Clinical efficacy of extracorporeal membrane oxygenation on severe acute respiratory distress syndrome caused by Pneumocystis jersima pneumonia after renal transplantation / 中华器官移植杂志

Objective:To explore the clinical efficacy of venovenous extracorporeal membrane oxygenation(V-V ECMO)in patients with severe acute respiratory distress syndrome(ARDS)caused by Pneumocystis pneumonitis(PJP)after kidney transplantation(KT).Methods:Cal data of 9 KT recipients on V-V ECMO were retrospectively analyzed. Timing of V-V ECMO support, complications during treatment and V-V ECMO performance were summarized.Results:All 9 patients with confirmed PJP adopted V-V ECMO with oxygenation index of 25~92 prior to V-V ECMO and average time from admission to initiating V-V ECMO was 5.56(1~17)days. Except for one death from hemorrhagic shock due to abdominal hemorrhage, the remainders were successfully weaned. Another recipient died from sepsis after weaning and there were 7 survivors. V-V ECMO support time was 215.5 h among 8 successfully weaned recipients. Among 7 survivors, 1 had premorbid deterioration of graft function and no fatal complications occurred.Conclusions:V-V ECMO is an effective treatment for severe ARDS caused by P. pneumoniae post-KT. And its early application is recommended for reducing complications and improving patient prognosis.

Comparison of neurologic outcome between active abdominal compression-decompression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation in asphyxia cardiac arrest / 中华危重病急救医学

Objective To compare the neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and chest compression cardiopulmonary resuscitation (STD-CPR) in asphyxia cardiac arrest (CA). Methods A prospective multicenter randomized controlled trial (RCT) was conducted. Adult patients with CA because of asphyxia such as drowning, airway obstruction admitted to Zhengzhou People's Hospital and Sanmenxia Central Hospital from June 2014 to December 2017 were enrolled. With the informed consent of patients' families, patients were divided into AACD-CPR group and STD-CPR group according to random number table method. The blood from median cubital vein or basilic vein were extracted at 1, 6, 12, 24 and 48 hours after the return of spontaneous circulation (ROSC), and the levels of S100B protein and neuron-specific enolase (NSE) were detected by enzyme linked immunosorbent assay. Neurological outcome was classified according to cerebral performance classification (CPC) after 3 months. Results A total of 183 patients were selected, including 78 ROSC patients after CPR. Patients with CA > 8 minutes and rescue time > 1 hour were excluded, 69 ROSC patients (36 in STD-CPR group and 33 in AACD-CPR group) were finally included. After ROSC, the levels of S100B protein and NSE in blood of two groups were increased gradually, reaching the peak at 6 hours, and then decreased gradually. The levels of S100B protein and NSE in AACD-CPR group at different time points after ROSC were significantly lower than those in STD-CPR group [S100B protein (μg/L): 1.62±0.52 vs. 1.88±0.46 at 1 hour, 1.71±0.41 vs. 2.02±0.58 at 6 hours, 1.24±0.37 vs. 1.52±0.59 at 12 hours, 1.05±0.23 vs. 1.28±0.37 at 24 hours, 0.82±0.29 vs. 1.05±0.36 at 48 hours; NSE (μg/L):24.76±3.02 vs. 26.78±4.29 at 1 hour, 58.78±5.58 vs. 61.68±5.44 at 6 hours, 53.87±4.84 vs. 56.78±5.68 at 12 hours, 40.96±3.52 vs. 43.13±4.50 at 24 hours, 33.23±2.89 vs. 35.54±3.44 at 48 hours; all P < 0.05]. 3 months after ROSC, the CPC classification of AACD-CPR group was lower than that of the STD-CPR group (average rank: 28.86 vs. 42.46, Z = -3.375, P < 0.001). Conclusion After suffering asphyxia CA, patients who accepted AACD-CPR had better neurologic outcome than STD-CPR.

Predictive value of partial pressure of end-tidal carbon dioxide on the effect of active abdominal compression-decompression cardiopulmonary resuscitation and serum S100B protein on cerebral function / 中华危重病急救医学

