Efficacy of norepinephrine in the treatment of neonatal septic shock: an observation study / 中国新生儿科杂志

Objective:To study the efficacy of norepinephrine in the treatment of neonates with septic shock.Methods:A prospective observation study of neonates with septic shock, who received norepinephrine in the neonatal intensive care unit of Guangdong Women and Children's Hospital from January 2019 to November 2020. All infants had functional echocardiography for hemodynamic monitoring before norepinephrine treatment and 1 hour thereafter blood pressure, heart rate, arterial blood gas analyses were recorded at the same time. The intravenous fluid volume and urine volume from the diagnosis of shock to the commencement of norepinephrine therapy (T0) and 24 hours thereafter (T1) were recorded, and the hemodynamic parameters, vasoactive drugs and clinical outcomes were analyzed.Results:A total of 66 newborns were enrolled, including 27 cases of mild shock, 33 cases of moderate shock and 6 cases of severe shock. 48 were male infants, 38 cases were premature infants. The gestational age was (35.2±4.1) weeks and the birth weight was (2 476±909) g. The median time of shock diagnosis was 2 days after birth, and the median shock score was 4 points. The median time from the diagnosis of shock to the start of norepinephrine treatment was 7.5 hours. Compared with that before norepinephrine treatment, stroke volume, stroke volume index, cardiac output, cardiac index, left ventricular ejection fraction, shortening fraction, systolic blood pressure, diastolic blood pressure, mean arterial pressure, blood pH and BE at 1 hour after treatment were increased, heart rate and blood lactic acid were decreased, the differences were statistically significant ( P<0.05). Urine volume was increased 24 hours after treatment ( P<0.05), and fluid overload decreased ( P<0.05). The maximum dopamine dose, the down-regulation time and duration of vasoactive drugs were positively correlated with the time to start norepinephrine therapy ( r=0.325、 r=0.383、 r=0.319, P<0.05). Among the 66 infants, 58 infants with shock had been corrected and 14 infants died within 28 days. Conclusions:Norepinephrine is effective and feasible in the treatment of neonatal septic shock and can significantly improve hemodynamic parameters.

Predictors and reference equations for augmentation index, an arterial stiffness marker, in healthy children and adolescents

OBJECTIVES: To investigate predictors and propose reference equations for the augmentation index normalized to 75 bpm heart rate (AIx@75) in healthy children and adolescents. METHODS: This was a cross-sectional, observational study involving 134 healthy children and adolescents aged 9 to 19 years old. Participants were categorized into child (n=53) and adolescent (n=81) groups, as well as into male (n=69) and female (n=65) groups. We evaluated AIx@75, vascular and hemodynamic parameters, anthropometric data, physical activity profile, and quality of life (Peds-QL4.0; physical, emotional, social and school domains). RESULTS: The predictors of AIx@75 in the whole sample were age, peripheral diastolic blood pressure (pDBP), mean arterial pressure, pulse pressure amplification (PPA), systolic volume (SV), cardiac index (CI), and pulse wave velocity (PWV; R2=80.47%). In the male group, the predictors of AIx@75 were SV, CI, total vascular resistence (TVR), and PWV (R2=78.56%), while in the female group, they were pDBP, PPA, SV, and PWV (R2=82.45%). In the children, they were pDBP, PPA, SV, and PWV (R2=79.17%), while in the adolescents, they were body mass index, pDBP, PPA, SV, TVR, and PWV (R2=81.57%). CONCLUSION: In the present study, we used a representative sample from Belo Horizonte to establish normality values of AIx@75. We also identified, for the first time, independent predictors of AIx@75 in healthy children and adolescents categorized by sex and age. Determining AIx@75 reference equations may facilitate the early diagnosis of preclinical atherosclerosis and allow an objective measure of the vascular effects of therapeutic interventions aimed at modifying cardiovascular risk factors.

Non-invasive ultrasound cardiac output monitor of hemodynamic parameters in neonates with different gestational age and birth weight / 中国新生儿科杂志

Objective:To study the correlations of neonatal hemodynamic parameters with gestational age (GA) and birth weight (BW) using non-invasive ultrasound cardiac output monitor (USCOM).Method:From March to September 2019, neonates with stable hemodynamics admitted to the Department of Neonatology of our hospital were enrolled in this prospective study. According to their GA, they were assigned into <29 w group, 29~33 w group, 34~36 w group and ≥37 w group. According to their BW, they were assigned into <1 000 g group, 1 000~1 499 g group, 1 500~2 499 g group and ≥2 500 g group. Cardiac output (CO), cardiac index (CI), stroke volume (SV), myocardial contractility (inotropy, INO), flow time corrected (FTC), systemic vascular resistance index (SVRI) and heart rate (HR) were measured using USCOM. The univariate linear regression method was used to analyze the correlation of hemodynamic parameters with different GA and BW.Result:A total of 120 neonates with stable hemodynamics were enrolled, including 69 males and 51 females. The average GA was (34.2±3.8)w and the average BW was (2 221±860) g. SV ( r=0.489, P<0.001), CO ( r=0.681, P<0.001), CI ( r=0.348, P<0.001), FTC ( r=0.266, P=0.003), INO ( r=0.446, P<0.001)and HR ( r=-0.322, P<0.001) showed significant linear correlations with GA. No linear correlation existed between SVRI ( r=-0.052, P=0.574) and GA. SV ( r=0.603, P<0.001), CO ( r=0.852, P<0.001), CI ( r=-0.390, P<0.001), INO ( r=0.576, P<0.001) and HR ( r=-0.440, P<0.001) showed significant linear correlations with BW. No significant linear correlations existed between SVRI ( r=-0.076, P=0.409) or FTC ( r=0.090, P=0.329) and BW. Conclusion:USCOM can monitor neonatal hemodynamic parameters in real-time.Hemodynamic parameters including SV, CO, CI and INO are significantly different among newborns with different GA and BW and these parameters are linearly correlated with GA and BW.

