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Objective:To investigate the volume management of intermittent veno-venous hemofiltration (IVVH) guided by critical care ultrasound in the treatment of acute kidney injury (AKI) in patients with heart failure (HF).Methods:A total of 216 patients with HF and AKI treated with IVVH in the coronary care unit (CCU) of the Third Central Hospital of Tianjin from April 2019 to June 2022 were selected as the study subjects, the patients were randomly divided into conventional guidance group (107 cases) and ultrasound guidance group (109 cases). According to the recovery of renal function, IVVH was performed 12 hours every day or 12 hours every other day. The conventional guidance group selected the conventional method to formulate IVVH prescription, and the ultrasound guidance group used critical care ultrasound to adjust the treatment parameters of IVVH on the basis of the conventional guidance group. Respiratory variation index (RVI) of inferior vena cava (IVC), right left ventricular end-diastolic transverse area ratio, early diastolic peak mitral flow velocity/mitral annulus velocity peak (E/E'), aortic flow velocity time integral (VTI), cardiac output (CO), bilateral lung ultrasound B-line range, bilateral renal interlobar arteries resistance index (RI) were recorded before and 3, 6, 9 hours after each treatment. The net dehydration rate was adjusted in real time according to the comprehensive results. Urine volume, serum creatinine (SCr), estimated glomerular filtration rate (eGFR), blood B-type brain natriuretic peptide (BNP), β 2-microglobulin (β 2-MG) and cystatin C (Cys C) levels of patients in both groups were monitored before and 3, 7 and 10 days after initial treatment, and renal function recovery and clinical prognostic indexes of patients in both groups were recorded. Results:The dehydration rate of the ultrasound guidance group was slow at the beginning of IVVH, and gradually increased after 6 hours, and the overall dehydration rate was significantly slower than that of the conventional guidance group. In the ultrasound guidance group using critical care ultrasound, the RVI gradually increased, the right left ventricular end-diastolic area ratio gradually decreased, the E/E' ratio gradually decreased, and the range of B-line of bilateral lungs gradually decreased, RI of bilateral renal interlobar arteries decreased. At 3, 7 and 10 days after the first IVVH, renal function related indexes in both groups were significantly improved compared with before treatment, and the decline rate of β 2-MG and Cys C in the ultrasound guidance group was faster than that in the conventional guidance group at early (3 days) [β 2-MG (mg/L): 3.69±1.31 vs. 3.99±1.45, Cys C (mg/L): 2.91±0.95 vs. 3.14±0.96, both P < 0.05], urine volume, SCr and eGFR at 7 days were also significantly improved compared with the conventional guidance group [24-hour urine volume (mL): 1 128.23±153.92 vs. 1 015.01±114.18, SCr (μmol/L): 145.86±32.25 vs. 155.64±28.42, eGFR (mL/min): 50.26±11.24 vs. 46.51±10.61, all P < 0.05]. The time of SCr recovery, the time of reaching polyuria, the total time of IVVH treatment, the time of non-invasive mechanical ventilation and the time of living in CCU in the ultrasound guidance group were shorter than those in the conventional guidance group. The incidences of hypotension, long-term RRT, incidence of major cardiovascular adverse event (MACE) and at 28-day mortality were all lower than those in the conventional guidance group. Kaplan-Meier survival curve showed that the 28-day cumulative survival rate in the ultrasound guidance group was significantly lower than that in the conventional guidance group (Log-Rank test: χ 2 = 3.903, P = 0.048). Conclusion:The strategy of IVVH guided by critical care ultrasound in the treatment of HF with AKI has unique advantages.
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Objective:To explore the early diagnosis and correct treatment of neurogenic pulmonary edema (NPE) and review the literature.Method:Retrospective analysis was performed in six patients diagnosed as NPE who were admitted to the emergency department of Tianjin Third Central Hospital from March 2017 to March 2021.Results:Six patients had acute onset, presenting severe dyspnea and hypoxemia, and obvious wet rales could be heard in both lungs. The white blood cell count (WBC) increased to varying degrees (11-22)×10 9/L, procalcitonin (PCT) was normal, or slightly increased, sputum bacteriological examination was negative, and oxygenation index was < 200 mmHg (1 mmHg≈0.133 kPa). Chest CT mainly showed patchy or patchy exudation. The lesions were of different sizes and were not distributed according to lobes. By reducing intracranial pressure, ventilator assisted breathing, liquid therapy, anti-infection therapy with antibiotics, nutritional support, all six patients were well and discharged, and no one died of NPE. Conclusions:NPE has complex condition, acute onset and rapid development. Early diagnosis and correct treatment can improve the success rate of treatment and prognosis of patients with NPE.
