-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Central venous pressure (CVP) and intrathoracic blood volume index (ITBVI) were used to assess the fluid status. It has previously been shown that CVP is not as accurate as ITBVI for all the shock patients. We therefore hypothesized that the change of CVP has the ability to predict fluid responsiveness in some clinical cases of shock. METHODS: From September 1st 2009 to September 1st 2011, sixty-three patients with shock from different Intensive Care Unit (ICU) were collected into this retrospective study. All the patients received fluid challenge strategy (infusing 300 ml hydroxyethyl starch in 20 minutes), were monitored with CVP and pulse-indicated continuous cardiac output (PICCO). The correlation between changes in cardiac index (ΔCI), CVP (ΔCVP) and ITBVI (ΔITBVI) were analyzed. Fluid responsiveness was defined as an increase in CI ≥ 10%. Receiver operating characteristic (ROC) curves were generated for ΔCVP and ΔITBVI. RESULTS: For all the patients, there was no correlation between ΔCI and ΔCVP (P = 0.073), but in the subgroup analysis, the correlation between ΔCI and ΔCVP was significant in those younger than 60 years old (P = 0.018) and those with hypovolemic shock (P = 0.001). The difference of areas under the ROC curves of ΔCVP and ΔITBVI were not statistically significant in the group younger than 60 years old or hypovolemic shock group (P > 0.05, respectively). However, no similar results can be found in the group older than 60 years old and the other two shock type groups from ROC curves of ΔCVP and ΔITBVI. CONCLUSIONS: ΔCVP is not suitable for evaluating the volume status of the shock patients with fluid resuscitation regardless of their condition. However, in some ways, ΔCVP have the ability to predict fluid responsiveness in the younger shock patients or in the hypovolemic shock patients.
Chinese medical journal 05/2013; 126(10):1844-1849. · 0.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study aimed to explore the effects of microbubble concentration, gene dosage, cell-microbubble mixing mode and fetal bovine serum (FBS) on gene delivery. 293T cells were transfected with Sonovue microbubbles carrying the hAng-1 gene via ultrasound irradiation. Various ultrasound exposure parameters and microbubble and DNA concentrations were investigated. In addition, FBS and the cell suspension or adherent mode was explored. Transfection efficiency and cell viability were used to determine the optimal transfection parameters. hAng-1 gene transfection efficiency gradually increased with elongation of ultrasound exposure and increasing microbubble concentration. However, if ultrasound irradiation exceeded 1.5 W/cm2 and 30 sec or the microbubble concentration was over 20%, hAng-1 gene expression was significantly decreased, coupled with extensive cell death. Gene transfection levels were low under DNA concentrations less than 15 µg/ml. Furthermore, the gene transfer rate was significantly increased under cell suspension mode; FBS had no effect on hAng-1 gene transfection. The integrity of hAng-1 DNA was not affected by ultrasonic irradiation under optimal conditions. The optimal transfection parameters for the hAng-1 gene and Sonovue microbubble were ultrasound exposure of 1.5 W/cm2 and 30 sec, 20% microbubbles, 15 µg/ml of DNA and under cell suspension mode.
Molecular Medicine Reports 09/2012; 6(6):1460-4. · 0.42 Impact Factor
-
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 03/2012; 24(3):185-8.
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the incidence and prevalence of left ventricular (LV) dyssynchrony in patients with heart failure after myocardial infarction (MI) by real- time three-dimensional echocardiography (RT-3DE), and to investigate the clinical application value of using RT-3DE as a method of providing more detailed information for clinical strategy.
This cross-sectional study was carried out in Renmin Hospital of WuHan University, Hubei Province, China from July 2009 to December 2010. The RT-3DE was performed on 43 patients with chronic heart failure after MI and 30 normal subjects, to analyze LV volume and left ventricular ejection fraction (LVEF), also the LV systolic dyssynchrony index (SDI).