Objective To explore the predictive value of partial pressure of end-tidal carbon dioxide (PETCO2) on the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and serum S100B protein on cerebral function. Methods 142 adult patients with in-hospital cardiac arrest (IHCA) AACD-CPR in Zhengzhou People's Hospital, Affiliated Southern Medical University from September 2014 to December 2017 were enrolled. Patients were divided into successful group and failure group according to restoration of spontaneous circulation (ROSC) or not; and then according to Glasgow-Pittsburgh cerebral performance categories (CPC) one month after ROSC, the successful group was divided into good prognosis group (CPC 1-2) and poor prognosis group (CPC 3-5) further. The variations of hemodynamic, arterial blood gas index, PETCO2and serum S100B protein level (25 healthy subjects as normal S100B protein level reference value) during the recovery were analyzed. The predictive value of PETCO2on the effect of AACD-CPR and serum S100B protein on cerebral function of successful resuscitation patients were analyzed by receiver operating characteristic curve (ROC). Results ① According to the traditional qualitative indexes, such as pulsation of the large artery, redness of lips and extremities, spontaneous fluctuation of chest, narrowing of pupil, existence of shallow reflex, etc, 54 in 142 patients with IHCA were successfully resuscitated; 57 cases were successfully resuscitated through the guidance of PETCO2, there was no significant difference between the two groups (χ2= 0.133, 1 = 0.715). With the AACD-CPR, 142 CA patients' arterial partial pressure of oxygen (PaO2), arterial blood carbon dioxide partial pressure (PaCO2) were all improved with different degrees; heart rate (HR), mean arterial pressure (MAP), PaO2and PaCO2were further improved at 20 minutes after ROSC. At beginning of AACD-CPR, PETCO2of both groups were about 10 mmHg (1 mmHg = 0.133 kPa). PETCO2was gradually rising to above 20 mmHg in successful group during AACD-CPR process; the failed group increased slightly within 2-5 minutes, then gradually decreased to below 20 mmHg, there was a significant difference in PETCO2between the two groups at each time. The area under the ROC (AUC) of PETCO2at CPR 20 minutes in predicting the outcome of the resuscitation was 0.969, 95% confidence interval (95%CI) was 0.943-0.995 (1 = 0.000), when the cut-off value of PETCO2was 24.25 mmHg, the sensitivity was 90.7%, and the specificity was 96.6%. ② The level of serum S100B protein at 0.5 hour after ROSC in the good prognosis group and the poor prognosis group were significant higher than that of the normal control group; there was no significant difference between poor prognosis group and good prognosis group. S100B protein concentration of the poor prognosis group reached the peak within 3-6 hours, then gradually decreased, and was higher than that of the normal control group at ROSC 72 hours; the good prognosis was gradually decreased and recovered to normal control group within ROSC 72 hours. The AUC of S100B at 3 hours after ROSC on cerebral function prognosis prediction was 0.925, 95%CI was 0.867-0.984 (1 = 0.000), when the cut-off value of S100B protein was 1.215 μg/L, the sensitivity was 85.2%, and the specificity was 85.5%. Conclusion The variation of PETCO2can be used as an objective index to predict the success of AACD-CPR, and serum S100B protein can be used as an objective clinical index to predict cerebral function after AACD-CPR, both of which have some reference and guiding significance for clinical treatment.

Experience of clinical efficacy of renal transplantation from donors of donation after brain death complicated with acute kidney injury / 器官移植

Objective To summarize the clinical efficacy of renal transplantation from donors of donation after brain death (DBD) complicated with acute kidney injury (AKI). Methods Fifty-nine DBD donors successfully undergoing renal transplantation were recruited in this investigation. According to the Scr level upon admission of intensive care unit (ICU), DBD donors were divided into the AKI group (n=14) and control group (n=45). A total of 101 recipients were assigned into the AKI group (n=23) and control group (n=78) correspondingly. The organ donation conditions of 59 donors were summarized. Main parameters of the donors before organ procurement were statistically compared between two groups. Postoperative kidney function, hospitalization condition and clinical outcomes of the recipients were statistically compared between two groups. Results Among 59 donors, 14 cases (24%) suffered from AKI. Two donors received continuous renal replacement therapy during organ maintenance. Compared with the donors in the control group, the APACHE Ⅱ score of the donors was significantly higher (P<0.05), the incidence of central diabetes insipidus was considerably higher (P<0.01), the Scr levels at admission of ICU and before organ procurement were significantly higher (both P<0.01) and the amount of urine at 24 h before organ procurement was dramatically less in the AKI group (P<0.01).Compared with the recipients in the control group, the Scr levels at postoperative 2 and 3 d were significantly higher (both P<0.05), the length of hospital stay was considerably longer (P<0.01) and the hospitalization expanse was significantly higher in the AKI group (P<0.05). No statistical significance was observed in the postoperative delayed recovery of renal graft function, incidence of acute rejection, infection and rehabilitation dialysis in the recipients between two groups (all P>0.05). At 3 months after transplantation, the recipients in two groups were discharged and the graft survival rate was 100%. Conclusions For renal transplantation from DBD donors complicated with AKI, active measures should be taken to maintain the organ and relieve the AKI, which yields similar clinical efficacy to renal transplantation from non-AKI donors and widens the origin of kidney graft.

