Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Mining ; Noninvasive Ventilation ; Pneumoconiosis ; rehabilitation ; Treatment Outcome

Objective To study the effect of endotracheal tube's resistance on the respiratory systolic variation test(RSVT).Methods The RSVT,a test to predict fluid responsiveness was performed in 20 patients.The test consisted of the delivery of three congecutive pressure-controlled breaths with incremental peak inspiratory pressures of 10,20 and 30 cm H2O(1 cm H2O=0.098 kPa).The minimal values of the systolic arterial pressure following each of these three breaths were measured and plotted against their respective airway pressures,producing the RSVT slope.RSVT slope were compared between normal airway resistance and increased resistance circumstances,and the latter was simulated by advancing a Cooperdech bronchial blocker into endotracheal tube.Results Under normal resistance,RSVT slope was(0.39±0.21) volumes were(461.5±95.9),(891.5±149.8)and(1207.5±159.1)ml,when peak inspiratory pressures of 10,20 and 30 cm H2O were dehvered.When bronchial blocker was advanced into endotrecheal tube, (0.27±0.17)mm Hg,cm H2O significantly(P<0.01),and tidal volumes decreased to(434.5±92.8), (796.5±96.6)and(1097.5±68.4)ml(P<0.05 or<0.01).Conclusion Changes in endotraeheal tube's resistance can distort the RSVT slope.

Objective To explore the difference between pressure-regulated volume controlled ventilation (PRVCV) and volume controlled ventilation (VCV) during videothoracoscopic bhb excision.Methods Consecutive 20 patients scheduled to undergo videothoracoscopic bleb excision were enrolled into the study.After induction, endotracheal blocker was advanced into endotracheal tube to establish one-lung ventilation,each patient was randomly assigned to receive successively PRVCV and VCV for 20 minutes.Ventilatory variables were kept constantly(tide volume 6 ml/kg, respiratory rate 15 breaths/min and I: E ratio 1: 2).Heart rate,blood pressure,peak airway pressure and blood gas parameters were compared.Results Peak airway pressure was significantly lower with PRVCV than that with VCV [(12.7±3.6 ) cmH_2O(1 cm H_2O =0.098 kPa) vs (18.2±4.3) cm H_2O,P < 0.01].However,there was no significant difference in arterial oxygen tension,arterlal partial pressure of carbon dioxide,heart rate and blood pressure between PRVCV and VCV.Conclusion During one-lung ventilation in videothoracoscopic bleb excision, PRVCV offers lower peak inspiratory airway pressures while maintaining equal oxygenation compared with VCV.

Objective To investigate the urinary albumin excretion of the diabetes patients and application value in the monitoring of early impairment in kidney. Methods The random urine samples from diabetes patients and controls within three days were collectod. The changes of urinary albumin excretion within day and between days were analyzed. 24-hour urine albumin was used as a standard to evaluate early kidney damage. The correlations between results of random urine albumin at the different time points and different periods were comparod. The sensitivity and specificity of random urine albumin at the different time points and different periods was evaluated and compared to deduce the best diagnostic porformance of the random urine albumin. Results There are greater variations of the levels of urinary albumin of patients with diabetes and control. After the correction with urine creatinine and urine volume the variations can be reduced (CV:49%±23% and 64%±30%). Urinary albumin excretion rate change rhythmically within the 24 h in healthy and diabetes patients. We found the best correlation between overnight ratio of urinary concentrations of albumin and creatinine (ACR) and 24-hour urinary albumin (R2 = 0.976). It was superior to urina sanguinis (R~2 = 0.900), postprandial urine (R~2 = 0.584) and random urine (R~2 =0.791). When 24 h urinary albumin was taken as the standard, receiver operating characteristic (ROC) curve analysis showed there was significant difference between male and female(male 12.8 μg/mg urine creatinine vs female 27.0 μg/mg urine creatinine),and the the cut-off value of ACR was 27.7μg/mg urine creatinine. When the smallest available negative likelihood ratio (0.011) and the greatest positive likelihood ratio (481.000) were obtained,the concentration of 13.0 μg/mg creatinine and 87.4 μg/mg creatinine were set as the cut-off value of ACR. Conclusions The correction with urinary creatinine can reduce the variation between-days compared with urine volume, but still can not completely eliminate the variability. The ACR of overnight urine has the best correlation with the 24 h urinary albumin and can replace 24 h urinary albumin. Random urine as the most convenient collecting urine samples can also replace 24-hour urinary albumin, but the gender discrepancy need to be considered. When the concentration of 13.0 μg/mg and 87.4 μg/mg was set as a random ACR exclusion value and the confirmative value, it can basically rule out and confirm the existence of microalbuminuria.

