Adult hemophagocytic syndrome in emergency department setting: the implications of hormone therapy on diagnosis and prognosis / 中华急诊医学杂志

Objective:To assess the implications of hormone therapy on confirmation of clinical diagnosis and prognosis of adult hemophagocytic syndrome (HPS) in the emergency department setting.Methods:The eligible 34 patients admitted with suspected HPS in the Emergency Department of Peking University People's Hospital from September 2019 to August 2021 were respectively collected. The patients were divided into the death group and survival group according to the prognosis and divided into early hormone therapy group and standard hormone therapy group according to the timing of hormone application. Patients in the early hormone therapy group were divided into the routine 4 criteria group and non-routine 4 criteria group according to the conditions of meeting the four HLH-2004 diagnostic criteria. Medical records of the following were collected and statistically analyzed: complete blood count, blood biochemical index, coagulation function, serum ferritin, NK cell activity, sCD25 level, peripheral blood smear, bone marrow biopsy, abdominal ultrasound scan, and abdominal CT on admission, and recheck the clinical indicators such as blood count, blood biochemical index and blood coagulation dunction 5-7 days later.Results:①Patients from the death group were older, with higher APACHEⅡ scores and SOFA scores, higher total bilirubin, and lower serum albumin. ② Univariate Logistic analysis showed age ( OR=1.098, CI: 1.019-1.183, P=0.014), APACHE Ⅱ score ( OR=1.144, CI: 1.017-1.285, P=0.024), SOFA score ( OR=1.441, CI: 1.079-1.925, P=0.013) were associated with the risk of death. Multivariate Logistic analysis showed that age ( OR=1.099, CI: 1.014-1.190, P=0.021) was associated with the risk of death. There was no significant correlation between early hormone therapy and clinical prognosis. Kaplan-Meier survival curves showed that there was no difference in the 60-day survival rate between the early hormone therapy group and the standard hormone therapy group. ③ The level of triglyceride still increased after early hormone therapy, and the number of indexes meeting the diagnostic criteria of HLH-2004 increased significantly. All patients met the criteria of Hscore>169, and 3 patients did not meet at least 5 diagnostic criteria of HLH-2004, accounting for 16.7% of the total cases of early hormone therapy. ④ Starting hormone therapy when the four HLH-2004 diagnostic criteria were met could reduce the length of hospital stay. Prothrombin time and activited partial thomboplastin time were closer to normal levels in patients 5-7 days after treatment. Early hormone therapy had no significant effect on treatment response and in-hospital death risk. There were no significant differences in APACHE Ⅱ score, SOFA score, confirmation of diagnosis, treatment response, clinical prognosis, and related clinical indicators after hormone therapy between the routine 4 criteria and non-routine 4 criteria groups. Conclusions:Initiation of early hormone therapy has no significant effect on the confirmation of clinical diagnosis, treatment response, in-hospital mortality, and 60-day survival rate of patients with HPS, and can quickly correct coagulation dysfunction and effectively reduce the length of hospital stay. An earlier start of hormonal therapy (meeting the four HLH-2004 diagnostic criteria) may be considered by the emergency physician when a patient is highly suspected of HPS diagnosis

Clinical efficacy of CT-guided radiofrequency thermal coagulation for the treatment of primary trigeminal neuralgia / 介入放射学杂志

Objective To evaluate the clinical effect of CT-guided radiofrequency thermal coagulation in treating primary trigeminal neuralgia.Methods A total of 165 patients with primary trigeminal neuralgia were selected as research objects.The patients were randomly divided into radiofrequency thermal coagulation group (study group,n=83) and drug damage group (control group,n=82).For the treatment of trigeminal neuralgia,CT-guided radiofrequency thermal coagulation was carried out in the patients of the study group,and CT-guided percutaneous puncturing of oval foramen with epirubicin injection as chemical damage therapy was employed in the patients of the control group.Follow-up check-up was conducted at 3,6,12 and 36 months after the treatment.Visual analog score (VAS),total effective rate and incidence of complications were calculated and the results were compared between the two groups.Results The excellent therapeutic rate of the study group was significantly better than that of the control group,the difference between the two groups was statistically significant (P＜0.05).The incidence of complications in the study group was remarkably lower than that in the control group,the difference between the two groups was statistically significant (P＜0.05).The VAS pain score of the study group was much lower than that of the control group.The total therapeutic effect in the study group was more prominent.Conclusion In treating primary trigeminal neuralgia,CT-guided radiofrequency thermal coagulation has excellent clinical effect.Therefore,this technique is worthy of popularization and application in clinical practice.

