SARS-CoV-2: minireview and review of first case in Foshan, China.

The first case of #COVID19 in Foshan provides a reference for the treatment of severe #SARSCoV2 pneumonia https://bit.ly/3eD81qj.

[Acute myocardial infarction complicated with cardiac arrest successfully managed by extracorporeal membrane oxygenation combined with intra-aortic balloon counterpulsation: a case report].

OBJECTIVE: Patients in acute myocardial infarction (AMI) with serious complications such as malignant ventricular arrhythmia and cardiogenic shock couldn't receive emergency percutaneous coronary intervention (PCI) procedures and had high perioperative mortality. A case of AMI patients who suffered cardiac arrest and long-term cardiopulmonary resuscitation (CPR) was admitted to the department of critical care medicine of the First People's Hospital of Foshan. With the assistance of extracorporeal membrane oxygenation (ECMO), PCI and intra-aortic balloon counterpulsation (IABP) were performed. ECMO and ventilator were successfully weaned after anti-shock, mechanical ventilation, organ support treatment. The patient was successfully treated and discharged. After 6 months of follow-up, the patient recovered well in heart function.

[Clinical feature of severe hand, foot and mouth disease with acute pulmonary edema in pediatric patients].

OBJECTIVE: To explore the clinical feature of severe hand, foot and mouth disease (HFMD) in pediatric patients, and to observe the hemodynamic changes in those with acute pulmonary edema. METHODS: A prospective observation study was conducted. Thirty-five severe HFMD pediatric patients with acute pulmonary edema admitted to the intensive care unit (ICU) and Department of Pediatric of First People's Hospital of Foshan from May 2008 to September 2014 were enrolled. The clinical features were thoroughly investigated. Hemodynamic data were monitored by pulse-indicated continuous cardiac output (PiCCO) in 5 cases, and the changes in PiCCO parameters were observed at ICU admission (0 hour), and 24, 48, 96 hours after treatment. RESULTS: Thirty-five patients who met the diagnostic standard of severe HFMD were enrolled, including 22 male and 13 female, aged from 7 months to 4 years. Six patients were younger than 1 year, 13 1-2 years, 12 2-3 years, and 4 patients 3-4 years old. The most common time of occurrence of pulmonary edema was 3-4 days after the onset of the disease. Fever and central nervous system symptoms were found in all the patients, and examination of the cerebral spinal fluid (CSF) revealed non-bacterial inflammatory changes. PiCCO results showed a tendency of lowering of heart rate (HR), systemic vascular resistance index (SVRI), and extravascular lung water index (EVLWI) after the treatment, and the values obtained at 96 hours were significantly lower than those at 0 hour [HR (bpm): 119.0±14.7 vs. 200.8±19.7, SVRI (kPa×s×L(-1)×m(-2)): 148.9±14.6 vs. 209.6±58.7, EVLWI (mL/kg): 10.5±1.9 vs. 34.8±10.8, P<0.05 or P<0.01], global end-diastolic volume index (GEDVI) was also gradually decreased without significant differences among all the time points, together with a tendency of increase in stroke volume index (SI) and cardiac index (CI). The values of the parameters at 96 hours were significantly higher than those at 0 hour [SI (mL/m2): 38.5±6.5 vs. 17.4±2.8, CI (mL×s(-1)×m(-2)): 75.0±8.0 vs. 55.5±8.5, both P<0.01]. Left atrium was found to be enlarged, and left ventricular systolic function decreased in two patients by cardiac ultrasonic. Four out of 35 patients died, and functional disability of extremities was found in 1 patient. Other patients were cured and discharged without any sequelae. CONCLUSIONS: Severe HFMD complicated by acute pulmonary edema is a perilous condition in children, accompanied commonly by pathologic changes in central nervous system and systolic dysfunction of left ventricle. According to the results with PiCCO monitoring, HFMD patients suffering from acute pulmonary edema may be of cardiac origin in addition to neurogenic origin.

[Human leucocyte antigen-DR expression on CD(14)(+) monocytes and its relationships with multiple organ dysfunction syndrome in severe sepsis].

OBJECTIVE: To explore the changes of CD(14)(+) monocyte human leucocyte antigen DR (HLA-DR) and their relationship with multiple organ dysfunction syndrome (MODS) in severe sepsis. METHODS: Ninety-one patients with a definite diagnosis of severe sepsis in the intensive care unit (ICU) were included. CD(14)(+) monocyte HLA-DR levels were detected by flow cytometry on the first, 4th and 7th days of the study, and Marshall scores and prognosis on day 28 were evaluated. RESULTS: Thirty-four patients died within 28 days following the onset with a mortality rate of 37.4%. Persistently lowered levels of HLA-DR were detected and significantly increased Marshall scores were found in the fatal cases at all the time points (P<0.001). In the surviving patients, the levels of HLA-DR were significantly increased (P<0.01) and Marshall scores were gradually decreased (P<0.001). During the observation period, the levels of HLA-DR decreased significantly as the number of dysfunctional organs and Marshall scores increased (P<0.001). The levels of HLA-DR were significantly increased in severe sepsis patients with 2-4 dysfunctional organs and Marshall score of 5-12 (P<0.05 or P<0.001). No changes in HLA-DR levels in severe sepsis patients with 5-6 dysfunctional organs and Marshall scores of 13-22. The levels of HLA-DR showed a significant inverse correlation to Marshall scores (r=-0.368, P<0.001). CONCLUSION: In patients with severe sepsis, persistent low CD(14)(+) monocyte HLA-DR levels predicts high mortality. The levels of HLA-DR are significantly correlated to the severity of organ dysfunction.

