Association of AluYb8 insertion in the MUTYH gene with the risk of decreased left ventricular diastolic function in elderly diabetic patients / 中华老年医学杂志

Objective:To explore the relationship between AluYb8 insertion in the MUTYH gene and the risk of decreased left ventricular diastolic function in the elderly.Methods:In the retrospective analysis, 498 elderly patients with decreased left ventricular diastolic function(the disease group)and 155 people without left ventricular diastolic function(the control group)were recruited.Polymerase chain reaction was employed to analyze the genotype distribution of AluYb8 insertion in MUTYH gene.Cardiac function was measured by high-resolution color Doppler ultrasound.Results:The frequencies of the A/A, A/P and P/P genotypes were 30.1%(150/498), 48.4%(241/498)and 21.5%(107/498)in patients with decreased left ventricular diastolic function, and 27.7%(43/155), 54.8%(85/155)and 17.5%(27/155)in the control group, respectively.There were no significant differences in genotype( χ2=2.162, P=0.339)and allele frequency( χ2=1.342, P=0.794)between the two groups.Further analysis after stratification revealed that there were statistically significant differences in genotype( χ2=7.173, P=0.028)and allele frequency( χ2=8.352, P=0.015). Multivariate Logistic regression analysis showed that, in elderly patients with diabetes, P-allele carriers had a higher risk of decreased left ventricular diastolic function than non-carriers( OR=3.450, 95% CI: 1.148-10.372, P=0.027). Conclusions:AluYb8 insertion in the MUTYH gene may be associated with the risk of decreased left ventricular diastolic function in the elderly with diabetes.

Influence of abnormal blood pressure circadian rhythms and the morning surge on aortic stiffness in the elderly patients with isolated systolic hypertension / 中华老年医学杂志

Objective:To investigate the influence of abnormal blood pressure circadian rhythms and the morning surge on aortic stiffness in elderly patients with isolated systolic hypertension(ISH).Methods:A total of 300 untreated elderly(≥60 years)patients with ISH were enrolled.24-hour ambulatory blood pressure was measured by using a non-invasive portable ambulatory sphygmomanometer with an inflatable cuff.Brachial-ankle pulse wave velocity(baPWV)and the ankle-brachial pressure index(ABI)were measured by using an automated device.Patients were divided into the dipper(n=95), no-dipper(n=177)and extreme dipper(n=28)groups according to the rate of nocturnal blood pressure reduction.They were also divided into the morning surge(n=88)and no morning surge(n=212)groups according to the morning blood pressure surge(MBPS). Differences between the groups were compared.Correlations between the parameters were calculated by partial correlation analyses.The effects on baPWV and ABI were calculated by multiple linear regression analyses.Results:baPWV was higher in the extreme dipper group than in the dipper and no dipper groups[(1 402±234)cm/s vs.(1 467±114)cm/s vs.(1 538±140)cm/s, P<0.01], while ABI values were lower in the extreme dipper group than in the dipper group(0.98±0.10 vs.1.05±0.12, P<0.01)and the no dipper group(0.98±0.10 vs.1.03±0.12, P<0.05). Moreover, baPWV[(1 508±170)cm/s vs.(1 430±163)cm/s, P<0.01]was higher while ABI values(0.98±0.13 vs.1.06±0.11, P<0.01)were lower in the morning surge group than in the no morning surge group.baPWV was positively correlated with daytime Systolic blood pressure(dSBP)( r=0.169, P<0.01), 24 hSBPCV( r=0.143, P<0.05), and MBPS( r=0.157, P<0.01), while ABI was negatively correlated with dSBP( r=-0.146, P=0.011)and MBPS( r=-0.321, P<0.01). Age( P<0.01), dSBP( P<0.05)and 24 h systolic blood pressure variation coefficient( P<0.05)were independent factors for baPWV, while dSBP and MBPS were independent factors for ABI(all P<0.01). Conclusions:Abnormal blood pressure circadian rhythms and the morning surge are associated with increased aortic stiffness in elderly patients with ISH.

Efficacy analysis of inferior vena cava variability combined with difference of central venous-to-arterial partial pressure of carbon dioxide on guiding fluid resuscitation in patients with septic shock / 中华危重病急救医学