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Acute myocardial infarction (AMI) and acute massive pulmonary embolism can be characterized by no pulse electrical activity. Patients of cardiac arrest (CA) with no pulse electrical activity have a high mortality rate before the cause was corrected. Extracorporeal membrane oxygenation (ECMO), as a kind of artificial heart-lung support organ, provides treatment for CA patients. A case of massive pulmonary embolism similar to AMI was treated in the Third Central Hospital of Tianjin, who received interventional thrombolysis assisted by ECMO. Through the review of the overall development of the case, we aim to broaden the diagnosis and treatment of CA patients with no pulse electrical activity, and to improve the understanding of the complications secondary to ECMO.
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Objective:To comprehensively analyze the situation of OTC sold by online pharmacies and put forward some corre-sponding countermeasures so as to provide reference for online pharmacies selling OTC drugs. Methods:The SWOT method was used to analyze the advantages, disadvantages, opportunity and challenges of online pharmacies selling OTC drugs and a conclusion was ob-tained. Results:The share of OTC drugs sold by online pharmacies was gradually raised, and online pharmacies are becoming the main force of the whole pharmacies. Although online pharmacies quickly seized the OTC drugs market, while the development is facing the complex market environment and unprecedented challenges. Conclusion: Although online pharmacies have some difficulties, but the sale of non-prescription drugs online pharmacies can use the traditional marketing theory and the combination of modern business model to find a strategy belonging to the development of the industry, it will be a tendency that more and more consumers buy the OTC in the online pharmacies.
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Acute myocardial infarction (AMI) and acute massive pulmonary embolism can be characterized by no pulse electrical activity. Patients of cardiac arrest (CA) with no pulse electrical activity have a high mortality rate before the cause was corrected. Extracorporeal membrane oxygenation (ECMO), as a kind of artificial heart-lung support organ, provides treatment for CA patients. A case of massive pulmonary embolism similar to AMI was treated in the Third Central Hospital of Tianjin, who received interventional thrombolysis assisted by ECMO. Through the review of the overall development of the case, we aim to broaden the diagnosis and treatment of CA patients with no pulse electrical activity, and to improve the understanding of the complications secondary to ECMO.
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Objective:To comprehensively analyze the situation of OTC sold by online pharmacies and put forward some corre-sponding countermeasures so as to provide reference for online pharmacies selling OTC drugs. Methods:The SWOT method was used to analyze the advantages, disadvantages, opportunity and challenges of online pharmacies selling OTC drugs and a conclusion was ob-tained. Results:The share of OTC drugs sold by online pharmacies was gradually raised, and online pharmacies are becoming the main force of the whole pharmacies. Although online pharmacies quickly seized the OTC drugs market, while the development is facing the complex market environment and unprecedented challenges. Conclusion: Although online pharmacies have some difficulties, but the sale of non-prescription drugs online pharmacies can use the traditional marketing theory and the combination of modern business model to find a strategy belonging to the development of the industry, it will be a tendency that more and more consumers buy the OTC in the online pharmacies.
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Objective@#To evaluate the effect of the ischemic post-conditioning (IPC) on the prevention of the cardio-renal damage in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI).@*Methods@#A total of 251 consecutive STEMI patients underwent PPCI in the heart center of Tianjin Third Central Hospital from January 2012 to June 2014 were enrolled in this prospective, randomized, control, single-blinded, clinical registry study. Patients were randomly divided into IPC group (123 cases) and control group (128 cases) with random number table. Patients in IPC group underwent three times of inflation/deflation with low inflation pressure using a balloon catheter within one minute after culprit vessel blood recovery, and then treated by PPCI. Patients in control group received PPCI procedure directly. The basic clinical characteristics, incidence of reperfusion arrhythmia during the procedure, the rate of electrocardiogram ST-segment decline, peak value of myocardial necrosis markers, incidence of contrast induced acute kidney injury(CI-AKI), and one-year major adverse cardiovascular events(MACE) which including myocardial infarction again, malignant arrhythmia, rehospitalization for heart failure, repeat revascularization, stroke, and death after the procedure were analyzed between the two groups.@*Results@#The age of IPC group and control group were comparable((61.2±12.6) vs. (64.2±12.1) years old, P=0.768). The incidence of reperfusion arrhythmia during the procedure was significantly lower in the IPC group than in the control group(42.28% (52/123) vs. 57.03% (73/128), P=0.023). The rate of electrocardiogram ST-segment decline immediately after the procedure was significantly higher in the IPC group than in the control group (77.24% (95/123) vs. 64.84% (83/128), P=0.037). The peak value of myocardial necrosis markers after the procedure were significantly lower in the IPC group than in the control group(creatine kinase: 1 257 (682, 2 202) U/L vs. 1 737(794, 2 816)U/L, P=0.029; creatine kinase-MB: 123(75, 218)U/L vs.165(95, 288)U/L, P=0.010). The rate of CI-AKI after the procedure was significantly lower in the IPC group than in the control group(5.69%(7/123) vs. 14.06%(18/128), P=0.034). The rate of the one-year MACE was significantly lower in the IPC group than in the control group(7.32%(9/123) vs. 15.63% (20/128), P=0.040).@*Conclusion@#The IPC strategy performed eight before PPCI can reduce myocardial ischemia- reperfusion injury, decline the rates of CI-AKI and one-year MACE significantly in STEMI patients, thus has a significant protective effect on heart and kidney in STEMI patients. Clinical Trial Registration Chinese Clinical Trials Registry, ChiCTR-ICR-15006590.
