Objective To approach the effect of Shenfu injection (SFI) and conventional early goal-directed therapy (EGDT) on organ functions and outcomes of septic shock patients. Methods Eighty-four cases conformed to the criteria for the diagnosis of septic shock admitted to Department of Critical Care Medicine of Xuzhou Central Hospital were randomly divided into conventional treatment group (42 cases), and SFI treatment group (42 cases). Conventional treatment was given in the two groups;in SFI treatment group, SFI 100 mL was additionally given by trace continuous intravenous pump 20 mL/h, twice daily for 7 days. Before and after treatment for 1, 6, 12, 24, 48, 72 hours, the levels of hemodynamic status, lactic acid and dosage of vasoactive drugs used, organ function, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, the time of weaning from ventilator, the length of stay in intensive care unit (ICU), time without organ failure and 28-day mortality rate were observed. Results Compared with those before treatment, after treatment in the two groups, the mean arterial pressure (MAP), cardiac index (CI) and systemic vascular resistance index (SVRI) were increased, while the levels of heart rate (HR) and lactate were decreased (all P<0.05). Compared with conventional treatment group, in SFI treatment group, after treatment for 24 hours, the MAP level was increased significantly [mmHg (1 mmHg=0.133 kPa):75.40±9.75 vs. 71.80±11.08, P < 0.05], that continued to 48 hours; after treatment for 6 hours, the CI level was increased obviously (mL·s-1·m-2: 75.18±34.84 vs. 67.35±39.34, P < 0.05) , that continued to 48 hours; after treatment for 6 hours, the lactic acid level was decreased markedly (mmol/L: 2.03±0.82 vs. 2.24±0.97, P < 0.05);in the comparison of dosage of vasoactive drugs used between two groups, the difference was not significant (all P >0.05). Compared with that before treatment, in the conventional treatment group after treatment for 1 and 3 days, gamma glutamyl transpeptidase (GGT) was increased, on the 5th day it began to decrease, reaching its minimum on the 7th day (U/L:26.75±16.74 vs. 46.96±25.85);while in SFI treatment group, GGT was increased after treatment for 1 day, on 3rd day it began to decrease, reaching its lowest level on the 7th day (U/L:22.41±17.87 vs. 51.23±27.74);aspartate aminotransferase (AST), total bilirubin (TBil), oxygenation index (PaO2/FiO2) were increased after the treatment for 1, 3, 5, 7 days, and blood urea nitrogen (BUN), creatinine (Cr) were decreased at different time points after treatment. In the conventional treatment group, the precursor protein (PA) was decreased after treatment for 1, 3, 5 days, on the 7th day it was increased (mg/L:134.20±63.44 vs. 115.70±45.96);while in SFI treatment group, after the treatment for 1 days and 3 days, it was decreased, on the 5th day it was increased, reaching its highest level on the 7th day (mg/L:145.40±59.75 vs. 108.20±54.34). Compared with those before treatment, after treatment for 1, 3, 5, 7 days, APACHEⅡscore and SOFA score were decreased in the two groups, but there was no statistically significant difference in APACHEⅡscore between the two groups, in SFI treatment group after treatment for 3 days, SOFA score was significantly lower than that of the conventional treatment group (6.31±3.86 vs. 7.14±4.03, P<0.05), that continued to the 7th day after treatment. In SFI treatment group, the time for weaning from ventilator (days:7.5±3.5 vs. 9.1±3.2) and the length of stay in ICU (days: 16.1±9.2 vs. 18.7±8.3) were significantly shorter than those in conventional treatment group (both P<0.05). There were no significant differences in time without organ failure (days:14.5±4.2 vs. 15.3±3.1) and 28-day mortality rate [28.6%(12/42) vs. 31.0%(13/42)] between SFI group and conventional group (both P>0.05). Conclusion The combined use of SFI and EGDT can improve hemodynamics, reduce damage to vital organs, and shorten the times for ventilation and stay in ICU in septic shock patients.