Attenuation of haemodynamic responses to endotracheal extubation-diltiazem versus lidocaine

Background:Endotracheal extubation is one of the frequently performed procedure in the practice of anaesthesia.This study was done to observe the haemodynamic responses during tracheal extubation and to compare the efficacy of IV diltiazem 0.2mg/kg versusIV lidocaine 1mg/kg in attenuating the hemodynamic response to tracheal extubation.Methods:90 patients aged 20 to 60 yrs, belonging to ASA I and II, normotensive were included in the study and they were randomly allocated into 3 groups of 30each. Group I received normal saline and served as control. Group II received0.2mg/kg of IV diltiazem 2 min before extubation. Group III received 1mg/kg of lidocaine IV 2 min before extubation. At the end of the surgery, heart rate (HR), systolic blood pressure (SBP)and diastolic blood pressure(DBP)were recorded served as base line values.Results:After tracheal extubation, all the haemodynamic parameters increase from the basal level in the control group and decreased in the study group. The change in HR, SBP and DBP were significantly less in group II and group III compared to group I. The change in HR, SBP and DBP were significantly less in group II compared to group III. Conclusions: Diltiazem hydrochloride, a calcium channel blocker belongs to the benzothiazepine group given in dose of 0.2mg/kg IV 2 min before tracheal extubation in ASA grade I andgrade II patients is a simple, effective and practical method of blunting cardiovascular responses to tracheal extubation. This suppressive effect of diltiazem was comparable to or even more potent than that of lignocaine 1mg/kg IV 2 min before tracheal extubation

Subacute effects of the number of Pilates exercise series on cardiovascular responses in hypertensive women

Abstract Aim: To evaluate the subacute effects of the number of Pilates exercise series (one and three) on the cardiovascular responses of medicated hypertensive women. Methods: Eight hypertensive and nine normotensive women underwent a Pilates session with low and high volume, and cardiovascular responses were measured. Aged sample of 50-65 years old underwent to anthropometrical measurements previously to the experimental procedures. The cardiovascular assessment was performed before and after every experimental session. The experimental procedures consisted of two familiarization sessions, load determination, and two experimental sessions (one or three series) for each group. Results: In the intragroup analysis, HR was found to be reduced in the normotensive group. In the hypertensive group, a reduction in the double product was observed after both Pilates sessions, and in the normotensive group only after the session with one series. The volume of exercises of the Pilates method did not interfere in the responses of systolic and diastolic BP after exercise. However, a more prominent area under the curve was seen in the systolic BP of hypertensive subjects who performed three series. Conclusion: The present study shows that performing one or three series of the Pilates exercise does not induce hypotension post-exercise and did not interfere in the cardiovascular responses of medicated hypertensive women.

Comparison of two doses of Dexmedetomidine on hemodynamic parameters of patients undergoing spinal anesthesia

Background: Dexmedetomidine is considered as safe adjuvant as it does not cause depression of the respiratory system. Whether it can be used in the dose of 5 mcg or 10 mcg needs evaluation. Objective of the study was to compare two doses of dexmedetomidine on hemodynamic parameters of patients undergoing spinal anesthesia.Methods: Present study was hospital based follow up study. 80 patients were studied who were of age 18-60 years. These patients were operated using spinal anesthesia. History in detail was taken. They were examined thoroughly and investigated. Informed written consent is taken. Two groups were made. One group with 30 patients received dexmedetomidine 5 mcg. Second group with 50 patients received 10 mcg dexmedetomidine.Results: All baseline parameters were similar in two group patients. Heart rate at various intervals was also similar in two groups patients. Systolic blood pressure at various intervals was also similar in two groups patients. Diastolic blood pressure at various intervals was also similar in two groups patients. Highest level of sensory block was also similar in two groups patients. Patients in 5 mcg group had both the sensory and motor block more compared to patients in 10 mcg group. All other parameters were similar in two group of patients.Conclusions: Dexmedetomidine in doses of 5 mcg and 10 mcg has been found to have similar effect on hemodynamic parameters of the patients. So, it can be used in any of these two doses without affecting the hemodynamic parameters.

