and pulmonary function were compared between the two groups before and after resuscitation. All patients were followed up for 28 days after admission and their prognosis was recorded. Results:At 12 and 24 hours of resuscitation, intrathoracic blood volume index, global end-diastolic volume index, cardiac index, and central venous pressure in the study group were significantly higher than those in the control group (all P < 0.05). At 6 hours of resuscitation, cardiac index and central venous pressure in the study group were (4.87 ± 0.48) and (11.04 ± 2.08), respectively, which were significantly higher than those in the control group [(4.53 ± 0.57), (9.48 ± 1.67), t = 3.25, 4.17, both P < 0.05). Before resuscitation, there was no significant difference in intra-abdominal pressure between the two groups ( P > 0.05). After resuscitation, intra-abdominal pressure in each group was significantly lower compared with that before resuscitation (both P < 0.05). After resuscitation, intra-abdominal pressure in the study group was significantly lower than that in the control group [(12.78 ± 2.35) cmH 2O vs. (15.01 ± 2.42) cmH 2O, t = 4.72, P < 0.05). Before resuscitation, there were no significant differences in PaO 2 and oxygenation index between two groups (both P < 0.05). After resuscitation, PaO 2 and oxygenation index in each group were significantly higher compared with those before resuscitation (both P < 0.05). After resuscitation, PaO 2 and oxygenation index in the study group were significantly higher than those in the control group ( t = 3.02, 5.55, both P < 0.05). The incidence of abdominal compartment syndrome and the incidence of invasive mechanical ventilation in the study group were 27.45% (14/51) and 35.29% (18/51), respectively, which were significantly lower than those in the control group [47.06% (24/51), 56.86% (29/51), χ 2 = 4.19, 4.77, both P < 0.05). There were no significant differences in the incidence of multiple organ dysfunction syndrome, acute renal injury, abdominal drainage rate, mortality between the two groups (all P > 0.05). Conclusion:Compared with large-volume fluid resuscitation, restrictive-volume fluid resuscitation can better improve hemodynamic indexes and pulmonary function, greatly decrease intra-abdominal pressure, and improve prognosis in patients with severe acute pancreatitis.

Application effect of severe ultrasound combined with extravascular lung water and intrathoracic blood volume in volume management of mechanical ventilation / 中国医师进修杂志

Objective:To explore the application effect of critical ultrasound combined with extravascular lung water (EVLW) and intrathoracic blood volume (ITBV) on volume management of mechanically ventilated patients.Methods:From May 2017 to January 2020, 98 patients treated with mechanically ventilated admitted to Hebei Petro China Central Hospital were selected and divided into two groups by random number table method, with 49 cases in each group. Both groups were treated with fluid resuscitation, the control group was guided by central venous pressure (CVP) and the observation group was guided by critical ultrasound combined with EVLW and ITBV. The acute physiology and chronic health score Ⅱ(APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores, hemodynamic indexes, respiratory system indexes , urine output and fluid intake at 6 h and 24 h after resuscitation and mechanical ventilation time, ICU stay, complications and prognosis were compared between the two groups.Results:The scores of APACHE Ⅱ and SOFA in the observation group at 6 h and 24 h after resuscitation were lower than those in the control group: 6 h after resuscitation: (22.02 ± 4.29) scores vs. (23.94 ± 3.56) scores, (10.02 ± 3.11) scores vs. (11.64 ± 2.30) scores; 24 h after resuscitation: (19.66 ± 2.85) scores vs. (21.78 ± 3.60) scores, (7.64 ± 2.15) scores vs. (9.83 ± 2.07) scores, the differences were statistically significant ( P<0.05). The mean arterial pressure (MAP) and CVP in the observation group at 6 h and 24 h after resuscitation were higher than those in the control group: 6 h after resuscitation: (69.44 ± 5.25) mmHg(1 mmHg=0.133 kPa) vs. (65.98 ± 4.33) mmHg, (13.64 ± 2.30) mmHg vs. (11.89 ± 3.07) mmHg; 24 h after resuscitation: (72.89 ± 4.69) mmHg vs. (69.26 ± 5.53) mmHg, (13.07 ± 2.15) mmHg vs. (11.89 ± 3.07) mmHg; the heart rate was lower than those in the control group: 6 h after resuscitation: (98.58 ± 9.32) bpm vs. (105.03 ± 8.76) bpm; 24 h after resuscitation: (94.97 ± 8.46) bpm vs.(101.44 ± 7.34) bpm, the differences were statistically significant ( P<0.05). The central venous oxygen saturation (ScvO 2) and oxygenation index (OI) in the observation group at 6 h and 24 h after resuscitation were higher than those in the control group: 6 h after resuscitation: 0.749 ± 0.043 vs. 0.711 ± 0.047, (258.18 ± 20.75) mmHg vs. (234.66 ± 25.42) mmHg; 24 h after resuscitation: (77.68 ± 4.09)% vs. (73.54 ± 4.23)%, (376.29 ± 22.39) mmHg vs. (234.66 ± 25.42) mmHg; the blood lactic acid was lower than that in the control group: 6 h after resuscitation: (3.04 ± 0.52) mmol/L vs. (4.22 ± 0.39) mmol/L; 24 h after resuscitation: (1.01 ± 0.34) mmol/L vs. (1.87 ± 0.41) mmol/L, the differences were statistically significant( P<0.05). The urine output at 6 h and 24 h in the observation group was higher than that in the control group: 6 h after resuscitation: (0.49 ± 0.08) ml/(kg·h) vs. (0.35 ± 0.06) ml/(kg·h); 24 h after resuscitation:(0.54 ± 0.05) ml/(kg·h) vs. (0.42 ± 0.07) ml/(kg·h); the fluid intake was lower than that in the control group: 6 h after resuscitation: (1 230.2 ± 562.3) ml vs. (1 782.4 ± 534.7) ml; 24 h after resuscitation: (3 065.5 ± 521.2) ml vs. (3 642.0 ± 507.8) ml; the mechanical ventilation time, and ICU stay in the observation group were lower than those in the control group: (3.3 ± 0.9) d vs. (5.0 ± 0.7) d, (9.7 ± 2.1) d vs. (10.9 ± 1.8) d, the differences were statistically significant ( P<0.05). There was no significant differences in complication rate and 28-day survival curve between the two groups ( P>0.05). Conclusions:Critical ultrasound combined with EVLW and ITBV has a good application effect on volume management of patients with mechanical ventilation, which can help maintain hemodynamic stability, improve oxygenation status.

