Treament of CRRT combined with low-flow ECMO for canines with ARDS / 医学研究生学报

Objective Single mechanical ventilation for curing severe acute respiratory distress syndrome (ARDS) is sometimes not effective in improving oxygenation and removing excess CO2 in the blood. The purpose of this study is to observe the effect of continuous renal replacement therapy（CRRT）combined with low-flow extracorporeal membrane oxygenation （ECMO）of V-V mode on clearance of inflammatory mediators，improving oxygenation and reducing PaCO2 in canines with ARDS and hypercapnia. Methods 30 healthy adult canines were divided into 3 groups (n=10 each) using a random number table method sham group, ECMO (EC) group and CRRT+ECMO（CR+EC）group. A canine model of ARDS with hypercapnia were prepared by injected intravenously oleic acid. Sham group was only treated with invasive mechanical ventilation. EC group was treated with invasive mechanical ventilation and ECMO. CR+EC group was treated with CRRT combined with low-flow ECMO of V-V mode besides invasive mechanical ventilation. The heart rate(HR)，mean artery pressure (MAP)，cardiac output(CO) and concentration of serum TNF-α and IL-6 were examined at the beginning of modeling(T0)，after 1，3，6 and 9 (T1, T3, T6, T9) hours of mechanical treatment respectively. Oxygenation index（OI），PaCO2, temperature（T）were examined at the beginning of modeling，after 3, 6, 9 hours of mechanical treatment，and at the time point of 3 hours(T12) after ECMO treatment (EC group) and CRRT+ECMO treatment(CR+EC group)，respectively. The differences were compared between groups involved in above-mentioned indexes at different time points. Results Compared with the sham group, the HR decreased at T6 and T9 in the EC group and CR+EC group (P<0.05), and the concentration of IL-6 and TNF-α decreased at T3, T6 and T9 in the CR+EC group (P<0.05). Compared with T0, HR decreased at T6 and T9 in the EC group (P<0.05). Compared with T0, the concentration of IL-6 and TNF-α decreased at T3, T6 and T9 in the CR+EC group (P<0.05). Compared with the EC group, the HR decreased at T6 and T9 in the CR+EC group (P<0.05). Compared with the EC group, the concentration of IL-6 and TNF-α decreased at T3, T6 and T9 in the CR+EC group (P<0.05). Compared with the sham group, the OI decreased at T9 and T12 in the CR+EC group (P<0.05). Compared with the sham group, PaCO2 decreased at T3, T6 and T9 in the EC group and CR+EC group (P<0.05). Compared with the EC group, the OI decreased at T9 and T12 in the CR+EC group (P<0.05). Compared with T0, the OI decreased at T6 and T12 in the CR+EC group (P<0.05). Conclusion The CRRT combined with low-flow ECMO of V-V mode has positive effects on clearance of inflammatory mediators，reducing hypercapnia and improving oxygenation in the canines with ARDS and hypercapnia.

Uso del test de rendimiento continuo de conners para diferenciar niños normales y con TDAH en Chile / Using the conners continous performance test for differentiation of normal and ADHD Chilean children

El trastorno de déficit atencional con hiperactividad (TDAH) constituye uno de los cuadros de mayor prevalencia durante la niñez. El presente trabajo se focalizó en evaluar si el Test de Rendimiento Continuo de Conners era capaz de discriminar entre niños con y sin TDAH diagnosticados por el docente. Se conformó una muestra no probabilística de 30 niños escolares (15 clínicos y 15 normales) a través de la aplicación del cuestionario de atención. Todos los niños completaron la aplicación del test computarizado de Conners. Se observaron diferencias significativas entre la muestra normal y clínica. Todos los niños seleccionados como normales no encajaron el perfil clínico. Solo el 50% de los casos considerados con TDAH encajaron el perfil clínico. Se analizan las implicancias del sobre/diagnóstico del trastorno.

Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent disorder during childhood. The present study aimed to evaluate if the Conners Continous Performance Test was able to discriminate among ADHD and normal children completed the Conners computarized test. Significant differences between normal and clinical sample were found. All children selected as normal did not fit the clinical profile. Only 50% of the children considered as having ADHD fit the clinical profile. Implications for the issue of overdiagnosis of the disorder are discussed.

