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Objective:To evaluate the autogenous arteriovenous fistula(AVF) insufficiency by ultrasound monitoring of brachial artery resistance index(RI).Methods:The brachial artery RI and blood flow volume(FV) data of 828 patients who underwent color-Doppler ultrasound detection after AVF in the General Hospital of Western Theater Command from January 2019 to June 2021 were retrospectively analyzed. The patients were grouped according to the adequacy of clinical dialysis, including 668 patients in the group with normal AVF function and 160 patients in the group with insufficient AVF function. The general information and ultrasonic measurement parameters were compared between the two groups. The correlation between brachial artery FV and RI was analyzed. The evaluation of brachial artery flow RI for AVF insufficiency was analyzed by ROC curve.Results:There were statistically significant differences between the two groups in brachial artery RI and FV(both P<0.001). The results of Pearson correlation analysis showed that brachial artery FV was negatively correlated to RI ( r=-0.657, P<0.001). The area under ROC curve for assessing AVF function by brachial artery RI was 0.970, with 95% CI was 0.955-0.986, the optimal cut-off value was 0.665, and the sensitivity and specificity were 0.888 and 0.955, respectively. Conclusions:Brachial artery RI in patients with AVF insufficiency is significantly higher than that in patients with normal AVF function. The optimal cutoff value of brachial artery RI can be used as an evaluation parameter for rapid screening of AVF function.
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Objective:To explore the application value of uterine artery blood flow ultrasound parameters in evaluating the prognosis of threatened abortion during early pregnancy.Methods:In this non-randomized controlled prospective clinical study, 108 women with threatened abortion during early pregnancy (6-12 weeks of pregnancy) who received treatment in the Health Community Group of Yuhuan Second People's Hospital from July 2021 to December 2022 were included in the observation group. An additional 108 healthy women who were at the early stage of pregnancy were selected for the control group. Color Doppler ultrasound was performed in both groups to measure the ultrasonic parameters of uterine artery blood flow (peak systolic/end diastolic flow velocity, resistance index, pulsatility index) and compare their differences. The pregnant women in the observation group were followed up until 28 weeks of gestation, and their prognosis was analyzed. The pregnant women who had successfully insured their babies were included in the good prognosis group, and the pregnant women who had aborted their babies were included in the poor prognosis group. The ultrasonic parameters of uterine artery blood flow in the two groups were compared. Logistic regression analysis was used to analyze the correlation between ultrasound parameters of uterine artery blood flow and poor prognosis.Results:In the observation group, the systolic peak/end diastolic flow velocity, resistance index, and pulsatility index on the left side were (6.46 ± 1.71), (0.97 ± 0.30), (2.72 ± 0.89), respectively, and they were (6.49 ± 1.70), (0.96 ± 0.32), (2.70 ± 0.91) respectively on the right side, which were significantly greater than (3.90 ± 1.02), (0.64 ± 0.17), (1.36 ± 0.54), (3.91 ± 1.04), (0.62 ± 0.18), (1.35 ± 0.52) in the control group ( t = 13.36, 9.95, 13.58, 13.45, 9.62, 13.39, all P < 0.001). Twenty-eight-week follow-up results showed that 72 women (66.67%) in the observation group had successfully insured their babies and 36 women (33.33%) had aborted their babies. In the good prognosis group, the systolic peak/end diastolic flow velocity, resistance index, and pulsatile index were (7.95 ± 1.89), (1.22 ± 0.36), (3.06 ± 0.95) on the left side, and they were (7.45 ± 1.94), (1.24 ± 0.37), and (3.03 ± 0.96) on the right side, which were significantly greater than (4.72 ± 1.27), (0.77 ± 0.24), (1.74 ± 0.69), (4.74 ± 1.32), (0.75 ± 0.25), (1.77 ± 0.70) in the poor prognosis group ( t = 10.53, 7.73, 8.23, 8.55, 8.14, 7.76, all P < 0.001). Logistic regression analysis showed that peak systolic/end diastolic flow velocity and resistance index were risk factors for poor prognosis of threatened abortion during early pregnancy, while the pulsatility index had no significant correlation with poor prognosis of threatened abortion during early pregnancy. Conclusion:Uterine artery blood flow ultrasound parameters have a certain predictive value for the prognosis evaluation of threatened abortion during early pregnancy, which can provide an important reference for clinical fetal protection treatment and benefit the prognosis of pregnant women.
