Effects of RNAi-mediated TUSC3 silencing on radiation-induced autophagy and radiation sensitivity of human lung adenocarcinoma cell line A549 under hypoxic condition.

This study examined the effects of RNAi-mediated TUSC3 silencing on radiation-induced autophagy and radiation sensitivity of human lung adenocarcinoma cell line A549 under hypoxic condition. Different CoCl2 concentrations were used to treat A549 cells and establish a CoCl2-induced hypoxic model of A549 cells. MTT and clone formation assays were used to determine the effects of different concentrations of CoCl2 on the growth and proliferation of A549 cells treated by different doses of X-ray irradiation. The siRNA-expressing vector was transfected by liposomes and for silencing of TUSC3. Flow cytometry was used to measure cell cycle changes and apoptosis rate. Real-time quantitative polymerase chain reaction (qRT-PCR) assay was performed to detect the expression of TUSC3 mRNA. Western blotting was applied to detect the changes of TUSC3, LC3, and p62 proteins under different CoCl2 concentrations and after siRNA silencing of TUSC3. The TUSC3 levels in A549 cells increased under hypoxic conditions in a dose-dependent manner (P < 0.05). Hypoxia inhibited the growth and proliferation of A549 cells and promoted apoptosis (P < 0.05). With an increasing dose of X-ray irradiation, A549 cells showed significantly increased growth and proliferation and decreased apoptosis (P < 0.05). After siRNA-TUSC3 was transfected by liposome, the TUSC3 level was substantially inhibited (P < 0.05). Silencing TUSC3 inhibited A549 cell growth and proliferation after radiotherapy under hypoxic condition, promoted apoptosis, increased G0/G1 phase cells, and reduced S phase cells (all P < 0.05). Hypoxia and radiation along with different CoCl2 concentrations could induce cell autophagy, which increased with concentration and dose, while silencing the TUSC3 gene inhibited autophagy (all P < 0.05). RNAi silencing of TUSC3 inhibited growth and proliferation, while enhanced apoptosis and radiation sensitivity of hypoxic A549 lung adenocarcinoma cells.

Expression of miR-148/152 family as potential biomarkers in non-small-cell lung cancer.

BACKGROUND: Altered miR-148/152 family expression contributes to human carcinogenesis. This study was designed to detect the potential for using miR-148/152 family as biomarkers for NSCLC patients. MATERIAL/METHODS: The relative expression levels of miR-148/152 family (miR-148a, miR-148b, and miR-152) in serum of 36 non-small-cell lung carcinoma (NSCLC) patients, 20 patients with benign pulmonary diseases (BPD), and 10 healthy individuals were assessed by real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR). RESULTS: The expression of all three miRNAs were significantly lower in the serum of NSCLC than that of BPD and healthy controls (all p<0.01), and their expression levels were strongly correlated with each other (r=0.781, 0.720, and 0.645, respectively). Downregulation of miR-148/152 family was found to be corrected with more aggressive tumors. The area under the receiver operating characteristic curves (AUCs) for miR-148a, miR-148b, and miR-152 discriminating NSCLC from BPD were 0.775, 0.725, and 0.774, respectively, all higher than that of CEA (0.506). Combining the three miRNAs increased the discrimination performance, yielding an AUC of 0.789 (95% confidence interval, 0.643 to 0.895), with a sensitivity of 72.2% and a specificity of 90.0%. CONCLUSIONS: The results of present study suggest that the expression levels of circulating miR-148/152 family may serve as biomarkers for NSCLC.

Clinical spectrum of intrathoracic Castleman disease: a retrospective analysis of 48 cases in a single Chinese hospital.

