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Chylothorax is one of the complications of surgery and lymphatic diseases. The incidence rate of chylothorax has been increasing in recent years. X-ray-guided interventional therapy is a new method for treating chylothorax, and its curative effect is no less than the traditional surgical treatment. Based on discussing the aetiology and diagnosis of chylothorax, this paper briefly summarizes the application progress of X-ray-guided interventional therapy for chylothorax to provide further reference and a basis for clinical practice.
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Objective:To summarize the clinical experience in the treatment of fulminant myocarditis with multiple organ dysfunction using extracorporeal life support in the ICU.Methods:Clinical data of 9 adult cases of fulminant myocarditis complicated with multiple organ dysfunction admitted in ICU from January 2019 to October 2020 were retrospectively analyzed.Results:All patients received immunoregulatory and antiviral therapy; mechanical ventilation and renal replacement treatment were performed. Extracorporeal life support was also applied, including 1 case receiving intra-aortic balloon pump (IABP) support, and 6 cases receiving IABP and venous-arterial extracorporeal membrane oxygenation (VA-ECMO). In 6 cases with ECMO, the SpO 2(100.0±0)%, ScvO 2(78.7±3.9)%, hsTnI [10.0(2.2,31.8)mg/ml], oxygenation index[437.0(326.5,450.8)], lactic acid [(1.5±0.5)mmol/L], BE(-1.1±1.9)and LVEF(53.5±12.6)% were significantly improved 5 days after treatment compared with before [(98.0±1.4)%,(61.9±4.3)%,27.1(16.6,50.0)mg/ml,159.7(70.3,190.9),(6.4±3.4)mmol/L,(-10.3±4.6),(29.0±11.1)%]( t=-3.46, -9.74; Z=-1.99, -4.89; t=3.63, -5.84, -3.33; P<0.05). Eight patients were discovered and discharged, and one patient died. Conclusion:Fulminant myocarditis develops rapidly, integrated treatment based on extracorporeal mechanical life support and immunomodulatory therapy can improve the outcome of patients in the ICU.
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Objective To investigate the effect of exogenous hydrogen sulfide (H2S) on intestinal mucosal barrier after cardiopulmonary resuscitation (CPR) in cardiac arrest (CA) rabbits. Methods Forty-four male New Zealand rabbits were divided into sham operation group (Sham group, n = 12), post-cardiac arrest syndrome (PCAS) group (n = 16) and H2S intervention group (PCAS+NaHS, n = 16) according to random number table method. The rabbit model of PCAS was established by tracheal clamping and suffocation, and CPR was started at 5 minutes after CA. However, Sham group did not clamp the tracheal intubation after anesthesia, and the other operations were the same as those in PCAS group. In the PCAS+NaHS group, a bolus of NaHS (0.5 mg/kg), a H2S donor, was injected via era vein 1 minute before the start of CPR, followed by a continuous injection of NaHS (1.5 mg·kg-1·h-1) for 3 hours, while the rabbits in other group were intravenously injected with the same volume of normal saline (NaCl 0.9%). Intestinal and portal vein blood samples were collected 24 hours after return of spontaneous circulation (ROSC). The level of serum fluorescein isothiocyanate-dextran (FD-4) was detected by fluorescein isothiocyanate (FITC) labeling method to reflect intestinal mucosal permeability. After hematoxylin-eosin (HE) staining of small intestine tissues, the morphological changes of mucosa were observed under light microscope, and the intestinal mucosa injury score was calculated. The expression of tight junction protein ZO-1 in intestinal mucosa was detected by immunohistochemistry. The content of malondialdehyde (MDA) in small intestinal tissue was determined by thiobarbituric acid chromogenic method, the activity of superoxide dismutase (SOD) was determined by xanthine oxidation method, and the level of myeloperoxidase (MPO) was determined by double antibody sandwich enzyme linked immunosorbent assay (ELISA) to reflect the oxidative stress and inflammatory reaction in small intestinal tissue. The expression of apoptosis protein (caspase-3) and autophagy related protein (Beclin-1, LC3) in small intestine tissue was detected by Western Blot. Results 12, 13 and 14 animals were successfully resuscitated in Sham group, PCAS group and PCAS+NaHS group respectively, while 12 animals in each group survived to the end of experiment. Compared with Sham group, the