Effect of intravenous acetaminophen versus fentanyl on postoperative pain after transurethral lithotripsy / Efeito do acetaminofeno versus fentanil intravenosos na dor pós litotripsia transuretral

Abstract Background: Postoperative pain is the most common postoperative complication. This study was conducted to assess the effect of acetaminophen versus fentanyl on postoperative pain relief in patients who underwent urologic surgeries. Methods: This clinical trial was conducted on patients aged 18-65 years. Patients were randomly assigned to receive either 2000 mg acetaminophen (propacetamol) or 2 mcg.kg-1 fentanyl intravenously, 15 min before the end of surgery. The postoperative pain was evaluated every 6 h for 24 h using the Visual Analog Scale. Total morphine dose taken in 24 h and hemodynamic status were evaluated. Results: Eighty patients were enrolled into the trial. The mean score of pain in 6, 12, 18, and 24 h after surgery was lower in the acetaminophen group than in the fentanyl group but the difference was not statistically significant except in 12 and 18 h after surgery (p < 0.05). The amount of administered morphine was higher in the fentanyl group than in the acetaminophen group, but the difference was not statistically significant. The hemodynamic status including systolic and diastolic blood pressure and heart rates were nearly the same in the two groups but the SpO2 mean was significantly higher in the acetaminophen group than the fentanyl group. Conclusions: This trial indicated that intravenous acetaminophen is as effective as intravenous fentanyl in pain relief after urologic surgeries (transurethral lithotripsy).

Resumo Justificativa: A dor pós-operatória é a complicação mais comum no período pós-operatório. Este estudo foi realizado para avaliar o efeito de acetaminofeno versus fentanil no alívio da dor pós-operatória em pacientes submetidos a cirurgias urológicas. Métodos: Este ensaio clínico foi realizado com pacientes cujas idades variou entre 18 e 65 anos. Os pacientes foram randomicamente designados para receber 2.000 mg de acetaminofeno (propacetamol) ou 2 mcg.kg-1 de fentanil por via intravenosa 15 min antes do final da cirurgia. A dor pós-operatória foi avaliada a cada 6 horas por 24 horas, utilizando a escala visual analógica. A dose total de morfina administrada em 24 horas e o estado hemodinâmico foram avaliados. Resultados: Oitenta pacientes foram incluídos no estudo. O escore médio de dor em 6, 12, 18 e 24 horas após a cirurgia foi menor no grupo acetaminofeno que no grupo fentanil, mas a diferença não foi estatisticamente significativa, exceto em 12 e 18 horas após a cirurgia (p < 0,05). A quantidade de morfina administrada foi maior no grupo fentanil que no grupo acetaminofeno, mas a diferença não foi estatisticamente significativa. O estado hemodinâmico, incluindo pressão arterial sistólica e diastólica e frequência cardíaca, foi quase o mesmo nos dois grupos, mas a média de SpO2 foi significativamente maior no grupo acetaminofeno que no grupo fentanil. Conclusões: Este estudo indicou que acetaminofeno intravenoso é tão eficaz quanto fentanil intravenoso no alívio da dor após cirurgias urológicas (litotripsia transuretral).

Functional and adaptive status of the first-year students' cardiovascular system / 国际药学研究杂志

The features of adaptation and functionality of the first-year students’ cardiovascular system at the beginning (1st stage) and at the end (2nd stage) of the school year by parameters of hemodynamics and heart rate variability (HRV) were studied. It is established that from the beginning to the end of the school year the disadaptation of the cardiovascular system by parameters of central hemodynamics and HRV increases in most of the students. Under relative rest conditions, students’ heart rate, systolic and diastolic blood pressure (SBP and DBP) at the 2nd stage increased (p< 0.05) in comparison to age norms and their values identified at the 1st stage. At the 2nd stage, adaptive potential (AP) values indicated expressed diastolic myocardial stress. At the 1st stage, the average level of training and physical performance was revealed in students by average values of Robinson index (RI), the 2nd stage showed decrease in aerobic support of the myocardium and its adaptive capabilities. According to the adaptive capacity (AC) average values, students at both stages were under adaptation failure condition.At both stages, the students demonstrated normotony according to R-R and heart rate parameters with increased of parasympathetic effects on the HR modulation at the 2nd stage. 58% and 66% of the first-year students, according to individual values of TI at the 1st and 2nd stages respectively, revealed poor adaptation, 29% and 25% of them showed the state of adaptation failure, the rest of them demonstrated satisfactory adaptation.