[Effect of continuous blood purification and thymosin alpha1 on the cellular immunity in patients with severe sepsis: a prospective, randomized, controlled clinical trial].

OBJECTIVE: To discuss the effect of continuous blood purification (CBP), thymosin alpha1 and combined therapy on cellular immunity in patients with severe sepsis. METHODS: Ninety-one patients, age over 18 years, suffering from severe sepsis with Marshall score over 5, admitted to the intensive care unit (ICU) from June, 2004 to October, 2007, were randomly divided into four groups. The patients in control group (24 cases) were treated with classical Surviving Sepsis Campaign (SSC) therapy, those in CBP group (22 cases) were treated with continuous renal replacement therapy (CRRT) or molecular adsorbent recirculating system (MARS) in the first 3 days. The group of thymosin alpha1 (23 cases) were treated with thymosin alpha1, in a dose of 1.6 mg subcutaneous injection per day for 7 days. The patients in the group of combined therapy (22 cases) were treated with CBP and thymosin alpha1. All three treatment groups were treated with classical SSC therapy at the same time. Acute physiology and chronic health evaluation II (APACHE II) score and Marshall score were evaluated. CD14(+) monocyte human leucocyte antigen DR (HLA-DR) levels and the count of T lymphocyte were measured before treatment and 3 days and 7 days after the treatment. RESULTS: All 91 patients were included in the study. Compared with the control group, the 28-day mechanical ventilation (MV) time, length of ICU stay, 28-day mortality of three treatment groups were decreased. There was statistically significant difference in the length of ICU stay of the CBP group, and also the 28-day MV time, length of ICU stay of the group of combined therapy group (all P<0.05). Compared with the variables before treatment, Marshall scores were decreased significantly and levels of HLA-DR, CD3(+), CD4(+), CD8(+)T lymphocytes were increased significantly after 7-day treatment with thymosin alpha1 group (all P<0.05) . The above indexes and APACHE II scores were changed significantly as early as 3 days after treatment in CBP group and combined therapy group (P<0.05 or P<0.01). Compared with the variables at the same period in the control group, only CD3(+) T lymphocytes were increased significantly after 7-day treatment in thymosin alpha1 group (P<0.05), APACHE II scores and Marshall scores were decreased significantly , levels of HLA-DR and CD3(+), CD4(+), CD8(+) T lymphocytes were increased significantly after 7-day treatment in CBP group (all P<0.05). The above indexes were already changed significantly after 3-day treatment in the combined therapy group (P<0.05 or P<0.01). Compared with thymosin alpha1 group, all the indexes were improved but only level of CD3(+) T lymphocytes after 3-day treatment in the combined therapy group increased significantly (P<0.05). CONCLUSION: CBP and thymosin alpha1 could increase cellular immunity in patients with severe sepsis, promote recovery of organ function and improve prognosis. The effect of CBP appears earlier and more pronounced. Combined treatment can be more effective.

[Emergency bedside temporary cardiac pacing through the left subclavicular vein guided by pacemaker impulse].

OBJECTIVE: To investigate the feasibility and merits of emergency bedside temporary cardiac pacing through left subclavicular vein guided by pacemaker impulse. METHODS: The left subclavicular vein was punctured with Seldinger technique for insertion of a cannula. After setting the rate of pacemaker at 20 beat/min above the patients' spontaneous heart rate with output current of 5 mA and sensing voltage of 3 mV, the electrode was inserted through the cannula until the electrocardiograph displaying pulsed signal and pacing rhythm. RESULTS: Good pacing was achieved in 18 patients with one having poor pacing, which was improved 2 h later. The pacing was not satisfactory in two cases. No postoperative complications occurred in the 21 patients. CONCLUSION: Emergency bedside temporary cardiac pacing through the left subclavicular vein guided by pacemaker impulse is rapid and ensures high success rate and safety.

[Intensive care and treatment of severe ovarian hyperstimulation syndrome].

OBJECTIVE: To investigate the clinical manifestations, pathogenesis and treatment of severe ovarian hyperstimulation syndrome (OHSS). METHODS: The clinical data of 20 OHSS patients were analyzed retrospectively. RESULTS: Severe OHSS occurred after controlled ovarian hyperstimulation for superovulation. The major manifestations of OHSS included abdominal distension, nausea, ascites, hydrothorax, oliguria, concentrated blood, acid-base and electrolytes, disturbance, azotemia, thrombosis etc., which could be controlled by volume expansion with albumin, low-molecular-weight dextran, 6% Haes, abdominal and thoracic drainages or even early pregnancy termination. CONCLUSION: Preventive measure of OHSS is very important, and the patients must be treated timely and correctly once OHSS occurs.

[The first case of severe acute respiratory syndrome in Foshan].

OBJECTIVE: To evaluate the epidemiologic feature, diagnosis and treatment of severe acute respiratory syndrome (SARS). METHODS: To describe the epidemiologic and clinical features of the first case of SARS in Foshan city, Guangdong province retrospectively, and to review the diagnostic procedure. RESULTS: This case had the following features: (1) a history of contact with mild cats and eating the animal's meat; (2) high fever (temperature, > 38 degrees C), followed by dry cough, rapid progression to respiratory failure, followed by radiographic evidence of bilateral air-space lesions; (3) no leukocytosis; (4) spread to 4 family members who had had direct contact with this patient; (5) the patient's serum SARS virus IgG was confirmed to be positive; (6) the patient was treated with anti-viral agents, antibiotics and mechanical ventilation and molecular adsorbent re-circulating system (MARS). CONCLUSIONS: The clinical manifestations of the SARS case, which was highly infectious, met world health organization (WHO) criteria for the diagnosis of SARS. Early initiation of mechanical ventilation and supportive therapy contributed to the good prognosis of this critical case.