Application of multiple post labeling delay time arterial spin labeling imaging in the quantitative blood flow analysis of brain subregions in healthy adults / 中华内科杂志

Objective:To explore the normal ranges of perfusion parameters between cerebral hemisphere, cerebellar hemisphere and brain anatomical subregions (56 pairs) in different gender and age groups with multiple post labeling delay time (Multi-PLD) arterial spin labeling (ASL) imaging.Methods:From November 2020 to December 2020, 42 healthy adult volunteers (Male 25, Female 17) were recruited to perform 7 PLD ASL imaging, including 21 young adults (15 males and 6 females, aged 23—35 years) and 21 seniors (10 males and 11 females, aged 36—74 years). The data was processed offline by Cereflow software to obtain arterial arrival time (ATT) and corrected cerebral blood flow (CBF) and cerebral blood volume (CBV) perfusion parameters. SimpleITK standardization function was used to standardize the calculated perfusion image according to the anatomical automatic labeling (AAL) template. Therefore, CBF, ATT, CBV perfusion values of brain subregions were obtained. Paired samples t test, Wilcoxon rank sum test, independent samples t test and Mann-Whitney U test were used to compare the differences of perfusion parameters in the cerebral hemisphere, the cerebellar hemisphere, brain subregions depending on side, gender and age. Pearson correlation analysis was used to compare the correlations of perfusion parameters with age. Results:CBF in 62.5% (35/56) subregions and CBV in 44.6% (25/56) subregions were higher in right side than those in left side. ATT in most brain anatomical subregions (16/56) were higher in left side. The CBF [(35.30±8.31) vs. (34.34±7.53) ml·100g -1·min -1, P=0.021], CBV [(0.47±0.11) vs. (0.45±0.09) ml/100g, P<0.001], ATT [(1.30±0.10) vs. (1.24±0.11) s, P<0.001] in left cerebellar hemisphere were higher than that of right side. The CBF (28/56) of cerebral hemisphere, cerebellar hemisphere and brain subregions was higher in females than that in males, while ATT in 83.9% (47/56) subregions was lower than that in males (all P<0.05). CBV in female subjects was higher only in 5 brain regions (superior occipital gyrus, middle occipital gyrus, inferior occipital gyrus, superior parietal gyrus and cerebelum_7b) (all P<0.05). In young subjects, CBF in 44.6% (25/56) subregions and CBV in 33.9% (19/56) subregions were higher than those in the senior group (all P<0.05). The ATT in most subregions in young group were lower than those in senior group, but the difference was statistically significant only in rectus gyrus ( P=0.026) and paracentral lobule ( P=0.006). The CBF ( r=-0.430, P=0.005) and CBV ( r=-0.327, P=0.035) of cerebral hemisphere were negatively correlated with age. The CBF (24/25, r range:-0.497 —-0.343, all P<0.05) and CBV (16/19, r range:-0.474 —-0.322, all P<0.05) in most subregions were negatively correlated with age, while ATT was positively correlated (gyrus rectus: r=0.311, P=0.045; paracentral lobule: r=0.392, P=0.010). Conclusions:Multi-PLD ASL imaging could be applied for quantitative analysis of brain perfusion. The perfusion parameters of anatomical subregions are different depending on side, gender, and age.

Normal ranges and Z-scores analysis of the normal fetal umbilical vein diameter, blood volume flow and normalized volume blood flow in the second and third trimesters of pregnancy / 中华超声影像学杂志

