[Clinical update in critical care of pulmonary medicine 2021].

In this review, we outlined the clinical studies in critical care field of pulmonary medicine from November 1, 2020 to September 30, 2021. A Chinese retrospective study for critically ill patients with COVID-19 showed that corticosteroid therapy was associated with a reduced 28-day mortality in patients with the hyperinflammatory phenotype. In hospitalized patients with COVID-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization, and early sedation with dexmedetomidine exhibited a high probability of reduced 90-day mortality in older patients regardless of operative or non-operative cluster status. High-flow nasal cannula (HFNC) improved the prognosis compared with conventional oxygen therapy in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with acute compensated hypercapnic respiratory failure. For COVID-19 patients suffering from acute respiratory failure with HFNC therapy, awake prone positioning reduces the incidence of treatment failure and the need for intubation. Compared with pressure-volume curve guiding positive end-expiratory pressure (PEEP) titration for acute respiratory distress syndrome (ARDS) patients, PEEP titration guided with EIT (Electrical impedance tomography) might be associated with improved driving pressure and survival rate. Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for severe ARDS patients, but the survival among ECMO-assisted patients with COVID-19 is strongly associated with a centre's experience in ECMO during the previous year and early ECMO management. Compared to conventional lung-protective mechanical ventilation (MV), neurally adjusted ventilatory assist (NAVA) decreased duration of MV. These findings also provide evidence for improving the clinical management in critical care of pulmonary medicine.

[Effect of renal function on sarcopenia in elderly male patients with chronic kidney disease].

Objective: To evaluate the effect of renal function on sarcopenia in elderly male patients with chronic kidney disease (CKD). Methods: A total of 105 male CKD patients aged ≥65 years who were admitted to the Chinese PLA General Hospital between October 1, 2018 and January 30, 2019 were included in this study. Using two different equations to estimate glomerular filtration rate (GFR), respectively. According to the sarcopenia criteria, the participants were categorized as the non-sarcopenia group (n=72) and the sarcopenia group (n=33), respectively. The association of estimated GFR (eGFR) and the sarcopenia in the male CKD patients was analyzed using the model of multivariate logistic regression. Results: Among the 105 patients, the median age was 74 (68, 77) years old. The prevalence of sarcopenia was 31.4% (33/105). According to the multivariate logistic regression analysis, eGFR based on serum creatinine and Cys-C (eGFRscr-cys) lower than 45 ml·min(-1)·(1.73 m(2))(-1) (OR=4.17, 95%CI:1.08-16.02, P=0.038) and eGFR based on Cys-C (eGFRcys) lower than 45 ml·min(-1)·(1.73 m(2))(-1) (OR=3.99, 95%CI:1.08-14.75, P=0.038) were independent risk factors for underlying sarcopenic, respectively. The area under the receiver operating characteristics curve (AUC) revealed that eGFRscr-cys (AUC=0.67) was more suitable than eGFRcys (AUC=0.64) to predict the sarcopenia in elderly male patients with CKD. Conclusion: The increased incidence of sarcopenia in elderly men with CKD is accompanied with deterioration of renal function.

[Related factors of frailty in the elderly male patients with chronic kidney disease].

Objective: To investigate the characteristics of frailty in the elderly male patients with chronic kidney disease (CKD) and the effects of renal function on the incidence of frailty. Methods: A total of 105 non-dialysis CKD patients aged ≥65 years who were admitted to the Chinese PLA General Hospital between October 1, 2018 and January 30, 2019 were included in this study. Their clinical data and laboratory indicators were collected. Frailty was defined according to Fried frailty criteria. According to the frailty scores, the participants were categorized as non-frail (n=37), intermediately frail (n=37) and frail (n=31). The association of frailty and the level of estimated glomerular filtration rate (eGFR) in the patients was analyzed using the model of multivariate Logistic regression. Results: Among the 105 patients, the mean age was 74 (68, 77) years old. The incidence of frail and intermediate frail was 35.2% (37/105) and 29.5% (31/105), respectively. Multivariate logistic analysis showed statistically significant associations of frailty with age (OR=1.14, 95%CI:1.08-1.20, P<0.001), body mass index (OR=0.87, 95%CI:0.79-0.95, P=0.001) and the level of eGFR (OR=0.98, 95%CI:0.96-0.99, P=0.003) in those patients. The incidence of frail in patients with eGFR<45 ml·min(-1)·(1.73 m(2))(-1) and 45-59 ml·min(-1)·(1.73 m(2))(-1) was 1.02 (OR=2.02, 95%CI: 1.06~3.87) and 0.84 (OR=1.84, 95%CI: 1.05-3.22) times higher than that of eGFR≥60 ml·min(-1)·(1.73 m(2))(-1), respectively. Conclusion: The incidence of frailty in the elderly patients with CKD is affected by many factors, such as age, body mass index and renal function, and increases with decreased renal function.

