Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue最新文献

Objective: To investigate the safety and effects of early bronchoscopy on atelectasis of the ventilation patients, whom had experienced craniotomy for severe cranial trauma and hemorrhage.

Methods: Fifty-five patients suffered from severe cranial trauma and hemorrhage with Glascow coma scores (GCS) less than 8 complicated by atelectasis after craniotomy were early given sputum suction by bronchoscope via extratracheal intubation and broncho-alveolar lavage (BAL) during tracheal intubation and mechanical ventilation. During the treatment, patients' consciousness, vital signs and arterial blood gas were closely monitored. The relevant data, before, during (5, 10, and 25 minutes), bronchoscopy treatment completed and 30 minutes after bronchoscopy, were recorded and analyzed.

Results: Eighty-two time of bronchoscopies and 111 time of local BALs in 55 patients were completed and were effective for atelectasis. The patient's GCS (5.6±2.5 vs. 5.4±2.6, P>0.05), heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), blood oxygenous saturation (SaO(2)) were not deteriorated during bronchoscopy. Compared with pre-bronchoscopy, the HR and SBP decreased (HR: 88.2±14.2 bpm vs. 98.2±18.3 bpm, SBP: 110.6±18.2 mm Hg vs. 118.4±18.5 mm Hg, both P<0.05), and SaO(2) increased (0.982±0.022 vs. 0.945±0.035, P<0.05), pH, arterial partial pressure of oxygen (PaO(2)) and arterial partial pressure of carbon dioxide (PaCO(2)) had no significant changes during bronchoscopy. There was obviously increased in PaO(2) (84.5±14.4 mm Hg, 81.6±18.2 mm Hg vs. 76.2±15.4 mm Hg, both P<0.05), and decreased in PaCO(2) (27.0±12.8 mm Hg, 29.3±18.2 mm Hg vs. 36.5±11.6 mm Hg, both P<0.05) respectively, significantly decreased in alveolar arterial pressure of oxygen difference [P ((A-a))O(2)] at 10 minutes and 25 minutes, and at the time bronchoscopy treatment completed and the time 30 minutes after compared with before bronchoscopy (36.1±4.7 mm Hg, 32.4±6.2 mm Hg, 32.5±5.2 mm Hg, 31.2±7.2 mm Hg vs. 38.5±5.6 mm Hg, all P<0.05). All patients had not encounter side effects related with bronchoscopy and ventilation.

Conclusion: The bronchoscope via extratracheal intubation for sputum suction and BAL were safe and effective treatment to the patients suffered from severe cranial trauma or hemorrhage complicated by atelectasis after craniotomy during mechanical ventilation, without obvious changes of the vital signs.

Objective: To explore the association of osteoprotegerin (OPG) gene polymorphisms 209G/A, 245T/G and 1181G/C in the Han population of Fujian province with acute coronary syndrome (ACS) and its severity.

Methods: A prospective study was conducted. Two hundred and fifty-two cases without sibship of Fujian Han people was enrolled from July 2010 to September 2011, in which 68 healthy subjects as controls. One hundred and eighty-four patients with ACS were divided into three groups, 60 had one-vessel, 68 had two-vessel, and 54 had three-vessel lesion, 2 had not been found stenosis. DNA was extracted from venous blood, different groups of OPG gene polymorphism was identified by Sanger Method. OPG 209G/A, 245T/G and 1181G/C genotype frequencies and allelic frequencies were analyzed between ACS subjects and normal subjects and among the three groups of ACS, and the relationship between gene polymorphisms and ACS severity.

Results: No significant differences were observed in the genotype and allelic frequencies of OPG gene 209G/A, 245T/G between the ACS and control groups. Significant differences were observed in the genotype and allelic frequencies of OPG gene 1181G/C between the ACS and control groups [1181G/C GG: 92 (50.0%) vs. 43 (63.2%), CC: 26 (14.1%) vs. 0, GC: 66 (35.9%) vs. 25 (36.8%), χ(2)=11.240, P=0.004; allelic gene G: 250 (67.9%) vs. 111 (81.6%), allelic gene C: 118 (32.1%) vs. 25 (18.4%), χ(2)=9.148, P=0.002]. No significant differences were observed in the genotype and allelic frequencies of OPG gene 209G/A, 245T/G and 1181G/C between those groups.

Conclusions: There were no significant difference in frequencies OPG genotype and allele in polymorphisms 209G/A, 245T/C between patients with ACS and control group in Han population of Fujian province. There were difference in frequencies OPG genotype and allele in polymorphisms 1181G/C between patients with ACS and control group, but it was not differently distributed among patients with single-, double-, or triple-vessel lesion.

Objective: To improve cost-efficiency, discriminant functions in stepwise method was founded for the differential diagnosis of angina pectoris by detecting the serum level of high-sensitivity C-reactive protein (hs-CRP), macrophage migration inhibitory factor (MIF), interleukin-4 (IL-4) and interleukin-10 (IL-10) in patients with stable angina pectoris (SAP) and unstable angina pectoris (UAP).

Methods: Thirty-nine SAP patients and 47 UAP patients were enrolled into the study, while 39 healthy volunteers were enrolled into the controlled group forming the entire set of training samples. The serum levels of hs-CRP, MIF, IL-4 and IL-10 were measured by enzyme linked immunosorbent assay (ELISA). Data was analyzed by software to define discriminant functions in the ways of "entering" and "stepwise". Both functions were evaluated by the results of validation.