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Objective:To investigate the predictive value of serum cystatin C (Cys-C) and renal artery resistance index (RRI) 24 h before coronary CT angiography (CTA) examination in contrast-induced nephropathy(CIN).Methods:Sixty-four patients with coronary heart disease who received coronary CTA examination in Hebei Petro China Central Hospital from January 2020 to March 2021 were selected as the research subjects. According to the incidence of CIN after coronary CTA examination, they were divided into the case group (25 patients) and the normal group(39 patients). Serum Cys-C level was measured by automatic biochemical analyzer at 24 h before CTA examination, and RRI value was measured by color Doppler ultrasound. Risk factors of CIN after CTA examination were analyzed by Logistic regression. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of serum Cys-C, RRI and the combination of the two indexes in CIN.Results:Compared with the control group, the dosage of contrast agent, patients with hypertension, serum Cys-C level at 24 h before CTA examination and RRI value in the case group were higher than those in the normal group: (85.53 ± 16.27) ml vs. (64.37 ± 15.08) ml, 80.00%(20/25) vs. 56.41%(22/39), (1.36 ± 0.18)mg/L vs.(1.02 ± 0.21) mg/L, 0.743 ± 0.093 vs. 0.632 ± 0.081, there were statistical differences ( P<0.05). Multivariate Logistic regression analysis showed that the amount of contrast agent, hypertension, serum Cys-C level at 24 h before CTA examination and RRI value were independent risk factor for CIN after CTA examination ( P<0.05). The results of ROC curve analysis showed that serum Cys-C (>1.318 mg/L) combined with RRI value (>0.653) at 24 h before CTA examination predicted CIN with the highest area under the curve was 0.922, sensitivity was 92.5% and specificity was 81.6%. Conclusions:The incidence of CIN after CTA is related to the dosage of contrastant, hypertension, serum Cys-C level and RRI value at 24 h before CTA. The combination of Cys-C level and RRI value has a high predictive value for the occurrence of CIN.
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Objective To explore the roles of different insulin resistance indexes[triglyceride-glucose (TyG),triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C),and metabolic score for insulin resistance (METS-IR)]and combinations of two indexes in predicting diabetes risk in hypertensive population. Methods The survey of hypertension was conducted for the residents in Wuyuan county,Jiangxi province from March to August in 2018.The basic information of hypertensive residents was collected by interview.Blood was drawn on an empty stomach in the morning and physical measurements were carried out.Logistic regression model was employed to analyze the relationship between different insulin resistance indexes and diabetes,and the area under the receiver operating characteristic curve was used for evaluating the predictive effects of each index on diabetes risk. Results A total of 14 222 hypertensive patients with an average age of (63.8±9.4) years old were included in this study,including 2616 diabetic patients.The diabetic hypertensive population had higher TyG (t=50.323,P<0.001),TG/HDL-C (Z=17.325,P<0.001),and METS-IR (t=28.839,P<0.001) than the non-diabetic hypertensive population.Multivariate analysis showed that each insulin resistance index was positively correlated with diabetes risk.The area under curve of each insulin index was in a descending order of TyG (0.770)> METS-IR (0.673)> TG/HDL-C (0.620).The difference in the area under curve between two indexes was statistically significant[TyG vs.TG/HDL-C (Z=42.325,P<0.001);TyG vs.METS-IR(Z=17.517,P<0.001);METS-IR vs.TG/HDL-C (Z=10.502,P<0.001)]. Conclusions Elevated insulin resistance indexes can increase the risk of diabetes.TyG and the combination of indexes outperform TG/HDL-C and METS-IR in the prediction of diabetes.
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Humans , Middle Aged , Aged , Insulin Resistance , Blood Glucose/metabolism , Biomarkers , Diabetes Mellitus , Hypertension , Glucose , Triglycerides , Cholesterol, HDLABSTRACT
Objective:To investigate the value of renal artery resistance index (RRI) and urinary angiotensinogen (UAGT) in the early diagnosis of acute kidney injury (AKI) in patients with sepsis.Methods:A prospective study was conducted. Seventy-eight patients with sepsis admitted to the department of critical care medicine of General Hospital of Ningxia Medical University from January to September 2021 were enrolled. Patients were observed for the development of AKI within 1 week. General data [gender, age, body mass index (BMI), major infection sites and critical illness related scores], laboratory indicators [mean arterial pressure (MAP), central venous pressure (CVP), procalcitonin (PCT), arterial blood lactic acid (Lac), etc.], duration of mechanical ventilation and length of intensive care unit (ICU) stay were recorded. After hemodynamic stabilization of the patients, renal ultrasound was performed to measure the RRI within 24 hours after ICU admission. Urine samples were taken immediately after diagnosis, and the level of UAGT was detected by enzyme-linked immunosorbent assay (ELISA). The above parameters were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of AKI in patients with sepsis. