[The value of passive leg raising test in predicting fluid responsiveness in patients with sepsis-induced cardiac dysfunction].

OBJECTIVE: To assess the value of passive leg raising (PLR) test in predicting fluid responsiveness in patients with sepsis-induced cardiac dysfunction. METHODS: A prospective observational cohort study was conducted. Thirty-eight patients under mechanical ventilation suffering from sepsis-induced cardiac dysfunction admitted to Department of Surgical Intensive Care Unit of First Affiliated Hospital of Sun Yat-Sen University from September 2013 to July 2014 were enrolled. The patients were studied in four phases: before PLR (semi-recumbent position with the trunk in 45°), PLR (the lower limbs were raised to a 45° angle while the trunk was in a supine position), before volume expansion (VE, return to the semi-recumbent position), and VE with infusing of 250 mL 5% albumin within 30 minutes. Hemodynamic parameters were recorded in every phase. The patients were classified into two groups according to their response to VE: responders (at least a 15% increase in stroke volume, A SV(VE) ≥ 15%), and non-responders. The correlations among all changes in hemodynamic parameters were analyzed by linear correlation analysis, and the receiver operating characteristic curve (ROC) was plotted to assess the value of hemodynamic parameters before and after PLR in predicting fluid responsiveness. RESULTS: Of 38 patients, 25 patients were responders, and 13 non-responders. There was no significant difference in the baseline and hemodynamic parameters at semi-recumbent position between the two groups. The changes in SV and cardiac output (CO) after PLR (Δ SV(PLR) and Δ CO(PLR)) were significantly higher in responders than those of non-responders [ Δ SV(PLR): (14.7 ± 5.7)% vs. (6.4 ± 5.3)%, t = 4.304, P = 0.000; ΔCO(PLR): (11.2 ± 7.5)% vs. (3.4 ± 2.3)%, t = 3.454, P = 0.001], but there was no significant difference in the changes in systolic blood pressure, mean arterial pressure, pulse pressure, and heart rate after PLR (Δ SBP(PLR), Δ MAP(PLR), Δ PP(PLR) and Δ HR(PLR)) between two groups. Δ SV(VE) in responders was significantly higher than that of the non-responders [(20.8 ± 5.5) % vs. (5.0 ± 3.7) %, t = 8.347, P = 0.000]. It was shown by correlation analysis that ΔSV(PLR) was positively correlated with Δ SV(VE) (r = 0.593, P = 0.000), Δ CO(PLR) was positively correlated with ΔSV(VE) (r = 0.494, P = 0.002). The area under ROC curve (AUC) of Δ SV(PLR) ≥ 8.1% for predicting fluid responsiveness was 0.860 ± 0.062 (P = 0.000), with sensitivity of 92.0% and specificity of 70.0%; the AUC of Δ CO(PLR) ≥ 5.6% for predicting fluid responsiveness was 0.840 ± 0.070 (P = 0.000), with sensitivity of 84.0% and specificity of 76.9%; the AUC of Δ MAP(PLR) ≥ 6.9% for predicting fluid responsiveness was 0.662 ± 0.089, with sensitivity of 68.0% and specificity of 76.9%; the AUC of Δ SBP(PLR) ≥ 6.4% for predicting fluid responsiveness was 0.628 ± 0.098, with sensitivity of 76.0% and specificity of 61.5%; the AUC of Δ PP(PLR) ≥ 6.2% for predicting fluid responsiveness was 0.502 ± 0.094, with sensitivity of 56.0% and specificity of 53.8%; the AUC of Δ HR(PLR) ≥ -1.7% for predicting fluid responsiveness was 0.457 ± 0.100, with sensitivity of 56.0% and specificity of 46.2%. CONCLUSION: In patients with sepsis-induced cardiac dysfunction, changes in SV and CO induced by PLR are accurate indices for predicting fluid responsiveness, but the changes in HR, MAP, SBP and PP cannot predict the fluid responsiveness.

