Objective To investigate the significance of pulse indicating the continuous cardiac output (PICCO) technique in patients with post-trauma capillary leak syndrome (PTCLS). Methods Twenty traumatic patients with PTCLS received PICCO monitor from 2011 to 2014 were enrolled in this study. analyzed, The patients, with twelve males and eight females, aged from twenty three to fifty. And twenty patients in the control group, with ten males and ten females, aged from twenty one to fifty two. Twenty six patients were injuried by traffic, ten patients were injuried by crash and four patients were injuried by sword. No significant differences were found in age、gender、weight、scores of ISS、Murray and APACHEⅡof all patients. All patients were survived. The balance of fluids, Lactate, Central venous oxygen saturation (ScvO2) and the mean artery pressure (MAP) were compared at 0, 24, 48 and 72 h after entering into the ICU. The duration of ICU stay and ventilation were also compared. Results (1)No significant differences in MAP、Lac and ScvO2 were observed in two groups. (2)No significant differences in the balance of fluids when patients entered into ICU, but significant differences were found at 24, 48 and 72 h post-entering into ICU (P < 0.05). (3)Significant differences in the duration of ICU stay and ventilation between the two groups were observed (P < 0.05). Conclusion PICCO technique can provid a quantitative target for PTCLS patients, with decreasing fluid infusion, and reducing the duration of ICU stay and ventilation.

Objective To investigate the changes of the serum vascular adhesion protein-1(VAP-1)and high sensitivity C reac-tive protein(hs-CRP) in diabetic nephropathy(DN) and the effects in the development of diabetic nephropathy .Methods 40 cases of DN were enrolled as the DN group ,39 cases of type 2 diabetic mellitus were enrolled as the T2DM group ,and 46 cases of healthy persons were enrolled as the control group .The levels of the serum VAP-1 and hs-CRP were tested by ELISA ,the blood glucose (Glu) was tested by autochemistry analyzer and the concentrations of glycosylated hemoglobin A-1(GHbA-1) was tested by high performance liquid chromatography(HPLC) .All the resoults were compared with that of the control group .Results the differences of the levels of VAP-1 ,hs-CRP ,Glu ,GHbA-1 in different groups were ststisticlly significant (P<0 .05) ,the levels of VAP-1 and hs-CRP were higher in DN group than that of T2DM group and the control group ,and the level of hs CRP was higher in T2DM group than that of control group .The positive correlation was found in T2DM group between VAP-1 with hs-CRP and Glu(r=0 .568 ,0 .755 ,P<0 .05 ,0 .01) ,hs-CRP with Glu and GHbA-1(r= 0 .886 ,0 .475 ,P< 0 .01 ,0 .05) ,and Glu with GHbA-1(r=0 .471 ,P<0 .05) .In DN group ,the level of VAP-1 has positive correlation with the levels of hs-CRP ,GHbA-1 ,Glu(r= 0 .521 , 0 .830 ,0 .454 ,P<0 .05 ,0 .01 ,0 .05) ,the levels of hs-CRP has positive correlation with that of Glu (r=0 .690 ,P<0 .001) .Conclu-sion the changes of the levels of Glu and GHbA-1 in patients with T2DM could affect the increase of VAP-1 and hs CRP ,high content of VAP-1 could cause microangiopathy and renal function damage .Antagonist therapy of VAP-1 is important for the pre-vention of the DM complication .