Objective To explore the use of pulse indication contour cardiac output (PiCCO) as a guidance for fluid resuscitation and vasopressors employment in patients with septic shock in order to find out the efficacy of this resuscitation strategy in the respect of outcome of patients. Mtthod A total of 30 patients with septic shock were treated with the EDGT fluid treatment protocol as the conventional treatment group from December 2006 to June 2008; and another 26 patients were given fluid treatment under the guidance of PiCCO as PiCCO group from July 2008 to October 2009. Exclusion criteria included patients with history of heart and lung diseases, and liver and kidney dysfunction. The mean arterial blood pressure was maintained above or equal to 65mmHg in PiCCO group,and fluid resuscitation was concluded when global end-diastolic volume index reached 600～750 mL·-2 with the stroke volume variation in ＜ 10% and without auricular fibrillation. Nor-epinephrine was administrated to adiust the systemic peripheral vascular resistance index during 1300～1500 d·s·cm-5·m-2.Dobutamine was empoyed when global ejection fraction was compromised. The options of liquid and diuretics depend upon the presence d extra-vascular lung water. Central venous oxygen saturation and the level of lactate were observed 6hours after resuscitation. The liquid equilibrium for 3 days and the dosage of vasopressors were also recorded. The rate of survival, the time taken for weaning from mechanical ventilation, the days of ICU stay and rate of intact organ function within 28 days were compared between two groups. Results The demphics of patients of two goups were similar. There were no significant difference between PiCCO and the conventional group in values of central venous oxygen saturation and lactate 6 hours after admission to ICU (P ＞ 0.05). And 6 h and 1d after fluid resuscitation, the dosages of dobutamine and the dosages of nor-epinephrine used in PiCCO group were significantly higher than those in conventional group in which the dosages of dobutamine in two groups were [(145.4±24.5)mg vs. (104.2 ± 46.3) mg and (330.2 ± 30.3) mg vs. (202.4 ± 40.3) mg], respectively, and the dosages of nor-epinephrine [(14.5±3.8) mgvs. (10.2±5.6) mgand (38.2±4.2) rng vs.(20.1±6.2) mg], respectively. However, the dosages of vasopressors were similar between two groups 2 d and 3 d later. The amounts of liquid administered to get equilibrium in 6 h and the 3 d in PiCCO group were significantly less than those in conventional group [(2121±578) mL vs. (2910±987) mL and (3845±435) mL vs. (4545 ± 765) mL and (2467±510) mLvs. (2867±618) mL and (951±332) mLvs. (1472±533) mL], respectively. The days required to get free from mechanical ventilation within 28d were significantly longer in PiCGO group[(19.7 ± 8.3) d vs.(15.1±9.1) d], but the days of ICU stay were significantly shorter in PiCCO group [(7.5 ± 3.5) d vs. (9.5±3.2) d] (P＜0.05). The rates of survival and days free from organ failure within 28 days of two groups were similar(P＞0.05). Conclusions When the early fluid management guided with PiCCO in septic shock patients,the fluid management can be implement more safely and precisely. It can shorten the days of ICU stay and days of mechanical ventilation support with avoidance of fluid resuscitation.

ObjectiveTo observe the effects of norepinephrine and dobutamine (NE+Dobu) on hemodynamics, tissue perfusion and oxygen metabolism in elderly patients with septic shock at different levels of mean arterial pressure (MAP). MethodsAfter aggressive fluid resuscitation,norepinephrine and dobutamine were administered in 18 elderly patients with septic shock to correct hypotension. The rate of dobutamine infusion was 5 ug. kg<'-1>. min<'-1> Norepinephrine was titrated to maintain MAP at levels of 65 mm Hg, 75 mm Hg and 85 mmHg. Four hours later, the changes of hemodynamics, oxygenation index, blood lactate, renal function and gastric pCO<,2> at every MAP level were observed. ResultsThere were no significant differences in heart rate (HR), pulmonary arterial wedge pressure (PAWP), volume of oxygen (VO<,2>), Blood lactate, pH value, △pCO<'2> and creatinine clearance rate (CCr) among the MAP levels of 65 mm Hg, 75 mm Hg and 85 mm Hg ( all P>0.05). Compared with MAP 65 mm Hg, cardiac index (CI), systemic vascular resistance index (SVRI), oxygen delivery over oxygen extraction ratio were obviously higher at MAP 75 mm Hg and 85 mm Hg [4.7±0.6, 5.1±0.7 vs. 4.0±0.6; 1162±278, 1276±319 vs. 1011±225; (697±53) ml. min<'1>. m<'2>,(711±68)ml. min<'-1>. m<'2> vs. (634±70) ml · min<'-1> · m<'2>; (0.28±0.02)%,(0.27±0.02)% vs. (0.25±0.02) %, respectively, all P<0.05). The urinary output at MAP levels of 65 mm Hg, 75 mm Hg and 85 mm Hg were (98±43)ml/h, (91±54) ml/h and(74±49)ml/h repectively, and only the differences between MAP 75 mm Hg and MAP 65 mm Hg had statistical significance (P<0.05).ConclusionsAfter aggressive fluid resuscitation, hemodynamics and renal function are improved at MAP 75 mm Hg after administration of norepinephrine and dobutamine in elderly patients with septic shock. It should be considered that MAP is appropriately increased in elderly patients with septic shock.

