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Chinese medical journal 05/2013; 126(10):1974-1977. · 0.86 Impact Factor
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ABSTRACT: BACKGROUND: The lowering of body temperature is a common, almost reflexive step in the daily care of septic shock patient. However, the effect of different magnitudes of fever control on the outcome of refractory septic patients with a very poor outcome is controversial and has yet to be explored. METHODS: This prospective trial examined sixty-five refractory septic shock patients with a core temperature higher than 38.5°C. Patients were randomly assigned to a group achieving a "low temperature" range (LT group: 36.0 - 37.5°C) or to a group achieving a "high temperature" range (HT group: 37.5 - 38.3°C) by physical methods including a water-flow cooling blanket and ice packs. A target core temperature was achieved in 1 - 2 hours post-treatment, and maintained for 72 hours. Averaged values of core temperature as well as hemodynamic, respiratory, and laboratory variables were analyzed at baseline and during the first 72 hours after fever control. RESULTS: Thirty-four (52.31%) patients were assigned to the LT group and thirty-one (47.69%) patients were assigned to the HT group. The mean core temperature was significantly lower in the LT group than in the HT group (36.61 vs. 37.85°C, respectively; P < 0.0001). The average heart rate (HR) (75.5 vs. 91.9 beats/min, respectively; P < 0.0001) and the mean cardiac output (CO) (5.35 vs. 6.45 L/min, respectively; P = 0.002) were also statistically significant lower in the LT group than in the HT group. The averaged serum lactate level was significantly higher in the LT group compared to the HT group (5.59 vs. 2.82 mmol/L, respectively; P = 0.008). Fibrinogen and activated partial thromboplatin time were also different between the two groups. The 28 days mortality was significantly higher in the LT group than in the HT group (61.8 vs. 25.8%, respectively; P = 0.003). A Cox-regression model analysis showed that mean core temperature during the 72 h period was an independent predictor of 28 days mortality (odds ratio (OR) = 0.42, 95%CI 0.25, 0.6; P = 0.001). CONCLUSION: Controlling fever to a lower range (36.0 - 37.5°C) may be harmful to patients with refractory septic shock by worsening tissue perfusion, compared to controlling it within a higher range (37.5 - 38.3°C). An understanding of the mechanisms responsible for these observations requires further investigation.
Chinese medical journal 05/2013; 126(10):1809-1813. · 0.86 Impact Factor
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ABSTRACT: To evaluate whether or not brachial artery peak velocity (Vpeak-BA) induced by passive leg raising (PLR) may predict volume responsiveness.
We prospectively studied 29 patients enrolled into our intensive care unit (ICU) with spontaneous breathing during mechanical ventilation. Through echocardiography we compared the changes of brachial artery peak velocity induced by passive leg raising (ΔVBA-PLR) and the changes of left ventricle outflow tract velocity-time integral after volume expansion (ΔVTI-VE). Also the sensitivity and specificity of ΔVpeak-BA were determined in predicting volume responsiveness.
Among them, 15 responded to volume expansion and the rest 14 did not. ΔVBA-PLR and ΔVTI-VE were mutually correlated (R(2) = 0.378, P = 0.011). The sensitivity and specificity of ΔVpeak-BA ≥ 16% to predict volume responsiveness were 73% and 87% respectively.
Brachial artery peak velocity induced by passive leg raising is a reliable indicator of predicting volume responsiveness in patients with spontaneous breathing.
Zhonghua yi xue za zhi 01/2013; 93(3):195-9.
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Zhonghua yi xue za zhi 12/2012; 92(45):3169-3171.
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Zhonghua nei ke za zhi [Chinese journal of internal medicine] 12/2012; 51(12):929-931.