Factores pronósticos en hipertensión pulmonar Nuestra experiencia

Introducción. La hipertensión pulmonar (HP) es una enfermedad multifactorial de elevada morbimortalidad. Si bien su evolución clínica ha mejorado en los últimos años gracias al avance en su diagnóstico y tratamiento, disponemos de escasa información, en nuestra región, acerca de los factores clínicos y pronósticos vinculados con dicha entidad. Objetivos. Determinar la prevalencia y las características de los factores pronósticos adversos en nuestra población con diagnóstico reciente de HP. Materiales y métodos. Se incluyeron pacientes con diagnóstico reciente de HP (menos de 7 días desde el diagnóstico) confirmado por cateterismo cardíaco derecho (CCD) con presión de arteria pulmonar media (PAPm) ≥ 25 mm Hg, entre Marzo de 2012 y Diciembre de 2016, por diferentes servicios especializados en insuficiencia cardíaca (IC) e HP. Se obtuvieron los siguientes datos personales y variables clínicas: síntomas y clase funcional (CF); grupo de HP (G); parámetros hemodinámicos directos: PAPm, presión de oclusión arterial pulmonar (POAP), presión en aurícula derecha (PAD) e índice cardíaco (Ic); datos funcionales: distancia en caminata de 6 minutos (DC6M); variables ecocardiográficas: función sistólica del ventrículo derecho (FSVD), desplazamiento sistólico del plano del anillo tricuspídeo (siglas en inglés, TAPSE), presión sistólica en arteria pulmonar (PSAP) y derrame pericárdico (DP). Los factores de mal pronóstico analizados fueron: historia de IC, síncope, CF avanzada (III/IV), DC6M < 350 metros, presencia de DP, TAPSE ≤ 15 mm, PAD ≥ 12 mm Hg e Ic ≤ 2,2 L/min/m². Resultados. Se incluyeron 107 pacientes, el 74% fue de sexo femenino, con una edad media de 58,8 (± 19) años, el 33% ≥ 70 años. El tiempo medio al diagnóstico fue de 24 meses desde la presencia del primer signo o síntoma referido. La distribución por grupde HP fue: GI (64%), GII (15%), GIII (9%), GIV (6%) y GV (6%). Dentro del GI se destacó la esclerodermia como etiología preponderante (29%). La CF de presentación fue: CF II del 41%, CF III del 35%, CF IV del 20%, CF I del 4%. Las variables clínicas destacadas fueron: historia de IC (72%), síncope (23%) y angina (19%). La DC6M tuvo una media de 320 (±148) m, siendo≤ 350 m en el 47% de los casos. Los parámetros hemodinámicos por CCD fueron: PAPm de 48,3 (±16) mm Hg; PAD 9,7 (±5,2) mm Hg y ≥14 mm Hg en un 27% con un Ic de 2,78 L/min/m² (≤ 2,2-23%). La evaluación ecocardiográfica constató deterioro de la FSVD en el 79% de los casos (42%: leve, 18%: moderado y 19%: severo) con un TAPSE medio de 17,8 (±4) mm y ≤ 15 mm en un 37%; en el 25% se observó DP. Conclusiones. En nuestra población con diagnóstico reciente de HP, se presenta un elevado porcentaje de pacientes añosos y de factores de mal pronóstico. Estos hallazgos remarcan la necesidad de un diagnóstico precoz y terapéuticas de inicio temprano.

Introduction. Pulmonary hypertension (PH) is a multifactorial disease with high morbidity and mortality. Although its clinical evolution has improved in recent years due to the advance in its diagnosis and treatment, we have little information about clinical and prognostic factors associated with this entity. Purpose. To determine the prevalence and characteristics of adverse prognostic factors in our population with a recent diagnosis of PH. Material and methods. Patients with a recent diagnosis of PH (less than 7 days after diagnosis) confirmed by right heart catheterization (RHC) with mPAP ≥ 25 mm Hg, between March 2012 and December 2016, by different specialized services in heart failure (HF) and PH were included. The following personal data and clinical variables were obtained: symptoms and functional class (FC); HP group (G); hemodynamic parameters: mPAP, pulmonary arterial occlusion pressure (PAOP), right atrial pressure (RAP) and cardiac index (CI); functional data: 6-minute walk distance (6MWD); echocardiographic variables: right ventricle systolic function (RVSF), tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (SPAP) and pericardial effusion (PE). Poor prognosis factors analyzed were: history of HF, syncope, advanced FC (III/IV), 6MWD <350 meters, presence of PE, TAPSE ≤ 15 mm, RA ≥12 mm Hg and CI ≤ 2.2 L/min/m². Results. One hundred seven patients were included, 74% female, with a mean age of 58.8 (± 19) years, 33%≥ 70 years. The mean time to diagnosis was 24 months from the presence of the first sign or symptom recorded. Distribution by HP G was: GI (64%), GII (15%), GIII (9%), GIV (6%) and GV (6%). Considering GI, sclerodermia was the predominant etiology (29%). FC of presentation was: FC II 41%, FC III 35%, FC IV 20%, FC I 4%. Among the clinical variables, history of HF was present in 72% of patients, syncope in 23% and angina in 19%. Mean 6MWD was 320 (± 148) m, ≤ 350 m in 47% of the patients. The direct hemodynamic parameters by RHC were: mPAP 48.3 (± 16) mm Hg; RAP 9.7 (± 5.2) mm Hg and ≥14 mm Hg in 27%, CI 2.78 L/min/m² (≤ 2.2-23%). Echocardiographic analysis showed Impaired RVSF in 79% of cases (42% mild, 18% moderate and 19% severe) with a mean TAPSE of 17.8 (± 4) mm and ≤ 15 mm in 37%; PE was present in 25% of patients. Conclusions. In our population with recent diagnosis of PH, there is a high percentage of elderly patients and poor prognosis factors. This findings remark the need for early diagnosis and therapeutic strategies.