Accuracy of Handheld Continuous - Wave Doppler Ultrasound in the Assessment of Varicose Veins

The incidence of varicose veins and the need for treatment has shown a tremendous increase over the years. Debilitating venous ulcers and dragging edemas of the lower limb with overall improvement in cosmetic results and availability of endovenous procedures has brought many patients forward for treatment. Continuous-wave handheld Doppler usage is limited by its diagnostic capabilities, thus the need to determine its real effectiveness. Benefits of using hand-held dopplers lies in its rapidity in assessment of patients, it's low running cost and short learning curve. This is important as duplex ultrasounds are not readily available in district hospitals. This study aims to determine the clinical effectiveness of hand-held continuous wave dopplers in the local setting especially in primary uncomplicated varicose articles veins. All electively referred patients with primary uncomplicated varicose veins who were referred to the Varicose Vein Clinic were evaluated with continuous-wave handheld Doppler (CWD) and duplex ultrasound (DUS) examination. The study duration was from the 1st of July to 31st of August 2013 (2 months). All patients in the study were independently evaluated with CWD and DUS in the clinic on the same day after adequate rest time. DUS was taken as the gold standard for evaluation of CWD specificity and sensitivity. The Chi-square and T-test was used to test for statistical significance. A total of 41 patients were evaluated in this study. The specificity of CWD when compared to DUS for diagnosing Sapheno-femoral junction (SFJ) was 100% and at the Sapheno-popliteal junction (SPJ) was 87%. Meanwhile sensitivity of CWD for SFJ was 75% and SPJ was 60%. The examination time with CWD was significantly faster than when compared with DUS examination with significant faster tracing times that can be achieved with CWD. CWD also significantly shorter reflux times when compared to DUS. Continuous-wave handheld doppler proves to be an indispensable clinical tool in the evaluation of SFJ and SPJ reflux in varicose veins. CWD assessment in this study was shown to be equal if not better for evaluating reflux when compared to DUS assessment for SFJ reflux. Main advantages for CWD also lie in its low running cost, rapidity in assessment and short learning curve when compared to duplex ultrasound examinations.

Desenvolvimento de meio quimicamente definido para produção de polissacarídeo capsular em cultivo de Streptococcus pneumoniae sorotipo 14 / Development of a chemically defined medium for capsular polysaccharide production by Streptococcus pneumoniae serotype 14

Neste trabalho avaliou-se a influência de fontes de carbono (FC) e composições de meio definido no crescimento celular e na produção do polissacarídeo PS14. Em batelada, testou-se como FC glicose, sacarose e frutose em diferentes concentrações. Testou-se também meios com ausência dos aminoácidos asparagina, ácido aspártico, fenilalanina, serina, alanina, treonina, triptofano, lisina e tirosina, das vitaminas/cofatores ácido fólico, piridoxamina, ácido p-aminobenzóico, b-NAD e riboflavina, além bem como da adição de maiores concentrações de aminoácidos identificados como importantes. Em cultivo contínuo foram avaliadas vazões específicas de alimentação (D) de 0,1h-1a 0,5h-1 e a influência das bases nitrogenadas. O meio com sacarose como FC, retirada dos aminoácidos e vitaminas citados e adição do dobro de glicina isoleucina, leucina, valina e o triplo de glutamina levou à maior produção de PS14 (441mg/L). Obteve-se a maior produtividade com D=0,4h-1e a maior quantidade de PS14 com adenina na concentração original no meio de cultura.

In this work we assessed the influence of different carbon sources (CS) and defined medium compositions on cell growth and polysaccharide PS14 production. In bath, glucose, sucrose and fructose were tested at different concentrations. Also, media were tested with absence of the amino acids: asparagine, aspartic acid, phenylalanine, serine, alanine, threonine, tryptophan, lysine, and tyrosine, and vitamins/cofactors: folic acid, pyridoxamine, p-aminobenzoic acid, riboflavin and b-NAD, besides the addition of higher concentration of amino acids identified as important. In continuous cultivation, dilution rates (D) from 0.1 h-1 to 0.5 h-1 were evaluated as well as the influence of nitrogenous bases. The medium containing sucrose as CS, absence of amino acids and vitamins and addition of twice glycine isoleucine, leucine, valine, and triple glutamine led to higher production of PS14 (441mg/L). D of 0.4 h-1 showed higher productivity and adenine in standard concentration produced greater amounts of PS14.