Objective:To explore the method of ultrasonography for detecting the fetal umbilical vein diameter, blood flow volume and normalized volume blood flow and establish normal reference ranges with umbilical vein diameter, blood flow volume and normalized blood flow and Z-scores for umbilical vein diameter and blood volume flow.Methods:This was a prospective study on 907 normal fetuses in the Second Xiangya Hospital, Central South University and Women and Children Healthcare Hospital of Zhuzhou from March 2019 to December 2020. The umbilical vein diameter (Duv), umbilical vein blood flow volume (Quv) and normalized volume blood flow (nQ = Quv/estimated fetal weight) of the free loop of umbilical vein (FUV) and fetal intra-abdominal umbilical vein (IUV) were collected. And the mean values and 90% confidence intervals of Duv, Quv and nQ in two segments of umbilical veins at different gestational ages were calculated. Regression analysis of Duv, Quv and nQ were performed with gestational age (GA), and the parameters of umbilical vein in different segments were compared. Finally, with gestational age (GA) as the independent variable, Z-scores of the Duv and Quv were built.Results:The mean values and 90% confidence intervals of Duv, Quv, and nQ in 858 (94.6%) normal fetal umbilical veins were successfully obtained. The Duv, Quv of the FUV and IUV increased as pregnancy progressed. The Quadratic curve of Duv and Linear curve of Quv were of the highest fitnesses, respectively( r=0.951, 0.941, 0.986, 0.982; all P<0.001). While nQ increased with GA followed by a decreased trend, and the Quadratic curve was the highest fitting curve of nQ( r=0.610, 0.611; all P<0.001). Duv-FUV was greater than Duv-IUV( P<0.001), nQ-FUV was bigger than Quv-IUV( P=0.001), and he difference was not statistically significant between Quv-FUV and Quv-IUV( P=0.133). Z-scores models of Duv and Quv were successfully established, and all Z-scores were Gaussian distribution. Conclusions:The normal ranges and Z-scores of umbilical vein parameters are useful to improve the evaluation of placental circulation and provide a strong basis for the monitoring of fetus-related diseases and the evaluation of pregnancy prognosis. The choice of FUV or IUV umbilical vein to evaluate placental circulation may depend on the actual situation in clinical application.

Effects of biofeedback dialysis mode of blood volume monitoring on cardiac function in the maintenance hemodialysis patients with intra-dialytic hypotension / 中国医师杂志

Objective:To discuss the effects of biofeedback dialysis mode of blood volume monitoring on cardiac function in the maintenance hemodialysis (MHD) patients with intra-dialytic hypotension (IDH).Methods:40 patients who underwent maintenance hemodialysis in Suzhou Hospital Affiliated to Nanjing Medical University from September 2018 to December 2020 and had IDH for many times were selected. They were divided into standard dialysis (SHD) group and biofeedback dialysis mode of blood volume monitoring (BVM) group, with 20 cases in each group. In the first 12 weeks of the first stage, the patients in both groups were treated with standard dialysis, and in the second 12 weeks, they were treated with maintenance hemodialysis according to standard dialysis and biofeedback dialysis mode of blood volume monitoring. The incidence of IDH and the changes of blood pressure before and after dialysis, body weight, ultrafiltration volume, B-type brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), left ventricular posterior wall thickness (LVPW), inlet ventricular septal defect (IVSD), mitral valve flow spectrum E/A value (E/A) and left ventricular mass index (LVMI) were observed.Results:(1) In the second stage of treatment, the number of IDH requiring nursing intervention in BVM group was significantly lower than that in SHD group ( P<0.05). (2) The difference of blood pressure change in BVM group during the second stage of treatment was significantly lower than that in the first stage and SHD group ( P<0.05). (3) In the second stage of treatment, the ultrafiltration volume of patients in BVM group was significantly higher than that in the first stage, and the BNP and body weight were significantly lower than that in the first stage (all P<0.05). However, the body weight, BNP and ultrafiltration volume of patients in SHD group had no significan change in the two stages of treatment (all P>0.05). (4) After treatment, the LVID, LVPW, IVSD and LVMI in BVM group were significantly lower than those before treatment, and LVEF and E/A were significantly higher than those before treatment (all P<0.05). However, there was no significant change in echocardiographic indexes in SHD group before and after treatment (all P>0.05). Conclusions:The biofeedback dialysis mode of blood volume monitoring can significantly reduce the occurrence of IDH, and this dialysis mode can effectively improve the cardiac function of MHD patients with hypotension.

Effects of intravenous thrombolysis with alteplase on immune function and quality of life in patients with cerebral infarction / 中国基层医药

Objective:To investigate the effects of intravenous thrombolysis with alteplase on immune function and quality of life in patients with cerebral infarction.Methods:Sixty-nine patients with cerebral infarction who received treatment in Rizhao Central Hospital, China between January 2014 and January 2019 were included in this study. They were randomly assigned to receive either intravenous thrombolysis with urokinase (control group, n = 34) or intravenous thrombolysis with alteplase (observation group, n = 35). Therapeutic efficacy and cerebral blood perfusion, immune function and quality of life before and after treatment were evaluated. Results:Effective rate in the observation group was significantly higher than that in the control group [82.86% (29/35) vs. 58.82% (20/34), χ2 = 4.840, P < 0.05]. After treatment, the transit time and peak time in the ischemic area in the observation group were (131.25 ± 25.41) seconds and (99.52 ± 17.50) seconds respectively, which were significantly shorter than those in the control group [(165.33 ± 31.05) seconds, (108.45 ± 12.52) seconds, t = 6.580, 3.215, both P < 0.05). The cerebral blood flow and cerebral blood volume in the observation group were (72.51 ± 21.35) mL/100 mg and (95.36 ± 31.25) mL/100 mg, respectively, which were significantly higher than those in the control group [(62.42 ± 19.35) mL/100 mg, (84.20 ± 28.05) mL/100 mg, t = 2.712, 2.243, both P < 0.05). After treatment, the proportion of CD 8+ cells in the observation group was significantly lower than that in the control group [(25.37 ± 3.73)% vs. (27.42 ± 3.25)%, t = 4.261, P < 0.05]. The proportions of CD 3+, CD 4+, CD 3-CD 16+CD 56+ cells in the observation group were (56.32 ± 6.57)%, (34.69 ± 3.44)%, (13.34 ± 3.75)%, respectively, which were significantly higher than those in the control group [(53.32 ± 4.05)%, (31.69 ± 3.72)%, (11.28 ± 3.06)%, t = 5.395, 3.694, 4.179, P < 0.05]. After treatment, the scores of all dimensions of Short Form 36 Health Status Questionnaire in the observation group were significantly higher than those in the control group (all P < 0.05). Conclusion:Intravenous thrombolysis with alteplase is superior to intravenous thrombolysis with urokinase in the treatment of cerebral infarction because it can better improve immune function and quality of life.