Objective:To investigate the effect of inferior vena cava variability (IVCV) combined with difference of central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO 2) on guiding fluid resuscitation in septic shock. Methods:Patients with septic shock admitted to the department of critical care medicine of Jiangxi Provincial People's Hospital from January 1, 2018 to December 31, 2020 were enrolled, and they were divided into control group and observation group according to random number table method. Patients in both groups were given fluid resuscitation according to septic shock fluid resuscitation guidelines. The patients in the control group received fluid resuscitation strictly according to the early goal-directed therapy (EGDT) strategy. Resuscitation target: central venous pressure (CVP) 12-15 cmH 2O (1 cmH 2O≈0.098 kPa), mean arterial pressure (MAP) > 65 mmHg (1 mmHg≈0.133 kPa), mean urine volume (UO) > 0.5 mL·kg -1·h -1, central venous oxygen saturation (ScvO 2) > 0.70. In the observation group, the endpoint of resuscitation was evaluated by IVCV dynamically monitored by bedside ultrasound and Pcv-aCO 2. Resuscitation target: fixed filling of inferior vena cava with diameter > 2 cm, IVCV < 18%, and Pcv-aCO 2 < 6 mmHg. The changes in recovery indexes before and 6 hours and 24 hours of resuscitation of the two groups were recorded, and the 6-hour efficiency of fluid resuscitation, 6-hour lactate clearance rate (LCR) and 6-hour and 24-hour total volume of resuscitation were also recorded; at the same time, the duration of mechanical ventilation, length of intensive care unit (ICU) stay, 28-day mortality and the incidence of acute renal failure and acute pulmonary edema between the two groups were compared. Results:A total of 80 patients were enrolled in the analysis, with 40 in the control group and 40 in the observation group. The MAP, CVP and ScvO 2 at 6 hours and 24 hours of resuscitation in the two groups were significantly higher than those before resuscitation, while Pcv-aCO 2 and blood lactic acid (Lac) were significantly decreased, and UO was increased gradually with the extension of resuscitation time, indicating that both resuscitation endpoint evaluation schemes could alleviate the shock state of patients. Compared with before resuscitation, IVCV at 6 hours and 24 hours of resuscitation in the observation group were decreased significantly [(17.54±4.52)%, (18.32±3.64)% vs. (27.49±10.56)%, both P < 0.05]. Compared with the control group, MAP and ScvO 2 at 6 hours of resuscitation in the observation group were significantly increased [MAP (mmHg): 69.09±4.64 vs. 66.37±4.32, ScvO 2: 0.666±0.033 vs. 0.645±0.035, both P < 0.05], 24-hour MAP was increased significantly (mmHg: 75.16±3.28 vs. 70.12±2.18, P < 0.05), but CVP was relatively lowered (cmH 2O: 9.25±1.49 vs. 10.25±1.05, P < 0.05), indicating that the fluid resuscitation efficiency was higher in the observation group. Compared with the control group, 6-hour LCR in the observation group was significantly increased [(55.64±6.23)% vs. (52.45±4.52)%, P < 0.05], 6-hour and 24-hour total volume of resuscitation was significantly decreased (mL: 2 860.73±658.32 vs. 3 568.54±856.43, 4 768.65±1 085.65 vs. 5 385.34±1 354.83, both P < 0.05), the duration of mechanical ventilation was significantly shortened (days: 6.78±3.45 vs. 8.45±2.85, P < 0.05), while the incidence of acute pulmonary edema was significantly decreased [2.5% (1/40) vs. 20.0% (8/40), P < 0.05]. There was no significant difference in the length of ICU stay, 28-day mortality or incidence of acute renal failure between the two groups. Conclusions:Dynamic monitoring of IVCV and Pcv-aCO 2 can effectively guide the early fluid resuscitation of patients with septic shock, and compared with EGDT, it can significantly shorten the duration of mechanical ventilation, reduce the amount of fluid resuscitation, and reduce the incidence of acute pulmonary edema. Combined with its non-invasive characteristics, it has certain clinical advantages.

Association between non-thyroidal illness syndrome and pre-sarcopenia in elderly patients / 中华老年医学杂志

Objective:To explore the association between non-thyroid illness syndrome(NTIS)and pre-sarcopenia in the elderly.Methods:In the retrospective study, a total of 219 patients aged 60-85 years in Department of Geriatrics, Sir Run Run Hospital, Nanjing Medical University from April 2018 to March 2021, included 60 patients with NTIS and 159 patients without NTIS.Clinical data, laboratory results and body composition data were collected.Pre-sarcopenia was diagnosed based on human composition determination data and diagnostic criteria of pre-sarcopenia.Logistic regression analysis, Pearson's correlation analysis and the area under receiver operator characteristic curve(ROC)were used to explore the correlation between serum thyroid hormone levels and diagnostic data level of pre-sarcopenia.Results:Of 54 pre-sarcopenia patients, 30.3%(36/119)were male, 18.0%(18/100)were female with statistically significantly differences( P<0.01). Mean age was higher in both male and female patients in the NTIS group than in the non-NTIS group( P<0.01). The body mass index, levels of triiodothyronine(T3), free triiodothyronine(FT3), hemoglobin, and albumin were lower in NTIS group than in non-NTIS group( P<0.05). The prevalence of presarcopenia in female patients was higher in the NTIS group than in the non-NTIS group[42.9%(10/17) vs.10.6%(8/83), χ2=9.564, P<0.01]. Multivariate logistic regression analysis showed that the risk of pre-morbidity of sarcopenia was significantly higher in NTIS patients than in non-NTIS patients.FT3 was positively correlated with skeletal muscle mass index, fat-free body weight, and phase angle, and negatively correlated with visceral fat area( r=-0.17, P<0.05). While, free thyroxine(FT4)was negatively correlated with skeletal muscle mass index( r=-0.21), fat-free body weight( r=-0.16)and phase Angle( r=-0.2, P<0.01 or P<0.05), and was positively correlated with body fat percentage and visceral fat area( r=0.20 and 0.22, respectively, P<0.01). The use of area under ROC curve(AUC)of FT3 predicting sarcopenia stage showed that the AUC was 0.768(95% CI: 0.691~0.844). Conclusions:In elderly patients, NTIS is correlated with the pre-sarcopenia in the elderly, and FT3 and FT4 are related to muscle mass.The low level of FT3 can predict the pre-validation of pre-sarcopenia.

