Application of improved Glasgow coma scale score as switching point for sequential invasive-noninvasive mechanical ventilation on chronic obstructive pulmonary disease (COPD) with respiratory failure.

BACKGROUND: To compare the efficacy and feasibility of using a modified Glasgow coma scale (GCS) score of 13 or 15 as the criterion for switching chronic obstructive pulmonary disease (COPD) patients with respiratory failure to sequential invasive-noninvasive ventilation. METHODS: COPD patients with respiratory failure who had undergone endotracheal intubation and invasive mechanical ventilation (IMV) between June 2017 and June 2020 at 4 different hospitals in China were included. A total of 296 patients were randomly divided into 2 groups. In group A, the patients were extubated and immediately placed on noninvasive ventilation (NIV) when the modified GCS score reached 13. In group B, the same was done when the modified GCS score reached 15. RESULTS: No significant differences in the mean blood pressure, oxygenation index, arterial partial pressure of oxygen, and arterial partial pressure of carbon dioxide were seen between groups A and B before extubation and 3 hours after NIV. The re-intubation times were also similar in the 2 groups. Compared to group B, the length of hospital stay, incidence of ventilator associated pneumonia, and time of invasive ventilation were all significantly lower in group A (P = .041, .001, <.001). CONCLUSION: Using a modified GCS score of 13 as the criterion for switching from IMV to NIV can significantly reduce the duration of IMV, length of hospital stay, and incidence of ventilator associated pneumonia in COPD patients with respiratory failure.

An analysis of the surgical outcomes of laparoendoscopic single-site myomectomy and multi-port laparoscopic myomectomy.

BACKGROUND: This study sought to compare the surgical results of patients undergoing a laparoendoscopic single-site myomectomy (LESS-M) and a conventional laparoscopic myomectomy (CLM) at our hospital. METHODS: The basic data of 233 patients undergoing LESS-M and 233 patients undergoing CLM at the Obstetrics and Gynecology Hospital Affiliated to Fudan University were collected from January 2018 to January 2020, and the results of the operations were compared by evaluating a number of factors, including operation time, intraoperative bleeding, postoperative fever, and postoperative maximum body temperature. RESULTS: The operation times of the LESS-M and CLM groups were 83.9±33.4 and 75.2±26.7 min, respectively; the difference between the groups was statistically significant. The surgical blood loss of the LESS-M group was 86.1±76.9 mL, and that of the CLM group was 83.8±79.9 mL (P>0.05). When the diameter of a fibroid was ≥8 cm, a fibroid was located in the posterior wall or the number of fibroids was ≥4, the operation time of the CLM group was shorter than that of the LESS-M group. When the diameter of a fibroid was ≥8 cm, the blood loss of the CLM group was less than that of the LESS-M group. CONCLUSIONS: LESS-M is safe and feasible. If the diameter of a fibroid is ≥8 cm, the fibroid is located in the posterior wall, or the number of fibroids is ≥4, the utility of single-port surgery should be carefully considered.

Use of the modified Glasgow Coma Scale score to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with AECOPD and respiratory failure.

Sequential invasive-noninvasive ventilation (NIV) improves the outcomes of patients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (AECOPD); however, there is no clear consensus on the optimal timing of the switch to sequential invasive-NIV in these patients. In the present study, a potential role for the modified Glasgow Coma Scale (GCS) score to guide sequential weaning was investigated. Patients with AECOPD and respiratory failure were prospectively recruited from three study centers (Wenling Hospital Affiliated to Wenzhou Medical University, the First Affiliated Hospital of Wenzhou Medical University and Changsha Central Hospital) between January 1st 2016 and December 31st 2018. Patients were randomly assigned to group A and B, with the switching point for sequential weaning strategy in the two groups being a modified GCS score ≥13 and 10 points, respectively. Each group included 240 patients. Baseline demographic characteristics were comparable in the two groups. The duration of invasive mechanical ventilation (IMV) in group A was significantly shorter than that in group B. However, there were no significant between-group differences with respect to the incidence of re-intubation, ventilator-associated pneumonia, in-hospital mortality or the length of hospital stay. Use of a modified GCS score ≥13 as the switching point for sequential invasive-NIV may help decrease the duration of IMV in patients with AECOPD and respiratory failure.

[Protective effect of ulinastatin on myocardium after cardiopulmonary resuscitation in rats].

OBJECTIVE: To investigate the changes in serum creatine kinase isoenzyme (CK-MB) and cardiac troponin I (cTnI) levels and the ultrastructure of myocardium, and the effect of ulinastatin after cardiopulmonary resuscitation (CPR) in rats. METHODS: One hundred and twenty Sprague-Dawley (SD) rats were randomly divided into sham operation group, CPR group and ulinastatin group. And each group was divided into five subgroups (n=8) according to time points of 0.5, 3, 6, 12, 24 hours after tracheostomy in sham operation group or after restoration of spontaneous circulation (ROSC) in CPR group and ulinastatin group. Cardiac arrest (CA) and CPR models were reproduced by asphyxia in CPR group and ulinastatin group, with injection of ulinastatin 100 kU/kg via carotid 2 minutes after ROSC in ulinastatin group. Normal saline was given in the same dosage as ulinastatin in CPR group. Serum samples was taken at each time point of subgroups for measuring serum levels of CK-MB and cTnI. The ultrastructure changes in myocardium were observed under the electron microscope. RESULTS: The serum levels of CK-MB and cTnI were increased from 0.5 hours after ROSC in CPR group and ulinastatin group compared with sham operation group ( all P<0.01), and CK-MB peaked at 12 hours, then decreased. The serum CK-MB or cTnI levels started to decreased from 3 hours or 0.5 hours after ROSC in ulinastatin group compared with CPR group (P<0.05 or P<0.01). There were milder pathological changes of ultrastructure of myocardium in ulinastatin group than in CPR group. CONCLUSION: Ulinastatin could decrease serum levels of CK-MB and cTnI, and alleviate myocardial injury after CPR in rats.