Prehospital Damage Control: The Management of Volume, Temperature… and Bleeding! / Control de Daños Prehospitalario: ¡Para Los Cristaloides, Para La Hipotermia Y…! ¡Para El Sangrado!

Abstract Damage control resuscitation should be initiated as soon as possible after a trauma event to avoid metabolic decompensation and high mortality rates. The aim of this article is to assess the position of the Trauma and Emergency Surgery Group (CTE) from Cali, Colombia regarding prehospital care, and to present our experience in the implementation of the "Stop the Bleed" initiative within Latin America. Prehospital care is phase 0 of damage control resuscitation. Prehospital damage control must follow the guidelines proposed by the "Stop the Bleed" initiative. We identified that prehospital personnel have a better perception of hemostatic techniques such as tourniquet use than the hospital providers. The use of tourniquets is recommended as a measure to control bleeding. Fluid management should be initiated using low volume crystalloids, ideally 250 cc boluses, maintaining the principle of permissive hypotension with a systolic blood pressure range between 80- and 90-mm Hg. Hypothermia must be management using warmed blankets or the administration of intravenous fluids warmed prior to infusion. However, these prehospital measures should not delay the transfer time of a patient from the scene to the hospital. To conclude, prehospital damage control measures are the first steps in the control of bleeding and the initiation of hemostatic resuscitation in the traumatically injured patient. Early interventions without increasing the transfer time to a hospital are the keys to increase survival rate of severe trauma patients.

Resumen La resucitación en el control de daños debe iniciarse lo más rápido posible después de presentado el evento traumático para evitar descompensación metabólica y aumento de la mortalidad. El objetivo de este artículo es sustentar nuestro enfoque respecto a la atención prehospitalaria y presentar nuestra experiencia en la implementación de la iniciativa "Stop the Bleed" en Latinoamérica. La atención prehospitalaria es la fase Cero de la resucitación del control de daños. Por medio de la implementación de la iniciativa "Stop the Bleed" se identificó que el personal prehospitalario tiene una mejor percepción sobre el uso de técnicas hemostáticas como el torniquete que el personal hospitalario. Se recomienda el uso de torniquetes como medida de control de sangrado en extremidades. El manejo de líquidos debe realizarse usando cristaloides a bajos volúmenes, con bolos de 250 mL para cumplir el principio de la hipotensión permisiva con un rango entre 80 y 90 mm Hg de presión arterial sistólica. Se deben realizar medidas para evitar la hipotermia como el uso de sábanas térmicas o paso de líquidos calientes. Estas medidas no deben retrasar en ningún momento el tiempo de traslado para recibir la atención hospitalaria. En conclusión, la atención prehospitalaria es el paso inicial para garantizar las primeras medidas de control de sangrado y de resucitación hemostática de los pacientes. Realizar intervenciones tempranas sin acortar el tiempo de traslado a la atención hospitalaria son las claves para aumentar la tasa de supervivencia.

Characteristics of blood pressure fluctuation in hemodialysis patients with insufficient effective blood volume and comparison with blood pressure at the beginning of hemodialysis / 中国综合临床

Objective@#To explore the clinical symptoms of effective blood volume deficiency caused by ultrafiltration in hemodialysis patients with chronic renal failure, and to analyze the changes of blood pressure during the formation of symptoms.@*Methods@#From October 2016 to February 2019, 146 patients with maintenance hemodialysis were selected from the Yangquan coalmine group General Hospital for 39 658 hemodialysis.There were 3527 cases of clinical symptoms of definable hypovolemia.The characteristics of clinical symptoms in the early stage of dialysis (>0-≤60 min), medium (>60-≤180 min) and late (>180-≤240 min) were analyzed.To define the hypotension, hypertension and maintenance blood pressure in dialysis, and to count the incidence of various blood pressure when clinical symptoms appear.The mean arterial pressure (mean arterial pressure, MAP) measured at the onset of the disease was compared with (MAP) at the onset of dialysis, and the evolution of (MAP) was classified.The dialysis interval weight gain≥5% or<5%, was counted for the onset of the condition caused by dialysis ultrafiltration.To analyze the clinical symptoms of hemodialysis caused by ultrafiltration speed and excess.@*Results@#The incidence of clinical symptoms was 8.9% (3527/39658). The clinical symptoms caused by the insufficiency of effective blood volume are manifested in each period of dialysis, and have the characteristics of disease.Blood pressure index can not accurately reflect the correlation of clinical symptoms.There were 493 cases of effective blood volume deficiency during dialysis >0-≤60 min.Among them, 341 cases of hypotension, accounting for 69.1% (341/493), 79 cases of hypertension, accounting for 16.1% (79/493), 73 cases of maintaining blood pressure, accounting for 14.8% (73/493). The incidence of clinical symptoms was increased when dialysis was >60-≤180 min, which was related to continuous or excessive ultrafiltration.There were 1306 cases in total, including 1003 cases of hypotension, accounting for 76.8% (1003/1306); 179 cases of hypertension, accounting for 13.7% (179/1306); 124 times of maintaining blood pressure, accounting for 9.5% (124/1306). Dialysis>180-≤240 min is the high incidence period of clinical symptoms, which is related to continuous ultrafiltration and exceeding the setting of dry body mass.There are 1728 cases in total, including 1408 cases of hypotension, accounting for 81.5% (1408/1728); hypertension is reduced, but there are still cases of stubborn hypertension.When the clinical symptoms of hypovolemia occurred, 1989 cases were hypotension, which was easy to attract clinical attention; 763 cases were hypotension, which was stable before the clinical symptoms appeared, and then the blood pressure dropped suddenly; 446 cases were significantly higher than before the clinical symptoms appeared, which made it difficult to judge the clinical symptoms; 329 cases maintained the blood before the dialysis pressure.Excessive water retention in the whole process of dialysis has clinical symptoms, the total number of times increased significantly.The incidence of common water retention was less than that of dialysis>180-≤240 min.The osmotic pressure of plasma colloid and crystal affects the refilling of plasma, the change of ultrafiltration mode and the change of dialysis temperature on blood pressure and blood volume.@*Conclusion@#Because of the characteristics of the disease and the particularity of the treatment, the hemodialysis ultrafiltration process is prone to the related clinical symptoms caused by insufficient effective blood volume.However, the occurrence of clinical symptoms is not synchronous with the change of blood pressure.To improve the understanding of clinical symptoms of insufficient blood volume, to achieve early detection and early treatment is conducive to the safe treatment of follow-up hemodialysis and better completion of ultrafiltration target value.