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of related indicators for AKI in sepsis.Results:A total of 78 patients were finally enrolled, of which 45 developed AKI and 33 did not. Compared with the non-AKI group, the rates of vasoactive drugs use, 28-day mortality, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, PCT, Lac, RRI and UAGT were significantly higher in the AKI group [rates of vasoactive drugs use: 68.9% vs. 39.4%, 28-day mortality: 48.9% vs. 24.2%, SOFA score: 12.0 (10.5, 14.0) vs. 8.0 (7.0, 10.0), APACHEⅡ score: 22.0 (18.0, 27.5) vs. 16.0 (15.0, 18.5), PCT (μg/L): 12.5±2.6 vs. 10.9±2.8, Lac (mmol/L): 2.6 (1.9, 3.4) vs. 1.9 (1.3, 2.6), RRI: 0.74±0.03 vs. 0.72±0.02, UAGT (μg/L): 75.16±19.99 vs. 46.28±20.75, all P < 0.05], the duration of mechanical ventilation and the length of ICU stay were significantly prolonged [duration of mechanical ventilation (days): 8.0 (7.0, 12.0) vs. 5.0 (4.0, 6.0), length of ICU stay (days): 14.0 (10.0, 16.0) vs. 9.0 (8.0, 11.5), both P < 0.01], and MAP was significantly lowered [mmHg (1 mmHg ≈ 0.133 kPa): 68.5±11.2 vs. 74.2±12.8, P < 0.05]. There was no significant difference in other parameters between the two groups. Multivariate Logistic regression analysis showed that SOFA score [odds ratio ( OR) = 2.088, 95% confidence interval (95% CI) was 1.322-3.299], APACHEⅡ score ( OR = 1.447, 95% CI was 1.134-1.845), RRI ( OR = 1.432, 95% CI was 1.103-1.859), and UAGT ( OR = 1.077, 95% CI was 1.035-1.121) were independent risk factors for sepsis complicated with AKI (all P < 0.01). ROC curve analysis showed that SOFA score, APACHEⅡ score, RRI and UAGT had certain predictive value for AKI in septic patients, the area under the ROC curve (AUC) were 0.814 (95% CI was 0.716-0.912), 0.804 (95% CI was 0.708-0.901), 0.789 (95% CI was 0.690-0.888), and 0.840 (95% CI was 0.747-0.934), respectively, and the AUC of RRI combined with UAGT was 0.912 (95% CI was 0.849-0.974), which was better than the above single index (all P < 0.05). Conclusion:RRI combined with UAGT has a high early predictive value for septic AKI.
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Objective:To analyze the correlation between phonographic cardiac function and uterine artery resistance index (RI) in pregnant women with hypertension of different conditions during pregnancy by color Doppler ultrasonically.Methods:A total of 100 pregnant women with gestational hypertension admitted to Lishui People′s Hospital from January 2020 to February 2021 were selected and divided into gestational hypertension group (40 cases), mild pre-eclampsia group (30 cases) and severe pre-eclampsia group (30 cases) according to the severity of their disease. Another 30 normal pregnant women who underwent physical examination during the same period were selected as the control group. The left ventricular function parameters isovolumetric relaxation time (IVRT), left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume(LVESV), left atrial volume index (LAVI) and uterine arter RI in 4 groups were quantitatively analyzed by ultrasound during 28 to 38 weeks of gestation. The correlation between cardiac ultrasound parameters and of pregnant women RI were analyzed.Results:As the severity of the disease, the levels of IVRT, LVEDV, LVESV, LAVI were gradually rised, and the level of LVEF was gradually decreased, there were significant differences among the 4 groups ( P<0.05). The uterine arter RI in the control group, gestational hypertension group, mild pre-eclampsia group and severe pre-eclampsia group was 0.42 ± 0.04, 0.50 ± 0.05, 0.54 ± 0.11, 0.58 ± 0.06, there was significant difference ( F = 34.11, P<0.001), and as the severity of the disease , the level of uterine arter RI was gradually rised, there were significant differences among the 4 groups ( P<0.05). Pearson correlation analysis showed that IVRT had certain correlation with RI in the 4 groups ( r = 0.331, 0.450, 0.531, 0.582; P<0.05). In mild and severe pre-eclampsia group, there were a certain correlation between LVEDV, LVESV and RI (in mild pre-eclampsia group: r = 0.360 and 0.411, P<0.05; in severe pre-eclampsia group: r = 0.383 and 0.451, P<0.05). Conclusions:The left heart function of pregnant women with different conditions evaluated by ultrasound showed a downward trend, and the uterine artery RI increased gradually in pregnant women with severe pre-eclampsia, and RI was closely related to the cardiac ultrasound parameter IVRT.
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Objective:To study the interaction effects between intestinal microflora features with serum inflammatory factors and homeostatic model assessment insulin resistance (HOMA-IR) in patients with first-episode untreated schizophrenia (SCZ).Methods:A total of 79 SCZ patients admitted to Suining Central Hospital from August 2016 to August 2019 were selected as observation group, and 60 healthy examiners were set as control group. The intestinal microflora, serum inflammatory factors and glucose metabolism indexes of the two groups were detected and compared. The correlation between intestinal microflora and inflammatory factors and HOMA-IR was analyzed.Results:The content of bifidobacteria in the observation group was lower than that in the control group while the content of bacteroides was higher than that in control group; the levels of serum inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and IL-6] and in the observation group were higher than those in the control group ( P<0.05); the level of HOMA-IR in the observation group was higher than that in control group ( P<0.05). The TNF-α, IL-1β, IL-6 and HOMA-IR in SCZ patients were significantly negatively correlated with intestinal bifidobacteria content ( P<0.05), and were obviously positively correlated with bacteroides content ( P<0.05). Conclusions:In first-episode untreated SCZ, the content of bifidobacteria decreased and the content of bacteroides increased, and there was a significant correlation with inflammatory factors and HOMA-IR, which may lead to the disorder of glucose and lipid metabolism and induce the occurrence of metabolic diseases such as diabetes.