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ABSTRACT: OBJECTIVE: To investigate the effect of the bedside lung ultrasound in emergency(BLUE)-plus lung ultrasound protocol on lung consolidation and atelectasis of critical patients. METHODS: All patients who need to receive mechanical ventilation for more than 48 hours in ICU from June 2010 to December 2011 in Peking Union Medical College Hospital were included in the study. BLUE-plus and BLUE lung ultrasound, bedside X-ray, lung CT examination were performed on all patients at the same time. The condition of lung consolidation and atelectasis discovered by BLUE-plus lung ultrasound protocol was recorded and compared with bedside X-ray or lung CT. The difference in assessment of lung consolidation and atelectasis between BLUE-plus lung ultrasound protocol and BLUE protocol was compared. RESULTS: A total of 78 patients were finally enrolled in the study. The lung CT found 70 cases (89.74%) had different degrees of lung consolidation and atelectasis. The sensitivity, specificity and diagnostic accuracy of lung consolidation and atelectasis by the bedside chest X-ray were 31.29%, 75.00% and 38.46%, respectively. BLUE-plus lung ultrasound protocol found 68 cases with lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 95.71%, 87.50% and 94.87%, respectively, which were significantly higher than those of lung CT. BLUE protocol found 48 cases of lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 65.71%, 75.00% and 66.67%, respectively. The position of lung consolidation and atelectasis which hadn't been found by BLUE protocol was mainly proved to be located in the basement of lung by lung CT. CONCLUSIONS: The incidence of lung consolidation and atelectasis in critical patients who received mechanical ventilation is high. The BLUE-plus lung ultrasound protocol has a relatively higher sensitivity, specificity and diagnostic accuracy for consolidation and atelectasis, which can find majority of consolidation and atelectasis. As BLUE-plus lung ultrasound is a bedside noninvasive method allowing immediate assessment of most lung consolidation and atelectasis, it will be likely the alternative of the CT and play a key role in assessment of lung consolidation and atelectasis.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 12/2012; 51(12):948-951.
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ABSTRACT: Currently, slightly more than 50% of bloodstream infections (BSIs) are hospital acquired. When these infections occur in patients in intensive care units, they are associated with a high mortality rate, additional hospital days and excess hospital costs. Because of multifactor of nosocomial BSIs, measurements of control nosocomial BSIs are wide variety and lead to some confusion in practice. The aim of this study was to explore special way in accordance with self-hospital base on common principle.
In one ward of the Intensive Care Unit, Peking Union Medical College Hospital, at first, we divided the all operation about bloodstream way into three sections used as keypoints. By surveying keypoints respectively, some operation faults of blood way were discovered. For decreasing the mobidity of nosocomial BSIs, some intervention measurements were executed. The rate of nosocomial BSIs was analyzed by chi-square test.
According to the statistics from January to June, we received and cured 618 patients in total; among them, there were 13 cases of nosocomial BSI and the average occurrence was 2.3 cases/month. After intervention measurements from July to December 2011, we received and cured 639 patients in total with seven cases of nosocomial BSI, and the average occurrence was 1.2 cases/month (P < 0.05). From January to April 2012, no nosocomial BSI occurred in the investigated ward.
Removing the operation faults of bloodstream way might decrease the nosocomial BSI rapidly and efficiently by utilizing a key point survey.
Chinese medical journal 09/2012; 125(17):3044-7. · 0.86 Impact Factor
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ABSTRACT: To investigate the relationship between end-tidal carbon dioxide with its related indicators and ventilation/perfusion of the acute respiratory distress syndrome (ARDS) lung, and to explore a feasible way to titrate positive end-expiratory pressure (PEEP) in clinical practice.
Five mixed-breed dogs with oleic acid lung injury model were mechanically ventilated at a serial PEEP trial including a recruitment maneuver (RM) before each PEEP level changed. The value of blood dynamics, end-tidal carbon dioxide partial pressure (PetCO2) and arterial carbon dioxide pressure under different PEEP levels were recorded. Arterial end-tidal carbon dioxide gradient (Pa-etCO2) and dead space fraction (Vd/Vt%) were calculated. All dogs received CT scan. Lung volume under different pressure levels, and ratio and volume of alveolar closing pressure, collapsed alveoli, sufficiently and insufficiently ventilated alveoli were obtained. Alveolar opening and closing analysis were performed by non-liner regression equation.
