Anemia, Aplastic ; therapy ; Hematopoietic Stem Cell Transplantation ; Humans ; Transplantation, Homologous

Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Thrombotic Microangiopathies ; etiology

ObjectiveTo investigate the efficacy of low-molecular-weight heparin (LMWH)combined with warfarin in advanced lung cancer patients with acute non-massive pulmonary embolism (PE) and the effect on dyspnea symptom.MethodsFifteen (stage Ⅲ B-Ⅳ ) lung cancer patients with PE from July 2008 to June 2010 were enrolled.All the patients were diagnosed as acute non-massive PE according to spiral computed tomography pulmonary angiography (SCTPA).Enoxaparin (1 mg/kg) was injected with subcutaneous injection twice a day for 7-14 days.Oral warfarin was added once a day 48 h after enoxaparin injection and the dosage was adjusted according to international normalized ratio (INR) level(maintain 2.0-3.0).The medical research council (MRC) grade,results of arterial blood gas analysis and adverse reactions were observed.ResultsSix patients were accompanied with deep venous thrombosis (DVT)according to vascular Doppler ultrasound,2 patients were died at the 6th day and 11th day due to multiple organ dysfunction syndrome.Six patients were cured.5 patients were good,2 patients were improved.The median survial time was 9.2 months.Thirteen patients' MRC grade was decreased trom (3.1 ± 0.5 ) grades to ( 1.9 ± 0.8 ),( 1.5 ± 0.5 ),(0.6 ± 0.6) grades,arterial oxygen pressure (PaO2) was raised from (60.5 ± 7.2)mm Hg (1 mm Hg=0.133 kPa) to (76.1 ±9.7),(81.6±9.2),(86.2±7.5) mm Hg,plasma D-dimer was decreased from (9.44 ± 5.29 ) mg/L to (4.33 ± 3.34 ),(0.88 ± 0.32 ),( 0.41 ± 0.1 7 ) mg/L and alveolar-arterial oxygen tension gradient [ P( A-a)O2 ] was increased from ( 38.5 ± 6.7 )mm Hg to ( 35.5 ± 5.1 ),(29.3 ± 3.2),(24.1 ± 4.1 ) mm Hg after 4,7,14 days of the treatment.There were significant differences in PaO2,MRC grade,plasma D-dimer before and after 4,7,14 days of the treatment(P ＜ 0.05),there was significant difference in P ( A-a)O2 before and after 7,14 days of the treatment (P＜ 0.05).There was no patient with big hemorrhage and thromboembolism during anticoagulant therapy.ConclusionsFor advanced lung cancer patients,the combination therapy with LMWH and warfarin for acute non-massive PE appears to be safe and effective on improving dyspnea symptom and hypoxemia.Adverse reaction is seldom.

Objective To evaluate the effects of proportional assist ventilation (PAV) and pressure support ventilation (PSV) on ventilate parameters of patients with chronic obstructive pulmonary disease (COPD) combined with respiratory failure.Methods Fifteen intubated stable patients recovering from acute exacerbation of COPD combined with respiratory failure were randomized to receive PAV or PSV support 60 min and then crossed over to alternative mode.Respiratory mechanics including respiratory systemelastic resistance and airway resistance were monitored by least square fitting (LSF) methed.During PAV support.the ratio of volume assist (VA) and flow assist (FA) level wag 80%.The ventilate parameters and arterialblood gas at different ventilate condition was observed.Results Compared with low level PSV (PS 10 cm H2O,1 cm H2O=0.098 kPa,PS10),tidal volume in high level PSV (PS 15 cm H2O,PS15) and PAV was significantly increased [(443±12)ml vs(532±34)ml,(464±23)ml,P<0.05].There was no difference in respiratory rate and peak inspiratory pressure between PAV and PS10.Airway occlusion pressure and time product of triggering was d()reased from (5.70±0.25)cm H2O to (4.53±0.25)cm H2O and (0.42±0.04) cm H2O to (0.32±0.03)cm H2O(P<0.05),PaO2/FiO2 ratio and PaCO2 was also significantly improved after PAV supported compared with PS10,and similar with PS15.The rapid shallow breath index at PAV was similar with PS10.Condusion As a positive feedback system,PAV seems more efficacious than low level of PSV in decreasing the work of breathing during the inspiratory phase,resulting in fewer patient-ventilator asynchronism,and it may be beneficial for weaning.

Objective To investigate the severity of airflow obstruction in stable COPD patients and to assess the effects of salbutamol by analysis of tidal breathing flow-volume curves(TBFV).Methods 61 moderate-to-severve COPD patients and 68 normal controls were performed pulmonary function test and TBFV loops in seated position.Measurements of TBFV loops and spirometry were performed at rest after salbutamol 400 ?g inhalation in 26 COPD patients.Results COPD patients exhibited a significant decrease in FEV_1%、FEV_1/FVC、FEF50% and FEF75%.The fraction of exhaled volume to achieve PTEF to V_(TE)(V_(PTEF)/V_(TE))and the fraction of exhaled time to achieve PTEF to T_(E)(T_(PTEF)/T_(E))were lower than 18%[(12.8?2.7)% and(11.6?2.4)%],and much lower than normals(25.0?3.1)% and(29.5?3.7)%.But peak tidal expiratory flow(PTEF)and peak tidal inspiratory flow(PTIF)were decreased slightly.After salbutamol administration,26 COPD patients exhibited a significant increase in TEF50%(21.5?6.8)% versus(15.6?4.2)%,P