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Objective:To investigate the correlation between multiple parameters of islet function evaluation and atherogenic index (AIP) in patients with type 2 diabetes mellitus (T2DM).Methods:A cross-sectional study was conducted to observe 216 T2DM patients hospitalized in Tianjin Medical University Chu Hsien-I Memorial Hospital in 2019. They were divided into non atherogenic phenotype group (N Group, AIP<0.06) and atherogenic phenotype group (A group, AIP≥0.06) with AIP=0.06 as the cut-off point. The general clinical indexes and evaluation indexes of oral glucose tolerance test (OGTT), such as insulin action index (IAI), quantitative insulin sensitivity check index (QUICKI), homeostasis model of insulin resistance index (HOMA-IR), homeostasis model assessment-β (HOMA-β), C peptide insulin resistance index (HOMA IR-CP) and C peptide islet function index suitable to diabetes patients (HOMA islet-CP DM) were compared between two groups. Pearson correlation analysis and multiple stepwise regression analysis were performed.Results:Compared with the N group, the very low density lipoprotein-cholesterol (VLDL-C), ln (HOMA IR-CP) and ln (HOMA islet-CP DM) in A group were higher ( P<0.01), while ln (QUICKI) was lower ( P<0.05), with statistical significance. AIP was positively correlated with VLDL-C ( r=0.765), ln (HOMA-IR) ( r=0.257), ln (HOMA-β) ( r=0.189), ln (HOMA IR-CP) ( r=0.418) and ln (HOMA islet-CP DM) ( r=0.377, P<0.01), and negatively correlated with IAI ( r=-0.145, P<0.05) and ln (QUICKI) ( r=-0.254, P<0.01). Multiple stepwise regression analysis showed that VLDL-C and ln (HOMA IR-CP) were independent influencing factors of AIP in type 2 diabetic patients ( P<0.01) . Conclusions:AIP is positively correlated with insulin resistance and negatively correlated with insulin sensitivity. VLDL-C and HOMA IR-CP are independent predictors of AIP.
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Acute kidney injury (AKI) is common in critically ill patients and it is directly related to the patient's prognosis and survival. Despite remaining uncertainties regarding the prevalence of AKI in intensive care unit (ICU), the overall incidence of AKI is relatively high, and prompt recognition is necessary to ensure the risk assessment, early diagnosis, clinical outcome, and treatment of critically ill patients. Doppler-based renal resistive index (RRI) mainly reflects vascular bed resistance state, which can be indirect to the extent of the damage of renal parenchyma. It is a relatively objective and quantitative evaluation, and is widely used in clinical prognosis of acute or chronic renal damage evaluation and judgment. This paper reviews the definition of RRI, the measurement methods of RRI, the application and progress of RRI in the field of AKI, the advantages and disadvantages of ultrasonic measurement of RRI, the long-term application of RRI, the effectiveness of RRI in predicting AKI, and the progress in clinical application.
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Background: Pre-eclampsia is the most common pregnancy complication associated with serious maternal and fetal morbidity. Uterine artery Doppler reflects the impaired trophoblastic invasion of the uterine spiral arteries, which is involved in the aetiology of preeclampsia. Thus, uterine artery Doppler was proposed as a screening test for pre-eclampsia.Methods: A prospective cohort study of 100 singleton pregnancies was conducted in a tertiary centre and the study population were subjected to uterine artery Doppler study at 18-22 weeks gestation. Uterine artery Doppler indices of pulsatility index (PI), resistance index (RI) and persistence of diastolic notch was obtained and the outcome of pre-eclampsia was studied.Results: Out of 100 women, 14 women developed pre-eclampsia in which the resistance index showed a sensitivity of 21.4%, specificity of 91.8%, positive predictive value of 30% and negative predictive value of 87.7% and pulsatility index showed sensitivity of 35.7%, specificity of 90.6%, positive predictive value of 38.4% and negative predictive value of 89.6%. Diastolic notch had a sensitivity of 35.7%, specificity of 98.8%, positive predictive value of 83.3% and a negative predictive value of 90.4%.Conclusions: The high negative predictive values, indicated that women with normal Doppler velocimetry were unlikely to develop preeclampsia. Uterine artery Doppler, being non-invasive can be included during routine sonography to identify patients at risk of developing pre-eclampsia. Early, screening for pre-eclampsia will help in individualized antenatal surveillance and initiation of prophylactic therapy, early to reduce the adverse maternal and foetal complications of preeclampsia.