Objective:To investigate the clinical efficacy of bilateral route minimal- incision necrosectomy combined with continuous lavage for the treatment of infected necrotizing pancreatitis (INP).Methods:The retrospective and descriptive study was conducted. The clinical data of 20 patients with IPN who were admitted to Daping Hospital, Army Medical University from April 2016 to July 2019 were collected. There were 11 males and 9 females, aged (42±9)years. All the 20 patients underwent bilateral route minimal-incision necrosectomy, and then be continuous perfused and drainage within the purulent cavity postoperatively. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detected patients fever, abdominal pain, abdominal distension, diarrhea, peripancreatic residual infection and survival up to January 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical situations: of the 20 patients who underwent surgery successfully, 14 patients underwent upper abdomen combined with left retroperitoneal approach, 1 patient underwent upper abdomen combined with right retroperitoneal approach, and the other 5 patients underwent upper abdomen combined with bilateral retroperitoneal approach. Fourteen of the 20 patients underwent additional surgery including 10 cases undergoing jejunostomy, 2 cases undergoing gastrostomy combined with jejunostomy, 1 case undergoing laparoscopic cholecystectomy combined with jejunostomy, and 1 case undergoing cholecystectomy. The operation time and volume of intraoperative blood loss of 20 patients were (228±41) minutes and 100 mL (range, 50-700 mL), respectively. (2) Postoperative situations: 20 patients began continuous perfused with 0.9% sodium chloride solution within the purulent cavity at postoperative day 2 (range, day 1-14). Six of the 20 patients had postoperative complications including 1 case with postoperative gastric fistula combined with intraperitoneal hemorrhage who underwent laparotomy hemostasis combined with gastrostomy at day 13 postoperatively, 1 case with postoperative duodenal fistula who underwent gastrointestinal anastomosis and jejunostomy at day 111 postoperatively, 1 case with postoperative retroperitoneal residual tissue necrosis and infection who underwent peripancreatic necrotic tissue debridement and drainage at day 11 postoperatively, 1 case with postoperative gallbladder fistula who underwent cholecystectomy at day 71 postoperatively, and 2 cases with postoperative pancreatic fistula who were cured with conservative treatment. The duration of hospital stay after 1st operation of the 20 patients were 42 days (range,20-178 days). (3) Follow-up: all 20 patients were followed up for 6.0 to 45.0 months, with a median follow-up time of 14.5 months. During the follow-up, 1 case developed secondary diabetes, and none of patient showed clinical manifestation such as fever, abdominal pain, abdominal distension and diarrhea. The peripancreatic residual tissue of all 20 patients absorbed well, and none of patient died.Conclusion:Bilateral route minimal-incision necrosectomy combined with continuous lavage is safe and feasible for the treatment of INP.

Objective To establish a rapid method to detect mutations in rpoB genes of rifampin-resistant Mycobacterium tubereulosis in dinical specimens using Real-time fluorescence PCR molecular beacon assay.Methods 174 strains of Mvcobacterium tuberculosis clinical isolates were analyzed using real-time fluorescence PCR molecular beacon assay foilowed with DNA sequencing while 12 strains of NTM and 4 strains of bacteria other than Mycobacterium tuberculosis were used as the contrast.Results Eighty-two 89.1 of 92 rifampin (RIF)-resistant strains and 3 of 82 RIF-sensitive strains were found to harbor mutation in the rpoB gene using real-time fluorescence PCR-molecular beacon assay.The specificity, sensitivity,and accuracy of this assay were 96.3%,89.1%,and 92.5%,respectively-Eithty-three of 92 RIF-resistant strains and 1 of 82 RIF-sensitive strains were found to harbor mutation in the rpoB gene using the direct DNA sequencing.The specificity,sensitivity,and accuracy of the direct DNA sequencing were 98.8,90.2%,and 94.2%,respectively.As compared with real-time PCR molecular beacon assay,171 of 174(98.3%)strains of myeobactefium tuberculosis clinical isolates had the salne results.Conclusion Real-time fluorescence PCR-molecular beacon assay can be used as a rapid screen method to detect RIF-resistant isolates.

