Objective To analyze the thyroid hormone levels before and after treatment in the patients with chronic obstructive pulmonary disease in acute exacerbation stage (AECOPD) with respiratory failure.Methods In 40 cases of elderly AECOPD patients with respiratory failure,the thyroid hormone levels before and after the treatment were measured.At the same time,the thyroid hormone levels in another 40 agematched healthy volunteers were determined.Results In elderly AECOPD patients,serum T3,FT3,T4 and FT4were significantly lower than that of the control group:T3 ( [ 1.23 ± 0.25 ] nmol/L vs.[ 1.70 ± 0.29 ] nmol/L,t =3.97,P＜0.01),FT3( [3.27 ±0.59] pmol/L vs.[4.48 ±0.95] pmol/L,t =6.09,P ＜0.01),T4 ([ 109.3 ±17.73 ] nmol/L vs.[ 116.01 ± 18.72 ] nmol/L,t =6.94,P ＜0.01 ),FT4( [ 15.11 ±2.37] pmol/L vs.[ 17.62 ±0.35 ] pmol/L,t =7.23,P ＜ 0.01 ) ; While in the elderly AECOPD patients with respiratory failure,the T3,FT3,T4 and FT4 were lower than those patients without respiratory failure:T3 ( [ 1.08 ± 0.10 ] nmol/L vs.[ 1.35 ±0.26 ] nmol/L,t =4.02,P ＜ 0.01 ),FT3 ( [ 2.89 ± 0.41 ] pmol/L vs.[ 3.59 ± 0.53 ] pmol/L,t =4.58,P ＜0.01 ),T4 ([96.54 ± 14.34] nmol/L vs.[ 115.20 ± 26.10] nmol/L,t =2.71,P ＜ 0.01 ),FT4 ( [ 14.05 ±2.05 ] pmol/L vs.[ 17.11 ± 1.55 ] pmol/L,t =5.37,P ＜ 0.01 ).In elderly AECOPD patients,the post-treatment T3,FT3 and T4 levels were elevated compared with that before treatment.The difference was statistically significant:T3 ( [ 1.43 ± 0.29 ] nmol/L vs.[ 1.25 ± 0.25 ] nmol/L,t =2.93,P ＜ 0.01 ),FT3 ( [ 3.61 ± 0.49 ]pmol/L vs.[3.26 ± 0.60] pmol/L,t =2.73,P ＜ 0.01 ),T4 ( [ 114.31 ± 10.99] nmol/L vs.[ 110.28 ± 16.91 ]nmol/L,t =4.58.P ＜0.01).Conclusion In elderly AECOPD patients,the T3,FT3,T4 and FT4 levels are reduced and those in AECOPD patients with respiratory failure were decreased even more.Supportive treatment is able to enhance the thyroid hormone levels and improve the patients' condition.Therefore,the level of thyroid hormone in elderly AECOPD patients is useful to predict the patient's condition and prognosis.

Both the sleep apnea scale of sleep disorders questionnaire (SA-SDQ) and the Epworth sleepiness scale (ESS) were used to evaluate 25 patients with snoring and 125 patients with obstructive sleep apnea hypoventilation syndrome ( OSAHS), and scores were calculated and compared to the results of polysomnography ( PSG). Results showed that there was significant difference in scores of ESS and SA-SDQ, apnea hyponea index (AHI) and the minimal saturation of blood oxygen (LSpO2) at night between patients with OSAHS and those with snoring (P ＜ 0.05). Score of both ESS and SA-SDQ significantly correlated with AHI ( r = 0. 78 and r = 0. 66, respectively, P ＜ 0. 01 ) , i. e. , more severe of the condition, higher the scores. Score of ESS is highly consistent with clinical presentations in patients with OSAHS and can be used as preliminary screening for its diagnosis, however, use of SA-SDQ score is limited in diagnosing OSAHS due to its lower consistency.

Objective To examine the effect of rapid infusion test guided by extravascular lung water index (EVLWI) on hemodynamics in critically ill patients at different states in order to guide volume resuscitation.Methods A prospective observation was conducted.Forty critically ill patients admitted to Department of Critical Care Medicine of Tianjin Third Central Hospital from June 2012 to April 2014 were enrolled.Based on the levels of EVLWI and pulmonary vascular permeability index (PVPI) and the cardiac function,the patients were divided into four groups:septic patients with normal EVLWI and PVPI (n =17),septic patients with increased EVLWI and PVPI (n =3),septic patients with increased EVLWI and normal PVPI (n =4),and coronary heart disease and heart failure patients with normal EVLWI and PVPI (n =16).The rapid infusion test was conducted in all patients using lactated Ringer solution 250 mL,followed by infusion of crystalloid with rate of 150 mL/h.The conditions of mechanical ventilation and vasoactive drugs were not changed during study.The changes in EVLWI,intrathoracic blood volume index (ITBVI),and cardiac index (CI) before capacity load,at immediate capacity load,and 15,45,105 minutes after load were determined by pulse indicator continuous cardiac output (PiCCO).On the base of volume status before and after the liquid infusion,the standard for the changes were:stroke volume (SV) increased by 12％-15％,central venous pressure (CVP) greater ≥ 2 mmHg (1 mmHg =0.133 kPa),CI ＞ 15％,and ITBVI change greater than 10％.Results There were no statistically significant differences in the observed indicators at the each time point before and after rapid infusion test among the four groups (all P ＞ 0.05).In septic patients with normal EVLWI and PVPI group,ITBVI was slightly increased by 5.4％-9.7％ from 15 minutes to 45 minutes after rapid infusion test.In coronary heart disease and heart failure patients with normal EVLWI and PVPI group,the EVLWI was increased by 11.9％,5.9％,and 14.7％ respectirely at 15,45,and 105 minutes,ITBVI was slightly increased by 6.4％ at 45 minutes,CI was increased by 29.5％ immediately after rapid infusion.In septic patients with increased EVLWI and PVPI group,CVP was increased by 8 mmHg immediately,EVLWI was increased significantly by 15.8％ at 45 minutes,ITBVI was slightly decreased by 10.0％ at 45 minutes,CI was increased by 24.7％ immediately,and increased by 17.0％ at 105 minutes,and PVPI was increased by 15.6％-28.1％ at 15-105 minutes after rapid infusion.In septic patients with increased EVLWI and normal PVPI group,CVP was increased by 1.5 mmHg at 15 minutes,EVLWI was increased immediately,which was increased by 17.4％,24.0％,and 31.4％ respectively at 15,45,and 105 minutes,ITBVI was increased by 13.9％ at 15 minutes,CI was increased by 16.1％ at 15 minutes after rapid fluid infusion.Conclusions Rapid fluid replacement in critically ill patients with crystalloid,regardless of whether the EVLWI was normal or increased,the short-term response was affected by the volume and cardiac function of patients.Different status of patients showed different volume effect curve:no significant changes in hemodynamic parameters were found in patients with normal EVLWI and volume parameters.In patients with potential cardiac dysfunction,CI and EVLWI increased significantly; regardless of PVPI increased or normal,EVLWI and CI were increased in patients with elevated EVLWI; two different changes could be found in the two types of pulmonary edema while ITBVI was increased.

