Comparison of the efficacy for early warning systems in predicting obstetric critical illness.

OBJECTIVE: To validate the accuracy of four early warning scores for early identification of women at risk. METHODS: This was a retrospective study of pregnant women admitted in obstetrics Critical Care Unit (ICU). Capacity of the Modified Obstetric Early Warning Score (MOEWS), ICNARC Obstetric Early Warning Score (OEWS), Maternal Early Obstetric Warning System (MEOWS chart), and Maternal Early Warning Trigger (MEWT) were compared in predicting severe maternal morbidity. Area under receiver operator characteristic (AUROC) curve was used to evaluate the predictive performance of scoring system. RESULTS: A total of 352 pregnant women were enrolled and 290 were identified with severe maternal morbidity. MOEWS was more sensitive than MEOWS chart, ICNARC OEWS and MEWT (96.9 % vs. 83.4 %, 66.6 % and 44.8 %). MEWT had the highest specificity (98.4 %), followed by MOEWS (83.9 %), ICNARC OEWS (75.8 %) and MEOWS chart (48.4 %). AUROC of MOEWS, ICNARC OEWS, MEOWS chart, and MEWT for prediction of maternal mortality were 0.91 (95 % CI: 0.874-0.945), 0.765(95 % CI: 0.71-0.82), 0.657(95 % CI: 0.577-0.738), and 0.716 (95 % CI, 0.659-0.773) respectively. MOEWS had the highest AUCs in the discrimination of serious complications in hypertensive disorders, cardiovascular disease, obstetric hemorrhage and infection. For individual vital signs, maximum diastolic blood pressure (DBP), maximum systolic blood pressure (SBP), maximum respiratory rate (RR) and peripheral oxygen saturation (SPO2) demonstrated greater predictive ability. CONCLUSION: MOEWS is more accurate than ICNARC OEWS, MEOWS chart, and MEWT in predicting the deterioration of women. The prediction ability of DBP, SBP, RR and SPO2 are more reliable.

Application and Optimization of the Rheological Model for a Hydrophobically Associating Dendrimer Polymer.

Polymer flooding is one of the most important enhancing oil recovery (EOR) technologies in the world. With the optimization of polymer synthesis, the performance of polymer solutions has been greatly improved, which can adapt to more complex oil and gas reservoirs. However, with the continuous improvement of the properties of polymer solutions, the elastic property of polymer solutions is significantly improved, and the rheological law has also changed. This series of changes affects the application of polymer flooding reservoir numerical simulation technology. Therefore, constructing an accurate description model and precise limitation conditions is particularly important. The rheological curve with a wide shear range (0.1~10,000 s-1) and the viscoelasticity of the two polymers (partially hydrolysed polyacrylamide (HPAM) and dendritic hydrophobic association polymer (DHAP)) were analyzed and tested by a rotating rheometer. The results showed that under the experimental conditions, the rheological curve of both polymers can be described by the Carreau rheological model. Meanwhile, the structural viscosity of the hydrophobically associating polymer solution (DHAP) greatly improved the elasticity of the solution and led to the change of elastic modulus. Considering the influence of elastic characteristics on the rheological curve, the relaxation time spectrum derived from small vibration experimental data was used to limit the characteristic relaxation time, that is, the value range of λ. It was observed that the experimental data were highly matched with the nonlinear regression fitting curve of the Carreau rheological model. Therefore, the relationship between different test parameters should be fully considered while studying the rheological constitutive equation of viscoelastic fluid, so as to optimize and improve the equation of it.

Decreased serum uric acid in patients with traumatic brain injury or after cerebral tumor surgery.