Objective To investigate the effect of daily quality checklist on intensive care unit (ICU) the incidence of severe patients with hospital associated infection (HAI). Methods A historical control study was conducted. In Tianjin Fifth Center Hospital from June 2016 to May 2017, 286 severe patients with mechanical ventilation (MV) and using ICU daily quality checklist were assigned as the experimental group, and from June 2015 to May 2016, 291 severe patients who did not use the daily quality checklist were selected as the control group. In the control group, the routine treatment, nursing care and ward rounds were the daily ordinary work; in the experimental group, the severe disease ICU quality checklist system was strictly carried out, and every day the doctor and nurse on duty applied the checklist to assess and verify the medical quality given to the patient, including sedation, analgesia, MV, glycemic control, nutrition, etc 16 items. The incidences of ventilation associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI), catheter-associated urinary tract infection (CAUTI), 28-day mortality, time of MV and the length of ICU stay were compared between the two groups. Results Compared with the control group, the incidences of VAP, CRBSI and CAUTI of experimental group were obviously decreased (VAP: 1.78‰ vs. 5.09‰, CRBSI: 1.46‰vs. 5.21‰; CAUTI: 1.39‰ vs. 4.41‰, all P ＜ 0.05), the time of MV and the length of ICU stay in experimental group were significantly shorter than those in the control group [the time of MV (days): 7.81±2.74 vs. 10.62±3.67, the length of ICU stay (days): 8.40±1.94 vs. 11.35±2.47, both P ＜ 0.05]; there was a decreasing tendency of 28-day mortality in experimental group compared with that in control group [5.24% (15/286) vs. 6.19% (18/291)], but no statistical significant difference was seen (P ＞ 0.05). Conclusion Implementation of daily quality checklist can effectively decrease the incidence of HAI in ICU patients, reduce the time of MV and the length of ICU stay.

Objective:To compare the therapeutic effect of fluid resuscitation strategy guided by pulse-indicated continuous cardiac output (PiCCO) monitoring and early goal-directed therapy (EGDT) on renal function of acute kidney injury (AKI) patients caused by septic shock.Methods:Septic shock patients with AKI admitted to the intensive care unit (ICU) of Tianjin Fifth Central Hospital and Teda International Cardiovascular Hospital from March 2017 to February 2020 were enrolled. All patients were given fluid resuscitation. Patients were divided into PiCCO-guided fluid resuscitation group [PiCCO group, intrathoracic blood volume index (ITBVI) was maintained between 850-1 000 mL/m 2] and EGDT-guided fluid resuscitation group [EGDT group, central venous pressure (CVP) was maintained between 8-12 mmHg (1 mmHg = 0.133 kPa) or CVP ≤ 15 mmHg when patients received mechanical ventilation (MV)] according to both the patient's condition and the informed consent of the patient's family. The changes of heart rate (HR), mean arterial pressure (MAP), CVP, blood lactic acid (Lac), fluid balance, urine volume and serum creatinine (SCr) at 6, 24, and 48 hours after fluid resuscitation in the two groups were observed, and the renal replacement therapy (RRT), duration of MV, length of ICU stay and 28-day mortality between the two group were compared. Results:① A total of 94 patients were enrolled, including 51 in the EGDT group and 43 in the PiCCO group. There was no significant difference in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, procalcitonin (PCT), HR, MAP, CVP, Lac or SCr at ICU admission between the two groups. ② The parameters of hemodynamics, fluid balance, urine volume and SCr were improved with the time of resuscitation in the two groups, and there was no significant difference in HR, MAP or Lac between the two groups. Compared with the EGDT group, the CVP decreased significantly at 24 hours and 48 hours after fluid resuscitation in the PiCCO group (mmHg: 9.1±0.9 vs. 12.0±1.3 at 24 hours, 8.0±1.0 vs. 10.2±1.3 at 48 hours), the fluid balance significantly decreased (mL: 2 929.8±936.3 vs. 3 898.4±923.5 at 24 hours, 3 143.5±1 325.4 vs. 4 843.8±1 326.7 at 48 hours), and the condition of urine volume and SCr were better in the PiCCO group [urine volume (mL·kg -1·h -1): 1.02±0.21 vs. 0.79±0.14 at 24 hours, 1.28±0.18 vs. 0.94±0.22 at 48 hours; SCr (μmol/L): 145.7±37.6 vs. 164.3±46.4 at 24 hours, 128.4±33.6 vs. 143.5±37.7 at 48 hours), with significant differences (all P < 0.05). ③ Compared with the EGDT group, the rate of RRT in the PiCCO group was lower [11.6% (5/43) vs. 17.6% (9/51)], the duration of MV and the length of ICU stay were shorter [duration of MV (days): 4.64±1.31 vs. 6.50±2.19, length of ICU stay (days): 10.35±3.50 vs. 14.50±5.78), with significant differences (all P < 0.05). There was no significant difference in the 28-day mortality between the PiCCO group and EGDT group [14.0% (6/43) vs. 15.7% (8/51), P > 0.05]. Conclusion:Fluid resuscitation strategy guided by PiCCO in septic shock patients with AKI can reduce the amount of fluid load, improve renal function, shorten the MV duration and length of ICU stay, and shows clinical significance.

