Objective To investigate the clinical effects of the pulse indicator continuous cardiac output (PiCCO) in goal-optimized fluid management on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure.Methods A total of 71 AECOPD patients with respiratory failure who were hospitalized in department of Critical Care Medicine in our hospital were selected from October 2010 to September 2013.The PiCCOtechnology was applied to monitor intrathoracic blood volume index (ITBI) and extravascular lung water index (ELWI).We compared the relationship of ELWI with ITBI and oxygenation index,and a simple correlation analysis was used for statistical analysis.Results A significantly negative correlation was found between ELWl and oxygenation index (r=-0.743,P＜0.01).ELWI =14 ml/kg was defined as the cutoff value for the subgroup analysis.A negative correlation still was found between ELWI and oxygenation index in the subgroup with ELWI ＜ 14 ml/kg,but it had no significant difference (r=-0.533,P=0.080),while a significantly negative correlation was found in the subgroup with ELWI≥14 ml/kg (r=-0.961,P＜0.01).There was no significant correlation between ELWI and ITBI (r=0.477,P=0.072).ITBI=1 000 ml/m2 was defined as the cutoff value for the subgroup analysis.There is no significant correlation between ELWI and ITBI in the subgroup with ITBI＜1 000 ml/m2(r=0.338,P=0.116),but in the subgroup with ITBI≥1 000 ml/m2,a significantly positive correlation between ELWI and ITBI was found (r=0.677,P＜ 0.01).Conclusions The results suggest that when ELWI is higher than 14 ml/kg,ELWI becomes an important influencing factor for oxygenation,which can be decreased to improve oxygenation in patients with AECOPD,and when ITBI≥ 1 000 ml/m2,ITBI can be reduced by decreasing ELWI.PiCCO has an important clinical significance on a goal-optimized fluid management in AECOPD patients with respiratory failure.

Adult ; Amides ; adverse effects ; Benzene ; adverse effects ; Burns, Chemical ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Nitro Compounds ; adverse effects ; Young Adult

Objective To explore the effect of early goal-directed therapy (EGDT) according to pulse indicated continuous cardiac output (PiCCO) on septic shock patients.Methods Eighty-two septic shock patients in Subei People's Hospital of Jiangsu Province from January 2009 to December 2012 were enrolled and randomly divided into two groups using a random number table,standard surviving sepsis bundle group (n=40) and modified surviving sepsis bundles group (n =42).The patients received the standard EGDT bundles in standard surviving sepsis bundle group.PiCCO catheter was placed in modified surviving sepsis bundles group.Fluid resuscitation was guided by intrathoracic blood volume index (ITBVI) with the aim of 850-1 000 mL/m2.Dobutamine was used to improve the heart function according to left ventricular contractile index (dPmax) and stroke volume index (SVI).The mean arterial blood pressure (MAP) was maintained 65 mmHg (1 mmHg=0.133 kPa) or above with norepinephrine.Extra-vascular lung water was monitored for the titration of liquid and diuretics.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,the number of patients needed vasopressor,serum procalcitonin (PCT),lactic acid and lactate extraction ratio,the amount of fluid resuscitation,duration of mechanical ventilation,duration of intensive care unit (ICU) stay,hospital mortality were recorded in both groups.Results After treatment,the APACHE Ⅱ score,SOFA score and the number of patients needed vasopressor were gradually reduced in both groups,and those in modified surviving sepsis bundle group were significantly lower than those of standard sepsis bundle group at 72 hours (APACHE Ⅱ score:13.1 ± 6.5 vs.20.9 ± 7.5,SOFA score:8.8 ± 4.3 vs.14.6 ± 4.9,the number of patients needed vasopressor:8 vs.17,all P＜0.05).Arterial blood lactate clearance rate was gradually increased after treatment in both groups.Lactate clearance rate in modified surviving sepsis bundle group was significantly higher than that of standard surviving sepsis bundle group [6 hours:(18.2 ± 8.3)％ vs.(10.8 ± 7.5)％,t=-6.036,P=0.001 ; 12 hours:(22.6 ± 7.3)％ vs.(12.4 ± 8.1)％,t=-4.536,P=0.001 ; 24 hours:(27.8 ± 5.6)％ vs.(16.4 ± 9.5)％,t=-5.882,P=0.000].The amount of fluid resuscitation within 6 hours in modified surviving sepsis bundle group increased significantly compared with standard surviving sepsis bundle group (mL:3 608 ± 715 vs.2 809 ± 795,t=-3.865,P=0.033).The amount of fluid resuscitation within 24,48 and 72 hours in modified surviving sepsis bundle group was significantly less than that of standard modified surviving sepsis bundle group with the nadir at 72 hours (mL:918 ± 351 vs.1 805 ± 420,t=5.907,P=0.037).Duration of mechanical ventilation (hours:98.4 ± 20.3 vs.143.3 ± 29.6,t=9.766,P=0.001) and ICU stay (days:7.1 ± 3.1 vs.9.5 ± 2.5,t=2.993,P=0.004) were significantly reduced in modified surviving sepsis bundle group compared with standard surviving sepsis bundle group.The hospital mortality in modified surviving sepsis bundle group was slightly lower than that in standard surviving sepsis bundle group [16.7％(7/42)比 17.5％(7/40),x2=0.010,P=0.920].Conclusions Modified surviving sepsis bundle treatment according PiCCO can reduce the severity of disease in patients with septic shock,can make more accurately guide fluid resuscitation,and can reduce lung water and duration of mechanical ventilation and ICU stay.It has great clinical significance.