Hypotonic enteral electrolyte solutions administered by nasoesophageal tube in continuous flow in dogs dehydrated by water restriction: Part 1 / Soluções eletrolíticas enterais hipotônicas administradas por sonda nasoesofágica em fluxo contínuo em cães desidratados por restrição hídrica: Parte 1

The present study assessed and compared the effects of hypotonic enteral electrolyte solutions administered by nasoesophageal tube in continuous flow in dogs submitted to water restriction on packed cell volume; total serum protein and serum osmolarity concentrations; blood volume; plasma glucose and lactate levels; blood gas analysis, anion gap, and strong ion difference. Six adult dogs were used (four males and two females). All animals were submitted to both proposed treatments in a crossover design 6×2. The treatments were as follows: ESmalt consisting of 5g sodium chloride, 1g potassium chloride, 1g calcium acetate, 0.2g magnesium pidolate, and 9.6g maltodextrin that were diluted in 1.000mL water (measured osmotic concentration of 215mOsm L−1) and ESdext consisting of 5g sodium chloride, 1g potassium chloride, 1g calcium acetate, 0.2g magnesium pidolate, and 9.6g dextrose that were diluted in 1.000mL water (measured osmotic concentration of 243mOsm L−1). All solutions were administered at 15ml kg−1 h−1 for 4 hours. Both solutions increased the plasma volume in dehydrated dogs without causing adverse effects. However, ESmalt was more effective in promoting the increase in blood volume.(AU)

O presente estudo avaliou e comparou os efeitos de soluções eletrolíticas enterais hipotônicas, administradas por sonda nasoesofágica em fluxo contínuo em cães submetidos a restrição hídrica, sobre o hematócrito, proteínas totais séricas, osmolaridade sérica, volemia, glicose e lactato plasmáticos, hemogasometria, ânion gap e DIF. Foram utilizados seis cães adultos (quatro machos e duas fêmeas). Todos os animais foram submetidos aos dois tratamentos propostos, em um delineamento crossover 6×2. Os tratamentos foram os seguintes: SEmalt - 5g de cloreto de sódio, 1g de cloreto de potássio, 1g de acetato de cálcio, 0,2g de pidolato de magnésio e 9,6g de maltodextrina, diluídos em 1.000mL de água (osmolaridade mensurada: 215mOsm L -1 ); SEdext - 5g de cloreto de sódio, 1g de cloreto de potássio, 1g de acetato de cálcio, 0,2g de pidolato de magnésio e 9,6g de dextrose, diluídos em 1.000mL de água (osmolaridade mensurada: 243mOsm L -1 ). Todas as soluções foram administradas no volume de 15mL kg -1 hora -1 , durante quatro horas, em fluxo contínuo. Ambas as soluções aumentaram o volume plasmático em cães desidratados, sem gerar o aparecimento de efeitos adversos. Porém, a SEmalt foi mais eficaz em promover a expansão da volemia.

Normal Reference Plots for the Bioelectrical Impedance Vector in Healthy Korean Adults

BACKGROUND: Accurate volume measurement is important in the management of patients with congestive heart failure or renal insufficiency. A bioimpedance analyser can estimate total body water in litres and has been widely used in clinical practice due to its non-invasiveness and ease of results interpretation. To change impedance data to volumetric data, bioimpedance analysers use equations derived from data from healthy subjects, which may not apply to patients with other conditions. Bioelectrical impedance vector analysis (BIVA) was developed to overcome the dependence on those equations by constructing vector plots using raw impedance data. BIVA requires normal reference plots for the proper interpretation of individual vectors. The aim of this study was to construct normal reference vector plots of bioelectrical impedance for Koreans. METHODS: Bioelectrical impedance measurements were collected from apparently healthy subjects screened according to a comprehensive physical examination and medical history performed by trained physicians. Reference vector contours were plotted on the RXc graph using the probability density function of the bivariate normal distribution. We further compared them with those of other ethnic groups. RESULTS: A total of 242 healthy subjects aged 22 to 83 were recruited (137 men and 105 women) between December 2015 and November 2016. The centers of the tolerance ellipses were 306.3 Ω/m and 34.9 Ω/m for men and 425.6 Ω/m and 39.7 Ω/m for women. The ellipses were wider for women than for men. The confidence ellipses for Koreans were located between those for Americans and Spaniards without overlap for both genders. CONCLUSION: This study presented gender-specific normal reference BIVA plots and corresponding tolerance and confidence ellipses on the RXc graph, which is important for the interpretation of BIA-reported volume status in patients with congestive heart failure or renal insufficiency. There were noticeable differences in reference ellipses with regard to gender and ethnic groups.