Optimization of the extraction process of oleanolic acid in Ligustrum lucidum fruits by macroporous resin purification / 国际药学研究杂志

Objective To optimize the extraction and purification process of oleanolic acid in Ligustrum lucidum fruits with macroporous resin. Methods Grinding degree,temperature,liquid ratio,extraction time,extraction times,ethanol volume fraction and pH were selected as factors,which may influence the extraction of oleanolic acid from L. lucidum. Single factor experiments were carried out on these factors. The optimal extraction conditions were determined,and the best type of resin was chosen for separation and purification of oleanolic acid in the optimal conditions. Results The optimal technological conditions were as follows:the temper?ature was controlled at 80℃,ethanol solution was 60%,liquid material ratio was 1∶11,extraction time was 120 min,and extraction times were twice. The crude extraction was processed at pH 12,and then the pH was adjusted to 2 to further purify the processed crude extraction. The content of oleanolic acid in the extract was 9.5%by UV visible spectrophotometric method. This extraction was further separated and purified by AB-8 resin,and the content of oleanolic acid detected by ultraviolet visible spectrophotometr was 15.2%.Conclusion The optimal process of the oleanolic acid extraction is reproducible,simple and feasible. It may provide refer?ence for using macroporous resin to extract oleanolic acid from L. lucidum in the industry production.

Fibrinogen/C reactive protein ratio as a parameter for diagnosis of disseminated intravascular coagulation in patients with sepsis / 中华急诊医学杂志

Objective To determine if the fibrinogen/C reactive protein (CRP) ratio could be used in sepsis patients as a predictor for disseminated intravascular coagulation.Methods A total of 61 patients with sepsis admitted to emergency intensive care unit (EICU) were enrolled.C reactive protein (CRP) and variables of coagulation such as Platelet (PLT),prothrombin time (PT),activated partial thrombopastin time (APTT),fibrinogen and D-dimer were analyzed during 24 hours after admission to EICU.APACHE Ⅱ score,ISTH score and JAAM score were evaluated.According to DIC score (JAAM score and ISTH score),the patients were divided into two groups:overt DIC and no overt DIC.Data were expressed in mean ±standard deviation and were statistically analyzed by SPSS 17.0.The differences of CRP,PLT,PT,APTT,fibrinogen and D-dimer of patients in each group were analyzed by independent samples t test.The receiver-operating characteristics (ROC) analysis was performed to predict the diagnostic power of the variables fibrinogen,CRP,and fibrinogen/C reactive protein (CRP) ratio.In addition,the odds ratios (OR) were estimated by chi-square test and the 95％ confidence intervals were calculated.Results In overt DIC group fibrinogen/C reactive protein (CRP) ratio was significantly lower.The receiver-operating characteristic analysis showed for the fibrinogen/C reactive protein (CRP) ratio (area under the curve:ISTH criteria 0.691 and JAAM criteria 0.814) significantly better discriminative power than for fibrinogen (area under the curve:ISTH criteria 0.608 and JAAM criteria 0.429) and CRP (area under the curve:ISTH criteria 0.561 and JAAM criteria 0.788).The odds ratio for fibrinogen/C reactive protein (CRP) ratio (＜ 45) was 11.14 and CRP (＞ 70 mg/L) was 8.05.Conclusions We suggest that the fibrinogen/C reactive protein (CRP)ratio could be a diagnostic factor for the occurrence of disseminated intravascular coagulation in sepsis patients.

Study on the resonance frequency comparison between rat and rabbit bowels / 国际生物医学工程杂志

Objective To find out the accurate resonance frequencies and vibration characteristics of intestine,lung,kidney,stomach,heart and liver of rat and rabbit in low frequency and to provide basic data for the study of organs' resonance injury and reaction.Methods Eight rats and eight rabbits were anaesthetized with 1.5％ sodium pentobarbital and acceleration sensor was fixed to the surface of their bowels.The rats were fastened on their back on the veneer hung horizontally by rubber band.The veneer was hammered upward from the down side,and the biggest value of frequency spectrum was considered the resonance frequency.Rabbits were fastened on their back on vibration platform and 2 mm amplitude vibration was given with the sweeping-frequency from 2 Hz to 50 Hz.The bowels amplitudes on each frequency point were measured.The frequency corresponding to the biggest amplitude was considered the resonance frequency.Results The resonance frequencies of rat intestine,lung,kidney,stomach,heart and liver were respectively 3.8,3.2,6.6,7.0,4,6 and 3.0 Hz within frequency interval of 0 Hz to 20 Hz.The resonance frequencies of rabbit intestine,lung,kidney,stomach,heart and liver were respectively 6.0,5.0,7.0,8.0,6.0 and 7.0 Hz within frequency interval of 2 Hz to 50 Hz.The vibration amplitude of lung was the biggest at the resonance frequency.The resonance frequencies of both rat and rabbit bowels showed no statistical correlations to body weights,bowel mass and bowel volumes.Conclusion Bowel resonance frequencies of rat and that of rabbit are evidently statistical different except for that of kidney.The resonance frequency values of rabbit bowels are closer to that of dog and monkey than to that of rat.Thus the resonance injury characteristic of rabbit bowels can be the research basis for dog,monkey,and even human bowels resonance injury.