OBJECTIVES: To investigate changes in sUA in patients with TBI or patients after cerebral tumor surgery and the possible mechanism of these changes. METHODS: This prospective cohort study enrolled patients with TBI or underwent cerebral tumor surgery at West China Hospital, China, from November 2014 to May 2018. Serum UA (sUA) levels, urine excretion, UA oxidant product allantoin and other clinical parameters were assessed. RESULTS: 100 patients were enrolled for analysis. sUA in patients with TBI or underwent cerebral tumor surgery started to decline from day 1 after injury or surgery compared to control. This decreasing trend continued from day 3 (143.2±59.3 µmol/L, 188.8±49.4 µmol/L vs 287.3±80.2 µmol/L, p<0.0001) until day 7. No difference in urinary UA excretion was found in the TBI group or cerebral tumor surgery group. Urine allantoin and the allantoin to sUA ratio of the TBI group decreased on day 3 compared with the control group. The structural equation model showed that the sUA level was related to the Glasgow coma score (GCS) (r=0.5383, p<0.0001), suggesting the potential association of UA with consciousness level, as well as serum protein and electrolytes including albumin, calcium and phosphate. CONCLUSION: The sUA was decreased in patients with TBI or underwent cerebral tumor surgery.

The seepage flow characteristics of hydrophobically associated polymers with different aggregation behaviours in porous media.

The polymer solution for oil displacement is subjected to strong shear action in practical application, and this action will affect its percolation characteristics in porous media. The effects of mechanical shearing on the solution properties and seepage characteristics of modified hydrophobically associated polymers and dendrimers with two different aggregation behaviours were studied. The results showed that mechanical shearing did not affect hydrophobic microzones. Polymers can re-associate to restore part of the network structure, thereby improving shear resistance (dendritic hydrophobically associating polymers > hydrophobically modified partially hydrolysed polyacrylamide). Polymers with 'cluster' aggregation behaviour enhanced solution performance, enabling them to establish higher resistance coefficient (RF) and residual resistance factor (RRF) in porous media but also bringing about injection difficulties. Increasing the injection rate would increase the injection pressure, but the established RF and RRF showed a downward trend. Mechanical shear pretreatment effectively improved the injectability of the polymer. To achieve polymer injection and flow control, pre-shearing polymer solution and low-speed injection can be used in field applications.

[Low Plasma High Density Lipoprotein-cholesterol Level Associated with Deep Vein Thrombosis in Traumatic Fracture Patients].

OBJECTIVE: To explore the association of plasma high density lipoprotein-cholesterol (HDL-C) and deep vein thrombosis (DVT) in traumatic fracture patients. METHODS: We performed a retrospective study in 1 054 traumatic fracture patients admitted between April 2012 and December 2014. 188 cases were divided into DVT and others (n=866) into control group based on ultrasound results. The relationship between HDL-C and DVT was determined by univariate and multivariate logistic regression analyses. RESULTS: Compared with control group, patients in DVT group had significantly lower HDL-C level, and low level of plasma HDL-C was associated with the occurrence of DVT. Deceased HDL-C, inceased age, inceased immobilization, inceasd anticoagulant-free days, fracture sites, and blood transfusion were risk factors for the occurrence of DVT in traumatic fracture patients. Patients with surgery had significantly lower level of HDL-C in both groups compared with patients without surgery respectively. CONCLUSION: Low level of plasma HDL-C was independently associated with the occurrence of DVT in traumatic fracture patients.

Efficacy and safety of electro-acupuncture treatment in improving the consciousness of patients with traumatic brain injury: study protocol for a randomized controlled trial.