The mean pressure when Vd/Vt% obtained lowest level were (11.2 ± 4.4) cm H2O (1 cm H2O = 0.098 kPa), which had no significant difference when compared to alveolar closing pressure [(11.5 ± 3.2) cm H2O](P > 0.05). The fraction of insufficiently ventilated and collapsed alveoli showed a significant linear correlation with the Vd/Vt% when PEEP was lower than P(min) (r = 0.632, P = 0.004). There was a linear correlation between the Vd/Vt% and the fraction of over-distended alveoli when PEEP was higher than P(min) (r = 0.770, P = 0.001).
Closing pressure is in accordance with PEEP level after RM having reached the best ventilation/circulation ratio. The characteristics of lung collapse can be revealed by Vd/Vt% changes after RM. To titrate PEEP for the lowest Vd/Vt% after RM may be a feasible way to match the best ventilation and circulation effects of PEEP.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 08/2012; 51(8):604-8.
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ABSTRACT: To assess the predictive ability of CD8(+) T-cell counts and the expressions of CD28, CD38, HLA-DR on CD8(+) T cells in immunocompromised critically ill (ICCI) patients with pulmonary invasive fungal infections (PIFI).
The evolution of CD8(+) T-lymphocyte subgroups (CD8(+), CD8(+)CD28(+), CD8(+)CD38(+), CD8(+)HLA-DR(+)) were measured in the peripheral blood of 80 ICCI patients with pulmonary infection on day 1 (D1), 3 (D3) and 7 (D7) of intensive care unit (ICU) admission by quantitative flow cytometry. Forty immunocompetent, uninfected critically ill patients were analyzed as control subjects at the time of admission.Immunocompromised risk factors and PIFI was diagnosed according to European Organization for Research and Treatment of Cancer-Mycoses Study Group (EORTC-MSG) 2008 definitions.
PIFI were diagnosed in 71.3% of the ICCI patients (57/80) and included 22 molds infections, 22 Candida infections and 13 mixed infections. Among the 80 ICCI patients, CD8(+), CD8(+)CD28(+), and CD8(+)CD38(+) T-cell counts were significantly lower (P < 0.01) and CD8(+)HLA-DR(+) T-cell counts were significantly higher (P < 0.01) than in the control subjects during the monitoring period, while CD8(+), CD8(+)CD28(+), and CD8(+)CD38(+) T cells demonstrated an additional significant decrease in PIFI patients compared with non-PIFI patients (P < 0.01). Receiver operating characteristic (ROC) analysis for discrimination of the 28-day mortality revealed area under the curve (AUC) values of 0.83, 0.84 and 0.87 for the CD8(+)CD28(+) T-cell counts (D1, D3 and D7, respectively). Cutoff values of D1 < 64 cells/mm(3), D3 < 75 cells/mm(3), and D7 < 88 cells/mm(3) had sensitivities of 0.73 (95%CI: 0.61 - 0.85), 0.74 (95%CI: 0.62 - 0.85), and 0.71 (95%CI: 0.58 - 0.84), specificities of 0.90 (95%CI: 0.77 - 1.00), 0.91(95%CI: 0.78 - 1.00), and 0.95 (95%CI: 0.85 - 1.00), and efficiencies of 77.8%, 79.5% and 78.5% respectively. The time interval between ICU admission and CD8(+)CD28(+) positive 1.7 days (range: 1.0 - 7.0) was significantly shorter than the time to diagnosis of IFI by radiological 4.1 days (range: 1.0 - 21.0) and microbiological 7.5 days (range: 3.0 - 17.0) criteria (P < 0.01).
An extreme distribution of CD8(+) T-lymphocyte subgroups in ICCI patients was closely related to PIFI. The measurement of CD8(+)CD28(+) T-cell counts may be an early predictor of PIFI in ICCI patients.
Zhonghua yi xue za zhi 05/2012; 92(18):1253-8.