level of FD-4 in portal vein serum was significantly increased in PCAS group (mg/L: 11.95±0.59 vs. 1.43±0.48, P < 0.05), the pathological injury and inflammation infiltration were obviously aggravated under light microscope, the score of small intestine injury was significantly increased (4.21±0.37 vs. 0.36±0.18, P < 0.05), the expression of tight junction protein ZO-1 in the intestine was visibly down-regulated detected by immunohistochemistry, MDA content and MPO activity were significantly increased [MDA (nmol/mg): 3.65±0.32 vs. 1.54±0.24, MPO (U/g): 362±35 vs. 134±18, both P < 0.05], while SOD activity was significantly decreased (U/mg:78.84±7.49 vs. 115.48±8.48, P < 0.05), the expression levels of cleaved capase-3, Beclin-1 and LC3 proteins in the intestine were significantly increased (caspase-3/β-actin: 1.11±0.08 vs. 0.21±0.02, Beclin-1/β-actin: 2.08±0.11 vs. 0.42±0.03, LC3/β-actin: 1.05±0.07 vs. 0.37±0.05, LC3-Ⅱ/ LC3-Ⅰ: 1.28±0.14 vs. 0.17±0.02, all P < 0.05). Compared with PCAS group, the portal vein serum FD-4 level in PCAS+NAHS group was significantly decreased (mg/L:5.59±0.48 vs. 11.95±0.59, P < 0.05), the intestinal mucosal pathological injury and inflammatory cell infiltration were significantly decreased, the score of small intestine injury was significantly decreased (2.18±0.47 vs. 4.21±0.37, P <0.05), the expression of ZO-1 in intestine was significantly increased, MDA content and MPO activity in intestine were significantly decreased [MDA (nmol/mg): 2.65±0.31 vs. 3.65±0.32, MPO (U/g): 251±21 vs. 362±35, both P < 0.05], while SOD activity was significantly increased (U/mg: 96.86±7.52 vs. 78.84±7.49, P < 0.05), while the expression of activated caspase-3, Beclin-1 and LC3 proteins was significantly decreased (caspase-3/β-actin: 0.72±0.06 vs. 1.11±0.08, Beclin-1/β-actin: 0.96±0.08 vs. 2.08±0.11, LC3/β-actin: 0.72±0.06 vs. 1.05±0.07, LC3-Ⅱ/ LC3-Ⅰ:0.83±0.09 vs. 1.28±0.14, all P < 0.05). Conclusion H2S has a protective effect on intestinal mucosal injury induced by CA/CPR, which may be related to tight junction protein ZO-1 up-regulation, oxidative stress alleviation, inflammation reduction, apoptosis and autophagy inhibition.
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Objective To observe and assess the effects of full marathon on hemodynamics and cardiac electrophysiology of marathon amateurs without adverse event after the race.Methods Fiftyone subjects were included in the final analysis of the study,blood pressure,heart rate,body surface electrocardiogram (ECG) of all subjects under static status before the race and within (15-30) min after the race were detected,and sufficient amounts of the peripheral blood and the radial arterial blood specimens of all subjects under static status before the race and within (15-30) min after the race were collected instantly.The peripheral blood was used for measuring markers of muscle injury and NT-proBNP,and the radial arterial blood was taken for blood gas analysis.The QTc interval,QRS,PR interval,and QTd interval were recorded from the 12-lead ECG report.Results Compared with those under static status before the race,the systolic blood pressure,diastolic blood pressure,mean arterial blood pressure and heart rate of all the subjects within (15-30) min after the race were significantly higher (P＜0.05).When the markers of striated muscle injury were compared before and after the competition,levels of CK,cTNI,LDH,and myoglobin after the race were significantly increased compared with them under static status before the race (P ＜0.05),and the level of NT-proBNP after the race was also significantly increased compared with it before the race (P＜0.05).When blood gas analysis before the race was compared with that after the race,the PH values after race were significantly lower than it before race (P＜0.05).The level of lactic acid after the race was significantly higher than it before race (P＜0.05).After the race,the levels of PCO2,SBE and HCO3-decreased significantly compared with those before race (P＜0.05),and the QTc and QTd intervals after the race increased significantly compared with those before the race,however,the QTc interval and QTd interval for all subjects before and after the competition were within the normal range.Conclusions Full marathon significantly affect the myocardial electrophysiological markers of healthy amateur athletes without chronic diseases,but those markers fluctuate within the normal range.