Celastrol alleviates sepsis-induced acute lung injury in rats by inhibiting the Toll-like receptor 4/nuclear factor-κB inflammatory pathway / 中华危重病急救医学

Objective:To investigate the protective effect and mechanism of celastrol in acute lung injury (ALI) of septic rats.Methods:According to random number table, 24 male Sprague-Dawley (SD) rats were divided into control group (Con group), Sham operation group (Sham group), sepsis-induced ALI group by cecal ligation and perforation (CLP group) and celastrol intervention group (CLP+celastrol group, 2 mg/kg intraperitoneal administration 1 hour before surgery), 6 rats in each group. The abdominal aortic blood of the rats was collected for blood gas analysis 24 hours after the surgery, and then the rats were sacrificed and the lung tissues were taken to calculate the lung wet/dry weight ratio (W/D). The pathological characteristics of lung tissues were observed under light microscope and calculated the lung injury score. The protein levels of Toll-like receptor 4 (TLR4), interleukins (IL-6, IL-10), and nuclear factor-κB (NF-κB) of cytoplasm and nucleus in lung tissues were detected by enzyme linked immunosorbent assay (ELISA).Results:The partial arterial oxygen pressure (PaO 2), lung W/D ratio, lung injury score and the protein levels of inflammatory factor in lung tissues had no differences between Con group and Sham group. Compared with the Con group, PaO 2 in the CLP group was significantly decreased [mmHg (1 mmHg = 0.133 kPa): 60.33±2.01 vs. 109.20±2.99], the lung W/D ratio and lung injury score were significantly increased (lung W/D ratio: 4.44±0.05 vs. 3.27±0.04, lung injury score: 10.67±0.42 vs. 0.50±0.22), and the protein levels of TLR4, IL-6, IL-10 and the nucleus NF-κB in the lung tissues were significantly increased [TLR4 (pg/L): 21.87±0.66 vs. 3.27±0.09, IL-6 (ng/L): 861.10±8.28 vs. 120.30±3.91, IL-10 (ng/L): 212.40±2.57 vs. 41.73±1.02, nuclear NF-κB (ng/L): 707.70±16.82 vs. 403.30±7.46], but the protein level of cytoplasm NF-κB was significantly decreased (ng/L: 213.70±8.67 vs. 408.30±8.71), with statistically significant differences (all P < 0.05). Compared with the CLP group, PaO 2 in CLP+celastrol group was significantly increased (mmHg: 76.83±3.21 vs. 60.33±2.01), the lung W/D ratio and lung injury score were significantly decreased (lung W/D ratio: 3.82±0.03 vs. 4.44±0.05, lung injury score: 5.00±0.37 vs. 10.67±0.42), and the protein levels of TLR4, IL-6, IL-10 and nucleus NF-κB in the lung tissue were significantly decreased [TLR4 (pg/L): 7.57±0.21 vs. 21.87±0.66, IL-6 (ng/L): 380.90±6.55 vs. 861.10±8.28, nuclear NF-κB (ng/L): 533.80±9.42 vs. 707.70±16.82], and the protein level of cytoplasm NF-κB was significantly increased (ng/L: 342.70±14.96 vs. 213.70±8.67), with statistically significant differences (all P < 0.05), while the protein level of IL-10 in lung tissues had no significant difference (ng/L: 210.50±3.16 vs. 212.40±2.57, P > 0.05). Conclusion:Celastrol may regulate the expression and release of inflammatory factors by inhibiting the TLR4/NF-κB pathway, thereby alleviating the ALI induced by sepsis in rats.