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Resumen Introducción: La cirugía de cardiopatías congénitas puede generar alteraciones perfusorias cerebrales con repercusión neurológica. Objetivo: Analizar la relación del índice de resistencia (IR) vascular cerebral periquirúrgico con funciones neurológicas mediatas posteriores a cirugía de cardiopatía congénita. Método: Estudio de cohorte prospectivo de 34 neonatos en quienes se determinó IR de la arteria basilar, niveles séricos de oxígeno, dióxido de carbono y lactato, antes y después de procedimientos paliativos o correctivos. Relacionamos el IR prequirúrgico con la capacidad posquirúrgica para iniciar la vía enteral o restablecer la respiración espontánea no asistida. Resultados: Se integraron tres grupos: 17 neonatos con IR alto > 0.73, cinco con IR normal de 0.63 a 0.73 y seis con IR bajo < 0.63. En los primeros persistió IR alto en el posquirúrgico, con hiperlactatemia e hipoxia persistentes; en 86 % no se logró iniciar la vía enteral ni retirar la ventilación asistida. En los segundos, el IR se mantuvo en valores normales. En los terceros, si bien el IR, el lactato sérico y la presión arterial de oxígeno tendieron a normalizarse, 71 % presentó daño neurológico grave. Conclusiones: Los cambios en el IR fueron frecuentes, aunque el daño neurológico parece presentarse más cuando el IR se mantiene alto, posiblemente asociado a flujos cerebrales bajos.
Abstract Introduction: Surgery for congenital heart disease can generate cerebral perfusion-associated alterations with neurological repercussions. Objective: To analyze the relationship of peri-surgical cerebrovascular resistance index (RI) with mediate neurological functions after congenital heart disease surgery. Method: Prospective cohort study of 34 neonates in whom basilar artery RI, serum oxygen, carbon dioxide and lactate levels were determined before and after palliative or corrective procedures. We related pre-surgical RI with post-surgical ability to initiate the enteral route or to restore unassisted spontaneous breathing. Results: Three groups were formed: 17 neonates with high RI (> 0.73), five with normal RI (0.63-0.73) and six with low RI (< 0.63). In the former group, high RI persisted in the postoperative period, with persistent hyperlactatemia and hypoxia; in 86%, the enteral route could not be initiated, and neither could assisted ventilation be withdrawn. In the second group, IR remained within normal values. In the third group, although RI, serum lactate and arterial oxygen pressure tended to normalize, 71% had severe neurological damage. Conclusions: RI changes were common, although neurological damage appears to occur more commonly when RI remains high, possibly associated with low cerebral blood flow.
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Humans , Infant, Newborn , Brain/blood supply , Heart Defects, Congenital/surgery , Cerebrovascular Circulation , Prospective Studies , Hyperlactatemia , HypoxiaABSTRACT
The pregnancy induced hypertension increase the fetal mortality and morbidity and the using of Doppler umbilical artery indices decrease the fetal mortality and morbidity however, there is few complete data about the most frequently altered Doppler US parameters to predict fetal outcome in pregnancy induced hypertension . Methods This ia cohort prospective study done in two hundred and six women of second and third trimester presenting to antenatal clinic in Soba University Hospital at the department of Obstetrics & Gynecology, in the fetus unit and critical pregnancy in the period From June 2008 to April 2013 to assess the Doppler indices of umbilical artery in pregnancy induced hypertension for prediction of prenatal outcome; 105 pregnancy induced hypertension patients and 101 women with uneventful pregnancies as normal control group included in this study . Baseline investigations and color Doppler of umbilical artery were done. Statistical analysis of data were done using SPSS, Receiver Operating Characteristic (ROC) curve analysis was performed and the area under the curve (AUC) used to determine sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of umbilical artery Doppler indices to predict fetal outcome. Results The study determine that there was significant difference in Doppler indices in PIH and control group ( p<0.01, the mean indices of umbilical artery is higher in PIH group compared with normal pregnancy group , the mean different of S/D ratio was 0.40, mean difference of RI was 0.06 and the mean different of PI index was 0.16, high percentage of adverse fetal outcome had been reported in in Pregnancy Induced Hypertension group than in control , which was more in absent and reversed flow velocity in umbilical artery in Pregnancy Induced Hypertension compared with group of Pregnancy Induced Hypertension with present end diastolic flow velocity. Systolic/Diastolic ratio was most accurate in predicting adverse outcome in pregnancy induced hypertension patients, followed by the Pulastility index then the Resistance index (75%, 66% and 57% respectively). Conclusion This study concluded that pregnancy induced hypertension leads to worsen placental insufficiently, which appears on the higher Doppler indices of umbilical artery to PIH patients when compared with normal pregnancy. A low diastolic flow and higher indices characterized the pregnancies with abnormal outcomes. Doppler of the umbilical artery was useful to predict fetal well being in PIH patients, high percentage of adverse fetal outcome had been reported in absent and reversed end diastolic flow velocity in umbilical artery compared with group of present flow velocity.
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Inevitable ischemia-reperfusion injury (IRI) occurred in organ donation after citizen's death often results in delayed graft function (DGF) after renal transplantation. Although the incidence of DGF had reduced to some extent due to continuous hypothermic machine perfusion (HMP) for renal graft using LifePort, DGF of renal graft remains a major clinical problem. In order to further reduce the incidence of DGF after renal transplantation, renal transplant surgeons should fully understand the role of continuous HMP in renal transplantation, continue to conduct more in-depth basic and applied research. This article mainly summarized the effect of continuous HMP on renal transplantation and its research progress.