ObjectiveTo evaluate the application of quantitative sensory testing(QST) in hemodialysis (HD) patients with peripheral neuropathy.MethodsThe values of the quantitative sensory testing and sensory conduction velocity at different locations of extremities in 40 cases of the HD patients and 40 normal persons were recorded.ResultsAccording to the control group,without symptoms group and with symptoms group,the thermal threshold(TT) and vibratory threshold (VT) at the four different locations of extremities were increased,thresholds of the later two groups were significantly higher than those of normal controls (P ＜ 0.05 ).Especially finger warm and vibratory thresholds,hypothenar heat pain thresholds,instep heat pain and vibratory thresholds,calf cold pain and vibratory thresholds were significantly difference between with symptoms group and normal control group (P＜0.01 ).Finger cool and warm thresholds,instep heat pain thresholds,thresholds of calf warm,cold pain and heat pain,and vibratory thresholds at the four different locations of extremities were significantly difference between wthout symptoms group and with symptoms group (P＜ 0.05).The SCV values of the median nerve,tibial nerve and lateral popliteal nerve were significantly difference between HD patients group and normal control(P ＜0.05 ).The total abnormal rate of QST was 65％,with symptoms group was 77.27％,total abnormal rate of SCV was 55.0％,with symptoms group was 68.18％.The total abnormal rate of QST were significantly higher than those of SCV (P＜0.01 ).ConclusionQST is a sensitive method for diagnosis of uremic neuropathy.

Objective To evaluate the performance of sST 2 ELISA kit and investigate the clinical application of sST2.Methods This verification study validated the precision , linearity of sST2 ELISA kit according to the CLSI EP-15A, EP-6A protocols.300 healthy adults(aged from 20 to 85, 124 male and 176 female) from 5 different districts of Shanghai were used to establish serum sST 2 reference interval .The correlations between sST2, NT-ProBNP, LVEF and NYHA class were analyzed in 117 patients diagnosed with heart failure who were grouped according to the New York heart association ( NYHA).Receiver operating characteristic (ROC) curve was used to compare the ablity of sST2, NT-ProBNP, LVEF in distinguishing heart failure patients .Results The within-lot and between-lot variation of three level samples were below 4% and 10% respectively.There was a good linear correlation ( Y=0.995X+0.005, R2 =0.999) between theoretical value and actual detection result in the range of 0 to 200 μg/ml.The reference interval of sST2 was 10.2 to 41.0μg/ml for males and 8.9 to 28.1μg/ml for females.sST2 was positively correlated with NT-ProBNP and NYHA class but did not correlate with LVEF in heart failure patients . Patients with NYHA class>II (Median:28.3,IQR:19.5-39.2)had higher serum sST2 level than patients with NYHA class≤II (Median:45.1,IQR:34.1 -85.6), P<0.05.The AUC of sST2 in distinguishing heart failure patients from normal people was 0.815(sensitivity :51.2%,specificity:92.7%).The AUC of sST2 ,sST2+NT-ProBNP and sST2+NT-ProBNP+LVEF in distinguishing patients between NYHA class≤II and>II were 0.743, 0.810, 0.831 respectively and the sensitivity of sST 2 +NT-ProBNP+LVEF was 94.7%.Conclusions Experimental results show that this sST 2 ELISA kit has a good performance in the precision, linearity.sST2 correlates with NT-ProBNP and NYHA class but do not correlates with LVEF . Serum sST2 level is not influenced by age , BMI, renal function.sST2 could be a good supplement of NT-ProBNP and LVEF in distinguishing patients between NYHA class≤II and>II.