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Objective To investigate the effects of hydrogen (H2) on myocardium injury post-cardiac arrest (CA) in rabbits.Methods Sixty New Zealand rabbits were randomly divided into H2 treatment group (n = 30) and control group (n = 30) by random number table. The rabbit CA model was established by means of electrical stimulation of external membrane, both groups were mechanically ventilated. Cardiopulmonary resuscitation (CPR) was performed after 6 minutes of nonintervention, and stopped after restoration of spontaneous circulation (ROSC). Inhalation of 2％ H2 gas was conferred to rabbits immediately at the end of CA modeling for 72 hours in H2 treatment group. Air was given to rabbits in control group instead. The survival rate of rabbits was analyzed. Heart rate, ventricular premature beat frequency, and the levels of blood samples cardiac troponin I (cTnI), left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP), and blood lactic acid (Lac) were collected before CA and after ROSC in all rabbits. Rabbits were sacrificed and microstructure injury was observed by electric microscope after ROSC 72 hours.Results There were 28 animals ROSC in both groups; the survival number in H2 treatment group was higher than that in control group at 72 hours after ROSC (number: 15 vs. 7,χ2 = 4.791,P = 0.029). In the early stage of ROSC, the heart rate of two groups slowed down, the number of premature ventricular increased, and then gradually recovered; the heart rate in H2 treatment group was returning to normal more quickly than that in control group at 48 hours after ROSC (bpm: 319±63 vs. 362±40,P < 0.05); the ventricular premature beat frequency was lower than that in control group at 72 hours after ROSC (times per minutes: 9.1±4.3 vs. 15.0±8.0,P < 0.05). The animals of two groups had different degrees of myocardial damage and cardiac insufficiency after ROSC, and restored with the extension of time. Compared with control group, the level of BNP in H2 treatment group was significant decreased at 24 hours after ROSC (ng/L: 385±98 vs. 488±174,P < 0.05), the levels of cTnI and Lac were significant decreased at 48 hours after ROSC [cTnI (μg/L:1.83±0.68 vs. 2.83±0.98, Lac (mmol/L): 5.5±1.6 vs. 7.9±2.6, bothP < 0.01], the LVEF was slightly higher than that at 72 hours after ROSC (0.690±0.040 vs. 0.650±0.041,P = 0.051). Compared with control group, less damage to myocardial ultra structure was found in H2 treatment group at 72 hours after ROSC.Conclusion Inhalation of H2 alleviates cardiac dysfunction and myocardial injury after CPR.