Study on the effect of sedation strategy guided by driving pressure on prognosis of patients with mechanical ventilation / 中华危重病急救医学

Objective:To evaluate the effect of airway driving pressure (ΔP) guided sedation strategy on the prognosis of patients with mechanical ventilation.Methods:Patients who needed invasive mechanical ventilation and admitted to the department of intensive care unit (ICU) of Jiangxi Provincial People's Hospital from January 2017 to December 2018 were enrolled. The patients were divided into study group and control group according to the random number table. After informed consent of patients or their families, both groups received routine treatment in ICU. The control group was treated with light sedation strategy, the Richmond agitation sedation score (RASS) was performed every 4 hours, and the target was RASS > -3. ΔP in the study group was measured once a day, and the sedative target of patients with low driving pressure (ΔP ≤ 14 cmH 2O, 1 cmH 2O = 0.098 kPa) was RASS > -3, while the patients with high driving pressure (ΔP > 14 cmH 2O) was RASS ≤ -3. The evaluation was conducted at 28 days after admission to ICU, and the patients were followed up to 60 days. The main outcome was days without mechanical ventilation in 28 days. The secondary outcomes were the rate of extubation, discharge outcome, incidence of ventilator associated pneumonia (VAP) and delirium, and 60-day survival rate. Results:A total of 60 patients with respiratory failure due to various reasons were recruited, 30 in each group. There was no significant difference in gender, age, primary disease, severity of disease or ΔP between the two groups. The days without mechanical ventilation within 28 days in the study group were significantly more than that in the control group [days: 20 (0, 23) vs. 12 (0, 16), P = 0.018], and the incidences of VAP (3.3% vs. 16.7%, P = 0.045) and delirium (0% vs. 10.0%, P = 0.038) were significantly lower than that in the control group. There were no significant differences in the rate of extubation (73.3% vs. 66.7%, P = 0.273), discharge outcome [improvement (cases): 24 vs. 21, unhealed (cases): 2 vs. 5, deaths (cases): 4 vs. 4, P = 0.506] and 60-day survival rate (83.3% vs. 76.7%, P = 0.519) between the study group and control group. Conclusion:Compared with light sedation strategy, ΔP directed sedation strategy can effectively shorten the duration of mechanical ventilation and reduce the incidence of VAP and delirium in the ICU patients.

Influence of air pollution on the development of intensive care unit pneumonia patients: a summary of 2454 cases from 2014 to 2016 in Nanchang City / 中华危重病急救医学

Objective To analyze the main characteristics of air pollution in Nanchang City, and discuss the correlation between air pollution exposure (especially PM2.5) and the development of pneumonia related intensive care unit (ICU) patients and their lag effect.Methods 2454 patients who lived in Nanchang City admitted to ICU of Jiangxi Provincial People's Hospital from January 1st, 2014 to December 31st, 2016 were enrolled. According to the diagnosis, the patients were divided into pneumonia group (156 cases) and non-pneumonia group (2298 cases). The general clinical characteristics of patients and air pollution concentration in Nanchang in the year between 2014-2016 were collected. Multiple regression model was used to analyze the influence of meteorological factors on the condition of ICU patients associated with pneumonia. Using odds ratio (OR), the correlation intensity of air pollution exposure and pneumonia related ICU patients' development was reflected, and the confidence level of association intensity was reflected by the 95％ confidence interval (95％CI). The distribution lag nonlinear model (DLNM) was established to evaluate the effect of air mass parameters on the time lag effect.Results The results of air pollution analysis in Nanchang City in the year between 2014-2016 showed that the annual average concentration of carbon monoxide (CO), sulfur dioxide (SO2) and nitrogen dioxide (NO2) was low and maintained at the same level in the year between 2014-2016. The annual average concentration of CO and NO2 increased in the year between 2014-2016, but the average annual concentration of SO2 decreased rapidly in the year between 2014-2016, and the average annual concentration of PM2.5 tended to slow down after the year between 2014-2016. The annual average concentration of PM10 decreased in the year between 2014-2016, but continued to rise in the year between 2014-2016. The annual mean concentration of O3 showed a trend of continuous increase from the year between 2014-2016. The age of pneumonia group was generally higher than that of non-pneumonia group, most of them were male, and had higher expected mortality and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score. The average air temperature in the pneumonia group was lower than that in the non-pneumonia group on the day of entering the group, and the air pollutants such as PM2.5 and PM10 were significantly higher than those in the non-pneumonia group. The analysis of multiple regression models showed that PM2.5 and air temperature were significantly related to patients with ICU pneumonia on the day of entry (PM2.5:OR = 1.02, 95％CI =1.00-1.03,P < 0.05; air temperature:OR = 0.96, 95％CI = 0.92-0.98,P < 0.05), and the effect of PM2.5 on patients with ICU pneumonia could last for at least 5 days (OR = 1.04, 95％CI = 1.00-1.09,P < 0.05), and the effect disappeared until the 7th day. According to the analysis of the influence of different concentrations of PM2.5 on ICU pneumonia patients, when the PM2.5 concentration reached 200μg/m3, its effect on ICU pneumonia patients would last for 5 days (OR = 1.45, 95％CI = 1.07-1.76,P < 0.01).Conclusion PM2.5 and air temperature are significantly related to the condition of ICU patients with pneumonia, and the influence of high concentration of PM2.5 on ICU patients with pneumonia has a lag effect.