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Objective To explore the clinical value of virtual touch tissue quantification (VTQ) technique in the diagnosis of acute rejection of transplant kidney at different stages. Methods Clinical data of 170 renal transplant recipients were retrospectively analyzed. According to the time of VTQ examination and the occurrence of acute rejection after renal transplantation, the recipients within 4 weeks and after 4 weeks post-renal transplantation were assigned into the normal renal function group (n=41, 51) and acute rejection group (n=22, 56). Clinical ultrasound parameters at different stages after renal transplantation were compared between two groups. The diagnostic value of ultrasound parameters in acute rejection at different stages after renal transplantation was evaluated. Results Within 4 weeks post-renal transplantation, the resistance index (RI) and shear wave velocity (SWV) in the acute rejection group were significantly higher than those in the normal renal function group (both P < 0.001). After 4 weeks post-renal transplantation, the SWV in the acute rejection group was significantly higher than that in the normal renal function group (P < 0.001). The area under curve (AUC) of RI and SWV in the diagnosis of acute rejection were 0.729 and 0.803 respectively within 4 weeks post-renal transplantation, which were 0.478 and 0.794 respectively after 4 weeks post-renal transplantation. The diagnostic value of SWV was higher than RI (P < 0.05). The cutoff value of SWV in the diagnosis of acute rejection within 4 weeks post-renal transplantation was considerably higher than that after 4 weeks post-renal transplantation. Conclusions VTQ technique can effectively assist in diagnosing acute rejection of transplant kidney at different stages.
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Objective To evaluate the clinical value of color Doppler ultrasonography (CDFI) in evaluating the degree of atherosclerotic renal artery stenosis (ARAS) in the elderly by using ROC curve analysis.Methods From March 2015 to September 2018,117 patients with ARAS admitted to Anji Branch of the First Affiliated Hospital of Medical College of Zhejiang University were selected.All patients underwent color Doppler ultrasonography and renal artery angiography.Renal artery angiography was used as the gold standard.The diagnostic value of color Doppler ultrasonography for ARAS was analyzed.The changes of color Doppler ultrasonography indicators of renal artery in different degrees of stenosis were compared.The ROC curve was used to analyze the value of color Doppler ultrasound in evaluating the degree of atherosclerotic renal artery stenosis in the elderly.Results Using renal arteriography as the gold standard,the sensitivity of color ultrasonography for ARAS was 82.17％ (129/157),and the specificity of diagnosis was 80.52％ (62/77).The PSV [(227.59 ± 34.28) cm/s] and EDV [(57.39 ± 6.48) cm/s] in the severe stenosis group were higher than those in the moderate stenosis group [(183.84 ±41.05) cm/s and(50.29 ± 5.22) cm/s] (t =6.269,6.506,all P ＜ 0.05) and the mild stenosis group [(128.47 ± 52.35) cm/s and(37.52 ± 7.15) cm/s] (t =10.517,12.813,all P ＜ 0.05) and the non-stenosis group [(86.49 ± 28.94) cm/s and (26.48 ± 5.02) cm/s] (t =18.598,21.971,all P ＜ 0.05).The RI in the severe stenosis group [(0.41 ±0.07)] was lower than that in the moderate stenosis group [(0.47 ± 0.06)] (t =4.966,P ＜ 0.05) and the mild stenosis group [(0.52 ±0.07)] (t =8.496,P ＜0.05) and the no stenosis group [(0.70 ±0.11)] (t =17.101,P ＜ 0.05).The ROC curve was used to analyze the diagnostic value of color ultrasound parameters for moderate and severe stenosis.The area under the diagnostic curve of PSV,EDV and RI for moderate and severe stenosis was 0.869,0.932 and 0.937,respectively.Conclusion CDFI plays an important role in the early diagnosis and clinical screening of elderly patients with ARAS.It is helpful to judge the degree of renal artery stenosis and evaluate the condition of the patients.It is non-invasive,simple and inexpensive,and worthy of clinical application.
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Background: The uterine artery Doppler has potentials for screening for complications of impaired placentation. The purpose of study was to assess the role of uterine artery color Doppler waveform analysis in second trimester for the prediction of preeclampsia in a high-risk pregnancy between 18-24 weeks of gestation.Methods: 100 women with moderate or high-risk factors for developing preeclampsia reporting to Obstetrics and Gynaecology department of Government Medical College and Hospital, Sector 32, Chandigarh were enrolled for present study. Transabdominal uterine artery doppler measurements was done at 18-24weeks of gestation in these patients. Doppler . The Doppler indices generated automatically from the machine , the Pulsatility Index (PI), Resistance Index (RI) , presence or absence of diastolic notch and S/D Ratio were recorded, and average was calculated.Results: Out of 100 patients there were 46 primigravidas with no additional risk factors, 22 pateints with two or more risk factors and there were no patients who had three or more risk factors in present study population. Preeclampsia is seen more commonly in primigravida and primigravida is considered as moderate risk factor for preeclampsia. It was found that an elevated second trimester uterine artery RI was significantly associated with developing preeclampsia later in pregnancy. The sensitivity and specificity of uterine artery Doppler velocimetry were found to be 84% and 55% respectively. Receiver operator characteristics (ROC) curves were created to demonstrate the prognostic value of RI and PI of uterine artery doppler indices at 18-24 weeks of gestation for the development preeclampsia. In addition, there were statistically significant positive correlations between mean RI of uterine artery doppler study and patients who developed preeclampsia. With a sensitivity of 84.21% it could identify 31% of the cases of preeclampsia at a false positive rate of 44.4%.Conclusions: Uterine artery doppler study can be used as a predictor of moderate strength for preeclampsia.