Estatus parcial continuo, causa de hiperintensidad de la corteza cerebral en la resonancia nuclear magnética / Continous partial status cause of hyperintensity in cerebral cortex in magnetic resonance imaging

Magnetic Resonance Imaging has demonstrated functional changes of the cerebral cortex in relation to status epilepticus, which can eventually localize the origin of the crisis. The purpose of this presentation is relevant to this condition and pretends to highlight the action of incidental situations that can modify it. We present a 29 year old woman with a neurosurgical intervention for a neuroblastoma irradiated fifteen years ago, which incidentally starts a continuous partial status epilepticus, expressed by clonies of the face and left limbs associated with functional impotence, resistant to oral therapy. Faced with the suspicion of recurrence of the tumor, a brain MRI is performed, showing hyperintensity of all neural areas the right hemisphere, with no evidence of tumor recurrence. Once submitted the status epilepticus, the hyperintensity disappeared in the hemisphere. This extensive reaction of the neural structures might be related to a permanent effect of radiation, which may have caused a mismatch functional glia, of the blood-brain barrier and interneural network.

La Resonancia Nuclear Magnética (RM) ha puesto en evidencia cambios funcionales de la corteza cerebral en relación a estados epilépticos que eventualmente permiten localizar el origen de las crisis. El propósito de esta presentación es hacer relevante dicha condición y destacar la acción de situaciones incidentales que pueden modificarla. Se presenta a una mujer de 29 años portadora de una intervención neuroquirúrgica por un neuroblastoma irradiado hace quince años, que incidentalmente inicia un estatus epiléptico parcial continuo, expresado por clonías de la cara y extremidades izquierdas asociadas a impotencia funcional resistente a la terapia oral. Frente a la sospecha de recidiva de la neoplasia se realiza RM cerebral que muestra una hiperintensidad de todas las áreas neuronales del hemisferio derecho, sin evidencias de recidiva tumoral. Una vez remitido el estado epiléptico se observó una desaparición de estas alteraciones. La interpretación para esta extensa reacción de las estructuras neurales podría estar relacionado con un efecto permanente de la irradiación, que pudo haber provocado un desajuste funcional de la glía, de la barrera hematoencefálica y de la red interneural.

Continuous veno-venous hemofiltration and intermittent hemofiltration in treatment of type 1 cardiorenal syndrome: A clinical research / 第二军医大学学报

Objective To compare the effects of continuous veno-venous hemofiltration (CVVH) and intermittent hemofiltration (IHF) on the hemodynamics and clinical outcomes of patients with type 1 cardiorenal syndrome. Methods From May 2008 to June 2011, 34 patients diagnosed with type 1 cardiorenal syndrome were admitted to our hospital and received CVVHQ9 cases) or IHF (15 cases). The general data, acute hemodynamic changes before and after hemofiltration and clinical outcomes at 28 days after hemofiltration were evaluated. Results There were no significant differences in the heart rates, diastolic blood pressure between the two groups before and after hemofiltration (P>0.05). The systolic pressure was similar between the two groups before hemofiltration (P>0.05), but that in the IHF group was significantly lower than that in the CVVH group after hemofiltration (P0.05), but the minimal mean pressure in IHF group was significantly lower than that in the CVVH group (P0.05). Multivariate analysis suggested that APACHE II was the main influence factor of 28-day mortality of patients, and APACHE II and net ultrafiltration were the main influence factor of the minimal mean pressure. Conclusion Compared with IHF, CVVH fails to greatly reduce the mortality of patients with type 1 cardiorenal syndrome. The severity of the disease is the main influence factor for the hemodynamic changes and the 28-day mortality of patients with type 1 cardiorenal syndrome.

Evaluation of Effectiveness of Continous Passive Motion after Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trails / 中国康复理论与实践

@#ObjectiveTo evaluate the effectivenes of continous passive motion(CPM) on limb function in patients after total knee arthroplasty.MethodsThe Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, PEDro, CNKI and VIP were retrieved from the date of establishment of the databases to July, 2010 to collect randomized controlled trials(RCTs). The quality of RCTs was critically appraised and data were extracted by 4 reviewers independently. Meta-analysis was conducted for the eligible RCTs.Results26 RCTs were included. The result of Meta-analysis showed that CPM improved the range of motion (ROM) in active knee flexion and passive knee flexion, eliminate swelling in short term(＜6 weeks) and alleviate pain in short and medium term (less than 6 months). CPM showed no significant difference in improving the ROM in active and passive knee extention and quadriceps strength, and shortening hospital stay.ConclusionThe patients carried out CPM training after total knee arthroplasty can effectively improve limb flexion function, eliminate joint swelling, and relieve pain in the short term. But more high-quality and large-scale RCTs are needed.