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Objective To effectually record cardiopulmonary resuscitation (CPR) procedure, analyze and compare the CPR performance of all medical and nursing staffs to find out the existed information for the improvement of the quality of CPR and its survival rate. Methods The medical data were collected according to the Utstein Criteria and CPR event was automatically recorded by a digital video-recording system, by which hands-off times within 10 minutes of CPR and times for installation of chest compression machine, establishment of endotracheal intubation and establishment of the venous channel were analyzed. Multiple regression analysis was conducted to analyze the factors affecting CPR effect. Results ① During the period from December 2009 to December 2015, a total of 376 patients with cardiac arrest (CA) was registered, including 248 males and 128 females, with a median age of 68 (53, 78) years. Estimated median time interval from CA to CPR initiation was 5.0 (0.1, 20.0) minutes and there were 189 cases less than or equal to 5 minutes. The acute myocardial infarction (AMI) with 145 cases (38.6%) was the main etiology of CA. Initial shockable rhythm was found in 16 patients (7.0%) out of 230 out-of-hospital cardiac arrest (OHCA) patients, of whom 13 underwent ventricular fibrillation (5.7%), 3 underwent ventricular tachycardia (1.3%). Initial shockable rhythm was found in 47 patients (32.2%) out of 146 in-hospital cardiac arrest (IHCA) patients, of whom 40 underwent ventricular fibrillation (27.4%), and 7 underwent ventricular tachycardia (4.8%). CPR by a mechanical device (Thumper) was performed in 219 patients (58.2%). In 376 patients, 186 patients had return of spontaneous circulation (ROSC, 49.5%), a successful CPR (ROSC ≥ 24 hours) was found in 110 patients (29.3%), 99 patients was hospitalized alive (26.3%) and 40 patients were discharged alive (10.6%). In 146 cases of IHCA, 89 patients had ROSC (61.0%), a successful CPR was found in 63 patients (43.2%), 56 patients were hospitalized alive (38.4%), and 29 patients were discharged alive (19.9%). In 230 patients of OHCA, 89 patients had ROSC (38.7%), 65 patients received pre-hospital CPR (28.3%), a successful CPR was found in 47 patients (20.4%), 43 patients were hospitalized alive (18.7%), and 11 patients were discharged alive (4.8%). There were 37 patients had a successful CPR (69.8%), and 25 patients were discharged alive (47.2%) in 53 patients with ventricular fibrillation. ② There were 77 patients with valid video information for analysis of CPR performance, with 48 patients of OHCA, and 29 patients of IHCA. Delay median time from the patients presence in the resuscitation room to be placed in rescue bed was 22 (0, 33) seconds. Hands-off median times during 10 minutes of CPR was 41 (18, 90) seconds. Thumper installment median times was 43 (31, 69) seconds. Median time for endotracheal intubation was 59 (35, 109) seconds. Median time of venous catheter placement was 112 (70, 165) seconds. It was shown by multivariate regression analysis that there was a significant correlation between estimated time interval from CA to CPR performed, hands-off time and success rate of CPR (t1 = -3.452, t2 = -2.729), rate of discharge alive (t1 = -2.328, t2 = -2.736, all P < 0.05). In 48 OHCA patients, success rate of CPR was significantly correlated with estimated time interval from collapse to CPR performed (t = -2.409, P = 0.021). In 29 IHCA patients, success rate of CPR and rate of discharge alive was significantly correlated with hands-off times (t1 = -3.412, t2 = -2.536, both P < 0.05). Conclusions Survival to hospital discharge following CA is significantly correlated with the time interval from collapse to CPR performed and hands-off times in CPR. Installment and usage of Thumper should be postponed in order to reduce hands-off times during CPR in IHCA.