Objective:To search and summarize the best evidence for preoperative prehabilitation in patients with lung cancer complicated by chronic obstructive pulmonary disease and to inform the management of preoperative prehabilitation in patients with lung cancer combined with COPD by clinical providers.Methods:Systematically guideline websites, professional society websites, evidence-based databases, and comprehensive databases were searched for types of literature including clinical decision making, guidelines, expert consensus, evidence summaries, systematic evaluations, Meta-analyses, and randomized controlled trials. The time for the retrieval was from the inception of databases until October 31th, 2023. And the quality of the included literature was evaluated and evidence was extracted, evaluated the quality of the included literature, and extracted evidence.Results:Finally, 18 articles were included, including 8 guidelines, 8 expert consensus, and 2 systematic reviews. Summarized the 30 best evidence in 4 areas of prerehabilitation: need, timing, location, content (including smoking cessation management, respiratory exercise, exercise, nutritional support, and medication management).Conclusions:This study summarizes the best evidence for preoperative prehabilitation in patients with lung cancer combined with chronic obstructive pulmonary disease, and healthcare professionals should be mindful of the need to develop preoperative prehabilitation protocols judiciously, taking into account the specific clinical context during the subsequent translation of the evidence to the clinic.

Objective To investigate the relationship between benign paroxysmal positional dizziness (BPPV) and cerebrovascular disease and to promotethe practice of evidence bases medicinein thediagnosis,treatment and recurrenceprevention of BPPV in the elderly.Methods A total of 80 elderly patients were consecutively recruited from the Dizziness Outpatient Clinic from January 2013 to June,2014,with 80 non-BPPV elderly individuals receiving routine physical checkups during the same period serving as the control group.Clinical characteristics,lab test results and imaging data were compared between the two groups.Single factor and multivariate logistic regression analyses were conducted to identify independent risk factors for BPPV in the elderly.Results The experimental group showed higher rates of lacunar infarction,leukoaraiosis and intracranial artery stenosis than the control group(x2 =10.180,4.606 and 3.956,respectively;P=0.001,0.032 and 0.047,respectively).The prevalences of hyperlipidemia and type 2 diabetes were higher in the BPPV group than in the control group(x2 5.013 and 6.041,respectively;P=0.025 and 0.014,respectively).Differences in number of carotid atherosclerotic plaque cases,total cholesterol,triglyceride,homocysteine and uric were found between the two groups (x2 =11.237,t=2.862,2.230 and 4.270,respectively;P=0.001,0.005,0.027 and 0.000,respectively).Multivariate logistic regression analysisfound that blood uric acid,hyperglycemia,type 2 diabetes and hypertension were independent risk factors for BPPV (OR=1.006,7.104,3.152 and 3.273,respectively;P=0.005,0.000,0.004 and 0.002,respectively).The existence of carotid atherosclerotic plaques also increased the risk of BPPV (OR =384.570,95 ％ CI:46.935～ 3151.055,P =0.000).Conclusions BPPV in the elderlyis closely associated with cerebrovascular disease and its risk factors.Therefore,it is of great clinical significance to assess cerebrovascular function and carotid atherosclerotic plaque development for improved prognosis and effective prevention of recurrence of BPPV in the elderly.