Effect of continous subcutaneous insulin infusion and mutiple subcutaneous insulin infusion on type 2 diabetes mellitus during perioperation / 中国综合临床

Objective To study the effect of continous subcutaneous insulin infusion (CSII) and mutiple subcutaneous insulin infusion (MSII) on type 2 diabetes mellitus during perioperation. Methods One hundred and eighty surgical patients complicated with Type 2 diabetes were randomly divided into two groups,98 cases in the CSII group (treated with CSII of novolin R) and 82 cases in the MSII group (treated with MSII of novolin R and no-volin N). Blood glucose level,the time to reach normal blood glucose level, the average dosage of insulin, the inci-dence of hypoglycemic,infection rate of incisions and inpatient days were measured in two groups before and after treatment. Results The level of fasting blood glucose after treatment in the CSII group (4.8 mmol/L (SD: 1.6)) was significantly lower than that of the MSII group (6.4 mmol/L(SD :2.1)) (t = 7.74,P < 0.05), and 2-h glucose in the CSII group (7.6 mmol/L(SD :2.3)) was significantly lower than that of the MSII group (9.3 mmol/L(SD: 2.4)) (t = 7.72, P < 0.05). The time to reach normal blood glucose level in the CSII group (4.1 days (SD: 2.9)) was shorter than that of MSII group (6.9 days (SD :2.0)) (t=2.81, P < 0.05). The average dosage of insulin in the CSII group (40.7 U(SD: 10.3)) was lower than that of the MSII group (63.2 U (SD: 17.0)) (t=3.57, P <0.05). The incidence of hypoglycemic in the CSII group (3.05%) was lower than that of the MSII group (9.20%) (χ~2 = 4.92,P < 0.05). The infection rate of incisions in the CSII group (0.0%) was lower than that of the MSII group (10.9%) (χ~2 =4.18, P < 0.05). The inpatient days in the CSII group (15.3 days (SD :7.2)) was shorter than that of the MSII group (22.5 days (SD :9.7)) (t = 3.12, P < 0.05). Conclusions Compared to multiple sub-cutaneous insulin infusion, continuous subcutaneous insulin infusion is more effective in controlling blood glucose, hypoglycemic and incision infection, thus is recommend to perioperative patients complicated with type 2 diabetes mellitus.

Continuous veno-venous hemofiltration in treatment of acute respiratory distress syndrome / 中国实用内科杂志

Objective In this study,we cooperated CVVH(continuous veno-venous hemofiltration)in treatment of Acute Respiratory Distress Syndrome(ARDS)and investigated the efficacy of CVVH in treatment of ARDS.Methods From May 2002 to Nov.2005,76 ARDS patients were involved.CVVH was carried out continuously for at least 24 hours.During CVVH,the patients' conditions were observed.Blood gas analysis and serum concentrations of endotoxin were detected.Results After CVVH,the patients' symptoms such as panting and cyanosis were remission.APACHE Ⅱscore decreased significantly.After six hours of CVVH,serum concentration of endotoxin was decreased significantly.Conclusion CVVH is effective in redressing the hypoxemia and relieving the patients' condition.

Continous Renal Replacement Therapy in intensive care unit of Cho Ray hospital

From October 2004 to March 2005, 13 acute renal failure patients were treated by Continuous Renal Replacement Therapy (CRRT) in Cho Ray hospital. Results: Multiple trauma accounted for 31%, sepsis 31%, multiple system organ failure 15%, APACHE II score were 24.97  6.35. Continuous Intravenous Hemodialysis (CVVHD) had been performed in 39% of patients, CVVH 31%, CVVHDF 15% and SCUF 15%. Patients’ serum concentration of creatinine and BUN decreased step by step and stable. Serum concentrations of creatinine and BUN before and after CRRT were 5.60  2.34 mg% and 49.60  35.19 mg%, respectively. Mean duration of CRRT was 28.0  10.9 hours. 8/13 patients partly recovered their renal functions. Mortality rate was 61.54%. Hemodynamic instability patients (76.92%) were well-tolerated with CRRT. Applying dose of ultrafiltration 35 ml/kg/h for septic patients improved dose and time of increased mean blood pressure. During over 400 hours of CRRT, there were not yet major complications reported.

