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Effects of Shengmai Injection on multiple organ failure in post cardiopulmonary resuscitation rabbits

Dong ZHANG ; Hongxiang LI ; Ying CHEN ; Yushan WANG

Chinese Journal of Emergency Medicine.2013;22(9):989-993. doi:10.3760/cma.j.issn.1671-0282.2013.09.012

Objective To observe the effect of Shengmai Injection (a Chinese herbal medicine preparation) on the serum levels of TNF-α used as indicators of organ function in post cardiopulmonary resuscitation rabbits.Methods Rabbit cardiac arrest model was made with asphyxia by clamping the trachea of rabbit.A total of 30 rabbits were randomly (random number) divided into two groups,namely the normal saline group (n =15) and the Shengmai injection group (n =15).Rabbits in Shengmai injection group were injected with 2 ml/kg Shengmai Injection immediately at the beginning of cardiopulmonary resuscitation (CPR),and the same dose of Shengmai injection given 10 min after CPR.Rabbits in saline group were injected with the same volume of physiological saline instead at the same intervals as previous group.The rate of restoration of spontaneous circulation (ROSC) and survival rates at 6,12,24 and 48 h after ROSC were observed.The serum levels of TNF-α were measured by enzyme-linked immunosorbent assay (ELISA).Biochemical methods were used to detect myocardial MB-isoenzyme of creatine kinase (CK-MB),alanine aminotransferase (ALT),creatinine (Cr),glucose (Glu) and arterial partial pressure of oxygen (PaO2) before resuscitation and 12,24 and 48 h after ROSC simultaneously in the two groups.Results There was no statistically significant difference in the ROSC rate and survival rate after resuscitation between the two groups (P ＞ 0.05).Before asphyxia,there was no significant difference in the level of TNF-α found between the two groups (P ＞ 0.05),but at 12,24 and 48 h after ROSC,the levels of TNF-α in Shengmai group were much lower than those in Saline group (P ＜ 0.05).At 24 h after ROSC,the levels of serum CK-MB,ALT,and Cr in Shengmai group were much lower than those in Saline group (P ＜0.05).Furthermore,at 48 h after ROSC,the levels of CK-MB and ALT in Shengmai group were still lower than those in Saline group (P ＜ 0.05),but there was no significant difference in the level of Cr between the two groups (P ＞ 0.05).There was also no significant difference in the blood glucose and arterial partial pressure of oxygen between the two groups (P ＞ 0.05).Conclusions Shengmai Injection has significant inhibiting effect on the serum level of TNF-α in post cardiopulmonary resuscitation rabbits,and it also has more or less some degrees of protective effect on organ function of heart,liver and kidney in rabbits after ROSC.

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The study of diagnostic test of using the ten-point scale for the early fat embolism syndrome

Guoqiang YIN ; Kun HU ; Hanning MA ; Andong DU ; Qinjun JIANG

Chinese Journal of Emergency Medicine.2013;22(9):1011-1015. doi:10.3760/cma.j.issn.1671-0282.2013.09.018

Objective To explore the clinical value of the ten-point scale in the early diagnosis of fat embolism syndrome.Methods The data of 129 patients with fat embolism syndrome diagnosed by Gurd criteria admitted from January 1993 to February 2012 were analyzed retrospectively.At the same time,another 97 patients with single or multiple long bone fracture and/or pelvic fracture without fat embolism admitted from July 2005 to February 2012 were enrolled as control group.Patients were excluded if they had any of the following diseases:simple brain trauma,thoracic injury,spine fracture,hemorrhagic shock and the complications of cardiopulmonary cerebral resuscitation (CPCR).The patients of two groups were comparable in respect of clinical setting.The clinical data were analyzed and scored by the ten-point scale.The x2 test were applied to statistical works.Results Among all the clinical characteristics,the incidence of increased D-dimer was the highest (74.1％) in early fat embolism syndrome,followed by the progressive decrease in hemoglobin (63.6％) and hypoxemia (57.4％),and the occurrence of dyspnea was the lowest (17.8％).The percentage of total scores over ten points in patients with fat embolism syndrome group was higher than that in those without fat embolism syndrome (x2 =202.6,P ＜ 0.01).The sensitivity of tenpoint scale was 96.12％ and the specificity was 99.8％.Conclusions Ten-point scale could be used to make early diagnosis of fat embolism syndrome,thereby reducing the occurrence of misdiagnosis and misseddiagnosis.