Objective In order to understand the relationship between myoblast and Schwann cell,our purpose was to investigate the effects of biological characters of myoblasts co-cul tured with Schwann cells and pro vide the basic theory for constructing artificial muscle involving artificial nerve.Methods After sterilizing with iodine tincture and alcohol,the brachial plexus,sciatic nerve and triceps surae muscle of neonatal SD rat were harvested and peeled off their membranes,blood vessels and fat tissues under operating microscope thor oughly.The nerve and muscle tissues were cut in pieces by microscis sors,and then digested and isolated by collagenase and pancreatin in20and15minutes respectively.DMEM medium was employed to culture my oblasts and Schwann cells.After co-culturing myoblasts of rats with Schwann cells in vitro,the morphological characteristics and the growth condition of two cells were observed under inverted phase contrast mi croscope,the effects of Schwann cells secretion for proliferation of myoblasts were detected by 3 HTdR iso topic tracing and expressed by disintegration per minute(DPM),formation rate of myotubes was counted under micro scope and statistic data was analyzed,the functional differentiation degree of my oblasts affected by Schwann cells was analysed by?-sarcomeric actin immunohistochemistry(SABC)and imaging analysis tech nique.Results Co-cultured myoblasts proliferated,and myotubes ap peared earlier.Comparing with sole-cultured my oblasts,the shape of myobutes from co-cultured myoblasts tended to be elongating and robust.The value of DPM far-exceeded the control group,and reached its peak of 2500(just800for con-trol group).The positive cells of ?-sarcomeric actin appeared in brown red color.However,syn thesis and excre tion of a-sarcome ric actin in co-cultured myoblasts were much greater than control group,and the gray ash value between two groups was of a significant difference.Conclusion Primary rat myoblasts co-cultured with Schwann cells in vitro is beneficial in regulating its the growth,proliferation and the differentiation.

Objective To study the clinical significance of the serum angiopoietin-2(Ang-2) in the diagnosis,recurrence,invasion and metastasis of gastric cancer.Methods The serum Ang-2 and carcino-embryonic antigen (CEA) levels in 158 patients with gastric cancer (gastric cancer group) and 30 normal controls(control group) were measured by enzyme linked immunosorbent assay(ELISA) technique respectively.The serum Ang-2 and CEA levels were also measured 2 weeks after operation in gastric cancer group and reexamined in the recurred gastric cancer patients in 2 years after operation (recurred and metastasis group).The correlation between the serum Ang-2 level and pathologic c haracterization of gastric cancer was evaluated.Results The serum Ang-2 and CEA levels in gastric cancer group [ (331.8 ±64.3),(42.6 ±37.3)μg/L] and recurred and metastasis group [(318.7 ±72.9),(40.5 ±36.7)μg/L] were significantly higher than those in control group [ (187.4 ± 32.7),(4.2 ± 3.1 )μ g/L] (P ＜ 0.01 ),and the serum Ang-2 level 2 weeks after operation [ (211.6 ± 75.1 ) μ g/L ] was significantly decreased to the control group (P ＞ 0.05 ),while the serum CEA level [ (33.4 ± 30.6) μ g/L ] was still significantly higher than the control group (P ＜ 0.01 ).The sensitivity of the serum Ang-2 for diagnosis of gastric cancer was markedly higher than that of the serum CEA (P ＜ 0.01 ).There was correlation between serum Ang-2 and degree of tumor differentiation,TNM pathological staging,lymphatic metastasis,invasion depth and tumor size (p ＜0.01 ),but there was no correlation between serum Ang-2 and tissue classification and location of gastric cancer (P＞ 0.05).Conclusion The serum Ang-2 level is suggested to be a valuable gastric cancer marker and conduce to the diagnosis of gastric cancer,the monitoring of recurrence after operation and evaluation of prognosis.