Examination and analysis of recurrent spontaneous abortion couples karyotype / 国际检验医学杂志

Objective To investigate the correlation between recurrent spontaneous abortion and karyotype correlation,and provide reference for clinical diagnosis and treatment of spontaneous abortion.Methods 51 couples peripheral blood lymphocyte were collected and cultured from March 2010 to March 2013 in the region.Karyotype analysis were performed to observe the distribution of the rate of chromosomal abnormalities situation.Meanwhile the correlation between the number of abortions and chromosomes were compared.Results Among the 102 subjects,32 cases(31.37％)of them were found chromosomal abnormalities in RSA.The ratio of polymorphic mutation accounted for 56.25 ％ of the chromosome abnormality.accounting for 17.65 ％ the total.Which was significantly higher than other chromosomal abnormalities(P＜0.05).Among the RSA and chromosomal karyotype cases,females accounted for 68.75 ％,which was significantly higher than males (31.25 ％)(P＜0.05).46XY(Y≥18)has the highest incidence in chromosome polymorphism,accounting for 33.33 ％,while abortions accounting for 30.77 ％.RSA number and incidence of chromosomal abnormalities to miscarriages three times the highest rate of abnormal,accounting for 43.48％.Conclusion Chromosomal abnormalities is an important factor in recurrent spontaneous abortion.Recurrent abortion is not only related to the structure of chromosomes,but also has a certain relationship with the variation of chromosome polymorphism.

Analysis on the effect of insulin subcutaneous pump combined with psychological intervention on the treatment of gestational diabetes mellitus / 中国生化药物杂志

Objective To explore the effect of insulin subcutaneous pump combined with psychological intervention on gestational diabetes mellitus.Methods A total of 118 patients were enrolled in this study from November 2015 to October 2016 in Lishui central hospital.The patients were randomly divided into the experimental group and the control group according to the time of hospitalization.The experimental group was given insulin subcutaneous pump combined with psychological intervention.The control group was given insulin subcutaneous pump.Results After intervention, the degree of complete compliance in the experimental group was 86.44% and 28.81% before intervention, the difference was statistically significant(P<0.05).Compared with before treatment, blood glucose and glycosylated hemoglobin were decreased after treatment(P<0.05).The incidence of complications in the two groups include: pregnant women with excessive amniotic, neonatal hypoglycemia, pregnancy induced hypertension syndrome and so on.The difference of complication rate between the two groups was statistically significant(P<0.05).Conclusion The timely and accurate psychological guidance of pregnant women with diabetes mellitus can control the blood glucose in the normal range, reduce the occurrence and development of maternal and child complications, and ensure the safe and healthy mother and child health.

Bacteriological analysis and treatment strategy in patients with biliary sepsis / 中华肝胆外科杂志

Objectives To access the bacteriology in patients with sepsis due to biliary tract infection to provide a basis for empirical selection of proper antibiotic treatment.Methods This is a single-center retrospective study on 214 patients with biliary tract infection admitted from August 2014 to July 2016 to the surgical intensive care units (ICU) of The First Affiliated Hospital of Sun Yat-sen University.To study the demographic information,sequential organ failure assessment (SOFA),usage of antibiotics before ICU and duration of ICU were analyzed.Bile,peritoneal drainage and blood samples were collected.Results 47 septic shock patients and 25 septic patients due to biliary tract infection were enrolled in the trial.The two groups (the shock group vs.the sepsis group) had a significant difference in the duration of ICU stay [(6.4 ± 4.6) d vs.(2.3 ± 1.8) d,P ＜ 0.05].48 strains of pathogens were isolated from the bile samples.The major pathogens were Escherichia coli (E.coli) (n =23,47.9％),Enterococcus faecalis (n =8,16.7％) and Enterococcus faecium (n =2,4.2％).80 strains of pathogens were isolated from the peritoneal drainage culture samples.E.coli,pseudomonas aeruginosa,and Klebsiella pneumoniae ranked the top 3 species,accounting for 26.3％,11.3％ and 7.5％,respectively.The sensitivity of E.coli isolated from bile to amikacin,imipenem and panipenem were all over 90.0％.Conclusions E.coli was the principal gram-negative bacterium in biliary infection induced sepsis.Early administration of carbapenemes may reduce the occurrence of septic shock in these patients.