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10.3969/j.issn.2095-4344.2013.25.015
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Objective To prepare and evaluate the biocompatibility of polycarbonate coated with low molecular weight heparin (LMWH) and partial oxidation sodium alginate(OSA).Methods Coating material was prepared by means of chemical graft-modification and the feature of the material was determined with infrared spectrum and the stablity of the coating in fluid was examined.Biocompatibility was evaluated by contact angle and in-vitro tests including protein adhesion,platelet adhesion and caugulation.Results LMWH or OSA was tightly combined with polycarbonate.After being coated,the contact angle,albumin and fibrinogen adhering to materials were decrease (P＜0.05).The anticoagulant activity was notably promoted by coating.Compared with LMWH coated material,the contact angle,albumin and fibrinogen adhering were decreased significantly,but the improvement of anticaugulation was limited(P＜0.05).Conclusion Chemical graft-modification LMWH or OSA can be applied to polycarbonate.The biocompatibility of the coated materials was significantly promoted.
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BACKGROUND:At present, a heparin-coated extracorporeal circulation pipe is used widely, but the price is expensive and limits its wide application. OBJECTIVE:To screen the optimal coating condition of oxidated sodium alginate as a coating material to coat the medical polyvinyl chloride pipe and to evaluate the anticoagulant properties and the stability of the coated pipe. METHODS:Oxidized sodium alginate was prepared with sodium periodate, and the mole ratio of sodium periodate and sodium alginate was 1:8, 1:10 and 1:12, respectively. Oxidized sodium alginate with different degree of oxidation was coated on the surface of medical polyvinyl chloride pipes by chemical methods, then to select the best degree of oxidation. The optimal coating condition was screened through an orthogonal experiment based on concentrations of sulfuric acid, polyethyleneimine and oxidized sodium alginate, and pH value and temperature of oxidized sodium alginate. Additional y, the anticoagulant properties and expulsion rates of the prepared pipes were evaluated in comparison with the blank control group and heparin-coated group. RESULTS AND CONCLUSION:The optimal oxidation degree for oxidized sodium alginate was 1:10 for the mole ratio of sodium periodate and sodium alginate. The best coating conditions were 50%concentrated sulfuric acid, 0.05%polyethyleneimine, 40 ℃ of reaction temperature, 2 g/L oxidized sodium alginate, and pH value=3.5. The oxidized sodium alginate coating group had a similar trend compared with heparin-coated group in the expulsion rate. The anticoagulant properties of oxidized sodium alginate coating group were little weaker than those of heparin-coated group (P<0.05), but significantly better than those of the blank control group. The oxidized sodium alginate-coated extracorporeal circulation pipe has a good anticoagulant property and stability.
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<p><b>OBJECTIVE</b>To analyze the cause of atypical manifestation of hepatocellular carcinoma (HCC) in triple-phase spiral CT enhanced scan.</p><p><b>METHODS</b>Triple-phase spiral CT scan was performed in 75 patients with HCC. The hepatic arterial phase (HAP), portal venous phase (PVP) and delayed phase (DP) images were started at 25 to 30 s, 65 to 70 s and 3 tp 5 min after injection of contrast medium. The contrast enhanced patterns of lesion were observed and analyzed.</p><p><b>RESULTS</b>Ninety-two lesions were found in 75 patients. Typical enhanced findings such as hyperdense in HAP and hypodense in PVP and DP was found in 60 of 92 lesions. Atypical enhanced findings were observed in the other 32 lesions. Fourteen of 32 atypical enhanced lesions were hyperdense in HAP and isodense in PVP, of which 8 were seen in liver cirrhosis and 3 in fatty liver. In DP, 10 were hypodense and 4 still isodense. Eight of the 32 lesions were hyperdense both in HAP and PVP, of which 6 were seen in fatty liver. In DP, 3 were isodense and 5 were hypodense. Six of 32 lesions were isodense in HAP which became hypodense in PVP and DP. Four of 32 lesions were all hypodense in HAP, PVP and DP.</p><p><b>CONCLUSION</b>Multiple atypical enhanced manifestations are present by triple-phase spiral CT scan in HCC. Pattern of blood supply, scanning technique and pathophysiologic status are usually the cause of these findings.</p>
