ABSTRACT
Objective:To evaluate the feasibility of using bedside ultrasound and serum biomarkers for the prediction of sepsis-induced myocardial dysfunction(SIMD)and mortality in septic shock patients.Methods:The patients diagnosed as septic shock were enrolled in the study from January 2019 to July 2021 in PICU at Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine.Bedside ultrasound results were recorded at day 1, 2, 3, 7 and 10.Blood samples were collected at the same time, markers of myocardial injury were detected, and prognosis was recorded at 28 days.According to the left ventricular ejection fraction (LVEF), children with septic shock were divided into SIMD group and non-SIMD group.Those with LVEF <50% or decreased by ≥10% from baseline level were defined as SIMD.Differences in cardiac ultrasound parameters and biomarkers between two groups were compared.Logistic regression analysis was performed to determine the independent risk factors for SIMD and the independent risk factors for death at 28 days after septic shock.The area under the receiver operating characteristic curve (AUC) was used to evaluate the efficacy of different indicators in predicting SIMD and the death outcome of children with septic shock on 28 days.Results:A total of 57 children were enrolled, including 28 cases in SIMD group and 29 cases in non-SIMD group.Univariate analysis showed that there were statistically significant differences in pediatric critical illness score, N-terminal B-type natriuretic peptide(NT-proBNP), LVEF and left ventricular short axis shortening rate between two groups ( P<0.05). Logistic analysis demonstrated that LVEF( OR=0.890, 95% CI 0.818-0.969, P=0.007)and NT-proBNP ( OR=1.000, 95% CI 1.000-1.000, P=0.015)could independently predict SIMD.There were 42 cases in survival group and 15 in non-survival group according to the prognosis on 28 days.Univariate analysis showed that there were significant differences in pediatric risk mortality score Ⅲ, pediatric sequential organ failure assessment, cardiac troponin I, and mitral annular plane systolic excursion(MAPSE)( P<0.05). Logistic analysis showed that only MAPSE independently predicted mortality( OR=85.670, 95% CI 1.685-4 356.736, P=0.026). Compared with MAPSE(AUC=0.727), MAPSE combined with pediatric risk mortality score Ⅲ, pediatric sequential organ failure assessment, cardiac troponin I(AUC=0.926) could be better to predict the 28 days prognosis of patients with septic shock on 28 days. Conclusion:NT-proBNP increases significantly in the early stage of SIMD.MAPSE shows no difference between SIMD and non-SIMD patients.MAPSE is correlated with the prognosis of patient with septic shock.
ABSTRACT
Objective@#To investigate the clinical effects of Kangai-Guben-Xiaozheng decoction based on pathogenesis theory of cancerous toxin combined with TP scheme in the treatment of advanced ovarian carcinoma in elderly patients.@*Methods@#A total of 218 elderly patients with advanced ovarian carcinoma in our hospital were randomly divided into the observation and control group, 109 in each group. The control group was treated by TP scheme, while the observation group was treated by Kangai-Guben-Xiaozheng decoction based on pathogenesis theory of cancerous toxin combined with TP scheme. Both groups received 1 chemotherapy cycle at 3 weeks, and a total of 4 cycles of chemotherapy were followed up for 2 years. Quality of life was assessed by Functional Assessment of Cancer Therapy- ovarian Cancer v4.0 (FACT-OV4). Enzyme-linked immunosorbent assay (ELISA) was used to detect tumor markers, including Integrin-Linked Kinase (ILK), Hypoxic Inducible Factor-α (HIF-α), Human Epididymal Protein (HE4) and Epithelial-type calcium mucin (E-cadherin). The toxic and side effects of two groups were observed and the clinical efficacy was evaluated. The survival rate, total survival time and disease-free survival time were observed and recorded during follow-up.