The value of passive leg raising test in predicting fluid responsiveness in patients with sepsis-induced cardiac dysfunction / 中华危重病急救医学

ObjectiveTo assess the value of passive leg raising (PLR) test in predicting fluid responsiveness in patients with sepsis-induced cardiac dysfunction.Methods A prospective observational cohort study was conducted. Thirty-eight patients under mechanical ventilation suffering from sepsis-induced cardiac dysfunction admitted to Department of Surgical Intensive Care Unit of First Affiliated Hospital of Sun Yat-Sen University from September 2013 to July 2014 were enrolled. The patients were studied in four phases: before PLR (semi-recumbent position with the trunk in 45°), PLR (the lower limbs were raised to a 45° angle while the trunk was in a supine position), before volume expansion (VE, return to the semi-recumbent position), and VE with infusing of 250 mL 5% albumin within 30 minutes. Hemodynamic parameters were recorded in every phase. The patients were classified into two groups according to their response to VE: responders (at least a 15% increase in stroke volume,ΔSVVE≥15%), and non-responders. The correlations among all changes in hemodynamic parameters were analyzed by linear correlation analysis, and the receiver operating characteristic curve (ROC) was plotted to assess the value of hemodynamic parameters before and after PLR in predicting fluid responsiveness.Results Of 38 patients, 25 patients were responders, and 13 non-responders. There was no significant difference in the baseline and hemodynamic parameters at semi-recumbent position between the two groups. The changes in SV and cardiac output (CO) after PLR (ΔSVPLR andΔCOPLR) were significantly higher in responders than those of non-responders [ΔSVPLR: (14.7±5.7)%vs. (6.4±5.3)%,t = 4.304,P = 0.000;ΔCOPLR: (11.2±7.5)% vs. (3.4±2.3)%,t = 3.454,P = 0.001], but there was no significant difference in the changes in systolic blood pressure, mean arterial pressure, pulse pressure, and heart rate after PLR (ΔSBPPLR,ΔMAPPLR,ΔPPPLR andΔHRPLR) between two groups.ΔSVVE in responders was significantly higher than that of the non-responders [(20.8±5.5) % vs. (5.0±3.7) %,t = 8.347,P = 0.000]. It was shown by correlation analysis thatΔSVPLR was positively correlated withΔSVVE (r = 0.593,P = 0.000),ΔCOPLR was positively correlated withΔSVVE (r = 0.494,P = 0.002). The area under ROC curve (AUC) ofΔSVPLR≥8.1% for predicting fluid responsiveness was 0.860±0.062 (P = 0.000), with sensitivity of 92.0% and specificity of 70.0%; the AUC ofΔCOPLR≥5.6% for predicting fluid responsiveness was 0.840±0.070 (P = 0.000), with sensitivity of 84.0%and specificity of 76.9%; the AUC ofΔMAPPLR≥6.9% for predicting fluid responsiveness was 0.662±0.089, with sensitivity of 68.0% and specificity of 76.9%; the AUC ofΔSBPPLR≥6.4% for predicting fluid responsiveness was 0.628±0.098, with sensitivity of 76.0% and specificity of 61.5%; the AUC ofΔPPPLR≥6.2% for predicting fluid responsiveness was 0.502±0.094, with sensitivity of 56.0% and specificity of 53.8%; the AUC ofΔHRPLR≥-1.7%for predicting fluid responsiveness was 0.457±0.100, with sensitivity of 56.0% and specificity of 46.2%.Conclusion In patients with sepsis-induced cardiac dysfunction, changes in SV and CO induced by PLR are accurate indices for predicting fluid responsiveness, but the changes in HR, MAP, SBP and PP cannot predict the fluid responsiveness.