Significant association between lower pulse pressure and increasing levels of a novel type of phospholipid.

The aim of this study was to analyze the association between pulse pressure and a novel type of phospholipid with solubility similar to that of lysophosphatidic acid (LPA), designated as AP, which was reported to be elevated during ischemia. In this cross-sectional study, 416 hypertensive patients and 252 controls aged between 35 and 70 years were enrolled consecutively. Fasting blood samples were extracted for assays of phospholipids and other biomarkers. Compared to controls, the hypertensive patients had higher levels of both LPA [odds ratio (OR) = 3.83] and AP (OR = 4.30). Changes in blood pressure did not affect the levels of LPA or AP. However AP, but not LPA, levels were significantly higher in patients with lower or higher pulse pressure (Pearson χ(2) = 11.239, P = 0.001). For patients whose pulse pressure was ≤60 mmHg, plasma levels of AP were significantly negatively correlated with pulse pressure. However, this was not observed for LPA and nine other biomarkers, including lipoproteins. Plasma levels of AP increased in hypertensive patients with higher or lower pulse pressure. Thus, attention should be paid to the possibility of cerebral ischemia in hypertensive patients when they have abnormal pulse pressure, especially for those with relatively low pulse pressure.

The value of microbiology rapid on-site evaluation of sepsis caused by pulmonary infection.

OBJECTIVE: This study aims to evaluate the value of microbial rapid on-site evaluation (M-ROSE) of sepsis, and septic shock caused by pulmonary infection. PATIENTS AND METHODS: Thirty-six patients with sepsis and septic shock due to hospital-acquired pneumonia were analyzed. Accuracy and time were compared with M-ROSE, traditional culture, and next-generation sequencing (NGS). RESULTS: A total of 48 strains of bacteria and 8 strains of fungi were detected by bronchoscopy in 36 patients. The accuracy rate of bacteria and fungi was 95.8% and 100%, respectively. M-ROSE took an average of 0.34±0.01 hours, much faster than NGS (22h±0.01 h, p<0.0001) and traditional culture time (67.50±0.91 h, p<0.0001). CONCLUSIONS: M-ROSE may quickly identify common bacteria and fungi, so it may be a useful method for the etiological diagnosis of sepsis and septic shock caused by pulmonary infection.

An animal model to study erythrocyte senescence with a narrow time window of erythrocyte production.

Using the method of inducing spherocytic anemia in the rabbit with antibody serum, we have developed an animal model in which red blood cells (RBCs) can nearly grow synchronously. With this model, we determined that the surface charge density on the RBC membrane decreased with cell aging. The change was not linear, being much more profound in the latter half of RBC life span. There was a positive correlation between the mean RBC density and its "age" (r = 0.847, p < 0.01). However, the density distribution of the RBCs at the same "age" showed a broad range, and the density values for RBC groups with different ages showed considerable overlap. This indicates that the density gradient technique can be used to separate RBC population into fractions with different mean ages, but has a low resolving power for obtaining individual RBCs of a given "age".

An animal model to study erythrocyte senescence with a narrow time window of erythrocyte production: alterations in osmotic fragility and deformability of erythrocytes during their life span.

Using the model in which the entire RBC population was nearly synchronously produced following the induction of spherocytic anemia in the rabbit with antibody serum, we determined the changes of RBC osmotic fragility and deformability with aging. The results showed that the osmotic fragility increased with the RBC aging process in a nonlinear manner, being much more profound in the later part of the RBC life span. The RBC deformation index (DI) was measured by an ektacytometry. It is found that the DI decreased with RBC aging in a nonlinear fashion, with increasingly greater changes in the later part of the RBC life span. The alterations of RBC mechanical properties with aging may be attributable to a number of factors, including changes of RBC size and shape, and the viscoelasticity of the cytoplasm and membrane.

Benzodiazepine receptors in isolated adrenal glomerulosa cells.

