Critical coronavirus disease 2019 complicated with heparin resistance in 2 patients / 中华危重病急救医学

Objective:To explore the diagnosis process and treatment experience of severe coronavirus disease 2019 (COVID-19) patients with heparin resistance (HR).Methods:The medical team of the First People's Hospital of Lianyungang admitted 2 severe COVID-19 patients with HR in intensive care unit (ICU) during their support to the designated hospital for the treatment of COVID-19 patients in Lianyungang City in November 2021. The clinical features, laboratory examinations, imaging features, treatment and prognosis of the two patients were analyzed.Results:Both severe COVID-19 patients received mechanical ventilation, 1 patient was treated with extracorporeal membrane oxygenation (ECMO) support. Both patients were complicated with lower extremity deep venous thrombosis and HR phenomenon under routine dose anticoagulant therapy. The maximum daily dose of unfractionated heparin exceeded 35 000 U (up to 43 200 U), the 2 patients failed to meet the standard of anticoagulation treatment, and the course of disease was prolonged. After that, argatroban was given 0.4 μg·kg -1·min -1 combined with anticoagulant therapy, the activated partial thromboplastin time (APTT) of patients undergoing ECMO could be maintained at 55-60 seconds and the activated coagulation time (ACT) of them could be maintained at 180-200 seconds. After ECMO support or later sequential mechanical ventilation, both patients recovered and were discharged, and deep venous thrombosis was also effectively controlled. Conclusion:HR phenomenon often occurs during the treatment of severe COVID-19 patients, the anticoagulation regimen should be adjusted in time, and the anticoagulation effect combined with argatroban is clear.

Progress in noninvasive assessment of fluid responsiveness / 中华全科医师杂志

Fluid infusion is one of the most common therapeutic measures in clinical practice.With the development of medical technology,the assessment of fluid responsiveness before fluid infusion has become simpler and less invasive.The assessment of fluid responsiveness is based on three aspects:cardiopulmonary interaction,volume-loading test and endogenous volume-loading test.This article reviews the progress in the assessment of fluid responsiveness with the application of ultrasound and noninvasive continuous cardiac output monitoring,and the prospect of future improvement.

Study of blood flow velocity and respiratory variability in different parts of left heart by ultrasonography / 中华急诊医学杂志

Objective To investigate the correlation between blood flow velocity and respiratory variability in different parts of left heart of patients with sepsis via measuring the flow velocity of the E-wave of mitral valve (MV), peak flow velocity of left ventricular outflow tract (LVOT), and respiratory variability (ΔVpeak) by ultrasonography. Methods Totally 81 patients with sepsis hospitalized in ICU were chosen consecutively from March 2017 to October 2017. Each patient's flow velocity of the E-wave of mitral valve and peak flow velocity of LVOT was inspected, by apical four-chamber view and apical five-chamber view respectively, to calculate the respiratory variability. Results (1) Of the 81 patients with sepsis, 33 patients (40.7％) had complete control of mechanical ventilation (no spontaneous breathing trigger), and 48 patients (59.3％) had spontaneous breathing and incomplete control of mechanical ventilation (partial spontaneous breathing trigger). (2) There was no significant difference in the mean values of flow velocity of the E-wave of mitral valve and peak flow velocity of LVOT in patients with sepsis. Whereas the flow velocity of the E-wave of mitral valve (0.15±0.05) was greater than the peak flow velocity of LVOT (0.12±0.04) with statistical significance (P<0.01). In sepsis patients with complete control of mechanical ventilation (no spontaneous breathing trigger), respiratory variability in the flow velocity of the E-wave of mitral valve (0.17±0.06) was significantly greater than the peak flow velocity of LVOT (0.11±0.03), P<0.01, whereas in sepsis patients with incomplete control of mechanical ventila tion (partial spontaneous breathing trigger), there was no statistically significant difference between the respiratory variability in flow velocity of the E-wave of mitral valve (0.14±0.04) and in the peak flow velocity of LVOT (0.13±0.03), P=0.102. (3) The respiratory variability in flow velocity of the E-wave of mitral valve was correlated with the peak flow velocity of LVOT (r=0.670, P<0.01). The flow velocity of the E-wave of mitral valve was all correlated with the peak flow velocity of LVOT in both sepsis patients with complete control of mechanical ventilation (no spontaneous breathing trigger) (r=0.894, P<0.01), and sepsis patients with incomplete control of mechanical ventilation (partial spontaneous breathing trigger) (r=0.774, P<0.01), respectively. Conclusions The respiratory variability in flow velocity of the E-wave of mitral valve was correlated with that in the peak flow velocity of LVOT, which may provide a new indicator in evaluating the fluid responsiveness of patients with sepsis.