Objective To evaluate the performance of serum sialic acid detection kit using enzymic method and investigate the clinical diagnosis value of sialic acid.Methods one hundred and fifty healthy adults were enrolled in this case control study to establish serum SA reference interval.The analytical performance (accuracy,precision,linearity) of serum sialic acid detection kit using enzymic method was assessed.Two hundred and forty patients were classified into different malignant tumor groups according to their pathological types.Serum SA level of each tumor group was compared with that of normal control group.In tumor groups with statistical difference,benign disease groups were further collected.Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the diagnostic value of SA compared with other tumor markers.t test,one-way ANOVA,Mann-Whitney U test were used as statistical methods.Results The reference interval of SA was 479 to 715 mg/L.The detection result of 2 level controls was 584 and 1 482 mg/L respectively,which were both within the acceptable limits.The within-lot and between-lot variations of three level samples were both below 5％.There was a good linear correlation (Y =0.995X-0.177,R2 =0.999) between theoretical value and actual detection result in range of 0-1 052 mg/L.The serum level of SA was (757 ± 177),(514 ± 86) and (597 ± 60) mg/L in gastric cancer group,benign disease control group and normal control group respectively,which had statistically significant difference(F =55.2,P ＜ 0.01).The serum level of SA was(659 ± 127) and (545 ± 66) mg/L in colorectal cancer group and benign disease control group respectively,which had statistically significant difference(F =42.8,P ＜ 0.01).The serum level of SA was (738 ± 157) and (672 ± 161) mg/L in colorectal cancer group and benign disease control group respectively,which did not have statistically significant difference(F =26.3,P ＞ 0.05).The AUC of SA was 0.804,0.724,0.755 in gastric cancer group,colorectal cancer group and lung cancer group respectively,which was higher than that of CEA and CA72-4.In gastric cancer group,the sensitivity of SA was higher than that of CEA (59.5％,24.3％).The AUC of SA was 0.791,0.687,0.790 in gastric cancer,colorectal cancer and lung cancer patients with normal CEA serum level respectively.Conclusions Experimental results show that serum sialic acid detection kit using enzymic method has good performance in the precision and linearity.Sialic acid has some value in the diagnosis of gastric cancer and colorectal cancer and could be a good supplement of CEA in screening of cancer.

Urinary albumin used as an important indicator in diagnosis of renal disease , but there are still many problems in the clinical application .The urine specimen type , threshold value , reference measurement procedures and some more aspect were summarized in this article .

Objective To investigate the MRI features of children's joint tuberculosis of the appendicular skeleton, and to evaluate the diagnostic value of MR imaging. Methods Sixteen consecutive patients confirmed clinically and pathologically were examined with SE-T1WI, FSE-T2WI, FSE-PDWI and PD-SPIR in Philips Achieva 3.0T superconduct MR scanner. Axial, sagital and coronal images were obtained. Articular structure was all analyzed based on the affected parts and features of MRI. Results Hip joint and knee joint were most likely to suffer (each 25.00%). Metaphysis was affected in 13 patients with long signal intensity on T1WI and long signal intensity on T2WI. The changes of articular cartilage presented as abnormality of signal intensity in 6 patients with focal high signal intensity on T2WI. Thirteen patients presented as joint effusion. Synovial thickening in 4 patients showed moderate homogeneous signal on T1WI and slightly lower signal on T2WI. Articular soft tissue was involved in 16 patients, including the formation of cold abscess in 2 and cellulitis in 1 patient, showing long signal intensity on T1WI and long signal intensity on T2WI. Conclusion MRI has the advantage of being able to detect early abnormalities of bone marrow, cartilage damage and to evaluate joint effusion, synovial thickening and soft tissue lesions.

ObjectiveTo evaluate the effects of ventilator circuit change frequency on ventilatorassociated pneumonia (VAP).MethodsMeta-analysis of effects of ventilator circuit change frequency on VAP was conducted with study-level data from 1995 to 2010 in Pubmed,Embase,Web of Science databases.ResultsNine articles were included (sample size:20 326 mechanically ventilated patients).Analysis of six articles showed that the incidence of VAP in ventilator circuit change every 2 or 3 days was 4.05％,while 3.65％ in ventilator circuit change every 7 days.Compared with change ventilator circuit every 2 or 3 days,the risk ratio (RR) of VAP in weekly changes was 0.77 [0.54,1.09] ( P =0.14 ).Analysis three articles showed that compared to ventilator circuit change every 7 days with 15.89％ incidence of VAP,the incidence of VAP in circuit change more than 14 days was 14.9％,and RR was 0.98 [0.69,1.39](P =0.91 ).ConclusionsRegular ventilator circuit change frequency in various intervals can't difference in the incidence of VAP in mechanical ventilation patients.