BACKGROUND: Thorax is the common place to develop Castleman disease (CD), but there is no systemic clinical analysis for intrathoracic CD. METHODS: We conducted a retrospective analysis of 48 intrathoracic CD patients with definite pathological diagnosis who were hospitalized between 1992 and 2012 in a Chinese tertiary referral hospital. RESULTS: The study included 16 cases with unicentric CD (UCD) and 32 cases with multicentric CD (MCD). UCD were younger than MCD (30.5y vs 41.6ys, P < 0.05). MCD were more symptomatic (50% vs 96.9%, P < 0.001) and sicker than UCD, including more fever, hepatomegaly and/or splenomegaly and hypoalbuminemia. All of UCD showed solitary mass in various sites and two of them were complicated by small pleural effusion. In the MCD group, their chest CT showed obvious lymphadenopathy in the hilum and/or mediastinum (100%), diffuse parenchymal lung shadows (43.75%), pleural effusion (40.6%), mass in the mediastinum (6.25%) or hilum (3.12%) and bronchiolitis obliterans (BO) (3.12%). Besides LIP-like images, multiple nodules of different size and sites, patchy, ground-glass opacities and consolidation were showed in their chest CT. Surgery were arranged for all UCD for diagnosis and treatment and all were alive. In MCD group, superficial lymph nodes biopsies (21 cases), surgery biopsy (9 cases) and CT-guided percutaneous lung biopsy (2 cases) were performed. Hyaline vascular (HV) variant were more common in the UCD group (75% vs 37.5%, P < 0.05). In MCD group, 28 cases were prescribed with chemotherapy, one refused to receive therapy and the rest three were arranged for regular follow-up. Among MCD, 18 cases was improved, 7 cases was stable, 4 cases lost follow-up and 3 cases died. CONCLUSIONS: Intrathoracic MCD was more common than UCD in our hospital. MCD was older, more symptomic and sicker than UCD. HV variant were more common in UCD. All of UCD showed mass in various intrathoracic locations and surgery resection was performed for all and all were alive. Mass, pleural effusion, BO and diffuse pulmonary shadows, including LIP-like images, multiple nodules of different size and sites, patchy, GGO and consolidations were showed in our MCD. Most of MCD cases were arranged with chemotherapy and their prognosis were worse than UCD's.

Intrapulmonary migration of a fractured acupuncture needle: a case report.

BACKGROUND: Acupuncture, a traditional Chinese medical treatment, has been gaining popularity over the years. However, it also presents certain risks. We report a case of a patient who discovered a foreign body in their lung several years after undergoing acupuncture. CASE PRESENTATION: A middle-aged woman presented to our hospital with chest pain. An X-ray revealed a needle-like foreign body in the middle lobe of her right lung. The patient had previously undergone acupuncture treatment for local pain in her lower back and lower extremities many years prior. Based on the imaging findings and her medical history, we hypothesized that the foreign body in her lung was a result of a dislodged acupuncture needle. Through preoperative 3-dimensional reconstruction and indocyanine green localization, we were able to locate the foreign body in the lateral segment of the right middle lobe. We successfully removed the foreign body via wedge resection, and the patient made a smooth recovery post-surgery. CONCLUSION: Acupuncturists and surgeons should remain vigilant about the potential risks associated with acupuncture.

[Lung cancer associated paraneoplastic limbic encephalitis: an analysis of 7 cases].

OBJECTIVE: To analyze the clinical features, diagnosis and treatment of lung cancer associated paraneoplastic limbic encephalitis (PLE). METHODS: The clinical data of 7 cases of patients with lung cancer associated PLE out of 8927 patients of lung cancer from January 2000 to May 2010 was analyzed retrospectively. All the patients were male, aging from 41 to 54 years with a mean of 48 years. The data including history, physical examination, laboratory tests, diagnosis, treatment and follow-up were collected and analyzed. RESULTS: All the 7 patients had smoking history. All 7 patients had varying short-term memory loss, 6 had epilepsy, 4 had different degrees of mental disorders, and 2 had syndrome of inappropriate secretion of antidiuretic hormone. Malignancies were screened and detected by chest X-ray or CT scan, while the pathological diagnoses were obtained through biopsy or transbronchial needle aspiration through electronic bronchoscope (5/7), biopsy of supraclavicular lymph nodes (1/7) and open pulmonary lobectomy (1/7). The pathological diagnosis included small cell lung cancer in 6 cases, adenocarcinoma of lung in 1 case. During the follow-up, 1 patient was lost, and the mean time of follow-up of the remaining 6 patients was about 11.5 months (ranged from 4 to 21 months). Four patients received early immunosuppressive treatment in terms of corticosteroids, only slight relief of neurological symptoms was seen in 2 patients. However, after chemotherapy (6/6), radiation (3/6), or surgical removal of the tumor (1/6), complete remission (3/6, with negative anti-Hu antibody) or partial remission (3/6, 2 of whom with positive anti-Hu antibody) of neurological symptoms were observed. Till October 2010, 3 patients with poorer tumor stag died ( survival were 4, 10, and 14 months respectively), while the other 3 patients with negative anti-Hu antibody and relative better tumor stag were still in the follow-up (the period were 5, 15, and 21 months). CONCLUSIONS: PLE is a rare disease. In comparison with immunosuppressive therapy, chemotherapy, radiation or surgical removal of the tumor could provide better remission of the neurological symptoms. Positive serum anti-Hu antibody, poorer tumor stag, and together with poorer response to treatments seem to indicate a poorer prognosis.