Relationship between serum homocysteine level and heart rate variability in elderly patients with acute cerebral infarction / 中国基层医药

Objective To investigate the relationship between serum homocysteine (Hcy) level and heart rate variability (HRV) in patients with acute cerebral infarction.Methods A retrospective study was conducted in 76 elderly patients with acute cerebral infarction in the Second Affiliated Hospital of Nanjing Medical University from January 2015 to December 2016,and the patients were monitored by 24 hours electrocardiogram within three months.According to age and Hcy level,the patients were divided into three groups:normal Hcy low age group (5-15μmol/L,60-80 years old),high Hcy low age group (＞ 15μmol/L,60-80 years old),high Hcy high age group (＞15μmol/L,≥80 years old).The correlation between Hcy and HRV was analyzed.Results The standard deviation of the normal-to-normal RR intervals (SDNN),the mean standard deviation of 5-minute RR intervals means (SDANN),the root mean square of successive differences in RR intervals (RMSSD),adjacent RR intervals greater than 50 ms (PNN50) in the high Hcy low age group were (108.75 ±34.18)ms,(97.63 ±31.34) ms,(22.04 ±6.97) ms,(3.78 ± 4.07) ％,respectively,which in the high Hcy high age group were (81.43 ± 27.68) ms,(71.46 ±25.45) ms,(23.82 ± 7.59) ms,(3.95 ± 3.56) ％,respectively,which were significantly lower than those in the normal Hey low agc group[(127.21 ± 22.21) ms,(114.75 ± 23.55) ms,(29.17 ± 9.71) ms,(7.68 ± 6.17) ％](t =2.219,2.140,2.920,2.585,t =6.502,6.328,2.227,2.722,all P ＜ 0.05).The levels of SDNN and SDANN in the high Hcy low age group were lower than those in the high Hcy low age group (t =3.185,3.322,all P ＜ 0.05).The low frequency (LF) and high frequency (HF) values in the high Hcy low age group were (11.86 ± 5.39) ms,(8.47 ± 3.25) ms,respectively,which in the high Hcy high age group were (9.29 ± 4.98) ms,(71.46 ± 25.45) ms,respectively,which were lower than those in the normal Hcy low age group[(15.15 ±4.56) ms,(11.36 ±4.36) ms] (t =2.281,2.612,t =4.392,2.900,all P ＜ 0.05).The LF/HF value of high Hcy high age group (1.09 ± 0.3) was lower than (1.42 ± 0.36) in normal Hcy low age group and (1.41 ± 0.40) in the high Hcy low age group (t =3.569,3.339,all P ＜ 0.05).Logistic regression analysis showed that SDNN,SDANN,RMSSD,nocturnal HF and nocturnal LF/HF were correlated with hyperhomocysteinemia (r =-0.037,-0.132,-0.087,-0.468,-3.746,all P ＜ 0.05).Conclusion Hyperhomocysteinemia with acute cerebral infarction in elderly patients is more likely to have cardiac autonomic nerve dysfunction.And clinically we should strengthen HRV detection of elderly patients with acute cerebral infarction and hyperhomocysteinemia.

The correlation between plasma homocysteine level and lower extremity atherosclerotic disease in elderly patients of Chinese Han nationality with primary hypertension / 中华老年医学杂志