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Clinical characteristics of dieulafoy lesion: analysis of 15 cases

Bin WANG ; Yaan ZHENG

Chinese Journal of Emergency Medicine.2013;22(9):1030-1033. doi:10.3760/cma.j.issn.1671-0282.2013.09.022

Objective To investigate the clinical characteristic and treatment of dieulafoy lesion in order to improve the early diagnosis and treatment.Methods A retrospective review of clinical records of 15 cases of dieulafoy lesion admitted to our emergency department from October 2005 to August 2012 was carried out.Results The male patients were more vulnerable to this disease than female patients,thereby the ratio of male to female patients was 6.5∶ 1,and the mean age was 48.3 years.The precipitating factors were often obscure,and some possible factors were related with certain amount of wine (1/15),using nonsteroidal anti-inflammatory drugs (2/15),and eating irritant food (2/15),and a few patients had a past history of hypertension (3/15) or diabetes mellitus (5/15) and no patient had past history of peptic lesion and cirrhosis of liver.The Dieulafoy' s lesion occurred suddenly without premonitory symptoms such as pain or upset of stomach,presented with the episodes of hematemesis or hemafecia,and the patients were in a stage of shock and moderate to severe anemia because of massive blood loss.The majority of lesions located at the posterior wall of the stomach (9/15) or adjacent to the lesser curvature (10/15).Endoscopy was of prime importance for confirming the diagnosis of Dieulafoy's lesions.Endoscopic treatments included hemostasis with clipping combined with epinephrine submucosa injection and successfully excising the lesion in 14 patients (14./15).Surgical treatment was done in 1 patient after failure of endoscopic treatments.Conclusions Dieulafoy lesion is characterized by sudden massive hemorrhage of the alimentary tract,it most commonly locates in the pars posterior of stomach adjacent to the lesser curvature in the middle-aged and the elderly males.Endoscopy is the most simple and essential method to confirm the diagnosis,and emergency endoscopic hemostasis with clipping for treating Dieulafoy lesion is an effective therapeutic strategy.

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Changes of PARP and NF-κB in adenohypophysis of rat model of severe acute pancreatitis

Wenhong DENG ; Kailiang ZHAO ; Bo YANG ; Qiao SHI ; Xing ZHOU ; Weixing WANG

Chinese Journal of Emergency Medicine.2013;22(10):1090-1095. doi:10.3760/cma.j.issn.1671-0282.2013.10.004

Objective To investigate the changes of poly-ADP-ribose polymerase (PARP) and NF kappa B (NF-κB) in adenohypophysis in rat model of severe acute pancreatitis (SAP),and their role in the mechanism of adenohypophysis injury in SAP.Methods Forty Wistar rats were randomly (random number) divided into 5 groups:the sham operation group (SO group,n =8),SAP 1 h,3 h,6 h and 12 h groups (n =8 in each group).SAP model was induced by retrograde injection of 5％ sodium taurocholate into the biliopancreatic duct.Serum levels of amylase,lipase and ascites were measured.After sacrifice of experiment rats,pancreas and adenohypophysis tissues were taken for pathological examination under light microscope.Adenohypophysis cells were observed under electronic microscopy as well.PARP and NF-κB expressions in adenohypophysis cell was studied by using immunohistochemisty assay.Results After modelling,serum levels of amylase,lipase and ascites in SAP group increased gradually,which were higher than those in SO group (P ＜ 0.05).Adenohypophysis cell swelling and partial necrosis were observed under light microscope.As the time prolonged,their nuclei became dark and pyknotic more and more,and the endoplasmic reticulum and mitochondrial swelling in adenohypophysis cells were observed under electronic microscopy.The expressions of PARP and NF-κB in SAP group increased gradually,which were higher than those in SO group.Conclusions Significant pathological and ultrastructural injuries were observed in adenohypophysis cells in severe acute pancreatitis.These changes might correlate with PARP and NF-κB signaling pathway.