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ABSTRACT: To explore the role of left ventricular-arterial coupling in the resuscitation of refractory septic shock.
A total of 58 patients with refractory septic shock admitted from January 2010 to July 2011 were retrospectively studied. Hemodynamic data, arterial lactate concentration and APACHEII (acute physiology & chronic health evaluation II) score at the beginning of and 24 hours after cardiac output monitoring, as well as the outcome of Day 28 post-diagnosis were recorded. Stroke volume index (SVI), cardiac index (CI) and global end diastolic volume index (GEDVI) were obtained through transpulmonary thermodilution technique by a pulse induced continuous cardiac output (PiCCO) system. Left ventricular end systolic volume index (LVESVI) was approximated to (GEDVI/4-SVI) while effective arterial elastance index/ventricular end systolic elastance index (EaI/EesI) was approximated to LVESVI/SVI.
(1) APACHEII score at the 24th hour, 24 hs lactate clearance rate and 24 hs Ea/Ees variation (ΔEa/Ees) were higher in non-survivors than those in survivors; (2) binary Logistic regression analysis showed that ΔEa/Ees and APACHEII score at the 24th hour were the independent risk factors of mortality for refractory septic shock. And the OR value of ΔEa/Ees was higher than that of APACHEII score (2.04 vs 1.63). Their areas of ROC curve were 0.705 (95%CI 0.569 - 0.841, P = 0.007) and 0.939 (95%CI 0.878 - 1.000, P = 0.000) respectively; (3) all hemodynamic parameters at the beginning had no difference between ΔEa/Ees > 0 and ΔEa/Ees ≤ 0 groups. CI, SVI, EGDT (early goal-directed therapy) compliance rate at the 24th hour in the ΔEa/Ees > 0 group were lower than those in the ΔEa/Ees ≤ 0 group. The effective arterial elastance index (EaI) at the 24th hour and the mortality rate of Day 28 in the ΔEa/Ees > 0 group were higher than those in the ΔEa/Ees ≤ 0 group; (4) during the 24 hs treatment, ΔEa/Ees was correlated negatively with the variations of CI, SVI, EesI and lactate clearance rate and positively with the variations of heart rate, GEDVI, systolic vascular resistance index and EaI.
ΔEa/Ees may be used as an excellent marker of predicting the outcome of refractory septic shock. Lowing Ea/Ees in resuscitation has beneficial effects on EGDT compliance, lactate clearance and outcome.
Zhonghua yi xue za zhi 04/2012; 92(15):1012-6.
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ABSTRACT: Central venous oxygen saturation (ScvO2) is a useful therapeutic target in septic shock and high-risk postoperative patients. We tested the hypothesis that central venous-to-arterial carbon dioxide difference (ΔPCO(2)) combine with ScvO2 to guide shock resuscitation is better than ScvO2 only.
A retrospective study was conducted for 93 septic shock and high-risk postoperative patients. They underwent resuscitation through early goal-directed therapy. We calculate whether there were correlations between the ΔPCO(2) and tissue perfusion index or blood flow index, including the beginning of resuscitation (T0) and after 6 hour resuscitation (T6). They were divided into 4 groups according to ΔPCO(2) and ScvO2. Then the clearance of lactate was compared between the groups.
No correlation existed between ΔPCO(2) and tissue perfusion index. But there was some correlation between ΔPCO(2) and the indices of blood flow such as CO, ScvO2 and clearance of lactate. At T0, the correlation (r) between ΔPCO(2) and cardiac index was -0.858 (P = 0.029) and the correlation between ΔPCO(2) and ScvO2 -0.403 (P = 0.000). At T6, the correlation (r) between ΔPCO(2) and ScvO2 was -0.363 (P = 0.000) and the correlation between ΔPCO(2) and clearance of lactate -0.314 (P = 0.002). After continuous 6-hour resuscitation, there was significant difference in clearance of lactate between the groups. The clearance of lactate was the highest in the group of patients achieving the goals of both ScvO2 > 70% and ΔPCO(2) < 6 mm Hg. We further analysis the ΔPCO(2) < 6 mm Hg and ScvO2 > 70% subgroup and found that the 6 h lactate clearance rate were statistically significant difference.