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Objective To explore the value of renal resistance index (RI) and urine oxygen pressure for early prediction of acute kidney injury (AKI) in patients with septic shock.Methods Patients with septic shock were enrolled from August 2018 to November 2018 in intensive care unit (ICU) at Peking Union Medical College Hospital.Subjects' general information and AKI characteristics were assessed.Area under the receiver operating characteristic (ROC) curve was used to analyze the predictive value of RI,urine oxygen pressure,or combination of RI on the occurrence of AKI.Results A total of 72 septic shock patients were enrolled including 29 patients with AKI and 43 without.Logistic regression analysis of AKI risk factors found that RI (OR=1.139,95％CI 1.029-1.261,P=0.012) and urine oxygen pressure (OR=0.957,95％CI 0.923-0.991,P=0.014) at admission were independent risk factors for AKI in patients with septic shock.The sensitivity and specificity of dual RI and urine oxygen pressure in predicting AKI were 65.5％and 76.7％ respectively (AUCROC 0.772,Youden index 0.423).We selected the cut-off value of RI as 0.70,and urine oxygen pressure as 48 mmHg (1 mmHg=0.133 kPa).According to this two cut-off values patients were divided into four groups,those with RI≥0.70 and urine oxygen pressure≤48 mmHg showed the highest incidence of AKI (75％).There was no statistically difference in 28-day survival rate between the four groups (P=0.197).Conclusion High RI and low urine oxygen pressure are independent risk factors for the development of AKI in patients with septic shock.The predictive cut-off values are 0.70 for RI and 48 mmHg for urine oxygen pressure.Combination of RI and urine oxygen pressure has a practical predictive value for AKI in patients with septic shock.
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Objective@#To analyze the changes and relationship of early hemodynamic indexes of patients with large area burns monitored by pulse contour cardiac output (PiCCO) monitoring technology, so as to assess the guiding value of this technology in the treatment of patients with large area burns during shock period.@*Methods@#Eighteen patients with large area burns, confirming to the study criteria, were admitted to our unit from May 2016 to May 2017. Pulse contour cardiac output index (PCCI), systemic vascular resistance index (SVRI), global end-diastolic volume index (GEDVI), and extravascular lung water index (EVLWI) of patients were monitored by PiCCO instrument from admission to post injury day (PID) 7, and they were calibrated and recorded once every four hours. The fluid infusion coefficients of patients at the first and second 24 hours post injury were calculated. The blood lactic acid values of patients from PID 1 to 7 were also recorded. The correlations among PCCI, SVRI, and GEDVI as well as the correlation between SVRI and blood lactic acid of these 18 patients were analyzed. Prognosis of patients were recorded. Data were processed with one-way analysis of variance, single sample ttest and Bonferroni correction, Pearson correlation analysis, and Spearman rank correlation analysis.@*Results@#(1) There was statistically significant difference in PCCI value of patients from post injury hour (PIH) 4 to 168 (F=7.428, P<0.01). The PCCI values of patients at PIH 4, 8, 12, 16, 20, and 24 were (2.4±0.9), (2.6±1.2), (2.2±0.6), (2.6±0.7), (2.8±0.6), and (2.7±0.7) L·min-1·m-2, respectively, and they were significantly lower than the normal value 4 L·min-1·m-2(t=-3.143, -3.251, -11.511, -8.889, -6.735, -6.976, P<0.05 or P<0.01). At PIH 76, 80, 84, 88, 92, and 96, the PCCI values of patients were (4.9±1.5), (5.7±2.0), (5.9±1.7), (5.5±1.3), (5.3±1.1), and (4.9±1.4) L·min-1·m-2, respectively, and they were significantly higher than the normal value (t=2.277, 3.142, 4.050, 4.111, 4.128, 2.423, P<0.05 or P<0.01). The PCCI values of patients at other time points were close to normal value (P>0.05). (2) There was statistically significant difference in SVRI value of patients from PIH 4 to 168 (F=7.863, P<0.01). The SVRI values of patients at PIH 12, 16, 20, 24, and 28 were (2 298±747), (2 581±498), (2 705±780), (2 773±669), and (3 109±1 215) dyn·s·cm-5·m2, respectively, and they were significantly higher than the normal value 2 050 dyn·s·cm-5·m2(t=0.878, 3.370, 2.519, 3.747, 3.144, P<0.05 or P<0.01). At PIH 4, 8, 72, 76, 80, 84, 88, 92, and 96, the SVRI values of patients were (1 632±129), (2 012±896), (1 381±503), (1 180±378), (1 259±400), (1 376±483), (1 329±385), (1 410±370), and (1 346±346) dyn·s·cm-5·m2, respectively, and they were significantly lower than the normal value (t=-4.593, -0.112, -5.157, -8.905, -7.914, -5.226, -6.756, -6.233, -7.038, P<0.01). The SVRI values of patients at other time points were close to normal value (P>0.05). (3) There was no statistically significant difference in the GEDVI values of patients from PIH 4 to 168 (F=0.704, P>0.05). The