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Objective To investigate the value of aortic dissection detection (ADD) risk score in the diagnosis of acute aortic syndromes (AAS). Methods Three hundred and forty-two patients with acute chest pain or back pain admitted to the Department of Emergency of the First Affiliated Hospital of Xiamen University from January 2013 to April 2016 were enrolled. At last, 71 patients were definitely diagnosed as AAS (AAS group), and 271 cases were diagnosed as non-AAS (non-AAS group). Furthermore, according to the ADD risk score, they were subdivided into two groups: low-risk (ADD score ≤ 1) and high risk (ADD score >1) subgroups. In the two groups, the ADD risk indexes and the proportions of patients with different risk scores were observed; the receiver operating characteristic curve (ROC curve) was drawn to evaluate the value of ADD risk score for diagnosing AAS. Results Compared with the non-AAS group, the proportions of patients in AAS group with indicators of high-risk pain characteristics, such as sudden pain and laceration-like pain were increased significantly [83.1% (59/71) vs. 31.0% (84/271), 29.6% (21/71) vs. 0 (0/271)];meanwhile, the proportions of patients with high-risk physical examination indicators, such as systolic blood pressure differences among the 4 extremities and the defect of local nerve function in AAS group were also significantly increased [23.9% (17/71) vs. 0 (0/271), 11.3% (8/71) vs. 0 (0/271), both P < 0.05]; the proportion of patients with high risk AAS score in AAS group was higher than that in the non-AAS group [66.2% (47/71) vs. 1.5% (4/271), P < 0.01]. The sensitivity of ADD score ≥ 1 for diagnosis of AAS and area under ROC curve (AUC) were all higher than those of ADD score ≥2 (sensitivity: 98.6% vs. 66.2%, AUC: 0.819 vs. 0.564), moreover, the specificity and the positive predictive value of ADD score ≥ 2 for diagnosis of AAS were higher than those of ADD score ≥ 1 (98.5% vs. 59.8%, 92.2% vs. 39.1%respectively). When the ADD risk score ≥ 1, its odds ratio (OR) = 104.0, 95% confidence interval (CI) was 0.761-0.877, P = 0.000; while ADD risk score ≥ 2, OR = 130.7, 95%CI was 0.516-0.612, P = 0.003. Conclusion It is shown that when ADD risk score (> 1) is used to diagnose AAS, it has relatively high sensitivity, when ADD score being high risk (> 1 score) is applied to diagnose AAS, its specificity is high, thus ADD risk score has important value in helping the early diagnosis of AAS.
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Objective To investigate the effects of hydrogen (H2) on myocardium injury post-cardiac arrest (CA) in rabbits.Methods Sixty New Zealand rabbits were randomly divided into H2 treatment group (n = 30) and control group (n = 30) by random number table. The rabbit CA model was established by means of electrical stimulation of external membrane, both groups were mechanically ventilated. Cardiopulmonary resuscitation (CPR) was performed after 6 minutes of nonintervention, and stopped after restoration of spontaneous circulation (ROSC). Inhalation of 2％ H2 gas was conferred to rabbits immediately at the end of CA modeling for 72 hours in H2 treatment group. Air was given to rabbits in control group instead. The survival rate of rabbits was analyzed. Heart rate, ventricular premature beat frequency, and the levels of blood samples cardiac troponin I (cTnI), left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP), and blood lactic acid (Lac) were collected before CA and after ROSC in all rabbits. Rabbits were sacrificed and microstructure injury was observed by electric microscope after ROSC 72 hours.Results There were 28 animals ROSC in both groups; the survival number in H2 treatment group was higher than that in control group at 72 hours after ROSC (number: 15 vs. 7,χ2 = 4.791,P = 0.029). In the early stage of ROSC, the heart rate of two groups slowed down, the number of premature ventricular increased, and then gradually recovered; the heart rate in H2 treatment group was returning to normal more quickly than that in control group at 48 hours after ROSC (bpm: 319±63 vs. 362±40,P < 0.05); the ventricular premature beat frequency was lower than that in control group at 72 hours after ROSC (times per minutes: 9.1±4.3 vs. 15.0±8.0,P < 0.05). The animals of two groups had different degrees of myocardial damage and cardiac insufficiency after ROSC, and restored with the extension of time. Compared with control group, the level of BNP in H2 treatment group was significant decreased at 24 hours after ROSC (ng/L: 385±98 vs. 488±174,P < 0.05), the levels of cTnI and Lac were significant decreased at 48 hours after ROSC [cTnI (μg/L:1.83±0.68 vs. 2.83±0.98, Lac (mmol/L): 5.5±1.6 vs. 7.9±2.6, bothP < 0.01], the LVEF was slightly higher than that at 72 hours after ROSC (0.690±0.040 vs. 0.650±0.041,P = 0.051). Compared with control group, less damage to myocardial ultra structure was found in H2 treatment group at 72 hours after ROSC.Conclusion Inhalation of H2 alleviates cardiac dysfunction and myocardial injury after CPR.