Objective:To compare the effects of freshwater and seawater drowning on sheep's pulmonary circulation hemodynamics and respiratory mechanics.Methods:According to the random number table method, healthy crossbred sheep were divided into freshwater drowning group ( n = 12) and seawater drowning group ( n = 12). 30 mL/kg of freshwater or seawater was infused respectively through trachea for approximately 5 minutes. Before the drowning, immediately after drowning, and 30, 60, 120 minutes after drowning, the systemic circulation hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), cardiac output (CO)] were monitored by pulse indicator continuous cardiac output (PiCCO); the respiratory parameters were obtained through the ventilator, including tidal volume (VT), lung compliance (Cdyn), oxygenation index (PaO 2/FiO 2), peak airway pressure (Ppeak)]; PiCCO and the right heart floating catheter (Swan-Ganz catheter) was used to measure pulmonary hemodynamic parameters [pulmonary systolic pressure (PAS), pulmonary diastolic pressure (PAD), pulmonary artery wedge pressure (PAWP), and extravascular lung water (EVLW)]. The animals were sacrificed at the end of the experiment, and the amount of residual water in the respiratory tract was measured; the pathological changes in the lung tissue were observed by hematoxylin-eosin (HE) staining. Results:① Systemic circulation hemodynamics: compared with the values before drowning, HR, MAP, and CO at the time of immediately after drowning in both freshwater and seawater were significantly increased and peaked. In addition, all indicators in the freshwater drowning group were significantly higher than those in the seawater drowning group [HR (bpm): 170.75±1.87 vs. 168.67±2.27, MAP (mmHg, 1 mmHg = 0.133 kPa): 172.92±1.62 vs. 159.42±3.18, CO (L/min): 13.27±0.71 vs. 10.33±0.73, all P < 0.05].② Respiratory parameters: compared with values before drowning, PaO 2/FiO 2, VT, and Cdyn decreased immediately in both freshwater and seawater drowning groups, Ppeak was significantly increased; in addition, the values in the seawater drowning group were decreased or increased more significantly than freshwater drowning group [PaO 2/FiO 2 (mmHg): 37.83±1.99 vs. 60.42±5.23, VT (mL): 86.25±7.66 vs. 278.75±9.67, Cdyn (mL/cmH 2O): 8.86±0.33 vs. 23.02±0.69, Ppeak (cmH 2O, 1 cmH 2O = 0.098 kPa): 42.17±2.69 vs. 17.67±1.15, all P < 0.01]. In addition, PaO 2/FiO 2 in the freshwater drowning group was gradually increased over time, while the seawater group continued to decline.③ Pulmonary circulation hemodynamic parameters: PAS, PAD, PAWP at the time of immediately after drowning in both freshwater and seawater groups were significantly higher than before drowning; in addition, the freshwater drowning group was significantly higher than the seawater drowning group [PAS (mmHg): 34.58±2.87 vs. 26.75±1.66, PAD (mmHg): 27.25±1.22 vs. 16.75±0.87, PAWP (mmHg): 27.83±1.85 vs. 11.75±1.82, all P < 0.01]. Thereafter, PAS and PAD in the freshwater drowning group gradually decreased, while the parameters in the seawater drown group continued to increase. PAWP gradually decreased after freshwater or seawater drowning, and recovered to pre-drowning levels 120 minutes after drowning and 30 minutes after drowning, respectively. EVLW continued to increase after freshwater drowning, reaching a peak at 30 minutes, and then decreased, until 120 minutes after drowning was still significantly higher than that before drowning (mL/kg: 10.73±1.27 vs. 7.67±0.69, P < 0.01); EVLW could not be measured.④ Residual water in the respiratory tract: residual water in the freshwater drowning group was significantly less than that in the seawater drowning group (mL: 164.33±25.21 vs. 557.33±45.23, P < 0.01).⑤ HE staining: partial alveolar atrophied in the freshwater drowning group, some alveolar spaces were broken, alveolar spaces and alveolar cavity showed a little powdery substance deposition; it was noted that alveolar expanded in the seawater drowning group, alveolar spaces were broken and bleeding and edema were obvious in the interstitial space. Conclusion:The effect of seawater drowning on the respiratory mechanics and pulmonary circulation of animals is more obvious than that of freshwater drowned animals, and the amount of residual water in the respiratory tract is also significantly more than that of freshwater drowned animals.