Characteristics of the sciatic nerve injuries inflicted by high-velocity triangle fragments in swine / 中华创伤杂志

Objective To study the characteristics of the sciatic nerve injuries inflicted by highvelocity triangle fragments in swine.Methods According to the injury position,14 swines weighing (34.29±5.2)kg were divided into two groups.All swines were shot by 0.37 g triangle fragments at (773.1±12.4)m/s aimed at the midpoint of the lateral body surface projection of the right sciatic nerve in Group A(n=7)and at 2 cm aside from sciatic nerve in Group B(n=7).The entrance,exit and length of wound tract,distance between nerve and wound tract were detected,and the pathology of sciatic nerve and wound tract at 48 hours after injury were observed under light microscope and electron microscope.Results The course of the fragments was deviated to different extent.Six sciatic nerves were in primary wound tract,four of which were lacerated and ruptured at different degrees.The light microscope showed pathological changes including severe hemorrhage and edema,leukocytic infiltration,neurotmesis,axonotmesis and light myelin coloration;while electron microscope showed severe degeneration of myelin sheath and neuraxon distortion.Six nerves(one in Group A and five in Group B)were in the concussion zone,with the distance between sciatic nerve and primary wound tract for(2.07±0.45)cm.Hyporrhea and hyperemia under perilemma and perineurium,partial nerve fiber disrupt and axonotmesis were observed by light microscope and partly myelin sheath delamination by electron microscope.Two nerves (one in Group A and another in Group B)were in the contusion zone,with moderate pathological changes.Conclusions The track of high velocity triangle fragments is unstable in the tissues.High disrupt rate,severe and wide extent lesion,early Wallerian degeneration are the main characteristics of direct injuries of swine's sciatic nerves.Indirect injuries can induce pathologic changes too,for which the lesion severity is related to the distance between nerves and primary wound tract.

Antinociceptive efficacy of preemptive intrathecal administration of CRH in rats / 第三军医大学学报

Objective To investigate whether preemptive intrathecal administration of CRH has an antinociceptive efficacy on inflammatory pain model rats. Methods The antinociceptive efficacy of preemptive intrathecal administration of CRH was evaluated by the flinch-licking time and the tail flicking latency in formalin-subjected pain model rats. The c-fos gene expression in spinal cord dorsal horn was analyzed by immunohistochemical technique and computer image technique. Results Comparing with NS control group, preemptive intrathecal administration of 0.5 ?g CRH could markedly inhibit the phase Ⅱpain reaction and meanwhile decrease c-fos gene expression by 25.02% in the superficial lamella of spinal cord dorsal horn of the model rats. The antinociceptive efficacy could be counteracted by preemptive intraperitoneal injection of CP-154526 (the specific antibody of CRHR1, 10 mg/kg). Conclusion CRH could significantly inhibit pain reaction and spinal cord c-fos gene expression, and thereby preemptive intrathecal administration of CRH will contribute to the antinociceptive efficacy because of its potency of inhibiting hyperalgesia.

Low-dose endotoxin induces non-overt disseminated intravascular coagulation in rabbits / 第三军医大学学报

Objective To study the changes of coagulation and fibrinolysis in rabbit model of non-overt disseminated intravascular coagulation induced by low-dose endotoxin and therapeutic effects of anticoagulation by heparin.Methods Twelve male rabbits were randomly divided into 2 groups,one receiving endotoxin intravenously(10 ?g/kg,n=6),one receiving endotoxin intravenously and 100 U/kg Heparin simultaneously(n=6).The blood sample obtained before experiment was used as control.Coagulation parameters including prothrombin time(PT),activated partial thromboplastin time(aPTT),thrombin time(TT),fibrinogen concentration,D-dimers,thrombelastography(TEG)were measured during 6 h after endotoxin induction.Tissue specimens of lungs and kidneys were examined.Results Parameters of coagulation deteriorated significantly in the endotoxin-induced rabbits,but was not altered in heparin-treated rabbits.TEG monitoring in the endotoxin-induced rabbits reflected consumption of clot factors and platelet dysfunction,and hypocoagulation status in heparin-treated rabbits.In endotoxin-induced group,fibrin deposition was found in lungs and kidneys.Conclusion Non-overt disseminated intravascular coagulation induced by low-dose endotoxin in rabbits is improved by heparin.