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Clinical study of the central venous catheter specialized for continuous drainage of exudates from severe acute pancreatitis (SAP) in patients with seroperitoneum

Junying LI ; Yun DONG ; Xiaohong ZANG ; Youdai CHEN ; Jun ZHENG ; Minghua SU

Chinese Journal of Emergency Medicine.2013;22(10):1096-1099. doi:10.3760/cma.j.issn.1671-0282.2013.10.005

Objective To investigate the application of the central venous catheter (CVC) specialized for drainage intervention in severe acute pancreatitis (SAP) patients.Methods Sixty-two severe acute pancreatitis patients with seroperitoneum were randomly (random number) assigned into two groups:the drainage group (n =31) and the control group (n =31).All patients were treated with conventional internal medicine therapy.Patients of drainage group were treated with continuous peritoneal drainage by using the central venous catheter.The intra-abdominal pressure (IAP),lactic acid (LAC),and procalcitonin (PCT) were detected before and 12 h,24 h,48 h,72 h,5 days after intraperitoneal drainage.The symptoms of abdomen pain,abdomen distention,resume of bowel movement and the rate of MODS were observed.Results All patients with drainage got catheter successfully inserted.Compared with the control group,the IAP,LAC and PCT decreased significantly in the patients of drainage group.And the duration of abdomen pain,abdomen distention and resume of bowel movement function in the drainage group were shorter and the rate of MODS was lower.Conclusions Application of CVC specialized for intraperitoneal drainage is a safe and effective method for the treatment of pancreatitis with seroperitoneum.It is worthwhile to be widely used in clinic.

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Effect of Valsartan on extracellular matrix remodeling in rats with heart failure after myocardial infarction

Juan ZHAO ; Liping WANG ; Wei PAN ; Dayang HUANG ; Xingtong ZHANG ; Chao LIANG

Chinese Journal of Emergency Medicine.2013;22(10):1100-1104. doi:10.3760/cma.j.issn.1671-0282.2013.10.007

Objective To investigate the effect of Valsartan on Disintegrin metalloproteinases (ADAMs10,17) expressions in the process of heart failure (HF) after myocardial infarction (MI).MethodsAdult male Wistar rats weighing (200 ± 30) g were given humane care in compliance with the rules of the Animal Experimentation Committee of the first hospital of Harbin Medical University.And then the left anterior descending coronary artery was ligated.Based on UCG (LVEF ＜ 45％) Results The successfully MI-operated Wistar rats were divided randomly (random number) into three groups:HF group (HF group),placebo group (Pla group) and valsartan group (Val group).The rats in the Pla group and Val group were given the same volume of normal saline and valsartan 50 mg/ (kg · d),provided by Novartis company) by gavage.After 16 weeks,heart function was assessed by hemodynamic evaluation and serum TNF-α from LV cavity was measured by ELISA (R&D,USA).Muscle samples were extracted from the ischemic zone,and then the ADAMs 10,17 expressions were measured by immunoblotting.All the data were expressed by mean ± standard and evaluated by Student' s t test.Results After 16 weeks,the data of LV function including LVdp/dt LVdp/dtmin and LVSP were significantly improved in Val group than the others (P =0.006,P =0.015,P =0.003),and the LVEDP level was decreased (P =0.002).At the same time,the TNF-o level in the Val group was lower than that in the HF group (P =0.023).The ADAM17 and TNF-R1 expressions in the Val group was reduced compared with those in the HF group (P =0.01 1,P =0.022).However,ADAM10 expression is unchangeable in the four groups.Conclusions Valsartan may reduce the ADAM17 and TNF-R1 expressions in the ischemic zone,decrease the TNF-αconcentration and function in LV cavity so as to inhibit cardiac remodeling and improve heart function after MI.