The combination of ΔPCO(2) and ScvO2 may guide the shock resuscitation. It helps identify the inadequately resuscitated when the ScvO2 goal is reached.
Zhonghua yi xue za zhi 04/2012; 92(13):909-14.
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ABSTRACT: The transcutaneous partial pressure of oxygen (PtcO₂) index has been used to detect low-flow state in circulatory failure, but the value of the transcutaneous oxygen challenge test (OCT) to estimate low cardiac output has not been thoroughly evaluated. The prospective observational study examined 62 septic patients requiring PiCCO-Plus for cardiac output monitoring. Simultaneous basal blood gases from the arterial, central venous catheters were obtained. Cardiac indices were measured by the transpulmonary thermodilution technique at the same time, then the 10-min inspired 1.0 fractional inspired oxygen concentration (FIO₂) defined as the OCT was performed. Transcutaneous partial pressure of oxygen was measured continuously by using a noninvasive transcutaneous monitor throughout the test. The values for arterial pressure of oxygen (PaO₂) were examined on inspired of 1.0 FIO₂. We calculated the PtcO₂ index = (baseline PtcO₂/baseline PaO₂), 10-min OCT (10 OCT) = (PtcO₂ after 10 min on inspired 1.0 O₂) - (baseline PtcO₂), and the oxygen challenge index = (10 OCT) / (PaO₂ on inspired 1.0 O₂ - baseline PaO₂). Patients were divided into two groups: a normal cardiac index (CI) group with CI of greater than 3 L/min per m (n = 41) and a low CI group with CI of 3 L/min per m or less (n = 21). The 10 OCT and the oxygen challenge index predicted a low CI (≤ 3 L/min per m) with an accuracy that was similar to central venous oxygen saturation, which was significantly better than the PtcO₂ index. For a 10 OCT value of 53 mmHg, sensitivity was 0.83; specificity, 0.86; a positive predictive value, 0.92; and a negative predictive value, 0.72 for detecting CI of 3 L/min per m or less. We propose that the OCT substituted for the PtcO₂ index as an accurate alternative method of PtcO₂ for revealing low CI in septic patients.
Shock (Augusta, Ga.) 11/2011; 37(2):152-5. · 2.87 Impact Factor
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ABSTRACT: To investigate the correlation of transcutaneous oxygen challenge test (OCT) [the degree of PtcO2 response to increased fractional inspired oxygen concentration (FiO2) of 1.0 is identified as transcutaneous OCT] and central venous oxygen saturation (ScvO2) in septic shock patients after resuscitation.
A total of 49 septic shock patients were prospectively studied. They underwent PtcO2 monitoring and OCT (a temporary increase of FiO2 for 10 min). Baseline central venous blood gases, baseline arterial blood gases and post-OCT arterial blood gases were examined. The parameters of PtcO2 index (baseline PtcO2/PaO2), tissue oxygen index (baseline PtcO2/FiO2), 10 min OCT value [(PtcO2 after 10 min on FiO2 of 1.0) minus (baseline PtcO2)], oxygen challenge index [(10 min OCT value)/(PaO2 on FiO2 1.0 minus baseline PaO2)] were calculated during OCT. The patients were divided into 2 groups according to ScvO2 values: normal ScvO2 group (ScvO2 ≥ 70%) versus low ScvO2 group (ScvO2 < 70%). The parametric differences of transcutaneous OCT were compared between two groups.