MiR-22-3p Expression is down-regulated in lung adenocarcinoma.

BACKGROUND: Our current study was performed with an attempt to detect the expression of microRNA-22-3p (miR-22-3p) in lung adenocarcinoma, as well as to analyze its role in clinical practice. In addition, its relationship with vascular endothelial growth factor (VEGF) and metastasis related indexes was focused. MATERIAL AND METHOD: The trials in which 62 cases of lung adenocarcinoma were received to collect tumor tissue (study group) and normal lung tissue (control group) were eligible for this study. The expression of miR-22-3p in the two groups was detected through RT-PCR. Immunohistochemical method was used to detect the expression of VEGF and leukocyte differentiation antigen 31 (CD31) marked microvessel density (MVD) in lung adenocarcinoma. The expressions of matrix metalloproteinase-3 (MMP-3) and matrix metalloproteinase-7 (MMP-7) in lung adenocarcinoma were also detected through the use of Western Blot. RESULTS: The present study revealed significant difference in the expression of miR-22-3p between the two groups. No significant difference in the expression of gender, age, neural invasion and the number of lesions were observed between groups. There was significant difference in the expression of miR-22-3p in the maximum diameter of tumor, pleural recidivism, vascular recidivism, lymph node metastasis and different TNM stages. Based on survival analysis, miR-22-3p was linked to survival time. Correlation analysis indicated that there was negative correlation between miR-22-3p and VEGF, miR-22-3p and MVD, miR-22-3p and MMP-3, and miR-22-3p and MMP-7 in lung adenocarcinoma. CONCLUSION: Our findings provide evidence that miR-22-3p is low expressed in lung adenocarcinoma tissues and the low expression of miR-22-3p is closely associated with clinicopathological characteristics and the prognosis. MiR-22-3p may be involved in the tumor progression of lung adenocarcinoma and may serve as a biomarker for the diagnosis and prognosis of lung adenocarcinoma.

Surgical treatment of intralobar pulmonary sequestration.

OBJECTIVE: To evaluate the clinical features, diagnosis, treatment, and outcome of intralobar pulmonary sequestration (ILS). METHODS: Patients who were diagnosed with ILS in our hospital between January 1988 and January 2009 were retrospectively reviewed. We recorded the clinical symptoms, imaging findings, operative technique, complications, and outcome of these patients. RESULTS: Forty-seven patients (25 men and 22 women) with an average age of 32.3 years were enrolled. Forty-two patients had symptoms including cough and hemoptysis. Chest X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and angiography were performed. Thoracotomy was performed in 45 patients, while thoracoscopy was performed in 2 patients. Lobectomy was the most common treatment procedure. Massive bleeding developed in 2 patients due to injury of aberrant supplying artery intraoperatively, 1 patient had atrial fibrillation, 1 patient had thrombosis of upper extremity postoperatively. All patients were confirmed the diagnosis pathologically, 4 accompanied with bronchogenic cyst, 15 with bronchiectasis, 8 with infection, 2 with aspergilloma, and 1 with carcinoid. No late complications occurred. CONCLUSIONS: ILS is rare, surgery is recommended because some patients may have potential severe complications. Contrast enhanced CT and three-dimensional reconstruction is the best diagnostic method. Both thoracotomy and thoracoscopy are appropriate for the selected candidates.

[Influence of pulse indicator continuous cardiac output in monitoring on the volume parameters of different tidal volume under pressure control ventilation mode and volume-controlled ventilation mode in sheep].