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Activating retinoid X receptor protected rat cardiomyocytes H9c2 from hypoxia/reoxygenation injury

Peiren SHAN ; Zhouqing HUANG ; Jun PU ; Weijian HUANG

Chinese Journal of Emergency Medicine.2013;22(10):1117-1122. doi:10.3760/cma.j.issn.1671-0282.2013.10.011

Objective To determine the protective effects and potential mechanism of activating retinoid X receptor (RXR) on rat cardiomyocytes H9c2 against hypoxia/reoxygenation (H/R) induced oxidative injury.Methods The model of H-/R injury was established with hypoxia for 2 hours and reoxygenation for 4 hours in cardiomyocytes of H9c2,and 9-cis-retinoic acid (c-RA) was obtained as RXR agonist,and HX531 as RXR antagonist.Cultured cardiomyocytes were randomly (random number) divided into four groups:sham group,H/R group,H/R + c-RA-pretreated group (100 nmol/L c-RA) and H/R +c-RA + HX531-pretreated group (2.5 μmol/L HX531).We measured the cell viability by MTT (methyl thiazolyl tetrazolium),apoptosis rate of cardiomyocytes by using flow cytometry,and mitochondrial membrane potential by JC-1 fluorescent probe,protein levels of Bcl-2,Bax and cleaved Caspase-9 with Western blot.All measurement data were expressed as (-x ± s),and statistically analyzed using One-way ANOVA and Dunnett-t test.Differences were considered significant when P ＜ 0.05.Results Pretreatment with RXR agonist enhanced cell viability,reduced apoptosis ratio,stabilized mitochondrial membrane potential.Dot blotting experiments demonstrated that under H/R stress conditions,Bcl-2 protein level decreased,while Bax and cleaved Caspase-9 increased.The c-RA administration prior to H/R stress prevented these effects,however,overall protective effects of activating RXR on rat cardiomyocytes against H/R induced oxidative injury were abolished when pretreated with RXR pan-antagonist HX531.Conclusions Activating RXR has the protective effects against H/R injury in rat cardiomyocytes H9c2 through attenuation of mitochondria apoptosis signaling pathway.

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Clinical significance of low triiodothyronine syndrome in critical patients and triiodothyronine impact on evaluation of prognosis

Haiyan ZHANG ; Lei DONG ; Caijun WU ; Fei ZHAO

Chinese Journal of Emergency Medicine.2013;22(10):1132-1135. doi:10.3760/cma.j.issn.1671-0282.2013.10.014

Objective To identify the clinical significance of low triiodothyronine syndrome and the potential impact of triiodothyronine (T3) on prognosis in critical patients.Methods A total of 150 critically ill patients enrolled from October 2012 to April 2013 were divided into two groups,namely low thyroidhormone group (n =38,group A) and normal T3 group (n =112,group B).APACHE Ⅱ scores of patients were recorded at admission and thyroid hormone levels were measured on the first and the third day after admission.Then the survival state of 28-day in each group was observed and then the relationship between prognosis and T3 levels was analyzed by receiver operating characteristic (ROC) curve.Results About 25.3％ of 150 critical patients were suffered from low thyroidhormone syndrome and the mortality rate in this group was 42.1％,which was much higher than 29.5％ in normal T3 group.There was no difference in prediction of death rate analyzed by ROC curve between the T3 level and APACHE Ⅱ scores.The area under curve of T3 level was 0.768 (95％ CI:0.701-0.835) and APACHE Ⅱ was 0.783 (95％CI:0.719-0.846).Best cut-off value of T3 level was 0.41 ng/mL resulting in 76.6％ sensitivity and 78.4％ specificity.Conclusions Critically ill patients complicated with low thyroidhormone syndrome has poor prognosis and T3 may be a predictive marker in evaluating the prognosis of critically ill patients.