Objective To investigate the efficacy of medial plantar flaps with cutaneous nerves on fixing palm skin defects for patients injured while working.Methods All cases with palm skin defects who received medial plantar flaps grafting from June 2003 to January 2013,were analyzed retrospectively.The data included 13 males and 10 females,with the mean age of 36 years old (range,18-61 years old).There were 16 cases with right hand injury and 7 cases with left,whose skin defects ranged from 3.6 cm×2.8 cm to 7.0 cru×5.5 cm.All cases had skin and soft tissue injury while 5 cases with vascular and nerve injury,3 cases with tendon involvement and being exposed,6 cases with open metacarpal fractures.15 patients were treated with emergency surgery within 8 hours after injury,while 8 patients were treated 10 days after debridement surgery.Results Altogether,23 patients who received medial plantar flaps grafting operations,with palm skin defects,were included in this study.All cases were followed up for 3 to 36 months with a average period of 18 month.The grafted flaps range from 4.6 cm×3.8 cm to 8.0 cm×6.5 cm.Among the patients,19 of them recovered excellently with healing by first intention,with 7-14 d healing time,fully-retained hand functions and palm appearance,and 4-8 mm for between two points distinguish test.Flaps survived fairly well in 3 patients because partial necrosis happened at plantar skin graft donor site.After being debrided and dressed,the wound healed at second phase with a healing time of 12-21 d and 5-9 mm for between two points distinguish test.The operated hands could flex and extend functionally in the follow-up period.Only one patient did not recovered from medial plantar flap grafting and the flap did not survive operationally.The patient recovered after another operation with groin skin grafting later.According to Gu Yudong et al' evaluation criteria,such as improved hand function,19 cases were scored as excellent recovery,3 cases as good,and 1 as poor.The excellent rate was 95.7％ (22/23).Conclusion Medial plantar flaps with cutaneous nerves are ideal flaps for palm skin defects restoration,which characterized by the advantages of fixed anatomical position,high survival rate and being good to the functional recovery and palm appearance.

Objective:To investigate the correlation between serum adiponectin (APN) and inflammatory markers, nutritional status and severe acute exacerbation in late stage in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:One hundred and sixty-three male patients with AECOPD from July 2017 to April 2019 in Wusong Hospital of Baoshan District, Shanghai City were selected. The patients were divided into low APN group (serum APN ≤ 102.38 μg/L, 97 cases) and high APN group (serum APN>102.38 μg/L, 66 cases). The interleukin (IL)-6, IL-8, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin, albumin, prealbumin, body mass index (BMI) and number of severe acute exacerbation in 1 year′ follow-up were compared between 2 groups, and the correlation between APN and inflammatory markers, nutritional status and number of severe acute exacerbation were analyzed.Results:The BMI, hemoglobin, prealbumin and albumin in low APN group were significantly higher than those in high APN group: (23.20 ± 3.26) kg/m 2 vs. (20.77 ± 3.78) kg/m 2, (133.23 ± 17.13) g/L vs. (125.68 ± 20.83) g/L, (185.36 ± 57.60) g/L vs. (148.83 ± 64.79) g/L, (37.09 ± 4.06) g/L vs. (33.77 ± 5.86) g/L, and there were statistical differences ( P<0.01 or<0.05); there were no statistical differences in total protein, IL-6, IL-8, CRP and ESR between 2 groups ( P>0.05). APN showed negative correlation with BMI, hemoglobin, albumin and prealbumin ( r = -0.42, -0.28, -0.33 and -0.31; P<0.01); there was no correlation with IL-6, IL-8, ESR and CRP ( P>0.05). The rate of 4 times of severe acute exacerbation in 1 year′ follow-up in low APN group was significantly lower than that in high APN group: 8.25% (8/97) vs. 22.73% (15/66), and there was statistical difference ( χ2 = 6.79, P<0.05). Conclusions:The AECOPD patients with low APN have better nutritional status and less exacerbation. Serum APN can be used as a predictive index of severe acute exacerbation in AECOPD patients