Introdução. A hipertensão pulmonar (HP) é uma doença multifatorial, com alta morbimortalidade. Embora sua evolução clínica tenha melhorado nos últimos anos devido ao avanço em seu diagnóstico e tratamento, temos pouca informação, em nossa região, sobre os fatores clínicos e prognósticos associados a essa entidade. Objetivos. Determinar a prevalência e as características de fatores prognósticos adversos em nossa população com diagnóstico recente de HP. Materiais e métodos. Foram incluídos pacientes com diagnóstico recente de HP (menos de 7 dias após o diagnóstico), confirmados por cateterismo cardíaco direito (CCD) com a pressão da artéria pulmonar média (PAPm) ≥ 25 mm Hg entre Março de 2012 e Dezembro de 2016, por diferentes serviços especializados em insuficiência cardíaca (IC) e HP. Foram obtidos os seguintes dados pessoais e variáveis clínicas: sintomas e classe funcional (CF); Grupo HP (G); parâmetros hemodinâmicos diretos: PAPm, pressão de oclusão arterial pulmonar (POAP), pressão atrial direita (PAD) e índice cardíaco (Ic); dados funcionais: distância de caminhada de 6 minutos (DC6M); variáveis ecocardiográficas: função sistólica do ventrículo direito (FSVD), excursão sistólica do plano anular da tricúspide (TAPSE), pressão sistólica da artéria pulmonar (PSAP) e derrame pericárdico (DP). Os fatores analisados de prognóstico pobre foram: história de IC, síncope, CF avançado (III/IV), DP6M<350 metros, a presença de DP, TAPSE ≤ 15 mm, PAD ≥12 mm Hg e Ic ≤ 2,2 L/min/m². Resultados. Foram incluídos 107 pacientes, sendo o 74% do sexo feminino, com média de idade de 58,8 (± 19) anos, o 33% ≥ 70 anos. O tempo médio para o diagnóstico foi de 24 meses a partir da presença do primeiro sinal ou sintoma referido. A distribuição por grupo de HP foi: GI (64%), GII (15%), GIII (9%), GIV (6%) e GV (6%). No GI, a esclerodermia foi destacada como a etiologia predominante (29%). A apresentação CF: CF II 41%, CF III 35%, CF IV-20%, CF I 4%. As variáveis clínicas destacadas: história de IC em 72%, síncope 23% e angina 19%. A DC6M teve uma média de 320 (± 148) m, sendo ≤ 350 m em 47% dos casos. Os parâmetros hemodinâmicos pelo CCD foram: PAPm 48,3 (± 16) mm Hg; PAD 9,7 (± 5,2) mm Hg e ≥14 mm Hg em 27% com Ic 2,78 L/min/m² (≤ 2,2-23%). A análise ecocardiográfica mostrou FSVD diminuída em 79% (42% leve, 18% moderada e 19% grave) com um TAPSE média de 17,8 (± 4) mm e ≤ 15 mm em o 37%; em o 25% foi observado DP. Conclusões. Em nossa população com diagnóstico recente de HP, há um alto percentual de pacientes idosos e fatores de mau prognóstico. Esses achados destacam a necessidade de diagnóstico precoce e início terapêutico precoce.

Protective effects of fentanyl preconditioning on cardiomyocyte apoptosis induced by ischemia-reperfusion in rats

We aimed to study the effect of fentanyl (Fen) preconditioning on cardiomyocyte apoptosis induced by ischemia-reperfusion (I/R) in rats. A total of 120 Sprague Dawley male rats (age: 3 months) were randomly divided into: sham operation group (S group), I/R group, normal saline I/R group (NS group), and fentanyl low, middle, and high dose groups (Fen1: 2 μg/kg; Fen2: 4 μg/kg; Fen3: 6 μg/kg). Heart rate (HR), mean arterial pressure (MAP), left ventricular developed pressure (LVDP), ±dp/dtmax, malondialdehyde (MDA), superoxide dismutase (SOD) activity, creatine phosphokinase-MB (CK-MB), and cardiac troponin-I (cTnI) were measured. Myocardial ischemic (MI) area, total apoptotic myocardial cells, and protein and mRNA expressions of B-cell lymphoma 2 (Bcl-2) and Bax were detected. HR and MAP were higher, while LVDP and ±dp/dtmax were close to the base value in the Fen groups compared to those in the I/R group. Decreased MDA concentration and CK-MB value and increased SOD activity were found in the Fen groups compared to the I/R group, while cTnI concentration was significantly lower in the Fen1 and Fen2 groups (all P<0.05). Myocardial damage was less in the Fen groups compared to the I/R group and the MI areas and apoptotic indexes were significantly lower in the Fen1 and Fen2 groups (all P<0.05). Furthermore, significantly increased protein and mRNA expressions of Bcl-2, and decreased protein and mRNA expressions of Bax were found in the Fen groups compared to the I/R group (all P<0.05). Fentanyl preconditioning may suppress cardiomyocyte apoptosis induced by I/R in rats by regulating Bcl-2 and Bax.