Evaluation of the use of tranexamic acid in total knee arthroplasty / Avaliação do uso do ácido tranexâmico em artroplastia total do joelho

ABSTRACT Objective: Evaluate the efficacy of tranexamic acid in reducing bleeding in patients undergoing total knee arthroplasty. Methods: 101 patients were randomized into two groups: the tranexamic acid group (n = 51) and the placebo group (n = 50). Patients were compared regarding the following parameters: reduction of hemoglobin, total estimated blood loss, drain output, and postoperative blood transfusion rate. Results: Comparing the groups, there were statistically significant differences (p < 0.05) in the following parameters: reduction of hemoglobin, decreased hematocrit, estimated blood loss, and drain output. All values were lower in the tranexamic acid group. Only placebo group patients required blood transfusion. Conclusion: The use of intravenous tranexamic acid is effective to reduce bleeding in patients undergoing total knee arthroplasty.

RESUMO Objetivo: Avaliar a eficácia do ácido tranexâmico na redução do sangramento em pacientes submetidos a artroplastia total de joelho. Métodos: Foram randomizados 101 pacientes em dois grupos: grupo ácido tranexâmico (n = 51) e grupo placebo (n = 50). Os pacientes foram comparados nos quesitos redução da hemoglobina, perda sanguínea total estimada, débito do dreno e taxa de hemotransfusão pós-operatória. Resultados: Na comparação entre os grupos, observou-se diferença estatística (p < 0,05) nos seguintes parâmetros: redução da hemoglobina, redução do hematócrito, perda sanguínea estimada e débito do dreno. Todos os valores foram menores no grupo do ácido tranexâmico. Somente pacientes do grupo placebo necessitaram de hemotransfusão. Conclusão: O uso de ácido tranexâmico intravenoso é eficaz para reduzir o sangramento dos pacientes submetidos a artroplastia total de joelho.

Correlation Between Blood Volume And Amplitude Of Qrs Complex In Young Healthy Individuals

Background Hemodynamic instability following trauma is perhaps the commonest cause of loss of life. The standard vital signsused to determine hemodynamic status are static measurements rather than dynamic, and may not truly reflect early volume loss. The Brody effect proposes a direct relationship between the QRS complex voltage and ventricular blood volume, a theory which has been supported by both human and animal studies. Aim To correlate blood volume and amplitude of QRS complex. Material and Methods Lead II ECG was recorded for 1 min in 56 healthy adult male volunteers (20–40 years) using the student Physiograph(Bio Devices). The amplitude of the largest QRS complex was measured in µV. Blood volume (in litres) was calculated by Nadler’s method using height and weight. RESULTS: Blood volume showed positive correlation with QRS amplitude.

Hemodinámica funcional: ¿Qué significa "ser respondedor"? / Functional hemodynamics: "Be responsive, what does this mean"?

The conventional analysis and approach to the physiology of the fluid responsiveness has traditionally been focused mainly on the physiology of heart-lung interactions, and on reviews of the technical, methodological, and epidemiological aspects of the dynamic parameters, which are translated into simple algorithms to assess fluid responsiveness and to guide fluid therapy.However, fundamental features of the dynamics of the peripheral circulation, heart-vasculature interaction, and blood volume distribution, are overlooked and sometimes not accounted for, motivating misconceptions about the cardiovascular system's response to fluid administration and fluid management, such as equating fluid loading with cardiac preload, a predictable interpretation whenever Starling's ventricular function curve is analyzed in isolation. This paper reexamines fluid responsiveness' rationale offering a broadened perspective on the circulatory phenomena involved in the physiological interaction between BV, cardiac preload and output, and stroke volume variation. Finally, implications relevant in physiological and clinical terms are discussed.

El análisis convencional y abordaje actual de la fisiología de la "respuesta a fluidos" (RF) ha estado focalizada principalmente sobre la fisiología de la interacción cardiopulmonar, y sobre aspectos técnicos, metodológicos y, epidemiológicos de los parámetros dinámicos, los cuales son traducidos en algoritmos simplificados para evaluar la RF y guiar la fluidoterapia. Sin embargo, aspectos fundamentales de la dinámica de la circulación periférica, el acoplamiento entre el corazón y la vasculatura, y la distribución del volumen sanguíneo son frecuentemente omitidos, motivando mal interpretaciones sobre la respuesta del sistema cardiovascular a la administración de fluidos, tal como equiparar la carga de fluidos con la precarga ventricular, una consecuencia predecible al interpretar la curva de función ventricular (Starling) de forma aislada. Así, esta revisión reexamina la rationale de la RF, ofreciendo una perspectiva ampliada sobre aquellos fenómenos circulatorios implicados en la interacción entre el volumen sanguíneo, la precarga ventricular, el gasto cardíaco y la variación del volumen sistólico. Finalmente, se analizarán las implicancias prácticas y conceptuales.