Continuous Renal Replacement Therapy in Pediatrics / 소아과

Continous renal replacement therapy(CRRT) is becoming increasingly popular for the support of critically ill patients with acute renal failure, and the development of pump-driven volumetric-control CRRT machines with small extracorporeal volumes has lead to the widespread use of venovenous form of CRRT in pediatric field. Basic principles are diffusion and convection. CRRT is indicated in the hemodynamically unstable pediatric patients for hypervolemic anuric acute renal failure, electrolyte abnormalities, multiorgan failure, catabolic patients with increased nutritional needs and hyperammonemia, etc. To date, experiences are limited for pediatric CRRT, but current reports support that CRRT is feasible and useful in children and even infants, and the survival rate of the patients on CRRT is as same as adults. We describe the basic principles, equipments, methods and complications of CRRT, with special considerations on small children to meet the current need for CRRT.

The Predictive Parameters of Erythropoietin Hyporesponsiveness in Patients on Continuous Ambulatory Peritoneal Dialysis

BACKGROUND: The present study was aimed at investigating the predictive parameters of erythropoietin (epoetin) hyporesponsiveness in patients on continous ambulatory peritoneal dialysis (CAPD). METHODS: We studied 40 patients with end-stage renal disease who had been receiving CAPD for at least 6 months and epoetin therapy for at least more than 2 months. Pearson's simple correlation and multiple stepwise linear regression analysis was used to discover what parameter can predict epoetin resistance. We expressed epoetin resistance index (ERI) as 'weekly epoetin dose/hematocrit/ body weight'. The dose of epoetin is titrated by about 25% every 2 to 4 weeks to maintain a target hematocrit level between 33% and 36%. RESULTS: We analyzed the relationship between ERI and other predictive parameters by Pearson's correlation. These results showed ERI has a statistically significant correlation with transferrin saturation (TS) (r=-0.327, p=0.042), total weekly Kt/Vurea (r=-0.423, p=0.018), serum albumin level (r=-0.458, p= 0.003), normalized protein catabolic rate (nPCR) (r=-0.479, p=0.006), normalized protein equivalent of total nitrogen appearance (nPNA) (r=-0.488, p=0.005) and serum C-reactive protein (CRP) (r=0.332, p=0.036). Regression analysis was performed using stepwise linear regression for multiple variables to discover the most independent variable which is correlated with ERI. ERI was entered as a dependent variable, whereas the other parameters (age, duration of peritoneal dialysis, serum albumin level, CRP, serum ferritin, total weekly Kt/Vurea, nPCR, nPNA, serum iPTH, serum aluminium, TS) were entered as independent variables. This analysis showed CRP is the most significant variable and, if CRP is excluded, nPNA is the significant variable. CRP has a statistically significant correlation with serum albumin level (r=-0.418, p=0.007) and total weekly Kt/Vurea (r=-0.366, p=0.043). High CRP group has more increased level of ERI (p<0.05), age (p<0.05) and serum creatinine level (p<0.05) than normal control, but more decreased level of serum albumin (p<0.01) and serum iron levels (p<0.05). CONCLUSION: These results indicate that CRP is the most important predictor of epoetin hyporesponsiveness.

Fixation of Epidural Catheters using Blood Set - Report of 120 cases / 대한마취과학회지

Secure fixation is essential for continous epidural catheterization on a long-term-basis. Adhesive tape or surgical knots were commonly used for those patients, but the surgical knot method has a tendency to cause strangulation of catheter. Another invasive technique, subcutaneous tissue tunnelling is more safe than other methods but requires sophisticated technique and time. We employed a simple device using a blood transfusion set for patients who have epidural catheters placed safely on their backs. In 120 patients treated for postoperative and chronic pain by means of this technique, the results were as follows: 1) Five of 120 patients (4.2%) developed backache and pruritus, but there were no instances of respiratory depression, local infection and headache. 2) Nine of 120 patients (7.5%) failed booster-injections, but two cases were due to be non-technical errors. 3) The duration of fixation was 1-3 days in most cases (85%), the longest being for 21 days.