Objective To investigate the correlation between plasma homocysteine(Hcy)level and lower extremity atherosclerotic disease(LEAD)in elderly patients of Chinese Han nationality with primary hypertension.Methods A total of 144 elderly Chinese Han outpatients with primary hypertension aged 60-90 years (92 cases in men,52 in women)were randomly recruited in our department from January 2015 to January 2017.The diagnosis of LEAD was confirmed in this study by ankle brachial index(ABI)≤0.90(ABI normal value=1.00-1.40).The patients were divided into three different plasma Hcy level groups:low-(＜ 10 μmol/L),middle-(10-29 μmol/L),and high-Hcy level group(≥30 μmol/L).The differences in Hcy,ABI,toe branchial index,high density lipoprotein,apolipoprotein-A1,and baPWV were compared between three different Hcy level groups.Pearson correlation was established between the influencing factors and serum level of Hcy.Moreover,binary logistic regression model was used to determine the independent risk factors for LEAD among elderly Chinese Han patients with primary hypertension.Results The values of apolipoprotein A-1,high density lipoprotein cholesterol,ankle brachial index,and toe brachial index were higher in the low Hcy group than in the middle-and high Hcy-group(P＜0.05).The ankle brachial index was higher in the middle Hcy group than in the high Hcy group(P＜0.05).The brachial-ankle pulse wave velocity was higher in the high Hcy group than in the middle and low Hcy group (P ＜ 0.05).No statistically significant difference was found in age,gender,body mass index,mean arterial pressure,triglyceride,low density lipoprotein cholesterol,blood urea nitrogen,serum creatinine,blood uric acid,and plasma hypersensitivity C-reactive protein among the three groups(all P＞0.05).Pearson correlation analysis showed that the level of serum Hcy was positively correlated with brachial-ankle pulse wave velocity (r=0.637,P =0.000),while it was negatively correlated with ankle brachial index,toe branchial index,high density lipoprotein cholesterol,and apolipoprotein A-1 (r =-0.743,-0.257,-0.240,-0.449,all P＜0.05).Binary Logistic regression model showed that gender,Hcy,and low density lipoprotein cholesterol level were independent risk factors for LEAD in elderly Chinese Han patients with primary hypertension.Conclusions Plasma Hcy level is an independent risk factor for LEAD in elderly Chinese Han patients with primary hypertension,and it is positively correlated with this disease.

Relationship between serum homocysteine levels and heart rate variability in elderly patients with metabolic syndrome / 中华老年医学杂志

Objective To investigate the relationship between the serum homocysteine(Hcy) level and heart rate variability in elderly patients with metabolic syndrome.Methods Retrospective analysis of 162 elderly patients with metabolic syndrome aged 60 and above was conducted in our hospital from January 2013 to August 2016.And the level of serum homocysteine and other biochemical indicators were measured.The 162 cases were divided into three groups of 42 cases in Hcy normal group(Hcy,5-15 μmol/L),70 cases in Hcy mildly high group(Hcy,16-30 μmol/L),50 cases in Hcy moderately high group (Hcy,31 ～ 100 μmol/L).Simultaneously 24-hour rhythm in ambulatory heart rate variability spectrum was used to detect HRV.And the relationship between heart rate variability(HRV) and Hcy levels were analyzed.Results Normal RR interval standand deviation (SDNN),5 min mean heart rate standard deviation (SDANN),Edinburg index (PNN50),root mean square value of adjacent RR interval difference(RMMSD)were all lower in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group (P＜0.05).Low-frequency(LF) and highfrequency(HF)were lower in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group(P ＜ 0.05).Sympathetic-vagal balance indicators (LF/HF) were higher in Hcy mildly high group and Hcy moderately high group than in the Hcy normal group (P＜ 0.05).The HRV indexes were lower in Hcy high groups than in the Hcy normal group.Hcy was negatively correlated with SDANN,RMSSD,LF,HF,and LF/HF at night(r=-0.578、-0.651、-0.531、-0.662、-0.729,all P ＜ 0.01).Conclusions The elevated homocysteine level and metabolic syndromecombined with decreased HRV in the elderly patients suggest that cardiac autonomic nervous system might be injuried.Enhancing the detection of HRV and homocysteine level in elderly patients with MS is clinically useful for early detection of autonomic neuropathy.

VEGF165 transfected endothelial progenitor cells mediated by lentivirus alleviated ALI in rats / 中华危重病急救医学