Significance of peripheral perfusion index in early diagnosis and goal-directed therapy of septic shock patients: a prospective single-blind randomized controlled trial / 中华危重病急救医学

Objective To investigate the application of peripheral perfusion index (PPI) in early diagnosis and goal-directed therapy of septic shock, and to provide reference for the early clinical diagnosis and treatment of septic shock. Methods A prospective single-blind randomized controlled trial (RCT) was conducted. Adult patients with sepsis admitted to emergency medical department and intensive care unit (ICU) of the First People's Hospital of Lianyungang City in Jiangsu Province from January 2013 to December 2016 were enrolled. The patients were randomly divided into two groups (n = 46). The PPI group was defined using PPI < 1.4 as diagnosis of septic shock standard, and PPI > 2 as treatment guide target. Control group was defined according to the traditional diagnostic criteria of shock which systolic blood pressure was less than 90 mmHg (1 mmHg = 0.133 kPa) or systolic blood pressure value decrease> 40 mmHg baseline and bundle treatment was performed. The volume of fluid resuscitation, organ dysfunction, the sequential organ failure score (SOFA), acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score,continuous renal replacement therapy (CRRT) time, mechanical ventilation (MV) time, the length of ICU stay and 28-day mortality were observed. Results There were 39 and 27 septic shock patients in PPI group and control group respectively. The diagnostic criteria of traditional septic shock with blood pressure as "gold standard", the sensitivity of PPI < 1.4 for septic shock was 94.3%, the specificity was 28.2%, the authenticity was 66.3%, the positive predictive value was 64.1%, the negative predictive value was 78.6%, the positive likelihood ratio was 1.31, the negative likelihood ratio was 0.18. The per capita fluid replacement within 24 hours in the PPI group was significantly higher than that in the control group (mL: 4 601±1 250 vs. 3 458±1 006, P < 0.01), but there was no significant difference in the per capita volume of the patients diagnosed as septic shock (mL: 4 596±1 320 vs. 4 205±1 058, P > 0.05). Compared with the control group, the PPI group treated patients within 48 hours with less vascular active drugs (cases: 6 vs. 15), APACHE Ⅱand SOFA score were lower (48 hours: APACHE Ⅱ was 10.2±2.1 vs. 12.0±3.2; 72 hours: SOFA was 5.1±1.8 vs. 6.0±2.1, APACHE Ⅱ was 8.9±1.8 vs. 9.8±2.2), the period of CRRT and the length of ICU stay were shorter [the period of CRRT (days): 3.0±0.9 vs. 3.6±1.4, the length of ICU stay (days): 5.2±2.1 vs. 6.3±2.9), the difference was statistically significant (all P < 0.05). There was no significant difference in the liver and kidney function index, arterial blood lactic acid (Lac), MV time (days: 3.3±1.4 vs. 3.5±1.2) and 28-day mortality (15.22% vs. 19.57%) between two groups (all P > 0.05). Conclusions The inadequacy of microcirculatory perfusion by oximetry-derived PPI is more sensitive to the diagnosis of septic shock than hypotension of systemic circulation. With PPI guiding the fluid resuscitation of septic shock patients, vasopressors can be withdrawn earlier and the duration of the CRRT and ICU can be decreased.

Application of acoustic elastography, conventional ultrasonography and mammography in the diagnosis of the breast cancer / 中华医学超声杂志（电子版）

ObjectiveTo explore the value of the diagnosis of breast cancer by acoustic elastography, conventional ultrasonography (including gray-scale ultrasonography, color Doppler flow imaging and Doppler spectrum) and mammography.MethodsOne hundred and four patients with breast disease conifrmed by surgical pathology were studied retrospectively in Zibo Maternal and Children Health Hospital. All the patients were examined by acoustic elastography, conventional ultrasonography and mammography before surgery.ResultsPathological results of 104 cases were: sixty-five malignanies and 39 benignities. The most common signs in the diagnosis of breast cancer by conventional ultrasonography were spicule sign (76.9%, 50/65), taller-than-wide sign (73.8%, 48/65), vascular resistance index>0.7 (70.8%, 46/65), calciifcation (53.8%, 35/65). And breast masses without these signs were regarded as benign lesions. The diagnostic criteria of breast cancer by acoustic elastography was 5-point method. We regarded the lesions got more than 3 points as malignancy. The most common signs in the diagnosis of breast cancer by mammography were dense shadow (73.8%, 48/65), spicule sign (70.8%, 46/65), calcification (69.2%, 45/65). And breast masses without these signs were regarded as benign lesions. The diagnostic accuracy of acoustic elastography, conventional ultrasonography, mammography, conventional ultrasound plus acoustic elastography, conventional ultrasound plus mammography and acoustic elastography plus mammography for breast tumor were 88.4% (92/104), 86.5% (90/104), 83.7% (87/104), 93.3% (97/104), 90.4% (94/104) and 89.4% (93/104), respectively. ConclusionsThe combination of any two imaging modalities can improve the diagnostic accuracy of breast cancer. And conventional ultrasound combined with acoustic elastography could be an effective method in the diagnosis of breast cancer.

