Breakthroughs in global critical care medicine 2019 / 中华危重病急救医学

The following trends emerged in international critical care practice in 2019: increasing analysis to phenotypes of sepsis and acute respiratory distress syndrome (ARDS), increasing evidences of early initiating of vasopressors and antibiotics for septic shock, also including the early furosemide stress test for critically ill patients with acute kidney injury (AKI). In addition, there are many significantly important trials with positive results: high dose vitamin C for septic shock, weaning strategy with pressure support ventilation (PSV) mode, tranexamic acid for patients with acute traumatic brain injury, and new monoclonal antibody for Ebola virus disease. And there are also negatives trials as following: individual mechanical ventilation, maximal recruitment open lung ventilation or early neuromuscular blockade for moderate-to-severe ARDS, N95 respirators preventing influenza, flexible family visit program against delirium or early sedation with dexmedetomidine to mechanically ventilated patients, intensive care unit (ICU) diary or nurse-led preventive psychological intervention against posttraumatic stress disorder (PTSD) in patients with mechanical ventilation, recombinant human soluble thrombomodulin (rhsTM) in patients with sepsis-associated coagulopathy, and so on. Further investigations should be focus on the phenotype analysis, by which individualized management fitting for specific pathophysiologic and immune characters for each patient could be clarified.

Review and forecast of critical care medicine in 2018 / 中华危重病急救医学

In 2018,a bunch of considerable positive progresses have been presented,including a revised "hour-1 bundle" introduced by international guideline for management of sepsis and septic shock,trans-pulmonary pressure monitoring via esophageal manometry in acute respiratory distress syndrome (ARDS) models,successful trials for new antibiotics,angiotensin Ⅱ in patients with vasodilatory shock and renal replacement therapy,advanced airway management in out-of-hospital cardiac arrest (OHCA) patients as well cellular immunotherapy for septic shock.But some of investigational trials did not yield expected results.For example,extracorporeal membrane oxygenation (ECMO) therapy for ARDS patients,the strategy of sequencing weaning with early extubation to noninvasive ventilation,prevention of delirium with haloperidol,surrogate decision supported by interprofessional intensive care unit (ICU)team and prophylaxis for gastrointestinal stress ulceration with pantoprazole in ICU.And more importantly,it has been obvious that the voices and evidences gathered by the opponents against guidelines development,compulsory polices of implementing bundled strategy,market position of hydroxyethyl-starch solutions (HES) and the usage of steroid in septic shock have been largely strengthen,highlighting a more divided and controversial situation.

Nasal surgery and upper airway radiofrequency ablation in patients with obstructive sleep apnea hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the efficacy and related factors of nasal surgery combined with upper air way radiofrequency ablation(RFA) for treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) with chronic nasal blockage.@*METHOD@#One hundred and three mild or moderate OSAHS patients with chronic nasal blockage were recruited, all cases had nasal surgery and upper airway RFA. All patients were evaluated by body mass index (BMI), Epworth sleep scale (ESS), snoring scale, and nocturnal polysomnography (PSG). Eighty-nine patients were reevaluated at least 6 months after surgery with the preoperative methods.@*RESULT@#After operation, the apnea and hypopnea index (AHI) decreased from (18.67 +/- 9.48)/h to (9.22 +/- 7.18)/h; the lowest artery oxygen saturation (LSaO2) increased from (0.83 +/- 0.08) to (0.92 +/- 0.06); the Epworth sleep scale(ESS) decreased from (8.74 +/- 5.67) to (5.12 +/- 3.74); the snoring scale decreased from (7.16 +/- 2.85) to (3.56 +/- 2.26), the percentage of time with oxyhemoglobin saturation below 0.90 (CT90) decreased from (18.64 +/- 12.98) to (10.73 +/- 8.29). All of the differences were obvious (P<0.01). Success was defined as a postoperative apnea-hypopnea in dex < 10 events per hour and at least 50% less than the preoperative value. The surgical success rate was 75.3% (67/89). No major perioperative complications occurred.@*CONCLUSION@#Our findings suggest that nasal surgery combined with upper airway RFA can improve snoring and disease-specific quality of life in patients with anatomic na sal obstruction with mild or moderate OSAHS.

Result of Z-palatoplasty for treating severe obstructive sleep apnea hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the efficacy and related factors of Z-palatoplasty for treating severe obstructive sleep apnea hypopnea syndrome (OSAHS).@*METHOD@#Thirty-two severe OSAHS patients with Friedman II and III oropharyngeal airway had Z-palatoplasty. Twenty-three patients with modified Mallampti Index (MMI) III-IV had coblation tongue channeling (CTC) simultaneously. The patients were followed up for one year post operatively.@*RESULT@#After operation, the apnea and hypopnea index (AHI) decreased from (54.74 +/- 20.38)/h to (22.72 +/- 18.36)/h; the lowest artery oxygen saturation (LSaO2 ) increased from (0.74 +/- 0.08) to (0.85 +/- 0.14); the Epworth sleep scale (ESS) decreased from (12.24 +/- 5.78) to (5.35 +/- 3.62); the percentage of time with oxyhemoglobin saturation below 0.90 (CT90) decreased from (31.48 +/- 20.15) to (15.73 +/- 12.29). All of the differences were statistically significant (P < 0.01). According to related criterion of chinese journal of otorhinolaryngology head and neck surgery in 2009, accumulative excellence rate was 71.9% and accumulative valid rate 84.4%. Six patients had temporary velopharyngeal insufficiency and returned to normal after 3 months.@*CONCLUSION@#Z-palatoplasty is an effective and safe surgical approach for OSAHS patients with Friedman II/III.

Effect of heparin,IGFBP-4 and IGF-1 on glucose metabolism and function in fibroblasts / 中国病理生理杂志

AIM: To study the inhibitory effect of IGF binding protein-4(IGFBP-4),especially in corporation with heparin on the pathopoiesis of insulin-like growth factor-1(IGF-1) in alveolitis and fibrosis.METHODS: The diploid human embryonic lung(HEL) fibroblasts were incubated respectively with control,100 ?g/L IGF-1,100 ?g/L IGF-1+100 ?g/L IGFBP-4,100 ?g/L IGF-1+200 ?g/L IGFBP-4,100 ?g/L IGF-1+100 ?g/L IGFBP-4+100 ?g/L heparin,100 ?g/L IGF-1 + 100 ?g/L IGFBP-4+200 ?g/L heparin,100 ?g/L IGF-1+100 ?g/L heparin,100 ?g/L IGF-1+200 ?g/L heparin for 24 h.Then the content of glucose transporter-4(GLUT-4),hexokinase-2(HK-2),collagen-4 and elastin were detected,respectively.RESULTS: Compared with control group,HK-2,GLUT-4,elastin and collagen-4 expressed in IGF-1 group were increased obviously.The expression in the group of IGFBP-4 plus IGF-1 was more than that in IGF-1 group.However,all expression was depressed strikingly when heparin was added.CONCLUSION:(1) IGF-1 apparently stimulates HK-2,GLUT-4,elastin and collagen-IV secretions from lung fibroblasts.(2) The intact IGFBP-4 associated with heparin can inhibit the pathopoiesis of IGF-1.