Humans ; Sialorrhea ; etiology ; therapy

Objective To survey the multi-drug resistance among the isolates of methicillinresistant Staphyloeocus from lower respiratory tract in post-cardiothoracic surgery patients and the risk factors contributing to infection aggravation.Methods The clinical data of lower respiratory tract infections were reviewed retrospectively from June 2011 to December 2012.The antimicrobial susceptibility testing was analyzed according to CLSI breakpoints 2010.Results A total of 323 clinical isolates was identified in 264 patients,including gram-positive coccus (126 strains) and gram-negative bacillus (197 strains).The prevalence of methiciIlin-resistant srtains was 88.5 ％ (54/61)in Staphylococus.Aureus (MRSA),and 77.3％ (17/22) in Staphylococcus epidermidis (MRSE).No VISA or VRSA strain was identified.One enterococcal strain was resistant to Vancomycin and teicoplanin.MRSA/MRSE were also isolated from hands and nasal vestibule of nurses,article surfae,pipeline/interface of breathing machine and ward atmosphere.Conclusions Patients after cardiothoracic operation are susceptible to lower respiratory tract infection with gram positive cocci,which should be paid more attention to airway management.Rational administration,sterile operation and antimicrobial therapy are effective ways for control of multi-durg resistance.

Objective To investigate the pathogenic bacteria types and distribution characteristics of critical patients with lower respiratory tract infection in neurosurgery department,and to analyze the high risk fac?tors of lower respiratory tract infections. Methods A retrospective analysis of 80 cases of critical patients with lower respiratory tract infection in neurosurgery department of General Hospital of People Liberation Army from April 2013 to April 2014 was carried out. The pathogenic bacteria types and distribution characteristics of lower respiratory tract infection were analyzed by means of bacterial identification,and single factor and multi factor Lo?gistic regression analysis was carried out to analyze the related factors of lower respiratory tract infection.Results One hundred and thirty?four strains of pathogenic bacteria were cultured from sputum of 80 cases of patients. Among which the gram negative bacteria were 109 strains,accounting for 81.34%(109/134),while the Gram positive bacteria were 17 strains,accounting for 12.69%(17/134) and the fungi were 2 strains,accounting for 1.49%(2/134).The proportion of three kinds of pathogenic bacteria had statistical significance(P=0.004, 0.001). The single factor Logistic regression analysis showed that,younger age,use of ventilator,use of antimi?crobial drugs and pulmonary infection rate were protective factors of lung infection(OR(95%CI)=0.586(0.475-0.722),0.708(0.574-0.873),0.827(0.697-0.981);P=0.043,0.007,0.000);disturbance of consciousness, tracheotomy,insert gastric tube, surgery and pulmonary infection incidence were risk factors for lung infection (OR(95%CI)=4.769(1.069-21.276),11.612(5.438-24.792),22.989(19.385-27.263),10.426(8.789-12.361);P=0.001,0.008,0.005,0.002).The multi factor Logistic regression analysis showed that there was a significant correlation between the trachea incision, the consciousness and the lower respiratory tract infection (OR(95%CI)=4.627(2.143-20.645),10.412(2.334-46.455);P=0.009,0.002).Conclusion Patients with conscious disturbance and tracheotomy were more likely to have lower respiratory tract infections. The pathogens of lower respiratory tract infections are Gram?negative bacteria,and the majority of pathogens are high resistance, and it is multi drug resistance.

Objective To investigate the effects of Panax notoginseng saponins(PNS,三七总皂苷) on extra-vascular lung water(EVLW) and respiratory dynamics in dog with oleic acid induced acute lung injury(ALI).Methods Eighteen Beagle dogs,intubated and mechanically ventilated with intermittent positive pressure ventilation(IPPV) mode(tidal volume(VT) 10 ml/kg, positive end-expiratory pressure(PEEP) 0,inspiratory oxygen concentration(FiO2) 1.00),were randomly assigned into three groups(each n=6): normal control group,ALI model group(induced by intravenous injection of oleic acid) and PNS group(received PNS after the ALI model was constructed).PNS 10 mg/kg being dissolved in 100 ml 5% glucose solution(GS) was pumped into central vein (2.5 ml/min) after ALI model was formed in the PNS group.Similar amount of glucose solution was given to the normal control and model groups.Respiratory dynamics and arterial blood gas(ABG) were monitored every hour.Four hours after the establishment of ALI,the dogs were sacrificed and extra-vascular lung water index(EVLWI) was quantified by a gravimetric measurement.Results In ALI dogs,PNS significantly decreased the index of EVLWI((14.10?1.45) ml/kg vs.(17.97?0.85) ml/kg,P0.05).Conclusion PNS has certain protective effect on dog with oleic acid induced ALI,it may lower EVLW and elevate the Cst total,that is beneficial to the improvement of hypoxemia.

0 05) After one year,plasma cortisol of the patients in either inhaled FP 500 ?g group or 750 ?g group was within normal rang Conclusions Long term inhaled FP with 500 ?g to 750 ?g per day is effective in moderate to severe asthma patients and has no significant suppression on adrenal cortex function