@*Results@#The control rate and effective rate of the observation group were 90.8% (99/109) and 41.3% (45/109), respectively, and those of the control group were 64.2% (70/109) and 28.4% (31/109), respectively. The comparison of control rate and effective rate between the two groups were statistically significant (Z value were 4.002, 3.401, respectively, all Ps<0.05). After treatment, the ILK (12.31 ± 1.15 ng/L vs. 23.57 ± 2.32 ng/L, t=3.245), HIF-α (2.41 ± 0.22 mg/L vs. 6.67 ± 0.67 mg/L, t=3.596), HE4 (0.34 ± 0.03 pg/L vs. 1.24 ± 0.12 pg/L, t=3.621) levels in the observation group are significantly lower than those in the control group (P<0.05), while the E-cadherin (5.25 ± 0.56 ng/L vs. 2.52 ± 0.26 ng/L, t=3.434) was significantly higher than that in the control group (P<0.05). After treatment, the scores of functional status and social/family status in the observation group were significantly higher than those in the control group (t values were 3.282, 3.214, all Ps<0.05), and the scores of additional attention, emotional status and physiological status were significantly lower than those in the control group (t values were 3.121, 3.512, 3.526, all Ps<0.05). During the treatment period, the incidence of cardiac toxicity, liver toxicity, renal toxicity, bone marrow suppression, nausea and vomiting, abdominal pain and diarrhea in the observation group were significantly lower than those in the control group (χ2 value were 4.947, 4.893, 4.525, 4.692, 4.637, 4.905, respectively, all Ps<0.05). During the follow-up, the 1, 2 year survival rate in the observation group was higher than those in the control group (χ2 value were 3.782, 3.893, respectively, all Ps<0.05).@*Conclusions@#The Kangai-Guben-Xiaozheng decoction based on the theory of cancer pathogenesis, combined with TP regimen show effectiveness for the Ⅳ stage of ovarian cancer of the elderly patients.
ABSTRACT
Objective To investigate the clinical effects of Kangai-Guben-Xiaozheng decoction based on pathogenesis theory of cancerous toxin combined with TP scheme in the treatment of advanced ovarian carcinoma in elderly patients. Methods A total of 218 elderly patients with advanced ovarian carcinoma in our hospital were randomly divided into the observation and control group, 109 in each group. The control group was treated by TP scheme, while the observation group was treated by Kangai-Guben-Xiaozheng decoction based on pathogenesis theory of cancerous toxin combined with TP scheme. Both groups received 1 chemotherapy cycle at 3 weeks, and a total of 4 cycles of chemotherapy were followed up for 2 years. Quality of life was assessed by Functional Assessment of Cancer Therapy- ovarian Cancer v4.0 (FACT-OV4). Enzyme-linked immunosorbent assay (ELISA) was used to detect tumor markers, including Integrin-Linked Kinase (ILK), Hypoxic Inducible Factor-α (HIF-α), Human Epididymal Protein (HE4) and Epithelial-type calcium mucin (E-cadherin). The toxic and side effects of two groups were observed and the clinical efficacy was evaluated. The survival rate, total survival time and disease-free survival time were observed and recorded during follow-up. Results The control rate and effective rate of the observation group were 90.8% (99/109) and 41.3% (45/109), respectively, and those of the control group were 64.2% (70/109) and 28.4% (31/109), respectively. The comparison of control rate and effective rate between the two groups were statistically significant (Z value were 4.002, 3.401, respectively, all Ps<0.05). After treatment, the ILK (12.31 ± 1.15 ng/L vs. 23.57 ± 2.32 ng/L, t=3.245), HIF-α (2.41 ± 0.22 mg/L vs. 6.67 ± 0.67 mg/L, t=3.596), HE4 (0.34 ± 0.03 pg/L vs. 1.24 ± 0.12 pg/L, t=3.621) levels in the observation group are significantly lower than those in the control group (P<0.05), while the E-cadherin (5.25 ± 0.56 ng/L vs. 2.52 ± 0.26 ng/L, t=3.434) was significantly higher than that in the control group (P<0.05). After treatment, the scores of functional status and social/family status in the observation group were significantly higher than those in the control group (t values were 3.282, 3.214, all Ps<0.05), and the scores of additional attention, emotional status and physiological status were significantly lower than those in the control group (t values were 3.121, 3.512, 3.526, all Ps<0.05). During the treatment period, the incidence of cardiac toxicity, liver toxicity, renal toxicity, bone marrow suppression, nausea and vomiting, abdominal pain and diarrhea in the observation group were significantly lower than those in the control group (χ2 value were 4.947, 4.893, 4.525, 4.692, 4.637, 4.905, respectively, all Ps<0.05). During the follow-up, the 1, 2 year survival rate in the observation group was higher than those in the control group (χ2 value were 3.782, 3.893, respectively, all Ps<0.05). Conclusions The Kangai-Guben-Xiaozheng decoction based on the theory of cancer pathogenesis, combined with TP regimen show effectiveness for the Ⅳ stage of ovarian cancer of the elderly patients.