Effect of Danshen injection combined with ulinastatin on the brain protection and inflammatory reaction in patients with severe traumatic brain injury / 中国生化药物杂志

Objective To observe the effect of Danshen injection combined with ulinastatin on the brain protection and inflammatory reaction in patients with Severe traumatic brain injury.Methods 83 cases of patient with Severe traumatic brain injury were randomly divided into the observation group(43 cases)and the control group(40 cases).The control group was given ulinastatin based on conventional treatment,and the observation group was given Danshen injection and ulinastatin based on the control group.For 10 days,the differences of hemodynamic parameters(Qmean、Zc、DR)and serum nerve function indexes(β-EP、DynAl-13、NSE),inflammatory factors(IL-1,IL-6,TNF-α,CRP)between the two groups were be compared.Results ①Comparison of hemodynamic parameters There was significantly difference of Qmean、Zc、DR in these two groups(Fgroup=6.126,5.024,5.621,P<0.05),Qmean was showed a rising trend over time and Zc、DR were showed a declining trend over time(Ftime=10.146,9.247,9.381,P<0.05),the changed amplitude in observation group was higher than the control group(Finteraction=5.357,4.257,4.813,P<0.05); Comparison of nerve function indexes There was significantly difference of β-EP、DynAl-13、NSE in these two groups(Fgroup=5.827,6.294,6.731,P<0.05),they was all showed a reducing trend over time(Ftime=12.613,11.746,9.842,P<0.05),the declined amplitude in observation group was higher than the control group(Finteraction=6.353,7.251,4.284,P<0.05);Comparison of inflammatory factors There was significantly difference of IL-1,IL-6,TNF-α,CRP in these two groups(Fgroup=4.284,5.162,6.174,4.291,P<0.05),they was all showed a rising then reducing trend over time(Ftime=9.163,10.357,13.457,12.434,P<0.05),the changed amplitude in observation group was higher than the control group(Finteraction=4.255,5.242,8.530,7.847,P<0.05).Conclusion Danshen injection combined with ulinastatin has more obviously function of protecting the cerebralfunction and suppressing inflammation in the treatment of Severe traumatic brain injury compared with ulinastatin alone.

The prognostic meaning of biomarkers and hemodynamic parameters in the postural tachycardia syndrome children treated with midodrine hydrochloride / 中华实用儿科临床杂志

Postural tachycardia syndrome (POTS) is one type of orthostatic intolerance.The treatment for POTS including non-drug treatment and medications,such as α-receptor agonists,β-recepter blockers and oral rehydration salts.The prognostic meaning of biomarkers and hemodynamic parameters in the POTS children treated with midodrine hydrochloride are discussed in this paper.

Clinical Observation of Naloxone Hydrochloride Combined with Danshen Injection in the Treatment of Neo-natal Hypoxic Ischemic Encephalopathy / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of naloxone hydrochloride combined with Danshen injection in the treatment of neonatal hypoxic ischemic encephalopathy(HIE). METHODS:104 patients with HIE were randomly divided into observation group and control group with 52 cases in each group. The control group was treated with Naloxone hydrochloride injec-tion 0.02 mg/kg,ivgtt,qd and conventional symptomatic treatment;while observation group was additionally treated with Danshen injection 4-6 ml+10% Glucose injection 20 ml,ivgtt,qd,on the basis of the control group. Treatment course of 2 groups lasted for 7 d. Clinical efficacy,symptom and sign recovery of 2 groups were compared,as well as levels of serum MMP-9,IL-6 and TNF-α,cerebral hemodynamic parameters and ADR. RESULTS:There was no statistical significance in MMP-9,IL-6,TNF-α and cerebral hemodynamic parameters before treatment(P>0.05). The total effective rate of observation group(92.31%)was signifi-cantly higher than that of control group (75.00%);after treatment,the recovery time of consciousness disturbance,primitive re-flex and muscle tension in the observation group were shorter than those in the control group;the levels of serum MMP-9,IL-6 and TNF-α in observation group were significantly lower than those in control group;peak systolic flow velocity(PSFV),end-dia-stolic flow velocity (EDTV) were higher in the observation group than in the control group,with statistical significance (P0.05). No ADR was ob-served in 2 groups. CONCLUSIONS:Naloxone hydrochloride combined with Danshen injection can significantly promote HIE and signs recovery,reduce the levels of serum MMP-9,IL-6 and TNF-α,and improve hemodynamic parameters with good safety.