In our experiments the isolated rat adrenal glomerulosa cells displayed peripheral-type benzodiazepine receptors, which could bind to [3H] PK11195 with an apparent equilibrium dissociation constant (KD) of 9.4 +/- 2.8 nmol/L and a maximal binding capacity (Bmax) of 5.6 +/- 1.8 pmol/10(6) cells. The effects of five ligands: PK11195, Ro5-4846, flunitrazepam, diazepam and clonazepam on aldosterone secretion responses of isolated glomerulosa cells to angiotensin II or extracellular potassium ions were observed. The logarithm of EO50 for these ligands as stimulators was well correlated with the logarithm of their Ki value for [3H] PK11195 binding, suggesting that the stimulative effects might be mediated by the benzodiazepine receptor in isolated glomerulosa cells.

[The effect of Coptis chinensis on lipid peroxidation and antioxidases activity in rats].

In order to make a systematic study of the effect of Coptis chinensis on free radicals, the authors used the method that the drug and the brain homogenate of rat were mixed and incubated to investigate the effect of Coptis on lipid peroxidation. The result showed that the malondialdehyde (MDA) product of rat brain homogenate inhibited by 5% Coptis was significantly different from control (P < 0.001). On the basis of the above-mentioned results, the effect of Coptis on lipid peroxidation and diabetes of rats induced by alloxan was investigated. The result showed: (1) The MDA product of both pancreas and liver homogenate in Coptis group was significantly less than that in control and alloxan group (P < 0.01, P < 0.05). (2) Superoxide dismutases (SODs) in erythrocytes activity was the same for all groups (P > 0.50). (3) The blood catalase (CAT) activity in alloxan group markedly decreased compared with control group (P < 0.05), but no significant change between Coptis and alloxan group (P > 0.05). (4) The value of serum glucose in alloxan group was significantly increased in comparing with control group (P < 0.05). There was a trend to decrease the value of serum glucose in Coptis group compared with alloxan group, but no significant difference between two groups (P > 0.05). The experiment indicated that there was very strong inhibitory effect of Coptis to the lipid peroxidation in vitro and in vivo. Coptis could protect rat from diabetes inducing by alloxan and that probably was due to the fact that Coptis was able to inhibit alloxan inducing free radicals.

Meconium peritonitis-observations in 115 cases and antenatal diagnosis.

In 20 years the authors have met with 115 cases of meconium peritonitis (MP). The high incidence in China is shown. In all cases there were intraabdominal calcifications. There were no cases of fibrocystic disease. The authors classify 3 types: 1. Neonatal obstructive type 41 cases. 2. Free perforation with: Free pneumoperitoneum 15 cases. Localized pneumoperitoneum 23 cases. 3. No signs or symptoms, with potential intestinal obstruction 23 cases. The series shows a low incidence of atresia. The authors suggest necrotizing enterocolitis as a cause because of the high incidence of stenosis. Three prenatally diagnosed cases are discussed. All had hydramnios and fetal abdominal calcifications. Two of these were confirmed after birth. The mortality is high (42.6%). Abdominal x-ray in all cases with polyhydramnios may lead to a positive diagnosis of MP.

Successful separation of xiphoomphalopagus twins.

A pair of female xiphoomphalopagus twins were delivered by Caesarean section at 35th week of gestation on March 2, 1982, their combined weight being 4,800 g. Examinations revealed that they were conjoined from the xiphoid process down to the umbilicus. Infant A also had congenital heart defect (VSD). X-ray and echography showed that they had a fused liver and two independent biliary systems and alimentary tracts. After 6 weeks, the twins gained weight up to 7,000 g. The separation operation was performed at 1 1/2 months of age. During operation it was demonstrated that the xiphoid process and costal cartilages were fused together and the peritoneal cavities were of free communication above the umbilicus, and the livers merged into a single common liver. The large single liver was divided by electrocautery, resulting in a section surface of 8 X 7.5 cm. After separation, the closure of the abdominal wall in both infants presented some difficulties which were resolved by making relaxation incisions on either flanks. In the post operative period, the ventral wounds of both infants were disrupted for several centimetres and infant B had wound infection. The granulating area of skin defect on either relaxation incision of the flanks and ventral denuded wound were covered with full-thickness dead-foetus homografts. The wounds were well healed. Eventually both infants were discharged in good condition at 2 1/2 months after operation. Now they live well at 2 1/2 years of age.

Electrochemical therapy (ECT) for thyroid adenoma during acupuncture anaesthesia: analysis of 46 patients.

Between February 1989 and April 1993, 46 patients with thyroid adenoma were treated by electrochemical treatment (ECT) during acupuncture anaesthesia. After three months to four years follow up period, the cure rate was 97.8%. ECT is a new technique which provides simple, effective and safe treatment of thyroid adenoma. Treatment of benign tumours with ECT represents a new application.