Effects of different doses in continuous veno-venous hemofiltration on plasma lactate in critically ill patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many studies have shown that continuous renal replacement therapy (CRRT) could clean lactate and treat the hyper-lactatemia. On the contrary, some other studies found that filter lactate clearance only accounted for a very small part of total lactate clearance and the hemofilter's contribution to the overall lactate clearance was negligible. The objective of this study was to evaluate the effects of various doses of continuous veno-venous hemofiltration (CVVH) on plasma lactate elimination in critically ill patients.</p><p><b>METHODS</b>Patients were divided into three groups according to their incipient plasma lactate concentration. Group A: lactate ≤ 2 mmol/L, group B: lactate 2-5 mmol/L, group C: lactate ≥ 5 mmol/L. Three different doses (20 ml × kg(-1)× h(-1), 35 ml × kg(-1)× h(-1) and 45 ml × kg(-1)× h(-1)) of CVVH were applied to critically ill patients who experiencing CVVH. The concentrations of plasma lactate in pre-(A), post-dialyzer (V) sites and ultrafiltrate were measured after each dosage of CVVH was carried out for 30 minutes. Rate of lactate clearance by the filter (RLC) and filter lactate clearance (FLC) and Lactate-Sieving Coefficient (LSC) were calculated under different circumstances, including different doses of CVVH and different incipient lactate levels.</p><p><b>RESULTS</b>Fifteen patients were enrolled and 104 blood samples were drawn and lactate concentrations were measured in this study. RLC was found increased ((9.36 ± 9.73) mmol/h, (13.92 ± 12.56) mmol/h and (16.52 ± 12.71) mmol/h, P < 0.05 respectively) with the dose of CVVH increased. RLC was also increased ((3.46 ± 1.46), (10.38 ± 5.50) and (24.53 ± 14.69) mmol/h, P < 0.05 respectively) with the incipient lactate increased. FLC was increased ((1.95 ± 0.63), (2.95 ± 0.74) and (3.45 ± 0.54) L/h, P < 0.05 respectively) with the dose of CVVH increased. There was no significant difference of LSC in different doses of CVVH and different incipient lactate levels.</p><p><b>CONCLUSIONS</b>Plasma lactate can be eliminated by CVVH and different doses of CVVH affect the rate of lactate clearance in critically ill patients.</p>

The Difference of Blood Chromosomal Centromeric dots of Patients Infected by CMV after Anti-virus Treatment / 医学研究杂志

Objective To study the change of chromosomal centrimeric dots(Cd)aberration of patents infected by CMV after anti-virus treatment.Methods 22 cases who had spontaneous abortion early and infected by CMV(PCR detection)were studied.We analyzed their blood Cd by simultaneous silver attaining technique before and after treatment by anti-virus medicines respectively.Results The rate of Cd aberration of patients infected by CMV was higher.But after treatment by anti-virus drugs,the rate would decrease gradually(P

Oxidant injury mediates TGF-β up-regulation in ventilator induced lung injury / 解放军医学杂志