BACKGROUND: Traumatic brain injury (TBI) has become a leading cause of death among young people worldwide. Survivors may live with a long-term TBI-related disability or even develop a disorder of consciousness resulting in poor life quality and shortened life expectancy. Thus far, very few approaches have been found to be effective in the consciousness recovery of these patients. Acupuncture has long been used in the treatment of neurological disorders in China. However, its efficacy and safety in consciousness recovery remain to be proved. METHODS: Here, we present a study design and protocol of a randomized, blinded, controlled study to evaluate the efficacy and safety of electro-acupuncture in the consciousness recovery of patients with TBI. A total of 150 patients with initial Glasgow coma scale score of less than 8 points will be recruited in the trial and randomized into acupuncture or control groups. Patients in the control group will receive routine pharmacological treatment alone while patients in the acupuncture group will receive electro-acupuncture treatment for 10 days in addition to routine treatment. The efficacy will be assessed with the changes in Glasgow coma scale score and mismatch negativity of event-related brain potentials before and after treatment. Moreover, Glasgow outcome scale and Barthel index of activities of daily living will be compared between the two groups at 3 months after treatment. The secondary outcome measures are the length of stay in ICU and hospital, expenses in ICU and hospital, as well as the incidence of coma-related complications. The safety of electro-acupuncture will be assessed by monitoring the incidence of adverse events and changes in vital signs during the study. DISCUSSION: Results from this trial will significantly add to the current body of evidence on the role of electro-acupuncture in the consciousness recovery of patients with severe TBI. In addition, a more convenient and consistent electro-acupuncture method can be set up for clinical practice. If found to be effective and safe, electro-acupuncture will be a valuable complementary option for comatose patients with TBI. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-INR-17011674 . Registered on 16 June 2016.

Robinetinidol-(4beta-->8)-epigallocatechin 3-O-gallate, a galloyl dimer prorobinetinidin from Acacia mearnsii De Wild, effectively protects human neuroblastoma SH-SY5Y cells against acrolein-induced oxidative damage.

Acrolein is a highly electrophilic alpha, beta-unsaturated aldehyde to which humans are exposed in many situations and has been implicated in neurodegenerative diseases such as Alzheimer's disease. A galloyl dimer prorobinetinidin from Acacia mearnsii De Wild, robinetinidol-(4beta-->8)-epigallocatechin 3-O-gallate (REO), has antioxidant properties and could protect brain against acrolein-induced oxidative damage. In this study, the molecular basis of acrolein-induced cytotoxicity in human neuroblastoma SH-SY5Y cells and the modulating effects of REO were examined. Our results indicate that REO protects SH-SY5Y cells from acrolein-induced damage by the attenuation of reactive oxygen species, the remediation of NADPH oxidase activity, the enhancement of the glutathione system, and the prevention of protein oxidation/nitration and lipid peroxidation. In order to determine the effects of REO on mitochondrial events, mitochondrial membrane potentials (Delta Psim) and caspase cascades downstream of mitochondria were assessed. REO inhibited the collapse of Delta Psi m, suggesting that REO reduces the mitochondrial dysfunction associated with acrolein treatment. REO also inhibited caspase-3 activation, which can be triggered by mitochondrial malfunctions. Furthermore, REO induced a significant reduction in the level of phospho-JNK, which is known as an apoptotic mediator in acrolein-induced neuronal cell death. Our results indicate that REO protects neurons from the deleterious effects of acrolein via the attenuation of oxidative stress, NADPH oxidase activity, GSH depletion, protein oxidation/nitration, lipid peroxidation, mitochondrial dysfunction, JNK activation, and caspase activity. These findings suggest that REO could be potentially useful as a protective agent for people exposed to acrolein.

Therapy of central pontine myelinolysis following living donor liver transplantation: Report of three cases.

We analyzed the clinical manifestations and experiences of diagnosing and treating central pontine myelinolysis following living donor liver transplantation. The clinical data of three patients with central pontine myelinolysis following living donor liver transplantation from January 2005 to November 2007 were retrospectively analyzed at the West China Hospital, Sichuan University, China. The three patients developed hyponatremia prior to surgery. Case 1 suffered locked-in syndrome following surgery, and received a large dose of gamma globulin, and subsequently recovered. Case 2 was in a coma for three days, and received hyperbaric chamber treatment. This patient remained in a mild coma for six months following surgery. Case 3 developed consciousness disturbances, gradually went into a coma following surgery, and died due to pulmonary infection. Central pontine myelinolysis is a severe complication in patients following living donor liver transplantation. Large-dose gamma globulin treatment, as well as hyperbaric oxygen, might be effective therapeutic methods.

[Carbapenem restriction reduce the incidence of multidrug-resistant Acinetobacter baumannii in ventilator associated pneumonia].

