ABSTRACT
Portal hypertension (PH) is a commonly seen complication of chronic liver disease and is a direct cause of decompensated cirrhosis. Early diagnosis of PH is essential for the treatment and prognosis of liver cirrhosis. Hepatic venous pressure gradient (HVPG) is the gold standard for the diagnosis of PH, but its invasiveness limits its use. At present, progress has been achieved on the noninvasive diagnostic techniques and of which the serological indicators are simple for use, including inflammatory mediators, vasoactive substances, extracellular matrix (ECM) components and their circulating degrading products. This article reviewed the advances in research on serological assessment of PH.
ABSTRACT
Objective To analyze the relationship between the optic nerve sheath diameter (ONSD) and the scoring of Glasgow Coma Scale(GCS)or CT score(Rotterdam CT score or Helsinki CT score).Methods Sixty-three adult patients with traumatic brain injury in our emergency room were enrolled.All the patients were presented with the data of GCS and the classification of cranial CT,as well as ONSD measured by ultrasound.The correlation between ONSD and classification of cranial CT scores or GCS was analyzed by Spearman correlation analysis.Patients were divided into mild group,moderate group and severe group based on GCS or CT scores.One-way Analysis of Variance (ANOVA) was used to discover the difference in mean ONSD among different groups on account of scoring of GCS or cranial CT scores.The intergroup comparisons were analyzed by the least-significant-difference (LSD) tests.Results ONSD measurements were strongly correlated with GCS(r=-0.540,P＜0.01)or classification of Rotterdam CT scores (r=0.654,P＜0.01) and Helsinki CT scores (r=0.663,P＜0.01).The mean ONSD of the mild,moderate and severe group were (3.89±0.70)mm,(4.50±0.65)mm and (4.81±0.72) mm,respectively.The mean ONSD of the mild group was significantly shorter than that of severe group (P＜0.01) and moderate group(P＜0.05).The same results were found when comparing mean ONSDs among different groups classified by Rotterdam CT scores (low group (3.74±0.64)mm vs.middle group (4.3 l±0.73)mm vs.high group (5.09±0.57)mm,P＜0.01 or P＜0.05) or classified by Helsinki CT scores (low group (3.54±0.61)mm vs.middle group (4.46±0.73)mm vs.high group (5.16±0.37)mm,P＜0.01.Conclusions Ultrasonography used to measure ONSD is significantly correlated with both GCS and classification of head CT including Rotterdam CT score and Helsinki CT score.The results indicate that ultrasonography measurement of ONSD is helpful for early bedside assessment in patients with traumatic brain injury.
ABSTRACT
Portal hypertension is a common complication of chronic liver diseases and is responsible for most of the clinical consequences of cirrhosis.Accurate assessment of portal venous pressure is essential for the designing of treatment strategy and judging of prognosis.Measurement of hepatic venous pressure gradient (HVPG) is the gold standard for evaluating portal venous pressure, however, it is an invasive procedure and is hard to be performed routinely in clinical practice.Therefore, it is urgent to explore a noninvasive method for assessing portal venous pressure.Recent evidence highlights that biochemical parameters, transient elastography, CT, MRI and the conjoint analysis model of multiple parameters have the potential diagnostic value.This article reviewed the advances in study on noninvasive assessment of portal venous pressure.
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Objective To investigate the feasibility and efficiency of monitoring noninvasive respiratory effort and respiratory load-capacity ratio in patients undergoing weaning from mechanical ventilation by mean inspiratory pressure(Pi) which were calculated on the basis of the formula, Pi = 5 × P 0.1 × Ti, as well as the noninvasire tension index calculated from Pi(TTIi). Method Totally 12 patients undergoing weaning from mechanical ventilation were enrolled in the study and their underlying diseases included COPD( n = 9), ARDS( n = 2) and status asthmaticus(n = 1) respectively. Esophageal pressure(PesoM) was monitored via the insertion of esophageal balloon and corrected esophageal pressure(Peso) was acquired by subtracting elastic pressure of chest wall from PesoM. P 0.1, Maximal inspiratory pressure on esophageal pressure curve(MIPeso) and on airway pressure curve(MIPaw) was measured with conventional technique. Pi was calculated on Pi = 5 × P 0.1 × Ti. Pi and MIPaw were used to calculate the noninvasive tension-time index TTIi, whereas Peso and MIPeso were used to calculate the invasive counterpart TTIeso. Comparisons, Correlation and Bland-Altman agreement analysis were made between P0.1 and Peso as well as between TIIi and TTIeso. Results There were no significant differences between Pi and Peso as well as between TTIi and TTIeso(P > 0.05) ,and the correlation coefficients were 0.974 and 0.957 respectively. In the agreement analysis, the mean difference between Pi and Peso, and between TTIi and TTIeso were lower than the minimal values of(Peso + PiSB )/2 and of(TIIi + TTIeso)/2, respectively. Conclusions There is a good correlation between Pi and Peso as well as between TTIi and TTIeso, in which Pi is calculated calculated from P 0.1 and in turn the TTIi is calculated from Pi. The noninvasive indices including Pi and TTIi can be used to monitor respiratory effort and respiratory load-capacity in patients undergoing weaning from mechanical ventilation.