Objective To investigate the protective effects of vascular endothelial growth factor-165 (VEGF165) transfected the endothelial progenitor cells (EPCs) mediated by lentivirus on acute lung injury (ALI) in rats. Methods The mononuclear cells from the male Sprague-Dawley (SD) rats were isolated and cultured to get the EPCs for study. The lentivirus vector carrying the human VEGF165 gene was constructed. According to the random number table method, 90 male SD rats were divided into ALI model group, phosphate buffer solution (PBS) group, EPCs treatment group, none transfected EPCs treatment group and VEGF165 transfected EPCs treatment group, and the rats in each group were subdivided into 4, 12 and 48 hours subgroups, with 6 rats in each subgroup. The rat model of ALI was reproduced by intravenous injection of oleic acid (0.15 μL/g). Then each treatment group was given PBS, EPCs, none transfected EPCs and VEGF165 transfected EPCs respectively with the same volume of 0.2 mL. For the groups with cells, about 1×106cells were contained. Abdominal aortic blood and lung tissue were harvested at 4, 12 and 48 hours. Arterial blood gas analysis was performed. The lung wet/dry weight ratio (W/D) was calculated. The expressions of induced nitric oxide synthase (iNOS), endothelin-1 (ET-1) and VEGF165 were determined by enzyme-linked immunosorbent assay (ELISA). After dyed with hematoxylin-eosin (HE), the lung tissue pathology was observed and the lung injury score was performed. Results Compared with the ALI model group, the arterial partial pressure of oxygen (PaO2) in EPCs, none transfected EPCs and VEGF165 transfected EPCs treatment groups was significantly increased from 4 hours, and lung W/D, expressions of iNOS and ET-1 were significantly decreased, and VEGF165 expression was significantly increased. Compared with the EPCs treatment group, the increase in PaO2, the decrease in lung W/D and expressions of iNOS and ET-1, and the increase in VEGF165 expression in VEGF165 transfected EPCs treatment group were more significant [4 hours: PaO2(mmHg, 1 mmHg = 0.133 kPa) was 82.84±10.69 vs. 72.34±9.36, lung W/D ratio was 4.83±0.23 vs. 5.55±0.37, iNOS (ng/mg) was 8.77±1.10 vs. 14.84±1.34, ET-1 (ng/mg) was 103.41±5.66 vs. 153.08±5.12, VEGF165 (ng/mg) was 130.56±12.16 vs. 83.03±5.95; 12 hours: PaO2(mmHg) was 91.67±6.81 vs. 78.5±8.81, lung W/D ratio was 4.44±0.35 vs. 5.32±0.25, iNOS (ng/mg) was 7.23±0.24 vs. 14.04±1.18, ET-1 (ng/mg) was 91.98±3.52 vs. 125.99±7.55, VEGF165 (ng/mg) was 164.49±5.71 vs. 96.61±6.12]; individual parameters reached valley value or peak value at 48 hours [lung W/D ratio was 4.26±0.30 vs. 4.89±0.15, iNOS (ng/mg) was 5.79±0.85 vs. 12.72±1.10, ET-1 (ng/mg) was 74.53±7.10 vs. 108.33±5.84, VEGF165 (ng/mg) was 237.43±10.79 vs. 134.24±11.99, all P < 0.05]. Over time, lung tissue injury in each group was gradually increased, and the lung injury score was gradually increased. The lung injury score at 48 hours in the EPCs, none transfected EPCs and VEGF165 transfected EPCs treatment groups were lower than that in the ALI model group. Compared with the EPCs treatment group, the VEGF165 transfected EPCs treatment group had a lower score at 48 hours (8.50±1.05 vs. 10.50±1.05, P < 0.05). Conclusion The transplantation of EPCs which were transfected with VEGF165 mediated by lentivirus could obviously improve the oxygen pressure, reduce the lung water seepage, decrease the iNOS and ET-1 expressions in lung tissue, and had obvious protective effects on ALI.

The impacts of low-dose corticosteroids infusion given in different manners on refractory septic shock ;patients / 中华危重病急救医学

Objective To discuss the influence of different ways of low-dose corticosteroids infusion on hemodynamics, changes in blood glucose level and prognosis in patients with refractory septic shock. Methods A prospective single-blind randomized controlled trial was conducted. Refractory septic shock patients admitted to the Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from April 1st, 2013 to October 31st, 2014 were enrolled for the study. The patients were divided into control group and research group by random number table. Besides conventional treatment for septic shock, patients in control group were given 200 mg/d hydrocortisone intravenous infusion lasting for 2 hours, while those of research group were given 8.33 mg/h hydrocortisone per hour with an intravenous pump. Treatment lasted for 5 continuous days for both groups. The changes in heart rate ( HR ), mean arterial pressure ( MAP ), central venous pressure ( CVP ) and arterial blood lactic acid in both groups were observed at the time of enroldment and 6 hours, 24 hours, 48 hours, and 5 days after the treatment. With a dynamic blood glucose monitor, mean blood glucose ( MBG ) level, largest amplitude of glycemic excursions ( LAGE ), glucose variability ( GV ), and the ratio of hyperglycaemia time were recorded. The duration of shock, length of intensive care unit ( ICU ) stay, total length of hospital stay, and 28-day mortality of both groups were recorded. Results Seventy-nine septic shock patients were assigned to the treatment, with 41 in control group, and 38 in research group. Compared with control group, 6-hour MAP in research group was obviously lowered [ mmHg ( 1 mmHg=0.133 kPa ):66.31±4.38 vs. 68.58±4.86, t=1.062, P=0.033 ], but there were no significant differences in HR, MAP, CVP, lactic acid clearance and norepinephrine ( NE ) utilization rates at other time points between two groups. No significant difference in MBG was found between research group and control group ( mmol/L:8.69±2.14 vs. 9.95±3.87, t=1.771, P=0.080 ), but LAGE, GV, the ratio of hyperglycemia time in research group were significantly lower than those of the control group [ LAGE ( mmol/L ): 17.18±8.97 vs. 22.71±11.80, t = 2.331, P = 0.022; GV ( mmol/L ): 2.57±1.05 vs. 3.16±1.37, t=2.136, P=0.036;the ratio of hyperglycemia time:( 43.1±11.7 )%vs. ( 49.4±15.3 )%, t=2.044, P=0.044 ]. There was no statistical difference in the following features between research group and control group, such as the duration of shock ( days:3.47±0.98 vs. 3.61±1.07, t=0.605, P=0.547 ), length of ICU stay ( days:8.74±3.12 vs. 9.97±3.37, t = 1.543, P = 0.120 ), total length of hospital stay ( days: 18.34±9.27 vs. 19.58±9.83, t = 0.576, P = 0.566 ) and 28-day mortality rate ( 23.68%vs. 26.83%,χ2=0.103, P=0.748 ). Conclusions Compared with slow intravenous infusion, a continuous intravenous supplementation of small amount of hydrocortisone to patients with refractory septic shock could stabilize blood glucose levels and maintain metabolic balance efficiently. However, in both groups there was no significant difference in the efficiency in stabilizing hemodynamics, shortening shock duration, reducing ICU or hospital days and decreasing 28-day mortality.