OBJECTIVE: To evaluate the auditory performance of infants with cochlear implants at the early stage after surgery, summarize the development of auditory ability, investigate the effect of age at cochlear implantation on auditory performance within the first year after surgery and provide a reference for their habilitation program. METHOD: A total of 272 infants with prelingually profound hearing loss participated in this study, ranging in age at cochlear implantation from 18 to 36 months. The mean age was 21 months with a standard deviation of 7 months. Infants with cochlear implants were divided into three groups according to their age at implantation. Infants in group A were implanted under 18 months of age. Infants in group B were implanted between 18 and 24 months of age. Infants in group C were implanted between 25 and 36 months of age. Categories of auditory performance (CAP) was used to evaluate the auditory performance, which rates auditory abilities in eight categories for a scale of 0 to 7. RESULT: The mean scores of CAP for all infants at each interval were significantly different after implantation. Significant differences were observed in mean scores of CAP among these three groups in 1 and 3 months after switch-on. However there were no significant differences in pre-operation, 6, 9 and 12 months after switch-on. CONCLUSION There is a significant improvement in auditory performance of infants with prelingually profound hearing loss within the first year after cochlear implantation. The age at cochlear implantation has no critical influence on the development of auditory capabilities at the early stage after surgery. CAP is a practical tool which can be used in clinic in China.
Age Factors ; Child, Preschool ; Cochlear Implantation ; Cochlear Implants ; Deafness ; surgery ; Female ; Hearing ; Humans ; Infant

OBJECTIVE: To analyze the characteristics and development of auditory skill for infants with different age before and after cochlear implantation by using infant-toddler meaningful auditory integration scale (IT-MAIS) questionnaire, and provide the useful information for the criteria of candidacy for cochlear implantation in infants and habilitation after cochlear implantation. METHOD: One hundred and thirty-nine prelingually infants with profound hearing loss were included in this study. According to the age at implantation, the infants were divided into 5 groups. They were group A ( < or =12 months), B (13-18 months), C (19-24 months), D (25-30 months) and E (31-36 months). Audiologists who were trained before this study used the IT-MAIS questionnaire to evaluate the auditory skill for all the infants and asked for the parents' or guardians' answers face to face. All the information about the infants spontaneous auditory behavioural responses was recorded in detail. The evaluation was performed before operation and 1 month, 3 months, 6 months, 12 months after switch-on. RESULT: There were no significant differences in mean scores over time between different gender who received cochlear implants by Independent-Samples T Test (P > 0.05). There were no significant differences in mean scores over time among the 5 groups by Multiple Comparison in ANOVA (P > 0.05). The scores were increased with time and there were significant differences in mean scores among the different time before and after switch-on by Multiple Comparison in ANOVA (P < 0.05) for each group. CONCLUSION The development of the auditory skill for infants followed the same rate in different gender. The auditory skill for infants after cochlear implantation developed rapidly regardless of age at implantation. Most of infants indicated rapid improvement in auditory skill within the first 6 months after switch-on, and then showed relative slow increase in the following 6 months.