The application of color Doppler flow imaging in the diagnosis and therapeutic effect evaluation of erectile dysfunction / 亚洲男科学杂志(英文版)

We aim to investigate the correlations between hemodynamic parameters, penile rigidity grading, and the therapeutic effects of phosphodiesterase type 5 inhibitors using color Doppler flow imaging after intracavernosal injection in patients with erectile dysfunction. This study involved 164 patients. After intracavernosal injection with a mixture of papaverine (60 mg), prostaglandin E 1 (10 mg), and lidocaine (2%, 0.5-1 ml), the penile vessels were assessed using color Doppler flow imaging. Penile rigidity was classified based on the Erection Hardness Score system as Grades 4, 3, 2 or 1 (corresponding to Schramek Grades V to II). Then, the patients were given oral sildenafil (50-100 mg) and scored according to the International Index of Erectile Function (IIEF-5) questionnaire. The number of patients with penile rigidities of Schramek Grades II to V was 14, 18, 21, and 111, respectively. The IIEF-5 score was positively correlated with the refilling index of the penile cavernosal artery (r = 0.79, P< 0.05), the peak systolic velocity (r = 0.45, P< 0.05), and penile rigidity (r = 0.75, P< 0.05), and was negatively correlated with the end diastolic velocity (r = -0.74, P< 0.05). For patients with erectile dysfunction, both the IIEF-5 score after sildenafil administration, which is correlated with penile rigidity, and the hemodynamic parameters detected using color Doppler flow imaging may predict the effects of phosphodiesterase type 5 inhibitor treatment and could provide a reasonable model for the targeted-treatment of erectile dysfunction.

Application effect of hyperbaric oxygen in the patients with optic atrophy and influence for the hemodynamic parameters / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM: To observe the application effect of hyperbaric oxygen in the patients with optic atrophy and influence degree for the hemodynamic parameters.?METHODS: Fifty patients with optic atrophy in our hospital from January 2012 to January 2014 were objected, they were randomly divided into control group ( conventional optic atrophy treatment group ) and observation group ( conventional treatment and hyperbaric oxygen treatment group ) , each group was 25 cases. Statistical analysis of two group before and after treatment eyesight, vision acuity, visual field defect and ophthalmic artery, central retinal artery blood flow parameters were undergone.?RESULTS: The sight, visual field sensitivity and field vision defect of observation group were all better than those of control group at first, second and third course after the treatment, arteriae ophthalmica and arteriae centralis retinae EDV and PSV were all higher than those of control group, Pl and Rl were all lower than those of control group were all significant differences (P<0. 05).? CONCLUSlON: The application effect of hyperbaric oxygen in the patients with optic atrophy is better, and the influence of treatment method for the ocular hemodynamic parameters are more active.

Clinical value of conditions of radial artery for autogenous arteriovenous fistula ostomy by color Doppler ultra-sound / 局解手术学杂志

Objective To evaluate the clinical value of the condition of radial artery for autogenous arteriovenous fistula ostomy by color Doppler ultrasound. Methods The condition of radial artery of 133 end-stage renal disease( ESRD) patients who received autogenous arteri-ovenous fistula ostomy were detected by color Doppler ultrasound,and compared with the postoperative parameters of fistula vascular. Results Among all 133patients,the preoperative radial artery of 95 cases were normal,abnormal in 38 cases. Ostomy surgery performed on 131 cases. Two cases gave up surgery for the poor condition of radial artery,13 cases with fistula failure. The success rate with normal radial artery (95. 8%) was higher than that with the abnormal radial artery(75%). The blood flow parameters of normal radial artery were significantly better than those of the abnormal radial artery,and 4 weeks after operation,the anastomotic blood flow and blood vessel diameter were better than those 1 week before and after surgery. Conclusion Color Doppler ultrasound that can provide preoperative data of radial artery, predict postoperative the state of fistula vascular,and monitor the conditions of postoperative fistula vascular,with better clinical value.

Clinical Analysis in Patients of Idiopathic Pulmonary Hypertension With Acute Pulmonary Vasodilator Test / 中国循环杂志

Objective: To explore the effect of calcium channel blocker (CCB) treatment in patients of idiopathic pulmonary arterial hypertension (IPAH) with positive acute pulmonary vasodilator test, and to compare the hemodynamic differences between the positive and negative patients. Methods: A total of 156 consecutive IPAH patients with acute pulmonary vasodilator test were studied. The patients were divided into 2 groups according to the testing result. Positive group, n=23 and Negative group, n=133. The positive patients were followed up by clinical or telephone visit to investigate their CCB dose, WHO PAH cardiac classiifcation and the survival conditions. Kaplan-meier curve was conducted to analyze the living condition and t test was used to compare the hemodynamic differences between the positive and negative patients. Results: There were 43 male and 113 female patients at the male/female ratio of 1: 2.6, and 14.7% (23/156) positive patients. The average follow-up period for Positive group was (50.9 ± 3.8) months. There were 13 patients using diltiazem with the mean dose of (277 ± 108) mg/d at the range of (90-450) mg/d; 3 patients using amlodipine, 1 with the dose of 15mg/d and 2 with the dose of 7.5mg/d. The 1, 2 and 3 years survival rate for the positive patients were for 91.3%, 86.6% and 79.7% respectively. The mean pulmonary arterial pressure and pulmonary vascular resistance were lower, P=0.000, while the mixed venous oxygen saturation was higher in Positive group than Negative group, P=0.009.The NT-pro BNP level was lower in Positive group, P=0.001. Conclusion: IPAH patients has lower ratio of positive acute pulmonary vasodilator test. The positive patients has the higher 1, 3 and 5 years survival rate and better hemodynamic parameters as the mean pulmonary arterial pressure, pulmonary vascular resistance and better level of NT-pro BNP.