The Influence of Different Levels of Cardiorespiratory Fitness on Exercise Performance 24 Hour Post Blood Donation in Male Donors

@#Introduction: Haematological parameters decrease following one unit of whole blood donation which results in a detrimental effect on cardiorespiratory fitness and maximal exercise capacity. However, it remains unclear to what extent blood donation will impact exercise performance across varying levels of cardiorespiratory fitness. The aim of this study is to compare the effects of a standard blood donation on maximal exercise performance performed 24 h post-blood donation in individuals with varying levels of cardiorespiratory fitness. Methods: Forty-two males (mean age 22 ± 2.1 years) were recruited and segregated into Low, Moderate and Superior fitness groups. Subjects performed a multi-stage shuttle run test on the day prior to a standard blood donation procedure, and subsequently 24 h post-blood donation. Blood samples were taken on both test days and analysed for haematological parameters. Results: Exercise performance, represented by predicted VO2max were 0.6%, 1.0% and 4.1% lower in the Low, Moderate and Superior fitness groups respectively. However, the magnitude of reduction was only statistically significant in the Superior fitness group (p = 0.017). Compared to baseline, all fitness groups demonstrated significant reductions in haematocrit (Low: -8.4%, Moderate: -9.1%, Superior: -7.2%) and haemoglobin (Low: -7.6%, Moderate: -7.8%, Superior: -5.5%) levels at 24 h post-blood donation. Spearman correlation analysis revealed that changes in haemoglobin concentrations were not associated with changes in exercise performance in all groups. Conclusion: Exercise performance was only significantly reduced in the Superior fitness group. Well-trained individuals should be refrained from blood donation just prior to competitions.

Cerebral Blood Volume Magnetic Resonance Imaging

Cerebral blood volume (CBV) is a hemodynamic correlate of oxygen metabolism and changes due to neuronal activity. CBV alteration may precede other hemodynamic correlates and provide an early indication of hemodynamic impairment. CBV can be easily quantified using magnetic resonance imaging (MRI); moreover, CBV MRI has a strong point of high resolution compared to other neuroimaging modalities. The early and accurate assessments of cerebral metabolism and the brain map with the high resolution of CBV MRI enable advanced neurorehabilitation examinations in a neuroimaging study.

Effect of progressive early bed exercise on blood flow in lower limb of patients on mechanical ventilation in intensive care unit / 中华危重病急救医学

Objective To investigate the effect of progressive early bed physical activity on blood flow in lower limb of patients on mechanical ventilation in intensive care unit (ICU). Methods Adult patients with mechanical ventilation ≥ 72 hours admitted to ICU of the Affiliated Hospital of Zunyi Medical University from February 22nd to November 30th, 2016 were enrolled. The patients were randomly divided into experimental group and control group by random number table method. Patients in the two groups were given the same basic treatment, including antibiotics, analgesia and sedation, mechanical ventilation, nutritional support, and routine ICU activities such as maintaining functional position of limbs and raising of bed head. On the basis of those, the experimental group was given early bed physical activity with gradual enhancement of grades Ⅰ-Ⅲ according to the nerve, circulation and respiration situations, such as passive/active exercise of the bicycle, straight leg lifting exercise, etc. The exercise intensity was evaluated with target heart rate, and the exercise was performed for 15-30 minutes at a time, twice a day. The control group was given intermittent pneumatic compression (IPC), 30 minutes in each time, twice a day. Mean blood flow and blood volume were measured before and immediately, 5, 10 and 15 minutes after intervention on the 3rd day. Heart rate and blood pressure were measured at 5 minutes before intervention, during 5 minutes, and 5, 10, 15, 30 minutes after intervention on the 3rd day. Results 214 adult patients were selected, after excluding the patients who died during the intervention or gave up treatment, 160 patients were included in the data analysis, with 81 in the experimental group and 79 in the control group. The mean blood flow velocity and blood volume were increased in both groups, and the mean blood flow velocity and blood flow volume in the experimental group were significantly increased and lasted longer than those in the control group [mean blood flow velocity (mm/s) of the experimental group were 11.92±1.06, 18.19±0.17, 17.24±0.14, 15.48±0.12, 12.68±0.16, and that of the control group were 12.01±1.41, 15.65±0.18, 12.91±0.14, 12.13±0.12, 11.59±0.16, respectively, the time effect was F = 1 043.101, P = 0.000, the intervention effect was F = 151.001, P = 0.000, and the interaction effect between intervention and time was F = 224.830, P = 0.001; the blood volume (mL/min) of the experimental group were 3.39±0.96, 5.59±0.11, 5.16±0.12, 4.19±0.10. 3.35±0.09, and that of the control group were 3.28±0.82, 4.04±0.11, 3.40±0.12, 3.02±0.10, 3.00±0.10, respectively, the time effect was F = 680.405, P = 0.000, the intervention effect was F = 125.359, P = 0.000, and the interaction effect between intervention and time was F = 79.631, P = 0.012]. The heart rate and blood pressure of the two groups of patients in the course of intervention were increased first, then decreased and then slowly recovered to the change trend before intervention, but the index of the experimental group fluctuated greatly [heart rate (bpm) of the experimental group were 97.64±1.50, 113.91±1.36, 105.96±1.34, 98.52±1.48, 97.84±1.46, 97.54±1.48, and that of the control group were 97.03±1.57, 105.39±1.38, 96.76±1.35, 96.54±1.50, 97.22±1.48, 96.53±1.49, respectively, the time effect was F = 235.030, P = 0.000, the intervention effect was F = 39.473, P = 0.000, and the interaction effect between intervention and time was F = 3.494, P = 0.063; the systolic blood pressure (mmHg, 1 mmHg = 0.133 kPa) of the experimental group were 118.57±1.06, 133.05±1.01, 120.44±1.10, 117.78±1.07, 117.65±1.01, 118.14±1.00, and that of the control group were 118.10±1.08, 126.68±1.02, 118.23±1.11, 117.48±1.08, 118.04±1.03, 118.90±1.10, respectively, the time effect was F = 336.604, P = 0.000, the intervention effect was F = 26.350, P = 0.000, and the interaction effect between intervention and time was F = 0.948, P = 0.332; the diastolic blood pressure (mmHg) of the experimental group were 68.07±0.72, 72.79±0.73, 70.68±0.74, 69.30±0.72, 68.73±0.74, 67.80±0.73, and that of the control group were 68.51±0.73, 72.03±0.74, 70.05±0.75, 69.10±0.73, 68.41±0.75, 67.85±0.74, respectively, the time effect was F = 286.390, P = 0.000, the intervention effect was F = 4.812, P = 0.000, and the interactive effect between intervention and time was F = 0.055, P = 0.815]. Conclusions The effects of progressive early bed physical activity on the mean blood flow velocity and blood volume of lower limbs in ICU patients with mechanical ventilation are better than those of IPC. Although the fluctuation of heart rate and blood pressure is large, it does not cause any harm to the patients.