OBJECTIVE: To compare the influence of pulse indicator continuous cardiac output (PiCCO) in monitoring tidal volume (V(T)) under pressure control ventilation mode and volume-controlled ventilation mode in sheep. METHODS: After anesthesia and tracheotomy, 5 sheep, which were apneic and receiving mechanical ventilation. Twenty minutes later, central venous pressure (CVP) and cardiac function were monitored with different selected V(T) levels of 6, 10, 15, 20 ml/kg under bi-level positive airway pressure (BiPAP) mode by changing the pressure of inspiration, or under the synchronized intermittent mandatory ventilation (SIMV) mode with the same ventilation conditions. RESULTS: In both modes, the increase in V(T) led to an decrease of cardiac index (CI) and intrathoracic blood volume index (ITBVI), reaching a statistically significant difference at 15 ml/kg [SIMV mode: CI (3.94 + or - 1.03) L x min(-1) x m(-2), ITBVI (707 + or - 105) ml/m(2); BiPAP mode: CI (4.11 + or - 1.11) L x mi(-1) x m(-2), ITBVI (715 + or - 122) ml/m(2)] and 20 ml/kg [SIMV mode: CI (3.87 + or - 1.04) L x min(-1) x m(-2), ITBVI (705 + or - 116) ml/m(2); BiPAP mode: CI (3.64 + or - 0.96) L x min(-1) x m(-2), ITBVI (694 + or - 114) ml/m(2)] compared with 6 ml/kg [SIMV mode: CI (4.96 + or - 1.58) L x min(-1) x m(-2),ITBVI(811 + or - 169) ml/m(2); BiPAP mode:CI(5.67 + or - 1.96) L x min(-1) x m(-2), ITBVI (823 + or - 182) ml/m(2), all P<0.05]; an increase in systemic vascular resistance index (SVRI) and mean airway pressure (Pmean) at 15 ml/kg [SIMV mode: SVRI (237.6 + or - 56.2) kPaxs(-1) x L(-1), Pmean (14.0 + or - 3.2) cm H(2)O (1 cm H(2)O=0.098 kPa); BiPAP mode: SVRI (230.8 + or - 32.9) kPaxs(-1) x L(-1), Pmean (13.0 + or - 2.2) cm H(2)O] and 20 ml/kg [SIMV mode: SVRI (253.1 + or - 76.7) kPaxs(-1) x L(-1), Pmean (18.2 + or - 4.8) cm H(2)O ; BiPAP mode: SVRI (246.7 + or - 48.8) kPaxs(-1) x L(-1), Pmean (16.8 + or - 3.3) cm H(2)O] compared with 6 ml/kg [SIMV mode: SVRI (184.8 + or - 47.5) kPaxs(-1) x L(-1); Pmean (8.8 + or - 1.6) cm H(2)O; BiPAP mode: SVRI (184.5 + or - 51.5) kPaxs(-1) x L(-1), Pmean (8.6 + or - 0.5) cm H(2)O, all P<0.05]; but there was no significant effects on CVP, heart rate (HR), mean blood pressure (MBP). There was no significant difference of CI, ITBVI, SVRI and Pmean between the two ventilation modes with various V(T) levels. CONCLUSION: When the cardiac function was normal, the increase in V(T) led to a decrease of CI and ITBVI, but it had no significant effects on CVP. There was no significant difference of CI and ITBVI in the two ventilation modes, both were decreased. So a relatively constant V(T) should be maintained in determining ITBVI.

[The lung protection strategy under the support of extracorporeal membrane oxygenation in patients suffering from influenza A H1N1].

OBJECTIVE: To study the effect of extracorporeal membrane oxygenation (ECMO) in patients suffering from severe pneumonia complicating influenza A H1N1 by putting lungs in rest to protect the latter. METHODS: Five patients with severe pneumonia following influenza A H1N1 were treated with ECMO and different modes of mechanical ventilation at the same time. Two patients died, both of them received synchronized intermittent mandatory ventilation (SIMV) and bi-level positive airway pressure (BiPAP) modes, with airway pressure release ventilation (APRV) to control lung expansion with expansion pressure 40 cm H(2)O (1 cm H(2)O=0.098 kPa). In 3 survivors, the strategy of lung rest was performed by giving an optimized positive end expiratory pressure (PEEP) with an optimal compliance by gradually elevation of PEEP, and high-level pressure (Phigh) at 20 cm H(2)O by application of BiPAP mode. RESULTS: One patient died due to lung damage and repeated spontaneous pneumothorax and sepsis; 1 patient died due to multiple organ dysfunction syndrome. Three patients recovered after following the strategy of lung rest. CONCLUSION: When ECMO is used for severe pneumonia complicating influenza A H1N1, prognosis can be obviously improved, with decrease in the occurrence of lung damage through the protection strategy of lung rest.

[The use of extracorporeal membrane oxygenation in sustaining pulmonary function patients with influenza A H1N1].