Objective:To compare the cuff pressure and leakage volume and the related complications of filling the tracheal tube cuff by minimum air leakage method and cuff pressure manometer method after endotracheal intubation, so as to provide theoretical basis for patients who was intubated to obtain appropriate cuff pressure.Methods:A prospective randomized controlled study was conducted. 100 patients admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from December 2015 to June 2019 were enrolled. According to the random number table method, the patients were divided into the experimental group and control group, with 50 patients in each group. After successful endotracheal intubation, all patients were placed in a supine position with the head of the bed raised by 30°. The experimental group used the minimum air leakage method, and used the cuff pressure manometer to obtain the cuff pressure. In the control group, cuff pressure was maintained at 25-30 cmH 2O (1 cmH 2O = 0.098 kPa). Parameters such as cuff pressure and ventilator leakage volume at the beginning and 4 hours, 8 hours after the inflation were compared between the two groups, as well as the incidence of ventilation-associated pneumonia (VAP) and airway complications after extubation. Results:Among the 100 cases, 53 were males and 47 were females. The age ranged from 23 to 87 years old, with an average of (68.53±8.46) years old. The intubation time ranged from 1 to 16 days.① At 4 hours and 8 hours after inflation, the cuff pressures of the two groups were lower than that of the first time of inflation, and the air leakage of the ventilator increased gradually with the extension of time. Compared with the control group, cuff pressures at each time point in the experimental group were significantly higher than those in the control group [mmHg (1 mmHg = 0.133 kPa): 33.72±9.14 vs. 25.68±5.26 at 0 hour, 30.54±7.81 vs. 24.35±4.93 at 4 hours, 26.57±5.64 vs. 22.42±4.14 at 8 hours, all P < 0.05], and ventilator leakage volumes were smaller than those in the control group (mL: 25.57±8.51 vs. 34.65±9.47 at 0 hour, 40.54±8.51 vs. 60.34±7.85 at 4 hours, both P < 0.05). ② The incidence of VAP in the experimental group was significantly lower than that in the control group (4% vs. 10%, P < 0.05). There was no statistically significant difference in the incidence of other airway complications between the experimental group and control group (airway mucosal edema: 14% vs. 12%, ulcer: 8% vs. 6%, tracheal esophageal fistula: 0% vs. 0%, hoarseness: 4% vs. 6%, cough: 30% vs. 34%, sore throat: 28% vs. 32%, tracheal softening: 0% vs. 0%, cuff rupture: 10% vs. 8%, all P > 0.05). Conclusions:The optimal cuff pressure is very important for preventing VAP and reducing airway complications. The minimum air leakage method makes the clinical obtained endotracheal intubation cuff pressure more accurately, with less air leakage, safe and effective, and it is worthy of clinical promotion.