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Objective To investigate the value of aortic dissection detection (ADD) risk score in the diagnosis of acute aortic syndromes (AAS). Methods Three hundred and forty-two patients with acute chest pain or back pain admitted to the Department of Emergency of the First Affiliated Hospital of Xiamen University from January 2013 to April 2016 were enrolled. At last, 71 patients were definitely diagnosed as AAS (AAS group), and 271 cases were diagnosed as non-AAS (non-AAS group). Furthermore, according to the ADD risk score, they were subdivided into two groups: low-risk (ADD score ≤ 1) and high risk (ADD score >1) subgroups. In the two groups, the ADD risk indexes and the proportions of patients with different risk scores were observed; the receiver operating characteristic curve (ROC curve) was drawn to evaluate the value of ADD risk score for diagnosing AAS. Results Compared with the non-AAS group, the proportions of patients in AAS group with indicators of high-risk pain characteristics, such as sudden pain and laceration-like pain were increased significantly [83.1% (59/71) vs. 31.0% (84/271), 29.6% (21/71) vs. 0 (0/271)];meanwhile, the proportions of patients with high-risk physical examination indicators, such as systolic blood pressure differences among the 4 extremities and the defect of local nerve function in AAS group were also significantly increased [23.9% (17/71) vs. 0 (0/271), 11.3% (8/71) vs. 0 (0/271), both P < 0.05]; the proportion of patients with high risk AAS score in AAS group was higher than that in the non-AAS group [66.2% (47/71) vs. 1.5% (4/271), P < 0.01]. The sensitivity of ADD score ≥ 1 for diagnosis of AAS and area under ROC curve (AUC) were all higher than those of ADD score ≥2 (sensitivity: 98.6% vs. 66.2%, AUC: 0.819 vs. 0.564), moreover, the specificity and the positive predictive value of ADD score ≥ 2 for diagnosis of AAS were higher than those of ADD score ≥ 1 (98.5% vs. 59.8%, 92.2% vs. 39.1%respectively). When the ADD risk score ≥ 1, its odds ratio (OR) = 104.0, 95% confidence interval (CI) was 0.761-0.877, P = 0.000; while ADD risk score ≥ 2, OR = 130.7, 95%CI was 0.516-0.612, P = 0.003. Conclusion It is shown that when ADD risk score (> 1) is used to diagnose AAS, it has relatively high sensitivity, when ADD score being high risk (> 1 score) is applied to diagnose AAS, its specificity is high, thus ADD risk score has important value in helping the early diagnosis of AAS.