OBJECTIVE: To determine the relation of carbapenem restriction with the incidence of multidrug-resistant (MDR) Acinetobacter baumannii in ventilator associated pneumonia (VAP). METHODS: Twenty-six patients admitted to the intensive care unit, West China Hospital, Sichuan University, from June to December in 2007, with confirmed VAP were randomized to two groups: conventional group (14 cases) and carbapenem restriction group (12 cases). All sputum samples were collected throughout the trial. The correlation between the incidence of MDR Acinetobacter baumannii and the consumption of carbapenem was analyzed. RESULTS: The incidence of MDR Acinetobacter baumannii (10.7%, 7/65) and consumption of carbapenem (61 g) in carbapenem restriction group were significantly lower than conventional group (17.8%, 13/73, 188 g, both P<0.05). The result implied that the decreased incidence of MDR Acinetobacter baumannii was attributable to the reduction of carbapenem consumption. CONCLUSION: Carbapenem constraint could reduce the incidence of MDR Acinetobacter baumannii in VAP.

[The crush syndrome patients combined with kidney failure after Wenchuan earthquake].

OBJECTIVE: To retrospectively analysis the treatment characteristics of the systemic situation in patients with crush syndrome after Wenchuan earthquake happened in May 12th, 2008. METHODS: Forty-nine patients with crush syndrome and subsequent acute renal failure (ARF) due to the earthquake were treated in West China Hospital. All of patients had been rescued from buildings that collapsed in Wenchuan earthquake. The major associated injuries were in the low extremities and upper extremities. 49 patients developed ARF with increased concentrations of serum creatinine (mean 64 022 U/L) had underwent haemodialysis. Hyperkalaemia was seen in 9 patients and four of them underwent haemodialysis. 49 patients were administered hemodialysis. RESULTS: No patient died. All patients who suffered from the ARF were weaned from hemodialysis after admitted 7 to 35 days. Forty-five extremities underwent amputations and 52 extremities had fasciotomy. CONCLUSIONS: Crush syndrome requires urgent recognition and prompt surgical treatment with simultaneous measures to control hyperkalemia and ARF. The authors believe that immediate intensive care therapy and multi-subjective coordination would have improved the survival rate.

[Clinical features and outcome of infection of type 2 Streptococcus suis in human].

OBJECTIVE: To analysis the clinical features and efficacy of treatment for patients with type 2 Streptococcus suis (S. suis 2) infection, and to inform better diagnosis and treatment of S. suis 2. METHODS: Clinical data of 68 patients with S. suis 2 infection were retrieved retrospectively. The diagnoses were confirmed by clinical symtom or/and isolation of S. suis 2 from the infected sites in Shichuan province in the summer of 2005. The patients ranged from general type (simple sepsis) to septic shock type; meningitis type and mixed type. RESULTS: The outbreak of S. suis 2 infection occurred in June to August in 2005. The common source of infection came from pigs. The people in great risks were farmers who exposed to sick or dead pigs with S. suis 2 infection. Most infection occurred on the people who slaughtered infected pigs, followed by those who dressed infected meats. The prominent symptoms included fever with sharp chills, dizziness, headache, malaise and myalgia. Some patients had abdominal pain and diarrhea. Septic shock and coma often occurred in severe cases. According to the clinical manifestations, patients were categorized into four different clinical types: general type, septic shock type, meningitis type, and mixed type. S. suis 2 isolated from the patients were susceptible to most antimicrobial agents, except for tetracycline. All of the patients were treated with beta-lactam antibiotics (penicillins or cephalosporins). Some were given combined antimicrobial agents. Seventy seven percent (52/68) of patients survived. All of the general patients recovered completely. Fifty eight percent (15/26) of patients with septic shock died. The artificial ventilation and persistent blood filtering treatment played an important role for treating patients with septic shock. Although most patients with meningitis (97.5%) survived, a decrease in hearing or even hearing loss occurred to some of the survivors. CONCLUSION: Purulent meningitis and septic shock are the major clinical manifestations for S. suis 2 infection in human. The treatment for patients with meningitis is more effective than that for patients with septic shock.