Application and significance of PiCCO monitoring technique combined with troponin I detection in fluid resuscitation of elderly patients with septic myocardial dysfunction.

OBJECTIVE: This study was designed to demonstrate the predictive value of Pulse indicate Contour Cardiac Output (PiCCO) monitoring technique combined with troponin I (cTnI) detection in septic myocardial dysfunction (SMD) of the elderly. METHODS: One hundred and nineteen elderly patients with SMD treated in our hospital from March 2016 to September 2019 were enrolled and allocated into the joint group (JG; 64 cases) for capacity management of fluid resuscitation under the guidance of PiCCO monitoring technique and cTnI detection, and the control group (CG; 55 cases) for conventional capacity management. Clinical indicators, hemodynamics, improvement of myocardial injury markers and inflammatory factors 6 h and 36 h post intervention, fluid balance 6 h, 12 h and 36 h post intervention, drug consumption (norepinephrine), treatment effect and 28-day hospitalization mortality were compared between the two groups. RESULTS: After resuscitation, the urine volume per hour and the fluid resuscitation volume were higher while the blood lactic acid (BLA) expression was lower in JG as compared to CG. JG presented a remarkably lower central venous pressure (CVP) than CG after resuscitation, with notably higher mean arterial pressure (MAP) and central venous oxygen saturation (ScvO2). In comparison with CG, JG displayed dramatically lower cTnI and N-terminal pro-brain natriuretic peptide (NT-ProBNP) 6 h and 36 h post intervention, as well as evidently reduced interleukin-6 (IL-6), procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP). After 36 h of intervention, the fluid balance was evidently lower in JG than in CG. JG showed statistically less use of norepinephrine, less time of mechanical ventilation and ICU stay, and noticeably lower incidence of multiple organ dysfunction syndrome (MODS), as well as dramatically lower 28-day hospitalization mortality than CG post intervention. CONCLUSIONS: PiCCO monitoring technique combined with cTnI detection is high-performing in fluid resuscitation of elderly patients with SMD, which can meliorate the myocardial function of patients, reduce medication and facilitate disease recovery.

Assessing the effect of Gotfried reduction with positive buttress pattern in the young femoral neck fracture.

BACKGROUND: Although many available surgical procedures for displaced femoral neck fractures in young patients, there are still many challenges to achieve satisfactory results. The incidence of avascular necrosis and nonunion rates remains relatively high despite the progress in our understanding and surgical technique. The purpose of this study was to evaluate the clinical efficacy of Gotfried reduction and cannulated screw fixation in the treatment of femoral neck fracture for young adults. METHODS: A retrospective analysis was made on 67 cases from May 2013 to March 2019. They were divided into three groups according to the first postoperative anteroposterior view of hip X-ray: Anatomic reduction (group A), Gotfried positive buttress reduction (group B), and Gotfried negative buttress reduction (group C). The incidence of avascular osteonecrosis of the femoral head (AVN) and the Harris scores of hip joints were compared in three groups at the last follow-up. RESULTS: The mean follow-up period after surgery was 22.5 ± 11.3 (range, 11-34) months. There were 21 cases (mean age, 49.7 ± 11.6) in group A, 24 cases (mean age, 48.6 ± 11.3) in group B, 22 cases (mean age, 48.3 ± 12.4) in group C. No significant difference in general preoperative demographics (P > 0.05). The incidence of avascular necrosis of femoral head in group A, B, and C was 19.05%, 20.83%, and 22.73%, respectively, showing no significant difference between groups (P = 0.156). The mean Harris hip scores at the final follow-up for groups A (85.6 ± 6.7) and B (84.5 ± 6.2) were significantly higher than group C (74.3 ± 8.3), and the difference was statistically significant (P = 0.043). The incidence of femoral neck shortening in group A and group B was significantly lower than that in group C in postoperative 1 year, and the difference was statistically significant (P < 0.05). CONCLUSIONS: Gotfried positive buttress reduction and fixation for femoral neck fracture may lead to similar clinical results with anatomic reduction, but much better than Gotfried negative buttress reduction. For the patients of femoral neck fracture with severe displacement and difficulty reduction, it is not necessary to pursue anatomical reduction. Achieving positive valgus reduction can also obtain satisfactory clinical results, and should try to avoid negative buttress.

Bistable wave speed of the Lotka-Volterra competition model.

This work deals with the speed sign of travelling waves to the Lotka-Volterra model with diffusion and bistable nonlinearity. We obtain new conditions for the determinacy of the sign of the bistable wave speed by constructing upper or lower solutions with an inside parameter to be adjusted. The established conditions improve or supplement the results in the references and give insight into the combined effect of system parameters on the propagation direction of the bistable wave.

Propagation direction of the bistable travelling wavefront for delayed non-local reaction diffusion equations.

For delayed non-local reaction-diffusion equations arising from population biology, selection mechanisms of the speed sign for the bistable travelling wavefront have not been found. In this paper, based on the theory of asymptotic speeds of spread for monotone semiflows, we firstly provide an interval of values of wave speed and a novel general condition for determining the speed sign by applying the comparison principle and the globally asymptotic stability of the bistable travelling wave. Moreover, through constructing novel upper/lower solutions, we give explicit conditions for the speed sign to be positive or negative. The obtained results are efficiently applied to three classical forms of the kernel functions.

A three-component reaction by photoinduced electron transfer mechanism with N-protected pyrroles as neutral carbon nucleophiles.

A new photoinduced three-component reaction between a cyanoarene, an alkene and an N-protected pyrrole has been developed. This reaction extended the scope of the photo-NOCAS reaction by introducing pyrrole as a neutral carbon-centered nucleophile. The cyanoarenes used include tetracyanobenzene (TCB), 2,3,5,6-tetrafluoro-1,4-dicyanobenzene (TFDCB) and 1,4-dicyanobenzene (DCB). N-Methyl, N-phenyl and N-Boc pyrroles are suitable nucleophiles in the reaction. Taking advantage of the strong electron acceptor ability of the singlet excited TCB, a wide range of alkenes, including the highly electron deficient 4-fluoro-, 4-chloro-, 2,3,4,5,6-pentafluorostyrenes and N-methylmaleimide take part in this reaction, leading to the simultaneous 1,2-diarylation of the alkene and the regioselective 2-alkylation of the pyrrole ring via sequential formation of two new C-C bonds between the three reactants.

Photoinduced three-component reactions of tetracyanobenzene with alkenes in the presence of 1,3-dicarbonyl compounds as nucleophiles.

Photoinduced three-component reactions between tetracyanobenzene (TCNB), an aromatic olefin, and a beta-dicarbonyl compound afford products composed of the three components via formal elimination of hydrogen cyanide, leading to the vicinal dialkylation of the olefin and the alpha-alkylation of the beta-dicarbonyl compounds. It is shown that these reactions are initiated by photoinduced electron transfer (PET) from the olefin to the singlet excited TCNB and proceed by a nucleophile-olefin combination, aromatic substitution (NOCAS) reaction sequence with the enolized beta-dicarbonyl compound as a nucleophile. Therefore, aromatic olefins are suitable substrates in photo-NOCAS reactions when TCNB is used as the electron acceptor. In addition, these results show that the enol of beta-dicarbonyl compound serves as a carbon nucleophile to trap the alkene cation radical in PET reactions to lead to C-C bond formation.