OBJECTIVE: To summarize the clinical method and initial experience of extracorporeal membrane oxygenation (ECMO) supportive treatment in influenza A H1N1 serious patients. METHODS: In 5 critically ill patients with influenza A H1N1, their arterial oxygen saturation was 0.70 to 0.85 with oxygen concentration (FiO(2)) 1.00 under mechanical ventilation. In these 5 patients, 3 males and 2 females, vein-vein mode ECMO bypass (femoral vein-internal jugular vein) was carried out to assist pulmonary function. The ratio between ECMO oxygen flow and blood flow was 2-1:1, FiO(2) was 0.21 to 1.00, FiO(2) for mechanical ventilation was 0.30 to 0.70, and positive end expiratory pressure (PEEP) was 5-10 cm H(2)O (1 cm H(2)O= 0.098 kPa). Activated coagulation time (ACT) was maintained at 160-250 s. When artery oxygen saturation and artery-venous blood gas became normal on discontinuation of ECMO, ECMO was weaned, and venous cannulas were removed. Mechanical ventilation was continued. RESULTS: In 5 patients the assisting time of ECMO was 48-330 hours, the mean duration was 178.2 hours. ECMO assisted flow was 2.4-4.0 L/min. The observation time after stoppage of ECMO was 4-24 hours. Four patients were weaned from ECMO, with continuation of assisted respiration successfully. One patient died because the family member gave up hope and the treatment was stopped. CONCLUSION: Vein-vein mode ECMO bypass through femoral vein-internal jugular vein can offer effective aid to pulmonary function in influenza A H1N1 patients who are critically ill. The strategy can win time for the patients to be able to continue mechanical ventilation treatment.

[A clinical study of rapid-shallow-breathing index in spontaneous breathing trial with pressure support ventilation and T-piece].

OBJECTIVE: To determine the threshold value of rapid-shallow-breathing index (RSBI) and its increased percentage (Delta RSBI) as predictors for successful weaning in spontaneous breathing trial (SBT) with pressure support ventilation (PSV) and T-piece. METHODS: In 2007, there were 208 patients on ventilators with oral intubation. They were divided into two groups: the PSV group (93 patients) and the T-piece group (115 patients). The duration of SBT was 30 minutes. Weaning indexes [mouth occlusion pressure 0.1 (P0.1), breathing rate (f), tidal volume (V(T))] of SBT 3 minutes and 30 minutes were recorded in each group. The averages of RSBI and Delta RSBI were calculated and compared between two groups. RESULTS: Among 208 patients, in 168 patients weaning was successful and the ratio was 80.77%. The successful ratios of PSV and T-piece group were 83.87% and 78.26%, respectively (P > 0.05). In PSV and T-piece groups the average of RSBI value (SBT 30 minutes) was (67.18+/-11.55) breaths x min(-1) x L(-1) and (99.11+/-15.53) breaths x min(-1) x L(-1), respectively (P < 0.01); the average of Delta RSBI was (69+/-33)% and (119+/-35)% (P < 0.01). In PSV group, the area under receiver operating characteristic (ROC) curve of RSBI was 0.747+/-0.045 (P = 0.000); when RSBI =75 breaths x min(-1) x L(-1), the diagnostic accuracy was 87%; the area under ROC curve of Delta RSBI was 0.709+/-0.065 (P = 0.001), and when Delta RSBI=90%, the diagnostic accuracy was 82%. In T-piece group, the area under ROC curve of RSBI was 0.821+/-0.049 (P = 0.000); when RSBI =100 breaths x min(-1) x L(-1), the diagnostic accuracy was 82%; the area under ROC curve of Delta RSBI was 0.738+/-0.046 (P = 0.000); when Delta RSBI =130%, the diagnostic accuracy was 77%. CONCLUSION: The average values of RSBI (SBT 30 minutes) are significantly different between the two groups. In PSV and T-piece groups, using RSBI = 75 breaths x min(-1) x L(-1) and 100 breaths x min(-1) x L(-1) as the threshold value for predicting successful weaning is more valuable than other values. Sequential observation of Delta RSBI is also valuable in predicting a successful extubation.

[A study of cough peak expiratory flow in predicting extubation outcome].

