[Circadian variation of the incidence of upper gastrointestinal bleeding and its relationship with climatic factors].

OBJECTIVE: To study the circadian patterns of the incidence of upper gastrointestinal bleeding (UGIB) and its relationship with climatic factors in Beijing. METHODS: We searched all UGIB records from August 1, 2005 to July 31, 2007 from Beijing Emergency Center and tracked the meteorological data during the same period. The variation of the incidence of UGIB was compared based on day, month, and season. The relation between climatic factors and the incidence of UGIB was also analyzed. RESULTS: Totally 2 580 patients, including 1 888 males (73.2%) and 692 females (26.8%) were included in the study. The mean age was significantly different between males and females [(53.3 +/- 20.4) years vs. (63.3 +/- 20.7) years, P < 0.05]. The occurrence of UGIB were significantly different among different seasons (chi2 = 49.82, P < 0.01), months (chi2 = 83.43, P < 0.01), and hours (chi2 = 126.79, P < 0.01). UGIB cases were presented more frequently in winter and spring, especially in January. More UGIB cases were presented at night, especially from 8 pm to midnight. Partial correlation test showed that the incidence of UGIB significantly correlated with temperature (r = -0.3785, P = 0.001) and barametric pressure (r = -0.3002, P = 0.011). No correlation was found between UGIB incidence and wind speed (P = 0.086) and relative humidity (P = 0.971). CONCLUSIONS: The incidence of UGIB varies in different months and seasons in Beijing. Its climate-related risk factors may include temperature and barametric pressure, but not include relative humidity and wind speed.

[Effects of methylene blue on refractory hemorrhagic shock].

OBJECTIVE: To evaluate the effects of methylene blue (MB) on refractory hemorrhagic shock. METHODS: Totally 24 rabbits subjected to prolonged hemorrhagic shock and resuscitation were randomly divided into hemorrhagic shock group (12 rabbits) and MB group (12 rabbits; MB was administered immediately after resuscitation was performed). The plasma levels of tumor necrosis factor alpha (TNFalpha) , interleukin (IL)-6, IL-8, nitric oxide (NO), lactic acid (LA) , and mean arterial pressure (MAP) were detected before shock, immediately after resuscitation, and 0.5, 2, and 4 hours after resuscitation. The 12-hour survival rates were observed. RESULTS: The plasma levels of TNFalpha, IL-6, IL-8, NO and LA after shock were significantly higher than before shock (P <0.01), and maintained at high levels. Compared with the shock group, higher MAP and lower plasma levels of TNFalpha, IL-6, IL-8, NO, and LA were observed in the MB group after resuscitation (P<0.01). The 12-hour survival rates were not significantly different between shock group and MB group. CONCLUSION: Although MB can not improve the prognosis of refractory hemorrhagic shock, it can increase and maintain the MAP and thus play a beneficial role in the treatment of hemorrhagic shock.

[Apoptosis of gastric mucosa and gastric barrier dysfunction in acute ischemic stroke].

OBJECTIVE: To evaluate the role of gastric mucosa apoptosis in the stress of ischemic stroke, and to discuss the relationship between gastric mucosa apoptosis and gastric barrier. METHODS: Ten dogs were artificially made ischemic stroke by operation (IS group), and another 10 shamly-operated dogs were served as control group. Sucrose permeability were measured after the operation. All dogs were sacrificed 24 hours after operation to measure the gastric mucosal apoptosis index, gastric gross classification, and histological score. RESULTS: The gastric mucosal apoptosis index in the IS group were significantly higher than in the control group (14.83 +/- 4.41 vs. 5.60 +/- 2.61, P < 0.05). The gastric mucosal apoptosis index were correlated with the sucrose permeability (r = 0. 89, P < 0.05) , gastric gross classification (r = 0. 87, P < 0.05), and histological score (r = 0.92, P < 0.05). CONCLUSIONS: Although ischemic stroke will not cause the obvious damage in the respiratory and circulatory system, it is responsible for the apoptosis of epithelial cell in the gastric mucosa and gastric barrier dysfunction. The apoptosis index is closely correlated with the damage of the function and morphology of the gastric barrier, indicating that the epithelial cell apoptosis acceleration in the gastric mucosa may result in the damage of gastric barrier function.

[Clinical features of respiratory failure secondary to hypothyroidism].

OBJECTIVE: To explore the clinical features of respiratory failure secondary to hypothyroidism. METHOD: We retrospectively analyzed the clinical data of 4 patients with respiratory failure secondary to hypothyroidism. RESULTS: Respiratory failure secondary to hypothyroidism usually happened in the aged patients, presenting as myxedema, disturbance of consciousness, anemia, and hyponatrium. Respiratory symptoms were rare. Type II respiratory failure might occur as disease progressed. The clinical presentation of hypothyroidism was atypical and easily neglected. The hypoxia and hypercapnia ameliorated after thyroid hormone therapy. CONCLUSION: Hypothyroidism is a rare reason of respiratory failure. The prognosis is good after hormone therapy and mechanical ventilation.

[Functional hemodynamic monitoring].

Hemodynamic monitoring is important for critically ill patients in emergency medicine. While the conventional static hemodynamic monitoring may not accurately reflect the hemodynamic status, functional hemodynamic monitoring can dynamicly and individually monitor the hemodynamic status, and thus becomes a valuable supplementation for conventional static hemodynamic monitoring. This article reviews the limitations of conventional hemodynamic monitoring and introduces the methodology of functional hemodynamic monitoring.

[Gastrointestinal dysfunction/failure and critical care medicine].

This article reviews the recent advances in gastrointestinal function research, especially the gastrointestinal dysfunction/failure in critical care medicine.

[An analysis of the early diagnostic criteria for tuberculosis meningitis].

OBJECTIVE: To find a method for the early diagnosis of tuberculous meningitis (TM). METHODS: Cases with the discharge diagnosis of TM during 1995 - 2004 ten years in the Peking Union Medical College Hospital were analyzed retrospectively. History of tuberculosis other sites of tuberculous infection, the findings of cerebrospinal fluid (CSF) and CSF culture result were studied. RESULTS: 16 of the 68 patients had past history of tuberculosis. During hospitalization 20 had pulmonary tuberculosis, while 9 had other sites of tuberculous infection. The rate of tuberculous infection aside from neurological system was 43%. The top 7 clinical manifestations were: coma, onset of the disease more than 5 days, lymphocyte predominant in CSF, glucose level in CSF 50% lower than that of blood, abnormal CT findings. Abnormal ocular fundi and proved tuberculosis of other sites. CONCLUSIONS: TM is often accompanied with tuberculous infection of other sites. Its diagnosis can not be relied mainly on the culture result of CSf. When 4 of the 7 above mentioned criteria are present, TM should be diagnosed and anti-tuberculosis therapy started.