Diagnosis and treatment of 56 cases of splenic tumors / 中国普通外科杂志

5 years, 1 for 3 years, 4 for less than 1 year. In addition, metastatic tumors to the spleen were found in 5 patients, splenectomy with or without combined resection of other organs was performed in all 5 patients. Conclusions Imaging examination is the main method of diagnosis for splenic tumors. Partial splenectomy is recommended for benign tumors. For malignant splenic tumors, surgery, as the main aspect of combined therapy, is required.

Deletion and Mutation of MTS1/p16 Gene in Human Pancreatic Carcinoma / 中国医科大学学报

Objective: Our aim was to investigate the alteration of p16 gene in human pancreatic carcinoma. Methods: A total of 66 human pancreatic tissue specimens, comprising 51 with pancreatic carcinomas and 15 normal pancreatic tissue specimens, were examined for homozygous deletion and mutation of p16 gene by using PCR-SSCP method. Results: No mutation and deletion was detected in 15 normal pancreatic tissue samples. Of 51 pancreatic carcinoma specimens, only one was found mutation for p16 gene in PCR-SSCP assay, and the deletion of the p16 gene in 23 samples were confirmed by using PCR, with a 45% p16 gene deletion rate. Conclusion: These data suggest that p16 gene alterations may play a role in the progression of human pancreatic carcinoma.

Evaluation on the use and results of computer-aided detection for full-field digital manunography / 中华放射学杂志

Objective To evaluate the using and results of computer-aided detection for full-field digital mammography in Chinese women. Methods 934 individuals more than 40 years old from a specific unit in Shenyang city were screened by full-field digital mammography ( Senographe 2000D, GE) . The examination images were diagnosed firstly by the experienced radiologists and then were analyzed by the computer-aided detection system ( R2' Image Checker ) , respectively. The results from these two assays were compared. Results The prompts were generated in 799 out of 1734 normal images, false-positive rate of computer-aided detection ( CAD) was 46. 1 % in the cases with normal breast image. The correct prompts rate was 70. 5 % in the cases with breast mass, 75. 0 % in the cases with breast microcalcification and 100. 0 % in the cases with breast cancer. Conclusion Although the CAD system has showed clinical values in practice, there are still some false-positive and false-negative results.

Localizing diagnosis of primary hyperparathyroidism / 中国普通外科杂志

Objective To evaluate the diagnostic value of US, ECT, CT and MRI in primary hyperparathyroidism (PHPT). Methods Data of 34 PHPT patients with diagnosis confirmed by postoperative pathology were retrospectively reviewed from January 1, 1990, through March 31, 2004. Results The preoperative diagnosis in 22 out of 25 cases (88%) undergoing preoperative ultrasonography of the neck with a positive result was verified by intraoperative findings. For 99m Tc-MIBI, CT and MRI, the positive results were 95%, 69% and 100% respectively. Conclusion Ultrasonography and 99m Tc-MIBI should be considered as the first choice for preoperative loci localization in patients with PHPT. Ultrasonography and 99m Tc-MIBI in combination is more sensitive and accurate for the localization of PHPT.

Reduction of the component ratio of the drag income and analysis of related medical economy in our hospital / 中华医院管理杂志

The overuse of drugs and the irrational increase in medical expenses are currently hot social issues. Standards need to be set in a strict way so as to reasonably contain the cost of medical and health care and die prices of drugs and to lower the expenses of medical services. Analyses conducted in our hospital indicate that the component ratio of the drug income fell from 48.1% in January through June, 2001 to 38.7% one year later; the hospital's overall income in January through June, 2002 dropped 5.3% as compared with the same period of 2001, with the drug income dropping 23.7% and the medical treatment income rising 11.8%; the average expenses bom by emergency outpatients and discharged patients in January through June, 2002 both lowered as compared with the same period of 2001. The authors hold that the component ratio of the drug income ought to be a key index in assessing the integrated management Wei of a hospital; the proportion of the drug income in the overall income of a hospital ought to be restricted to 40% or so; and when general plans are being made for a hospital as a whole with regard to the proportion of the drug income, different standards ought to be set for various specialties.