OBJECTIVE: To study the value of cough peak expiratory flow (CPEF) in predicting extubation outcome of patients. METHODS: A prospective study of 200 adult patients was conducted and treated in the Third Central Hospital intensive care unit (ICU), receiving mechanical ventilation (MV) via an endotracheal tube during November 2006 through December 2007. All the patients received MV longer than 24 hours. They were conscious and cooperative at the time of extubation. Extubation was successful after 30 minutes of spontaneous breathing trial (SBT). They were asked to cough for three times, during which CPEF was measured with an in-line spirometer, and the average value was recorded. They were classified as strong, moderate, and weak according to the ability to cough. If the patients did not require reintubation within 72 hours, extubation was noted as successful. RESULTS: In 200 patients, in 172 patients extubation was successful and failed in 28 patients. Sex, age, severity of illness and vital signs during SBT showed no difference between patients with successful extubation and patients with unsuccessful extubation. CPEF was the independent predictor for the extubation outcome [odds ratio (OR) < 1]. The cut-point was 58.5 L/min. CPEF< or =58.5 L/min had a specificity of 68.0% and sensitivity of 71.4% in predicting extubation failure. The positive predicted value was 0.16, and the negative predicted value was 0.94. The cough strength in patients with successful extubation was almost always "strong", and in very few it was "medium". In those extubation failed, there were only 3 patients showed strong cough strength, and for the rest it was "moderate" or "weak". CONCLUSION: After patients have recovered from respiratory failure and SBT is successful, factors affecting airway competence, such as cough strength, may be important predictors of extubation outcome. The study confirms that CPEF is a strong and independent predictor of extubation outcome when the patient is mentally clear and has a successful SBT. When the CPEF>58.5 L/min, the successful rate is high. On the contrary, when the CPEF< or =58.5 L/min, the unsuccessful rate is high. Failure is often due to poor cough. The extubation outcome is highly correlated with cough strength. The prognosis in patients with failure is poor.

[Study on the effect of control mode of pressure and volume on cardiac index and intrathoracic blood volume index in critically ill patients].

OBJECTIVE: To compare the effect of control mode of pressure and volume of mechanical ventilation on cardiac index (CI), intrathoracic blood volume index (ITBVI) in patients. METHODS: Twenty-four patients in whom mechanical ventilation and pulse indicator continuous cardiac output (PiCCO) monitoring were necessary were involved, and they were divided into normal heart function group (9 cases) and heart dysfunction group (15 cases) on the base of CI. Mechanical ventilation was used with the mode of bi-level positive airway passage (BIPAP), and the inspiratory pressure was maintained at the tidal volume (V(T)) of 6, 10, 15 ml/kg. After the mechanical ventilation mode was changed to synchronized intermittent mandatory ventilation (SIMV) and maintained for 20 minutes, breathing mechanics and central venous pressure (CVP), CI, ITBVI were measured. RESULTS: In the normal heart function group, there were decrease in mean arterial pressure (MAP), CI and ITBVI, increase in heart rate (HR), mean airway pressure (Pmean) and intrinsic positive end expiratory pressure (PEEPi) in both modes of mechanical ventilation without significant difference (P values were 0.067, 0.124, 0.348, 0.328, 0.110, 0.187, respectively). Systemic vascular resistance index (SVRI) was higher in the BIPAP group compared with SIMV group (P=0.030). In the heart dysfunction group, the CI and ITBVI were decreased in the SIMV mode, and CI was decreased significantly in the 10 ml/kg group (P<0.05). Pmean in BIPAP group was increased than that in SIMV group in all V(T) levels (P values were 0.003, 0.000, 0.004, respectively). There was no significant difference in SVRI, HR, MAP and PEEPi in all groups. CONCLUSION: In the two mechanical ventilation modes, with an increase in V(T), CI and ITBVI may decrease. The Pmean is lower when BIPAP mode in used compared with SIMV, when V(T) is same. So mechanical ventilation and V(T) can influence the readings of CI and ITBVI when PiCCO monitoring is employed.

[The preemptive treatment of invasive Candida infection with reference of corrected colonization index in critically ill patients: a multicenter, prospective, randomized controlled clinical study].