Effect of enteral nutrition via nasal jejunal tube on liver function / 中华临床营养杂志

Objective To observe the liver function changes in patients after enteral nutrition through nasal jejunal tube.Methods Altogether 74 inpatients requiring enteral nutrition were collected for this study from September 2011 to August 2014 in the Intensive Care Unit of Zhengzhou People's Hospital and divided into 2 groups with random number table:the nasal jejunal tube group (n =36) and the nasogastric tube group (n ＝38),with nasal jejunal tube and nasogastric tube inserted,respectively,for early enteral nutrition.We observed the two groups of patients in terms of liver function indexes on day 7 and day 14 after starting enteral nutrition.Results In the nasal jejunal tube group,31 patients (86.11％) showed abnormality in at least 1 liver function index,while that number was 23 in the nasogastric tube group (60.53％),with significant inter-group difference (x2 =6.136,P =0.013).On day 7 after enteral nutrition,there were no significant differences in alanine transaminase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),γ-glutamyl transpeptidase (γ-GGT) and albumin (ALB) between the two groups [(39.1 ± 8.6) U/L vs.(42.3 ±8.9) U/L,t=-1.475,P=0.145;(36.2±6.8) U/Lvs.(38.0±7.1) U/L,t=-1.237,P=0.220;(61.8±11.5) U/Lvs.(63.1 ±13.2) U/L,t=-0.696,P=0.489;(47.3±8.2) U/Lvs.(50.5±7.5) U/L,t=-1.640,P=0.106;(35.2±6.7) g/Lvs.(36.2±7.4) g/L,t=-0.610,P=0.543];but on day 14,the nasal jejunal tube group had significantly higher levels of ALP,γ-GGT,and ALB compared with the nasogastric tube group [(201.2 ± 15.2) U/L vs.(116.5 ± 13.6) U/L,t =-25.380,P =0.000;(109.4±7.2) U/Lvs.(49.2±6.5) U/L,t=-37.665,P=0.000;(37.2±7.1) g/Lvs.(30.1±6.5) g/L,t =-4.490,P =0.000].On day 7 and day 14,there were no statistically significant differences in totalbilirubin [(4.6±0.9) μmol/L vs.(4.8 ± 1.0) μmol/L,t =-0.905,P=0.368;(4.8±12) μmol/Lvs.(5.2±1.1) μmol/L,t=-1.492,P=0.140],indirect bilirubin [(6.1 ±0.8) μmol/Lvs.(6.3±0.9) μmol/L,t=-1.012,P=0.315;(6.9±0.9) μmol/L vs.(7.3±1.0) μmol/L,t=-1.811,P =0.074],and direct bilirubin [(4.0 ± 0.6) μmol/L vs.(3.9 ± 0.5) μmol/L,t =0.777,P =0.440;(5.1 ±0.8) μmol/L vs.(5.4±0.9) μmol/L,t=-1.517,P=0.134] between the nasogastric tube and the nasal jejunal tube groups.The incidence of pulmonary infection in the nasal jejunal tube group was significantly lower than that in the nasogastric tube group (30.56％ vs.55.26％,x2 =4.598,P =0.032).Conclusion Compared with enteral nutrition through nasogastric tube,enteral nutrition through nasal jejunal tube may be more likely to lead to abnormal liver function.

The clinical significance of detection of telomerase in bronchoalveolar lavage liquid in patients with lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>To investigate the diagnostic significance of detection of telomerase activity of bronchoalveolar lavage liquid (BALF) in primary lung cancer.</p><p><b>METHODS</b>BALF of 63 patients with lung cancer and 31 patients with non-cancerous pulmonary disease was collected, and telomerase activity was detected with silver-stained TRAP. Brush cytology and BALF cytology were carried out simultaneously.</p><p><b>RESULTS</b>The positive rate of telomerase was 76.2% (48/63) in lung cancer group, which was higher than 6.5% (2/31) in control group (Chi-square=40.6, P < 0.01). The positive rate was also higher than that of brush cytology (58.7%, 37/63) (Chi-square =3.6, P > 0.05), and higher than that of BALF cytology (14.3%, 9/63) (Chi-square=46.3, P < 0.01). In central type lung cancer group, the positive rate of telomerase was 71.4% (35/49), and higher than that of BALF cytology (12.2%, 6/49) (Chi-square= 35.3 , P < 0.01), but had no significant difference compared to that of brush cytology (61.2%, 30/49) (Chi-square=1.1, P > 0.05). In peripheral-type lung cancer group, the positive rate of telomerase in BALF was 92.9% (13/14), and higher than that of brush cytology (50.0%, 7/14) and that of BALF cytology (21.4%, 3/14).</p><p><b>CONCLUSIONS</b>The telomerase activity could be detected in the BALF of the primary lung cancer. Hence, detection of telomerase in the BALF of patients may be helpful to diagnose lung cancer.</p>