Objective To improve the awareness of the CT and/or MRI appearances and clinical presentations of Kasabach-Merritt syndrome(KMS),6 cases were reported.Methods The CT and/or MRI and clinical characters of 6 cases of KMS were reviewed and analyzed.Results Thrombocytopenia,and consumption coagulopathy were presented in all 6 cases.The paravertebral mass of posterior mediastinum, right pericardial lesion,skin and soft tissue of left arm were shown as iso-,hypointensity on T1-weighted image,iso-,hyper-intensity on T_2-weighted image,and with heterogeneous enhancement after contrast administration in three cases.Splenomegaly was presented in one case,it showed homogenous hypoattenuation on unenhanced CT,and diffused heterogeneous enhancement after contrast administration. On MRI,spleen was shown as hypointensity on T_1-weighted image,hyperintensity on T_2-weighted image, and with heterogeneous enhancement after contrast administration.There were lesions in both bones and spleen in one case.Osteopenia and thinned cortex were shown on the metaphyses of upper and lower extremities.Spleen enlarged and showed multifocal hypoattenuation lesions,the peripheral region enhanced on the early phase,and some of the lesions filled on the delayed phase after the contrast administration.One case showed huge hypoattenuation lesion in the left lobe of liver with gradually filling of the mass after peripheral enhancement.Conclusion Thrombocytopenia and consumption coagulopathy suggest the entity of extensive hemangioma.Splenomegaly with diffuse or focal hypoattenation or hypointensity in MRI infers the diagnosis of hemangioma.

Adult ; Humans ; Male ; Occupational Exposure ; Sodium Azide ; poisoning

Objective To evaluate the compliance of sepsis bundles and its impact on the mortality rate in patients with sepsis shock.Methods Fifty-eight adult patients with sepsis shock admitted in the intensive care units from January to December 2007 were enrolled in the study,and the compliance with the 6-h bundle was analyzed.Age,gender,sites of infection,acute physiology and chronic health evaluation II (APACHE II)score,duration of mechanical ventilation,ICU stay and the mortality rate were compared between patients completed 6-h bundles and those not completed 6-h bundles.Results Compliance with the 6-h bundle was obtained in 22 out of 58 patients(37.9%).Patients receiving bundle care had shorter duration of mechanical ventilation and shorter length of ICU stay than non-bundle patients(t=-2.225 and -3.702,P=0.037 and 0.001,respectively),and the mortality rate in 6-h bundle patients was also lower (X2=10.236,P=0.000).Conclusion The application of 6-h bundle care can reduce the mortality rate of the patients with sepsis shock.and the compliance should be improved.

Objective To establish a method of automatic analysis of iodide in drinking water.Methods In accordance with the principles of the National Standard Methods Standard Testing Methods for Dringking Water (GB 5750-2006),the reagent concentration and the ratio of dosage were optimized; the national standard artificial colorimetric detection of iodide in drinking water was substituted by automatic biochemical analyzer colorimetric analysis procedure; the accuracy and the precision of the new method were observed and compared with the National Standard Methods.Results In determination of iodide in drinking water by using automatic biochemical analyzer,the best linear ranges of the standard curve:low concentrations 0-＜ 50 μg/L with a correlation coefficient of 0.999 1,and the detection limit was 0.4 μg/L; at high concentrations of 50-500 μg/L the correlation coefficient was 0.999 3,and the detection limit was 4.0 μg/L.The coefficient of variation was 2.2％-4.2％ and the recovery was between 98.6％-1035％.Compared with the National Standard Methods,the difference was not statistically significant (t =0.97-1.70,all P ＞ 0.05).Conclusions The method of determination of iodide in drinking water by using automatic biochemical analyzer is successfully established.The accuracy and the precision of the method can meet the quality requirements of water quality analysis.

Objective To evaluate the clinical effects of PiCCO in the treatment of COPD patients with sepsis shock.Methods 43 COPD patients with sepsis shock were randomly divided into two groups.The control group (n =23) were guided fluid resuscitation according to CVP.The study group (n =20) were placed PiCCO,and according to the PiCCO for fluid resuscitation.The average amount of fluid resuscitation,the amount of norepinephrine and the blood lactate level in 24 hours were observed.The average duration of mechanical ventilation and ICU mortality were also observed.Results After 24 hours,the average amount of fluid resuscitation was (3 986.2 ± 542.1) ml of control group and (4 927.9 ± 761.8)ml of study group,the difference between the two groups was statistically significant (t =-4.71,P ＜ 0.05).The average norepinephrine dosage was (0.38 ± 0.21) μg · min-1 · kg-1 of control group and (0.14 ±0.08)μg · min-1 · kg-1 of study group,the difference between the two groups was statistically significant (t =2.45,P ＜ 0.05).The blood lactate level was (4.79 ± 1.95) mmol/L of control group and (3.44 ±1.45) mmol/L of study group,the difference between the two groups was statistically significant(t =2.59,P ＜ 0.05).Five patients died in control group(mortality 21.7％),and three patients died in study group(mortality 15.0％).Mortality between the two groups was not statistically different (x2 =0,03,P ＞ 0.05).The duration of mechanical ventilation in the control group was (101.22 ± 44.77) h,that in the study group was (74.71 ± 20.25) h,the difference between the two groups was statistically significant (t =2.234,P ＜ 0.05).Conclusion Long-term COPD patients maybe have right ventricular dysfunction,and CVP is difficult to truly reflect the volume status of patients,PiCCO can make up for deficiencies in CVP.PiCCO used to guide these patients with fluid resuscitation,which could guide fluid management of patients,reduce the amount of vasoactive drugs,improve tissue hypoxia,and could reduce the duration of mechanical ventilation.