Objectives To explore ventilation induced cytokine production and the role of oxidant stress in lung stretch. Methods Both in vitro and in vivo models of ventilator-induced lung injury (VILI) were used. Alveolar epithelial cells were stretched in vitro to mimic the lung injury in VILI. Rats were ventilated at large tidal volume to produce ventilator-induced lung injury in vivo. A total of 23 inflammatory cytokines were screened with micro gene array in stretched alveolar epithelial cells. Cytokines found to have up-regulated in cells were measured in serum and lung tissue of rats exposed to large tidal volume ventilation. For investigating the intracellular pathway of cytokine up-regulation in VILI, exogenous TNF-α or H2O2 was added to culture media of alveolar epithelial cells. Cytokines were then measured. To explore the role of oxidant stress in VILI, N-acetylcysteine (NAC), as an anti-oxidant, was used in vitro and in vivo. Results We found that transforming growth factor-β1 (TGF-β1 and transforming growth factor-β2 (TGF β2) were up-regulated in stretched alveolar epithelial cells and also in serum of rats with large tidal volume ventilation. Tumor necrosis factor-α (TNF-α) had no effects on TGF-β production in alveolar epithelial cells. Exogenous H2O2, as an oxidant, increased TGF-β production in alveolar epithelial cells. NAC, an anti-oxidant, decreased stretch induced TGF-β production, along with a down-regulation of oxidant injury. NAC also blocked the up-regulation of TGF-β in in vivo model of VILI. Conclusion TGF-β1 and TGF-β2 were up-regulated in VILI. Oxidant injury mediated up-regulation of TGF-β in VILI. NAC, which attenuated oxidant injury and blocked TGF-β up-regulation in VILI, could be a future therapeutic strategy in VILI.

Fungal infection following orthotopic liver transplantation: report of 43 cases / 中国普通外科杂志

ObjectiveTo improve the diagnosis, treatment and prophylaxis of fungal infections following orthotopic liver transplantation (OLT). Methods Medical records from 175 consecutive patients who underwent 180 OLT at our centre from 1993 and 2002 were retrospectively reviewed for fungal infection. ResultsTwenty nine patients(16 6%) developed invasive fungal infection. Median posttransplantation interval was 26 days (range 3 to 96) and respiratory tract was the most common infectious site (37%). Pathogens were Candida species (24 of 43, 98%) and Aspergillus (1 of 43, 2%). Fungal infections occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use over 3 weeks or hepatic artery complications. After treatment with Fluconazole (26 patients) and liposomal amphotericin B (8 patients with serious fungal infections), 16 patients were cured and 13 patients died. The mortality related to fungal infection was 4 0% (7/175). Conclusion Fungal infections are associated with mortality following OLT. Eliminating the various risk factors will decrease the incidence of fungal infection. Amphotericin B or liposomal amphoterin B are effective for patients with serious fungal infection.

Oxidant injury mediates TGF-? up-regulation in ventilator induced lung injury / 解放军医学杂志

Objectives To explore ventilation induced cytokine production and the role of oxidant stress in lung stretch. Methods Both in vitro and in vivo models of ventilator-induced lung injury (VILI) were used. Alveolar epithelial cells were stretched in vitro to mimic the lung injury in VILI. Rats were ventilated at large tidal volume to produce ventilator-induced lung injury in vivo. A total of 23 inflammatory cytokines were screened with micro gene array in stretched alveolar epithelial cells. Cytokines found to have up-regulated in cells were measured in serum and lung tissue of rats exposed to large tidal volume ventilation. For investigating the intracellular pathway of cytokine up-regulation in VILI, exogenous TNF-? or H_ 2O_ 2 was added to culture media of alveolar epithelial cells. Cytokines were then measured. To explore the role of oxidant stress in VILI, N-acetylcysteine (NAC), as an anti-oxidant, was used in vitro and in vivo. Results We found that transforming growth factor-?_1 (TGF-?_1 and transforming growth factor-?_2 (TGF-?_2) were up-regulated in stretched alveolar epithelial cells and also in serum of rats with large tidal volume ventilation. Tumor necrosis factor-? (TNF-?) had no effects on TGF-? production in alveolar epithelial cells. Exogenous H_ 2O_ 2, as an oxidant, increased TGF-? production in alveolar epithelial cells. NAC, an anti-oxidant, decreased stretch induced TGF-? production, along with a down-regulation of oxidant injury. NAC also blocked the up-regulation of TGF-? in in vivo model of VILI. Conclusion TGF-?_1 and TGF-?_2 were up-regulated in VILI. Oxidant injury mediated up-regulation of TGF-? in VILI. NAC, which attenuated oxidant injury and blocked TGF-? up-regulation in VILI, could be a future therapeutic strategy in VILI.