GEDVI values of patients at PIH 8, 12, 16, 20, and 24 were significantly lower than normal value (t=-3.112, -3.554, -2.969, -2.450, -2.476, P<0.05). The GEDVI values of patients at other time points were close to normal value (P>0.05). (4) There was statistically significant difference in EVLWI value of patients from PIH 4 to 168 (F=1.859, P<0.01). The EVLWI values of patients at PIH 16, 20, 24, 28, 32, 36, and 40 were significantly higher than normal value (t=4.386, 3.335, 6.363, 4.391, 7.513, 5.392, 5.642, P<0.01). The EVLWI values of patients at other time points were close to normal value (P>0.05). (5) The fluid infusion coefficients of patients at the first and second 24 hours post injury were 1.90 and 1.39, respectively. The blood lactic acid values of patients from PID 1 to 7 were 7.99, 5.21, 4.57, 4.26, 2.54, 3.13, and 3.20 mmol/L, respectively, showing a declined tendency. (6) There was obvious negative correlation between PCCI and SVRI (r=-0.528, P<0.01). There was obvious positive correlation between GEDVI and PCCI (r=0.577, P<0.01). There was no obvious correlation between GEDVI and SVRI (r=0.081, P>0.05). There was obvious positive correlation between blood lactic acid and SVRI (r=0.878, P<0.01). (7) All patients were cured except the one who abandoned treatment.@*Conclusions@#PiCCO monitoring technology can monitor the changes of early hemodynamic indexes and volume of burn patients dynamically, continuously, and conveniently, and provide valuable reference for early-stage comprehensive treatment like anti-shock of patients with large area burns.
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Objective To investigate the effect of electroacupuncture on hypothalamic insulin receptor substrate 1 (IRS-1) in a rat model of type 2 diabetes mellitus (T2DM). Methods Sixty Wistar rats were randomized to a normal group (15 rats) and an observation group (45 rats). In the observation group, a rat model of T2DM was made by high-energy diet induction. After the model was successfully made 8 weeks later, the observation group was randomized to model making, treatment and blocker groups, 15 rats each. The treatment group received electroacupuncture and the blocker group, electroacupuncture plus intraventricular perfusion of phosphatidylinositol 3-hydroxyl kinase (PI3K) blocker. After 8 weeks of treatment, fasting plasma glucose (FPG) was measured using a glucometer, fasting insulin (Fins) was determined by ELISA, insulin resistance index (IRI) was calculated and IRS-1 expression was examined by SABC immunohistochemistry assay in every group of rats. Results FPG and Fins increased significantly (both P<0.01) and IRI and IRS-1 expression decreased significantly (P<0.01) in the model making group compared with the normal group. FPG and Fins decreased significantly (both P<0.01) and IRI and IRS-1 expression increased significantly (P<0.01) in the treatment group compared with the model making group. FPG and Fins decreased significantly (P<0.05, P<0.01) and IRI and IRS-1 expression increased significantly (P<0.01) in the treatment group compared with the blocker group. Conclusion Electroacupuncture can improve FPG, Fins and insulin sensitivity by regulating hypothalamic IRS-1 expression in T2DM rats.
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Objective:To explore the application of fetal multi-organ hemodynamics in the detection and evaluation of oxygen supply and blood supply for fetus in the third trimester of pregnancy. Methods: 42 pregnant women with gestational diabetes mellitus and 42 healthy pregnant women were divided into observation group and control group, respectively. All of the fetuses of pregnant women received Doppler ultrasound examination, and the pulsatility index(PI), resistance index(RI) and systolic/diastolic(S/D) ratio of umbilical artery (UA)and middle cerebral artery (MCA) of every fetus in the two groups were observed. Besides, the number of fetal distress was recorded and the relationship between fetal distress rate and gestational diabetes mellitus were calculated.Results:The PI, RI and S/D of MCA of fetuses of pregnant women with gestational diabetes mellitus was significantly higher than that of healthy pregnant women (t=7.52,t=6.04, t=8.69,P<0.05). And the PI, RI and S/D of UA of fetuses of pregnant women with gestational diabetes mellitus also was significantly higher than that of health pregnant women (t=11.95,t=9.78,t=8.95, P<0.05). Besides, the fetal distress rate of observation group was significantly higher than that of control group (x2=19.56,P<0.05).Conclusion: The fetal blood flow information which obtained from Doppler ultrasound has very importantly value in the diagnosis of gestational diabetes mellitus, and it verifies the relationship between fetal distress rate and gestational diabetes mellitus. It provides beneficial basis for the prevention and treatment of the gestational diabetes mellitus in the clinical practice.