Age Distribution ; Auditory Perception ; Child, Preschool ; Cochlear Implantation ; Cochlear Implants ; Female ; Humans ; Infant ; Language Development ; Male ; Persons With Hearing Impairments ; rehabilitation ; Treatment Outcome

OBJECTIVE: The purpose of this study is to investigate the effects of hearing level on auditory performance in infants with hearing aids and provide a clinical database for their hearing and speech habilitation. METHOD: A total of 32 infants with prelingual hearing loss participated in this study, ranging in age at hearing aid fitting from 3 to 34 months with a mean of 16 months. According to their hearing level, they were divided into three groups. Infants in group A were with moderate hearing loss (41-60 dB HL). Infants in group B were with severe hearing loss (61-80 dB HL). Infants in group C were with profound hearing loss (>81 dB HL). The infant-toddler meaningful auditory integration scale (IT-MAIS) was used to evaluate their auditory performance. The evaluation was performed before hearing aid fitting and 1, 3, 6, 9, 12 months after fitting. RESULT: The mean scores of auditory performance showed significant improvements with time of hearing aid use for the three groups of infants (P < 0.05). The mean score of auditory performance for group A at 3 months after fitting was significantly superior in comparison with the scores before hearing aid fitting and at 1 month after fitting (P < 0.05). The mean score of auditory performance for group B at 6 months after fitting was significantly superior in comparison with the scores before hearing aid fitting and at 1, 3 months after fitting (P < 0.05). The mean score of auditory performance for group C at 9 months after fitting was significantly superior in comparison with the scores before hearing aid fitting and at 1, 3, 6 months after fitting (P < 0.05). There were no significant differences in mean scores between group A and B at each evaluating interval (P > 0.05). However, significant differences were observed between group A and C at 3, 6, 9, 12 months after fitting (P < 0.05). Significant differences were also shown between group B and C at 1, 3, 6, 9, 12 months after fitting (P < 0.05). CONCLUSION Auditory performance of infants with prelingual hearing loss developed significantly with the use of hearing aids within the first year after fitting. The degree of hearing loss in infants had significant influence on the development of auditory performance.
Child, Preschool ; Deafness ; rehabilitation ; Female ; Hearing ; Hearing Aids ; Hearing Tests ; Humans ; Infant ; Male

ObjectiveTo explore the possible mechanisms of Shujin Jiannao Formula （舒筋健脑方） for cerebral palsy. MethodsThirty 7-day-old SD rats were randomly divided into normal group， model group， and Shujin Jiannao Formula group， with 10 rats in each group. The model group and Shujin Jiannao Formula group established a cerebral palsy model by the classic Rice-Vannucci method. After successful modeling， rats in Shujin Jiannao Formula group were given Shujin Jiannao Formula 16 g/（kg·d） by gavage， while the normal group and model group were given normal saline 10 ml/（kg·d） by gavage once a day. After one week of intervention， the rats' body weight was measured， and Zea-Longa scores， the righting reflex test， and the hindlimb suspension test were conducted for assessment； hematoxylin-eosin （HE） staining and Nissl staining were used to observe pathological changes in brain tissue， and the number of Nissl-positive neurons was counted； enzyme-linked immunosorbent assay （ELISA） was employed to measure levels of inflammatory cytokines in the brain tissue， specifically interleukin-1β （IL-1β） and tumor necrosis factor-α （TNF-α）； immunofluorescence was used to detect the expression levels of neurofilament protein 200 （NF200） and myelin basic protein （MBP） in brain tissue； Western Blot analysis was conducted to determine the protein levels of phosphoinositide 3-kinase （PI3K）， protein kinase B （Akt/PKB/Rac）， and mammalian target of rapamycin （mTOR） in brain tissue. ResultsCompared with the normal group， rats in the model group showed significantly higher Zea-Longa scores and lower scores in the hindlimb suspension test （P＜0.01）； pathological findings revealed loose structure in the cerebral cortex， hippocampal atrophy， and neuronal damage in brain tissue. Levels of IL-1β and TNF-α elevated， and the number of Nissl-stained positive neurons in the cortex and hippocampal CA1 region reduced， and immunofluorescence intensity of NF200 and MBP， as well as protein expression levels of PI3K and mTOR， significantly decreased （P＜0.05 or P＜0.01）. Compared with the model group， rats in Shujin Jiannao Formula group showed decreased Zea-Longa scores and increased hindlimb suspension test scores （P＜0.05）； pathological damage in brain tissue alleviated， levels of IL-1β and TNF-α reduced， the number of Nissl-stained positive neurons in the cortex and hippocampal CA1 region increased， and the immunofluorescence intensity of NF200 and MBP， as well as the protein levels of PI3K and mTOR， significantly elevated （P＜0.05 or P＜0.01）. There were no statistically significant differences among the groups in body weight， body-turning time， or AKT protein levels in brain tissue （P＞0.05）. ConclusionShujin Jiannao Formula can improve the neurological function of rats with cerebral palsy， exert neurorestorative effects， and its mechanism of action may be related to the reduction of inflammatory response in brain tissue and the activation of the PI3K/AKT/mTOR signaling pathway.