(1) There was a significant correlation between baseline PtcO2 (r = 0.382, P = 0.007), tissue oxygen index (r = 0.355, P = 0.012), 10 min OCT value (r = 0.427, P = 0.002), oxygen challenge index (r = 0.5, P < 0.001) and ScvO2, but not with arterial blood lactate concentration; (2) there were 27 patients in the low ScvO2 group and 22 patients in the normal ScvO2 group. ScvO2 was significantly lower in the low ScvO2 group than in the normal ScvO2 group (61 ± 8 vs 77 ± 6, P < 0.05). No differences in age, severity score, vital signs, arterial blood lactate concentration, vasoactive drugs, PtcO2, PtcO2 index and tissue oxygen index were observed between these groups. Compared with those in the normal ScvO2 group, the patients in the low ScvO2 group had a lower 10 min OCT value and oxygen challenge index (P < 0.05); (3) the area under the receiver operating characteristic curve (ROC) for detecting the lower ScvO2 values was 0.621, 0.560, 0.589, 0.721 and 0.763 respectively according to baseline PtcO2, PtcO2 index, tissue oxygen index, 10 min OCT value and oxygen challenge index. The cutoff of 10 min OCT value was ≤ 57 mm Hg (1 mm Hg = 0.133 kPa) for detecting ScvO2 values under 70%, resulting in a sensitivity of 51.9% and a specificity of 95.5%.
OCT may improve the diagnostic accuracy of PtcO2 in assessing the low ScvO2 values in septic shock patients after resuscitation.
Zhonghua yi xue za zhi 09/2011; 91(35):2449-52.
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ABSTRACT: To investigate the acid-base abnormalities of the patients with hyperlactatemia and explore the relationship of hyperlactatemia and metabolic acidosis so as to seek a more precise index of reflecting organ perfusion.
From August 2009 to April 2010, all consecutive patients admitted into intensive care unit received an analysis of blood gas. Those individuals with arterial lactate ≥ 2 mmol/L were selected.
In the group of hyperlactatemic patients, the occurrence of metabolic acidosis as judged by the traditional method was less than that by the Stewart's method (33.9% vs 56.0%). No typical acidemia was found. And all components of metabolic acidosis were calculated. Lactate and SIG (strong ion gap) contributed a certain percentage to metabolic acidosis in the survivor and nonsurvivor groups [(33.6 ± 17.9)% vs (28.6 ± 23.5)%, (42.1 ± 18.5)% vs (44.9 ± 23.0)%].
Among the hyperlactatemic patients (Lac ≥ 2), lactate and unmeasured anions account for most instances of acidosis. These two indicators may offer a more accurate reflection of tissue perfusion.
Zhonghua yi xue za zhi 09/2011; 91(33):2324-8.
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ABSTRACT: To investigate the impact of extended focus assessed transthoracic echocardiography (eFATE) in septic shock patients.
A total of 83 septic shock patients were recruited. And they were divided into the eFATE and routine groups. In the routine group, the patients were assessed by routine methods. And in the eFATE group, the following parameters of central venous pressure (CVP), mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI) and ScvO(2) (central venous oxygen saturation) were measured routinely. The PiCCO (pulse indicator continuous cardiac output) method was employed when needed. All parameters and the others [acute physiology and chronic health evaluation II (APACHEII) & lactate] were recorded every 6 h. At 6, 24, 72 h and 1 w, the fluid intake volumes were recorded. All values were analyzed by statistic methods. And the mortality rates of intensive care unit and Day 28 were recorded.
In the eFATE group, the 24 h targeting rate was markedly higher than the routine group. Yet there was no effect on the 6 h targeting rate. In the eFATE group, the fluid intake volumes at 6, 24 h and 1 w were markedly lowered than those of the control group. And the myocardial inhibition occurred earlier versus the control group. There was no difference in mortality rate between two groups.
eFATE plays an important role in the correct assessment of septic shock patients. But its prognostic impact remains to be further defined.
Zhonghua yi xue za zhi 07/2011; 91(27):1879-83.
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Zhonghua nei ke za zhi [Chinese journal of internal medicine] 07/2011; 50(7):539-40.
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ABSTRACT: To investigate the effects of central venous pressure on acute kidney injury (AKI) in septic shock.