The influence of positive end-expiratory pressure on cerebral blood flow and cerebrovascular autoregulation in patients with acute respiratory distress syndrome / 中华危重病急救医学

Objective To explore the influence of different positive end-expiratory pressure (PEEP) levels on cerebral blood flow (CBF) and cerebrovascular autoregulation in patients with acute respiratory distress syndrome (ARDS).Methods A prospective study was conducted.Moderate or severe ARDS patients admitted to Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from January 1st,2013 to October 1st,2013 were enrolled.The changes in hemodynamics,respiratory mechanics and gas exchange under different levels of PEEP were observed.CBF velocity of middle cerebral artery (MCA) was measured using transcranial Doppler (TCD),and breath-holding index (BHI) was also calculated.Results 35 patients with ARDS were included.The oxygenation index (OI),peak inspiratory pressure (PIP),plat pressure (Pplat) and central venous pressure (CVP) were markedly elevated [OI (mmHg,1 mmHg=0.133 kPa):324.7± 117.2 vs.173.4± 95.8,t=5.913,P=0.000; PIP (cmH2O):34.7 ± 9.1 vs.26.1 ± 7.9,t=4.222,P=0.000; Pplat (cmH2O):30.5 ± 8.4 vs.22.2 ± 7.1,t=4.465,P=0.000; CVP (mmHg):12.1 ± 3.5 vs.8.8 ± 2.2,t=4.723,P=0.000] when PEEP was increased from (6.4 ± 1.0) cmH2O to (14.5-± 2.0) cmH2O (1 cmH2O=0.098 kPa).But no significant difference in the heart rate (beats/min:85.5 ± 19.1 vs.82.7 ± 17.3,t=0.643,P=0.523),mean arterial pressure (mmHg:73.5 ± 12.4 vs.76.4 ± 15.1,t=0.878,P=0.383) and CBF velocity of MCA [peak systohc flow velocity (Vmax,cm/s):91.26 ± 17.57 vs.96.64 ± 18.71,t=1.240,P=0.219; diastolic flow velocity (Vmin,cm/s) 31.54 ±7.71 vs.33.87 ±8.53,t=1.199,P=0.235; mean velocity (Vmean,cm/s) 51.19 ± 12.05 vs.54.27 ± 13.36,t=1.013,P=0.315] was found.18 patients with BHI＜0.1 at baseline demonstrated that cerebral vasomotor reactivity was poor.BHI was slightly decreased with increase in PEEP (0.78 ± 0.16 vs.0.86 ± 0.19,t=1.905,P=0.061).Conclusions Some of moderate or severe ARDS patients without central nervous system disease have independent of preexisting cerebral autoregulation impairment.However,independent of preexisting cerebral autoregulation may not further be impaired when a high PEEP was chosen.

Effect of glutamine on Hsp70 expression and immune in patients with acute cerebral infarction / 肠外与肠内营养

Objective: To study the effects of glutamine on heat shock protein 70(Hsp70) expression and immune in patients with acute cerebral infarction.Methods: 60 patients with acute cerebral infarction were randomly divided into 2 groups,the control group(n=30) and the glutamine group.Patients in glutamine group were supplemented intravenously with alanyl-glutamine during 24 hours after hospitalization.Other treatments were the same as in the control group.Serum Hsp70 concentrations,immune parameters,and infection rates were compared.Results: The serum Hsp70 level,the immune globulin level,the CD4+ cell and CD4+/CD8+ in the glutamine group were significantly higher than those in the control group(P