Objective To compare the systemic pathologic physiology parameter changes in sheep drowning in freshwater and seawater. Methods The experimental animals were healthy crossbred sheep. According to the envelope method, 24 sheep were randomly divided into two groups, with 12 animals in each group. The animals in both groups were subjected to mechanical ventilation and analgesia and sedation, the drowning models were reproduced by injecting 10-25 mL/kg of seawater or freshwater into the endotracheal tube of animals. The changes in hemodynamics before drowning, immediately after drowning (immediately after water injection) and 30, 60, and 120 minutes after drowning in both groups were recorded. The urine color changes after drowning and occurrence time were recorded. The animals were sacrificed at 120 minutes after drowning, and heart, kidney, liver, spleen and intestine were harvested for pathological observation under light microscope using hematoxylin and eosin (HE) staining. Results ① The changes in systemic hemodynamic: there was no significant difference in hemodynamics before drowning between the two groups.Compared with before drowning, heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), left ventricular maximum systolic force index (dPmax), and pulmonary wedge pressure (PAWP) immediately after drowning in both seawater and freshwater groups were significantly increased, which showed a decrease tendency with drowning time prolongation. Compared with drowning immediately, dPmax at 30 minutes after freshwater drowning was significantly decreased (mmHg/s: 919.83±14.51 vs. 2 628.42±59.75, P < 0.01), which was below the level before drowning till 120 minutes. CO at 30 minutes after freshwater drowning was retreated as compared with drowning immediately, but it was still higher than that before drowning (L/min: 8.25±0.66 vs. 5.75±0.73, P < 0.01). Global end-diastolic volume (GEDV) and PAWP at 120 minutes after freshwater drowning were decreased to the level before drowning [GEDV (mL): 642.92±7.29 vs. 638.25±7.00, PAWP (mmHg, 1 mmHg = 0.133 kPa): 5.83±1.19 vs. 5.42±1.08, both P > 0.05]. Compared with immediately after drowning, MAP, CO and PAWP at 30 minutes after seawater drowning were significantly lowered [MAP (mmHg): 90.50±3.58 vs. 159.42±3.18, CO (L/min): 2.37±0.45 vs. 10.33±0.73, PAWP (mmHg): 4.17±0.72 vs. 11.75±1.82, all P < 0.01], which were lower than those before drowning till 120 minutes. After drowning for 30 minutes, MAP, CO and PAWP in seawater group were significantly lower than those in freshwater group [MAP (mmHg): 90.50±3.58 vs. 117.42±1.78, CO (L/min): 2.37±0.45 vs. 8.25±0.66, PAWP (mmHg): 4.17±0.72 vs. 24.83±1.27], dPmax was significantly increased (mmHg/s: 1 251.42±62.50 vs. 919.83±14.51, all P < 0.01), and the tendency continued till 120 minutes. There was no significant difference in HR at all the time points between the two groups. ② The changes in urine: after freshwater drowning, the animals had hemoglobinuria and lasted until the end of the experiment, and the time of hemoglobinuria occurrence was at 20-35 minutes after drowning with an average of (25.30±5.15) minutes. After seawater drowning, the change in urine was not found until the end of the experiment.③ The variations of each organ tissue in pathology and hematology at 120 minutes after drowning: after freshwater drowning, the systemic tissue edema was found in organs such as heart, kidney, liver, spleen, and small intestine. After seawater drowning, there were different degrees of edema in the systemic organs, and some of them shrank. Conclusions After freshwater drowning, the animals showed decreased dPmax, increased CO and blood volume, edema and hemolysis of the tissue cells. After seawater drowning, CO and blood volume decreased, and some tissue cells were in atrophy.

Coronary artery disease (CAD) is a chronic disease but causes the highest mortality and morbidity among the cardiovascular diseases worldwide. Correlations between CAD and gut microbiota have been observed. This suggests that the gut microbiota could become a vital diagnostic marker of CAD, and restoring the gut habitat may become a promising strategy for CAD therapy. The elevated level of trimethylamine-N-oxide (TMAO), a gut microbiota-derived metabolite, was found to be associated with the increased risk of cardiovascular disease and the all-cause mortality. Preclinical studies have shown that it has pro-arteriosclerosis properties. It is likely that regulating the production of TMAO by gut microbiota may become a promising strategy for anti-atherosclerosis therapy. This review summarizes the clinical and preclinical researches on the intervention of CAD by regulating the gut microbiota and the microbiota-derived metabolite TMAO, with the aim to provide new target for the therapy of CAD.
Coronary Artery Disease ; Gastrointestinal Microbiome ; Humans ; Methylamines ; Oxides