OBJECTIVE: To evaluate preemptive treatment for invasive Candida infection (ICI) with reference of corrected colonization index (CCI) in critically ill patients with high risk factors of Candida infection, and to collect the epidemiology data of Candida infection. METHODS: One hundred and ten critically ill patients with acute physiology and chronic health evaluation II (APACHE II) score>10 were selected from intensive care units (ICUs) of 5 grade III class A hospitals in Tianjin from October 1st 2008 to April 30th 2009, and they were randomly divided into two groups: CCI group and control group (55 cases in each group). CCI was monitored in all patients. In control group the responsible intensivists ordered the treatment according to their own experience, and in CCI group, when the patient's CCI> or =0.4 and with evidence of sepsis, the patients were given anti-Candida immediately. When CCI<0.4, anti-Candida treatment was not given. But when the patients' condition became worse or unstable, complementary anti-Candida treatment was given. RESULTS: There were no significant differences in general data, treatment of diseases of the patients, APACHE II scores, incidence of sepsis and length of ICU stay (LOS) between two groups ( all P>0.05 ). There were 50 patients and 48 patients developing sepsis in control group and CCI group, respectively. In CCI group, the time between the onset of sepsis to beginning of anti-Candida treatment was significantly shorter than the control group [(0.94+/-0.67) days vs. (3.75+/-3.62) days, P<0.05]. In the group of CCI> or =0.4 (57 patients) the LOS [(15.34+/-6.63) days] and the incidence of failure in establishing enteral nutrition (64.9%) were significantly higher than that of the group of CCI<0.4 [53 patients, (7.24+/-3.75) days, 43.4%, both P<0.05]. There was no significant difference in APACHE II scores, incidence of mechanical ventilation and blood purification between two groups ( all P>0.05 ). Analysis of 575 strains of Candida colonized in 110 patients, revealed that C. albicans ranked first (59.3%), C. tropicalis ranked second (10.8%), followed by C. glabrata, Cryptococcus and C. krusei. CONCLUSION: Application of CCI may enhance the accuracy of timely preemptive treatment for ICI, and facilitate the collection of epidemiological data of Candida in critically ill patients.

[Clinical investigation of extravascular lung water index and pulmonary vascular permeability index in diagnosis and continuous monitoring of lung edema].

OBJECTIVE: To study the clinical value of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) in the diagnosis and continuous monitoring of lung edema. METHODS: To retrospectively analyze pulse index continuous cardiac output (PiCCO) monitoring in 40 patients with lung edema. They were divided into two groups: acute cardiac pulmonary edema (ACPE) group (ACPE group, 15 cases) and acute respiratory distress syndrome (ARDS) group (ARDS group, 25 cases), according to their case history, symptoms, physical signs, results of auxiliary examinations and cardiac index (CI) on admission. Parameters such as EVLWI and intrathoracic blood volume index (ITBVI) on admission were recorded, correlation analysis was performed, and PVPI was calculated at 0, 24, and 72 hours after tracheal intubation. RESULTS: (1) PVPI in ARDS group was significantly higher than that in ACPE patients (P<0.01) at 0 hour after tracheal intubation. (2) PVPI had no correlation with oxygenation index (PaO(2)/FiO(2)), acute physiology and chronic health evaluation II (APACHEII) score, EVLWI, ITBVI, and central venous pressure (CVP) in ACPE group (all P>0.05), while it showed significant correlation with EVLWI (r=0.904, P<0.01), as well as with APACHEII and PaO(2)/FiO(2) (r=0.390, P<0.05, r=-0.554, P<0.01) in ARDS group. EVLWI in ACPE group was significantly correlated with PaO(2)/FiO(2) (r=-0.672, P<0.01) and correlated with APACHEII (r=0.412, P<0.05). There was some correlation between EVLWI and PaO(2)/FiO(2) (r=-0.602, P<0.01), APACHEII, ITLWI in the two groups (r=0.457, P<0.05; r=0.636, P<0.05). (3) Protracted receiver operating characteristic curve(ROC) of PVPI was plotted, and area under the curve (AUC) was 0.956+/-0.019 (P<0.01). When 2.23, which was one of the cut-off points of PVPI, was selected, the sensitivity was 92.0%, and the specificity was 93.3%. (4) When the patients were divided into survivor group and non-survivor group, EVLWI was found to be decreased gradually in the survivor group (ACPE group: P<0.05; ARDS group: P<0.01), and PVPI of ACPE patients increased in non-survivor group (P<0.01). CONCLUSION: EVLWI and PVPI monitoring is of clinical value to some degree in early diagnosis of hydrostatic pulmonary edema and permeability pulmonary edema.

[Study of the effects on the heart function when different positive end expiratory pressure levels were used on patients treated with mechanical ventilation].