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The analysis of correlation between serum procalcitonin concentration and microbial infections in patients with sepsis

Shengnan SUN ; Jingjun LV ; Jie WEI

Chinese Journal of Emergency Medicine.2013;22(10):1136-1141. doi:10.3760/cma.j.issn.1671-0282.2013.10.015

Objective To investigate the diagnostic and predict vaIue of procalcitonin (PCT) in ICU patients with sepsis and the correlation between PCT concentration and positive results of bacterial culture.Methods A total of 278 patients with sepsis were admitted into emergency ICU,general ICU and respiratory ICU from October 2011 to September 2012.Of them,193 patients had definite microbial infection evidence.Serum PCT levels among groups of different pathogens were compared.The analysis of correlation between the PCT concentration of the first assay was got after admission and short-term prognosis was evaluated.The correlation between PCT level and positive results of bacterial culture was also evaluated.Results Spearman correlation analysis showed that serum PCT levels of bacterial infections in patients with sepsis were significantly higher than those of the non-bacterial infections in patients with sepsis (P =0.001).And there was a positive correlation between the PCT concentration of the first specimen after admission and 7-day in-hospital mortality in patients with sepsis due to bacterial infections (r =0.277,P =0.004).The patients with PCT levels greater than 2 ng/ml had high vulnerability to bacterial infection Conclusions The PCT concentration of the first assay after admission was positively correlated to 7-day mortality in ICU patients with sepsis due to bacterial infections.The serum PCT concentration indicated the severity of host response to the bacterial infection.And etiological evidence directly showed pathogenic factors.Both of PCT and etiological evidence related to bacterial infection,reflected different aspects of bacterial infection.

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The effects of early rehabilitation therapy in mechanically ventilated patients

Zehua DONG ; Bangxu YU ; Yunbo SUN ; Wei FANG ; Lei LI

Chinese Journal of Emergency Medicine.2013;22(10):1153-1156. doi:10.3760/cma.j.issn.1671-0282.2013.10.019

Objective To investigate the effects of early rehabilitation therapy in mechanically ventilated ICU in patients.Methods A randomized controlled trial was carried out.Sixty mechanically ventilated patients,with tracheal intubation or tracheostomy more than 48 h and less than 72 h,were admitted to the intensive care unit (ICU) of the Affiliated Hospital of Medical College Qingdao University from May 2010 to May 2012.These patients were randomly (random number) divided into two groups,the rehabilitation group and the control group,30 patients in each group.In rehabilitation group,rehabilitation therapy was taken twice daily,and the training time and intensity was adjusted according to the condition of the patients.Early rehabilitation therapy included head up actively,transfer from the supine to sit,out of bed,transfer to a chair,standing bedside bed and walking bedside bed.The patient' s body mass index,days to first out of bed,duration of mechanical ventilation,ICU stay,APACHE Ⅱ score,highest FiO2,lowest PaO2/FiO2 and hospital mortality of patients were compared between rehabilitation group and control group.The differences between the groups were compared using t test.Results There was no significant difference in body mass index,APACHE Ⅱ score,highest FiO2,lowest PaO2/FiO2 and hospital mortality between rehabilitation group and control group (P ＞ 0.05).Patients in the rehabilitation group had shorter first out of bed time [(3.8 ± 1.2) d vs.(14.9 ±4.7) d; P =0.00],duration of mechanical ventilation [(5.6±2.1) dvs.(12.7±4.1) d; P=0.005] andICUstay [(7.3±2.8) dvs.(15.2±4.5) d;P =0.01] compared with control group.Conclusions Early rehabilitation therapy was safe and effective in improving the outcomes of mechanical ventilation patient.

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