Anestesia en la cirugía laparoscópica abdominal / Anesthesia in abdominal laparoscopic surgery

El desarrollo tecnológico alcanzado permite realizar cirugía de acceso mínimo que con anterioridad requerían grandes incisiones, con elevada morbilidad y traumatismo para el paciente. Junto con la evolución de los medios técnicos e instrumental para este tipo de cirugía, también la anestesiología ha tenido que enfrentar nuevos retos. La monitorización, drogas y el manejo anestésico del paciente han sufrido modificaciones, pues las nuevas variaciones fisiológicas y de complicaciones quirúrgicas han traído consigo cambios importantes en los parámetros hemodinámicos y respiratorios, debidos a la insuflación de la cavidad peritoneal con CO2, el aumento de la presión intraabdominal y los cambios de posición durante el procedimiento.

Current technological development allows minimum access surgeries previously requiring big incisions resulting in high patient’s morbidity and trauma. Along with the development of technology and instruments for this type of surgery, anesthesiology also faced new challenges. Patient’s monitoring, drug and anesthetic management changed because new physiological variations and surgery complications have produced changes in hemodynamic and respiratory parameters, due to CO2 peritoneal cavity insuflation, increased intra-abdominal pressure and changes of position during the procedure.

The Effects of Tapping Force and Speed on the Activation of Motor-related Cortices / Jurnal Sains Kesihatan Malaysia

This single participant functional magnetic resonance imaging (fMRI) study investigates the effects of tapping force and speed on the activation characteristics in motor-related cortices during bilateral self-paced tapping of hand fi ngers. The participant performed four types of self-paced hand fi nger tapping which are soft-slow (SS), soft-fast (SF), hard-slow (HS) and hard-fast (HF) in an fMRI scan. A general linear model (GLM) was implemented in generating brain activation. Statistical inferences were then made about the brain activations using Gaussian random fi eld theory (RFT) at corrected signifi cant level (α = 0.05), given that there is no activation. The results indicate that the brain coordinates bilateral selfpaced tapping of hand fi ngers with the involvement of motor-related cortices which are bilateral precentral gyrus (PCG), bilateral cerebellum and supplementary motor area (SMA). The increase in tapping force accentuate signifi cant activation (p < 0.05 corrected) in bilateral PCG (Brodmann Area (BA) 6) in accordance with its function in triggering motor action such as controlling the tapping force. The increase in tapping speed causes a signifi cant (p < 0.05 corrected) increase in brain activation only in somatosensory associated region in the right superior parietal lobule (SPL) or right BA7. This suggests that SPL plays important roles in coordinating purposeful, skilled movements

Effects of continuous intermedin infusion on blood pressure and hemodynamic function in spontaneously hypertensive rats / 老年心脏病学杂志（英文版）

Objective To examine the effects of exogenously administered intermedin (IMD,adrenomedullin-2) on arterial blood pressure,cardiac function and the cardiovascular IMD receptor system in spontaneously hypertensive rats (SHRs) as well as to investigate the associated mechanisms.Methods Thirteen week-old male rats were divided in Wistar Kyoto (WKY) group (n =12),SHR group (n =12),IMD group (SHRs infused with IMD 1-47 500 ng/kg per hour,n =12),and ADM group (SHRs infused with adrenomedullin 500 ng/kg per hour,n =12).Results A two-week continuous administration of low dose IMD 1-47 via mini-osmotic pumps markedly reduced blood pressure,the maximal rates of increase and decrease of left-ventricle pressure development (LV ± dp/dtmax),left ventricular systolic pressure and heart rate in SHRs.Furthermore,IMD also inhibited protein over-expression of cardiovascular IMD receptors,myocardial Receptor Activity-Modifying Proteins (RAMP1 and RAMP2),aortic RAMP1,RAMP2,RAMP3,and calcitonin receptor-like receptor (CRLR);suppressed up-regulation of aortic RAMP1,RAMP2,RAMP3 and CRLR gene expression; and markedly elevated the mRNA abundance of myocardial atrial natriuretic peptide (ANP) and myocardial brain natriuretic peptide (BNP).Additionally,IMD 1-47 administration in SHRs increased aortic cAMP concentration and reduced myocardial cAMP concentration.Conclusion These findings support the speculation that IMD,as a cardiovascular active peptide,is involved in blood pressure reduction and cardiac function amelioration during hypertension.The mechanism underlying this effect may involve IMD binding of a receptor complex formed by RAMPs and CRLR,and consequential regulation of cAMP levels and other cardiovascular active factors,such as ANP and BNP.