The dyssynchrony rate of the total MI patients was 83.7%, and was 100% in the severe dysfunction group. The SDI of MI patients was significantly higher than the control subjects (p less than 0.01), and the SDI of those whose LVEF </=35% is obviously higher than the patients whose LVEF ranges from 35-50%. The LVEF was well correlated with SDI (r = -0.84, p less than 0.001) in MI patients. The LV dyssynchrony prevalence was more severe in the anterior MI than the inferior MI.
The LV dyssynchrony occurred more often in patients with cardiac dysfunction after MI, and was well related with the LV systolic function. The RT-3DE could be considered as an effective and informative tool for the evaluation of LV dyssynchrony.
Saudi medical journal 03/2012; 33(3):256-61. · 0.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: First reported by Coto in 1980, aorta-right atrial tunnel (ARAT) is a rare congenital vascular connection between the aortic root and RA. The case report presents a 38-year-old male patient with ARAT. Echocardiography showed a tunnel-like structure which appeared to be a connection between the left coronary sinus and the left atrium although the tunnel was connected to the right atrium. The misdiagnosis may be explained that the images were overlaid and abnormal color flow signal was not detected in RA because of the failure to detect color flow spectrum at the outlet of superior vena cava (SVC). We have discussed the diagnostic experience of the rare congenital cardiac anomaly in echocardiography: (1) carefully detect the origin and termination of abnormal tunnel structure; (2) the outlet of SVC into RA should be detected for possible artery flow spectrum and color flow signal into RA; (3) transesophageal echocardiography should be performed for identifying the diagnosis of ARAT if it is necessary.
Echocardiography 02/2012; 29(2):E43-4. · 1.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To study the cost-efficiency and safety of bedside forceps dilatational tracheostomy (FDT) in the intensive care unit (ICU).
FDT was performed in 83 patients who needed prolonged artificial airway. The time interval between the decision and actual time of operation, time for completing the procedure, operation cost, perioperative and postoperative complications were recorded and analyzed. The operation cost was compared between 83 FDT cases and other 102 surgical tracheostomy (ST) cases which were performed in the operation room during the same period.
FDT was successfully performed for 83 patients. The average time interval between the decision and undertaking FDT was (11.5±8.5) hours, the average operating time was (14.5±5.5) minutes, the operation cost of FDT [(1 560±340) yuan] was lower than that of ST [(2 600±450) yuan, P <0.05]. The incidence of the perioperative and postoperative complication of the 83 patients was 15.66% and 2.41% respectively. Nine patients died within 28 days after FDT.
FDT performed by intensivists for critically ill patients in ICU is safe and cost-effective.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 09/2010; 22(9):537-9.
-
[show abstract]
[hide abstract]
ABSTRACT: To observe the effect of low-dose hydrocortisone on the requirement of norepinephrine and lactate clearance in patients with refractory septic shock, and to investigate the effect of stress dose corticosteroids in reversing septic shock and improving tissue oxygen supply.
Seventy-seven septic shock patients with hypotension refractory to fluids and administration of norepinephrine were randomly divided into control and treatment groups. In treatment group intravenous injection of low-dose hydrocortisone was given on top of the treatment given in control group for 14 days. The mean arterial pressure (MAP), lactate clearance and the data of norepinephrine use were compared between two groups during the course of treatment.
The number of patients requiring norepinephrine was significantly lower and the MAP was significantly higher in 24 hours, 7 days, 14 days than those at the beginning of treatment in both groups (all P<0.01). Compare to the control group, the course of using norepinephrine was shorter and the number of using norepinephrine was smaller in 7 days in treatment group (both P<0.05 ); the MAP and lactate clearance were higher in 24 hours and 7 days in treatment group (P<0.05 or P<0.01). But there were no differences in mortality and the length of stay in intensive care unit (ICU).
For the patients with septic shock with refractory hypotension, low-dose hydrocortisone can decrease the time course and dosage of vasopressors, improve tissue oxygen supply, thus can reverse septic shock more rapidly.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 09/2009; 21(9):529-31.