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Objective To observe the impact of improving the compliance of ventilator bundle on morbidity of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients undergoing mechanical ventilation (MV) guided by context of Joint Commission International (JCI) settings, and to study the oral care efficacy of suction tube sponge brush. Methods A prospective study was conducted. The patients who needed MV admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Xiamen University from January 2013 to December 2016 were enrolled. In the context of JCI settings, necessary measurements were taken to enhance the compliance of ventilator bundle each year. In 2013, the preventive measures were set up and the education was strengthened. In 2014,the compliance of hand hygiene and bedside elevation was strengthened. In 2015, a control study was conducted to evaluate the effect between the traditional cotton dipped in chlorhexidine and the suction tube sponge brush rinsed with chlorhexidine on oral health impact parameters. The suction tube sponge brush rinsed with chlorhexidine oral care was introduced to improve compliance. In 2016, electronic bundle checklist for daily self-audits was conducted. The annually morbidity of VAP through the software of hospital and ICU was collected and calculated. The annual incidence of VAP was indicated by the VAP cases per 1000 MV days. Based on the VAP incidence rate in 2013 as 1, the VAP incidence-rate ratio (IRR) of each year was calculated. Results During the study period, a total of 2733 patients admitted to the ICU, including 1403 patients undergoing MV. Ninety-four of the 1403 patients with community-acquired pneumonia (CAP), aspiration pneumonia, back elevation ban, incomplete information, and withdrew from the study were excluded. 1399 patients undergoing MV were enrolled in the final analysis, with total MV days of 11012 days, and 94 patients occurred VAP. The annual incidence of VAP was progressively declined from 2013 to 2016, and the VAP cases per 1000 MV days were 17.0, 10.0, 5.9, 3.5 cases, respectively. Based on the VAP incidence rate in 2013, the IRR of VAP from 2014 to 2016 was also progressively declined, which was 0.59 [95% confidence interval (95%CI) = 0.35-0.98], 0.35 (95%CI = 0.18-0.64), and 0.21 (95%CI = 0.09-0.41), with statistical significance (all P 0.05). Conclusion Ventilator bundle can effectively reduce the morbidity of VAP in the context of JCI settings, and the oral care by using suction tube sponge brush and chlorhexidine can effectively improve oral hygiene.
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Objective To approach the effects of full Marathon on striated muscle and renal function of Marathon amateurs without complaints. Methods A prospective self-paired design study was conducted. The amateurs without body discomfort, hematuria, brown urine, or persistent muscle pain within 1 week after the 2012 Xiamen International Marathon Race were enrolled voluntarily. The peripheral blood and random urine specimens of all subjects under static status 1 week before the race and after the race instantly (within 10 minutes after finishing the race) were collected to detect markers of renal function and striated muscle injury. Results Sixty-one subjects were included in the final analysis of the study with full Marathon of 42.195 km and mean race time of (297.05± 55.60) minutes. Compared with those under static status before the race, the markers of renal function including the levels of urinary N-acetyl-beta-D-glucusamidase [NAG (U/L): 64.00 (54.50, 85.50) vs. 9.50 (8.10, 11.50)], urinary β2-microspheres protein [β2-MG (μg/L): 261.00 (128.50, 1 608.00) vs. 66.60 (33.75, 123.00)], random urinary creatinine [UCr (μmol/L): 19 066.56±10 938.31 vs. 5 872.52±4 363.20] and serum creatinine [SCr (μmol/L): 129.97±25.84 vs. 97.39±14.51] immediately after the race were significantly increased (all P < 0.01); the markers of muscle injury including the levels of serum creatine kinase [CK (U/L): 864.00 (504.00, 1 644.00) vs. 164.00 (128.00, 256.00)], lactic dehydrogenase [LDH (U/L): 383.26±141.69 vs. 182.23±41.12], myoglobin [Mb (mg/L): 1 880.00 (1 080.00, 3 300.00) vs. 42.00 (36.00, 54.50)], alanine aminotransferase [ALT (U/L): 27.0 (19.5, 38.0) vs. 24.0 (15.0, 29.5)] and aspartate transaminase [AST (U/L): 52.07±25.13 vs. 28.28±11.86] were also significantly increased (all P < 0.01), and the increase in CK, Mb, and LDH were more significant. It was shown by correlation analysis that CK after race was negatively correlated with age (r = -0.352, P = 0.005) and body mass index (r = -0.271, P = 0.035), and it was positively correlated with racing time (r = 0.387, P = 0.002) and urinary β2-MG after the race instantly (r = 0.364, P = 0.004). Mb after race was negatively correlated with body mass index (r = -0.331, P = 0.009), and it was positively correlated with urinary β2-MG after the race instantly (r = 0.315, P = 0.013). LDH after race was negatively correlated with age (r = -0.275, P = 0.032) and body mass index (r = -0.377, P = 0.003), and it was positively correlated with urinary β2-MG after the race instantly (r = 0.424, P = 0.001). Conclusion Full Marathon could significantly impact striated muscle and renal function of Marathon amateurs without complaints.