Systemic pathologic physiology parameters changes in sheep drowning: a control study in freshwater and seawater / 中华危重病急救医学

Objective To compare the systemic pathologic physiology parameter changes in sheep drowning in freshwater and seawater. Methods The experimental animals were healthy crossbred sheep. According to the envelope method, 24 sheep were randomly divided into two groups, with 12 animals in each group. The animals in both groups were subjected to mechanical ventilation and analgesia and sedation, the drowning models were reproduced by injecting 10-25 mL/kg of seawater or freshwater into the endotracheal tube of animals. The changes in hemodynamics before drowning, immediately after drowning (immediately after water injection) and 30, 60, and 120 minutes after drowning in both groups were recorded. The urine color changes after drowning and occurrence time were recorded. The animals were sacrificed at 120 minutes after drowning, and heart, kidney, liver, spleen and intestine were harvested for pathological observation under light microscope using hematoxylin and eosin (HE) staining. Results ① The changes in systemic hemodynamic: there was no significant difference in hemodynamics before drowning between the two groups.Compared with before drowning, heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), left ventricular maximum systolic force index (dPmax), and pulmonary wedge pressure (PAWP) immediately after drowning in both seawater and freshwater groups were significantly increased, which showed a decrease tendency with drowning time prolongation. Compared with drowning immediately, dPmax at 30 minutes after freshwater drowning was significantly decreased (mmHg/s: 919.83±14.51 vs. 2 628.42±59.75, P < 0.01), which was below the level before drowning till 120 minutes. CO at 30 minutes after freshwater drowning was retreated as compared with drowning immediately, but it was still higher than that before drowning (L/min: 8.25±0.66 vs. 5.75±0.73, P < 0.01). Global end-diastolic volume (GEDV) and PAWP at 120 minutes after freshwater drowning were decreased to the level before drowning [GEDV (mL): 642.92±7.29 vs. 638.25±7.00, PAWP (mmHg, 1 mmHg = 0.133 kPa): 5.83±1.19 vs. 5.42±1.08, both P > 0.05]. Compared with immediately after drowning, MAP, CO and PAWP at 30 minutes after seawater drowning were significantly lowered [MAP (mmHg): 90.50±3.58 vs. 159.42±3.18, CO (L/min): 2.37±0.45 vs. 10.33±0.73, PAWP (mmHg): 4.17±0.72 vs. 11.75±1.82, all P < 0.01], which were lower than those before drowning till 120 minutes. After drowning for 30 minutes, MAP, CO and PAWP in seawater group were significantly lower than those in freshwater group [MAP (mmHg): 90.50±3.58 vs. 117.42±1.78, CO (L/min): 2.37±0.45 vs. 8.25±0.66, PAWP (mmHg): 4.17±0.72 vs. 24.83±1.27], dPmax was significantly increased (mmHg/s: 1 251.42±62.50 vs. 919.83±14.51, all P < 0.01), and the tendency continued till 120 minutes. There was no significant difference in HR at all the time points between the two groups. ② The changes in urine: after freshwater drowning, the animals had hemoglobinuria and lasted until the end of the experiment, and the time of hemoglobinuria occurrence was at 20-35 minutes after drowning with an average of (25.30±5.15) minutes. After seawater drowning, the change in urine was not found until the end of the experiment.③ The variations of each organ tissue in pathology and hematology at 120 minutes after drowning: after freshwater drowning, the systemic tissue edema was found in organs such as heart, kidney, liver, spleen, and small intestine. After seawater drowning, there were different degrees of edema in the systemic organs, and some of them shrank. Conclusions After freshwater drowning, the animals showed decreased dPmax, increased CO and blood volume, edema and hemolysis of the tissue cells. After seawater drowning, CO and blood volume decreased, and some tissue cells were in atrophy.