Results: By the way of "enter independent together", the following discriminant functions were defined based on the data of training samples' age, hs-CRP, MIF, IL-4, IL-10: healthy control group =-129.858 + 2.869×age -2.451×hs-CRP + 1.393×MIF + 6.001×IL-4 + 4.848×IL-10; SAP group=-161.037 + 2.896×age-2.022×hs-CRP + 1.662×MIF + 6.703×IL-4 + 6.287×IL-10; UAP group=-199.087 + 2.468×age-1.440×hs-CRP + 3.404×MIF-13.875×IL-4 + 7.752×IL-10. Retrospective validation showed 4.8% of total miss-grouping, while cross-validation showed 5.6% of total miss-grouping. By the way of "stepwise", the above data was screened by software and training samples' age, MIF and IL-10 were suggested to define the following functions: healthy control group = - 125.218 + 2.659 × age + 0.599×MIF + 5.040 × IL-10; SAP group=-157.864 + 2.721×age + 1.008×MIF + 6.468×IL-10; UAP group=- 197.327 + 2.360×age + 2.932×MIF + 7.640×IL-10. Both retrospective and cross validation showed 6.4% of total miss-grouping. Both sets of discriminant functions had the same efficiency (100%) for differential diagnosis of SAP and UAP.

Conclusion: The discriminant functions based on samples' age, MIF and IL-10, which were screened and suggested by stepwise method, may contribute to the differential diagnosis of atypical SAP and UAP, and therefore demonstrate better cost-efficiency.

Objective: To observe the change of urine level of cardiac specific microRNA-1 (miR-1) in patients with ST segment elevation acute myocardial infarction (STEAMI) and investigate its potential applications.

Methods: Urine samples were collected from 20 STEAMI patients within 12 hours after STEAMI and from 20 healthy volunteers as control. Urine miR-1 concentrations were measured with real-time quantity reverse transcription-polymerase chain reaction (qRT-PCR), at the same time serum cardiac troponin I (cTnI) and MB isoenzyme of creatine kinase (CK-MB) concentrations were measured.

Results: Serum level of cTnI, CK-MB and urine level of miR-1 in STEAMI patients were obviously higher than those in healthy control group [cTnI in blood: 19.27±7.53 μg/L vs. 0.02±0.01 μg/L, CK-MB in blood: 93.82±12.30 μg/L vs. 0.86±0.63 μg/L, miR-1 in urine (Ct value): 45.50±4.21 vs. 52.63±4.41, P<0.05 or P<0.01]. The urine miR-1 level in patients with STEAMI had a strong correlation with serum CK-MB or cTnI when CK-MB < 300 μg/L and cTnI <50 μg/L (Ct value of urine miR-1 with blood CK-MB: r=-0.81, P<0.01; Ct value of urine miR-1 with blood cTnI: r=-0.63, P<0.05).

Conclusions: The results suggest that urine miR-1 could be a novel sensitive biomarker the early diagnosis of SETAMI.

Objective: To investigate the protective effect of melatonin (MLT) on myocardial injury in severely-burned rats and its mechanism.

Methods: A total of 30 Sprague-Dawley (SD) rats were randomly assigned to three groups: sham group, burn group and MLT group, each n=10. The dorsal skin of animal was immersed into boiling water for 15 seconds to induce 30% total body surface area (TBSA) full-thickness burn, or immersed into 37 centigrade water for sham operation. Immediately after burn, the animals in burn group and MLT group were given intraperitoneally vehicle (1% alcohol in normal saline) or MLT (10 mg/kg) respectively. Six hours postburn, the blood from tail vessel was collected for serum preparation. After sacrificed, the myocardial tissues of rats were collected for the determination of malondialdehyde (MDA) and reduced glutathione (GSH) as well as glutathione peroxidase (GSH-Px) and myeloperoxidase (MPO) activities. Serum levels of creatine kinase (CK) and lactate dehydrogenase (LDH) were also estimated.

Results: Compared with the sham control, burn injury increased MDA by 66.7% (1.55±0.17 nmol/mg vs. 0.93±0.05 nmol/mg) and decreased GSH by 27.8% (13.58±0.33 nmol/mg vs. 18.82±0.55 nmol/mg, both P<0.01) in myocardial tissues, GSH-Px activity was also slightly inhibited (74.04±3.42 nmol×min(-1)×mg(-1) vs. 93.79±3.76 nmol×min(-1)×mg(-1), P<0.05), but MPO level was found to increase to 2.8 folds (9.43±1.15 U/g vs. 3.41±0.27 U/g, P<0.01). These changes indicated the occurrence of oxidative stress in myocardial tissues after severe burn. MLT treatment relieved most of the abnormality with significant statistical significances (MDA: 0.89±0.08 nmol/mg vs. 1.55±0.17 nmol/mg, GSH: 17.23±0.54 nmol/mg vs. 13.58±0.33 nmol/mg, MPO: 6.91±0.51 U/g vs. 9.43±1.15 U/g, P<0.05 or P<0.01). In addition, the serum levels of CK and LDH in burn group increased to 37.8 folds and 7.4 folds respectively (both P<0.01). MLT treatment reduced CK by 32.9% and reduced LDH by 21.2% (P<0.05 and P<0.01).

Conclusion: MLT treatment exerts the protective effect on myocardial injury in severely-burned rats, which is attributed predominantly to its inhibition on burn-induced oxidative stress injury.