A total of 86 septic shock patients with PiCCO (pulse indicator continuous cardiac output) monitoring admitted at our department from January 2009 to January 2011 were retrospectively studied. They were divided into 2 groups based on central venous pressure (CVP) at 24 hs after PiCCO monitoring. There were 41 cases in low CVP group (CVP ≤ 10 mm Hg and 45 cases in high CVP group (CVP > 10 mm Hg). Their hemodynamic data, lactate concentration, ScvO₂ (central venous oxygen saturation), APACHEII (acute physiology & chronic health evaluation II) score and serum creatinine were obtained at the beginning and 24 hours after PiCCO monitoring. The incidence and mortality of AKI, the outcome of these patients in ICU and at Day 28 post-diagnosis were recorded.
(1) The incidences of AKI were 51.2% (21/41) and 75.6% (34/45) in low and high CVP groups respectively; (2) Nine cases (22.0%) died in ICU in low CVP group and 20 cases (44.4%) in high CVP group. And 12 cases (29.3%) died within 28 days in low CVP group while 21 cases (46.7%) in high CVP group.
A high CVP may increase the incidence and morbidity of AKI in septic shock. And an excessively high CVP should be prevented.
Zhonghua yi xue za zhi 05/2011; 91(19):1323-7.
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ABSTRACT: Hepatocytes emerge from a quiescent state into a proliferative state to recover from septic injury. We hypothesize that hepatocyte cell cycle regulation after sepsis potentially contributes to the recovery of liver function.
An animal model of sepsis was induced by cecal ligation and puncture (CLP) in rats. At serial time points after CLP, hepatocyte expression of p21, P53, cyclin D1, cyclin E, CDK2, CDK4 and PCNA was determined by immunoblot analysis, and the DNA content of isolated hepatocytes was analyzed using flow cytometry.
Sepsis-induced liver injury of rats was associated with G1 cell cycle arrest. Recovery of liver function was related to cell cycle progression 48 h after CLP. The upregulation of p53 and p21 correlated with G1 cell arrest 48 h after CLP. The upregulation of cyclin D1/CDK4 and cyclin E/CDK2 also correlated with the G1/S transition 48 h after CLP, resulting in PCNA expression.
The data suggests that G1 cell cycle arrest and p53, p21, CDKs, cyclins and PCNA expression may be involved in the injury/recovery of liver function after intraperitoneal sepsis.
Agents and Actions 04/2011; 60(8):783-9. · 1.59 Impact Factor
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ABSTRACT: To study clinical effectiveness and possible side effects of lower tidal volume combine with lung recruitment on acute respiratory distress syndrome (ARDS) for post operative esophageal carcinoma surgery patients.
Twenty six hypoxemie post operative esophageal carcinoma surgery patients from Cancer Hospital and Peking Union Medical College Hospital were included from 1st January 2007 to 30th September 2009. There were 20 male and 6 female with an average age of 65.5 years (51 - 76 years). Circulation was stable among them. They could not weaned from mechanical ventilation due to ARDS. Bedside monitoring included noninvasive continuous artery blood pressure (NBP), pulse oximetry saturation (SPO2). Patients were ventilated on volume control mode. Tidal volumes set to 6 ml/kg. Recruitment maneuvers were conducted by stepwise rising of positive end expiratory pressure (PEEP) level. PEEP, fraction of inspired oxygen (FiO2), static compliance of lung (CLS) and arterial blood gas analysis (ABG) before and at 30 min after each of twice applying recruitment maneuvers were measured.
Fifty-two recruitments were completed on these 26 cases. PaO2/FiO2 improved significantly in 26 cases. The level of FiO2 were significantly lowered, CLS were increased significantly 30 min after each of twice applying recruitment maneuvers in all 26 cases. No complication was encountered. All patients were discharged successfully.
Hypoxemia of ARDS following esophageal carcinoma surgery can be improved by lower tidal volume combine with lung recruitment maneuver.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2010; 48(19):1484-7.
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Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 07/2010; 22(7):443-6.