OBJECTIVE: To study the effects on the hemodynamics and the heart function when different positive end-expiratory pressure (PEEP) levels were used on patients treated with mechanical ventilation. METHODS: Thirty-nine critical patients with respiratory failure and treated with mechanical ventilation, and hemodynamics was monitored, were divided into two groups according to the cardiac index (CI). Hemodynamics was measured with non-invasive cardiac output (NICO) continuously. The changes in hemodynamic parameters [including cardiac output (CO), CI, pulmonary capillary blood flow (PCBF), central venous pressure (CVP), systemic vascular resistance (SVR)], lung mechanical parameters [intrinsic positive end expiratory pressure (PEEPi), peak inspiratory pressure (PIP), mean of airway pressure (Pmean)], pulse saturation of oxygen (SpO(2)), blood pressure (BP) and heart rate (HR)] were determined with different selected PEEP levels of 0, 5, 7, 10 and 13 cm H(2)O (1 cm H(2)O=0.133 kPa) under the bi-phasic positive airway pressure (BIPAP) mode in normal cardiac function group (CI > or =2.0 L x min(-1) x m(-2), n=18) and poor cardiac function group (CI<2.0 L x min(-1) x m(-2), n=18). RESULTS: In the normal cardiac function group, the increase in PEEP led to an increase of CVP, but it had no significant effects on CO, CI, PCBF and SVR; in the poor cardiac function group, the increase of PEEP led to an increase of CVP and SVR, a decrease of PCBF, CO, CI, and the latter two variables showed a curvilinear change. In both groups, PIP, Pmean, PEEPi increased and the resistance of airway (R) fell with the increase of PEEP. CONCLUSION: Under the condition of mechanical ventilation, when the lung volume was relatively constant, change in PEEP levels (0-13 cm H(2)O) had no obvious effects on the normal cardiac function group, but can significantly decrease right ventricular preload, PCBF and left ventricular preload. Optimal PEEP may improve the cardiac function. The change in the airway pressure is not consistent with the changes in cardiac function.

[Clinical study of mechanical ventilation in acute cardiogenic pulmonary edema patients].

OBJECTIVE: To study the application of mechanical ventilation in acute cardiogenic pulmonary edema (ACPE), and compare the changes in hemodynamics between continuous positive airway pressure proportional pressure support (CPAP-PPS) with continuous positive airway pressure-pressure support ventilation (CPAP-PSV). METHODS: Non-invasive and invasive ventilation were performed in 77 ACPE patients. At the initiation of invasive ventilation and the phase of low assist ventilation in 61 patients who were treated with mechanical ventilation longer than 24 hours, hemodynamics was monitored by partial CO(2) rebreathing method (non-invasive cardiac output, NICO) cardiopulmonary management system, and then compared the changes in the two kinds of ventilation under medicinal intervention. RESULTS: Among 33 of 61 ACPE patients underwent non-invasive ventilation, 24 were successful, and the ratio was 72.7%. Among 33 patients with invasive ventilation (including 5 in whom ventilation was switched to non-invasive mode), 11 failed. Biphasic positive airway pressure/pressure support ventilation (BIPAP/PSV) was used in pressure controlled ventilation, with high pressure (Phigh) 16-24 cm H(2)O (1 cm H(2)O=0.098 kPa), time of high pressure (Thigh) 1.5 seconds, positive end expiratory pressure (PEEP) 6-15 cm H(2)O, fractional concentration of inspired oxygen (FiO(2)) 0.5, cardiac output (CO)/cardiac index (CI) was significantly improved compared with those of initial ventilation in successful ones in invasive group, and the improvement was more significant in PPS compared with PSV in low assist ventilation (all P<0.001). Those in whom invasive ventilation was failed had a low CI (<1.5 L.min(-1).m(-2)) even under drug intervention. CONCLUSION: Hemodynamic monitoring should be performed when medicinal intervention and non-invasive/invasive ventilation are given to ACPE patients. Pressure controlled ventilation is recommended, and PEEP should be individualized (normally 6-15 cm H(2)O). Spontaneous ventilation should be restored as soon as possible, CPAP-PPS mode is practicable in patients in whom weaning of mechanical ventilation is difficult.

[Study of continuous hemodynamics monitoring techniques in patients with mechanical ventilation].

OBJECTIVE: To elucidate the relativity among three kinds of continuous hemodynamics monitoring techniques: thermodilution via Swan-Ganz catheter, pulse contour analysis method (PiCCO), partial CO(2) rebreathing method (non invasive cardiac output, NICO), in patients with mechanical ventilation. METHODS: In 13 patients with respiratory failure due to different causes, hemodynamics were continuously monitored with Swan-Ganz catheterization, PiCCO, NICO simultaneously. The therapeutic measures and the type of ventilator were similar. Data were collected at the same time points to compare the relativity among these three kinds of monitor. RESULTS: Linear relative analysis showed a good relativity in PiCCO/Swan-Ganz (r=0.883), NICO/Swan-Ganz (r=0.853) and PiCCO/NICO (r=0.857) in cardiac index (CI). CONCLUSION: PiCCO and NICO can be used as reliable measure to monitor ventilated patients bedside in intensive care unit (ICU), thus offering an assistance to optimize therapeutic strategy.