ABSTRACT
Objective To develop a better method for preparation of porcine model of acute myocardial infarction by permanent occlusion of the left circumflex coronary artery and minimally invasive surgery, evaluate its validity and stability, and explore its application in experimental studies of ischemic heart diseases.Methods 25 healthy female 3-month-old Bama minipigs, body weight 25±3 kg, were used in this study.The porcine model of myocardial infarction was established by minimally invasive surgery and the left circumflex artery ligation at the site of OM1 posterior position under general anesthesia.Heart function was assessed by echocardiography at 15 min before surgery, 1 hour and 4 weeks after surgery.Pathological examination was performed at 4 weeks after the left circumflex artery occlusion.The mortality and cause of death were statistically analyzed.Results The 1-hour and 4-week postoperative cardiac function was considerably decreased, showing a decreased ejection fraction from 64.2±4.6% to 48.2±5.3% (1hour after MI) and 49.7±6.1% (4 weeks after MI) (P<0.01).Pathological examination revealed that the ventricular wall was thinner and the amount of collagens was increased in the infracted area.The ventricular fibrillation rate at 1-hour after myocardial infarction was 17.3% and the infarction area was 19.2%.Conclusions A pig model of acute myocardial infarction can be prepared by our modified left circumflex coronary artery ligation at the obtuse marginal artery (OM1) and minimally invasive surgery.This model exhibits advantages such as minimal surgical trauma, high stability of the model, and low mortality, therefore, provides an ideal and economic animal model for experimental studies on acute ischemic heart diseases.
ABSTRACT
Objective To establish a porcine allogeneic left lung orthotopic transplantation model to closely simu-late human lung transplantation.Methods Twelve Huanjiang mini-pigs were used as donors and 12 Bama mini-pigs as recipients.The left lung orthotopic transplantation was completed by the left fourth intercostal thoracotomy.At 1 h, 2 h, 4 h, 6 h, 12 h after transplantation, the left and right pulmonary artery pressure were measured, the left and right pulmonary vein blood gas was analyzed, and samples of the left and right lung tissues were taken to determine the water content and for pathological examination.Results All animals survived, and the transplanted pulmonary vein blood PaO2/FiO2 and PAP were rised along with the prolonged postoperative time, compared with those of the recipient normal lung showing a signifi-cant difference (P<0.05).With the pass of time, there were increasing edema, inflammatory cell infiltration, RBC ooze, thickening of alveolar wall in the transplanted lung tissue, and some alveolar lumen occlusion and lung tissue consolidation. The water content of the transplanted lung tissue was increased significantly compared with that in the recipient lung tissue ( P<0.05 ) .Conclusions The established method in this study provides an ideal animal model for research on lung transplantation ischemia-reperfusion injury and immune rejection mechanism.
ABSTRACT
Objective To modify the techniques for establishment of an abdominal working heart transplantation model in rats and to sum up the key factors to success.Methods A total of 180 12-week old Brown Norway rats ( donor) and Lewis rats ( recipient) were used in this study:50 BN rats and 50 Lewis rats for pilot experiment, and 40 BN rats and 50 Lewis rats for the formal experiment.The rat model of working heart heterotopic transplantation was adopted and estab-lished by Wiedemann’ s mode.We transplanted the heart from BN rats to Lewis rats and analyzed the survival rate, causes of death and histological changes of the heart ( HE staining) in this experiment.Results After exercise and modification, the survival rate was increased to 77.5%, and the mean total duration of operation was 71 ±11 min, and the mean ische-mic time of the donor hearts was 34 ±5 min.Histological examination ( HE staining) of the cardiac allograft showed a mild inflammatory cell infiltration in the graft at 24 h after transplantation, indicating that the model was reliable.Conclusions A variety of factors may affect the final operation success rate in the establishment of this heart transplantation model.A-mong them, the major affecting factors include: healthy animals, donor heart protection, rapid and effective vascular su-ture, and postoperative animal management.