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Zhonghua wei zhong bing ji jiu yi xue. 05/2013; 25(5):274-6.
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ABSTRACT: BACKGROUND: Weaning difficulties occur in 31% of total intubated patients, and result in prolonged weaning duration. A computer-driven automated weaning system can perform a spontaneous breathing trial (SBT) automatically and display a message when the trial is successfully passed. Such a system might have a beneficial effect on difficult-to-wean patients. The aim of this study was to examine whether the computer-driven automated weaning system can accelerate discontinuation of mechanical ventilation and improve outcomes in difficult-to-wean patients. METHODS: This randomized controlled study included 39 difficult-to-wean patients who failed their first spontaneous breathing trial. Before initiating weaning, eligible patients were randomly allocated to wean by computer-driven automated weaning system (CDW group, n = 19) or a physician-controlled local protocol (PW group, n = 20). Weaning duration, defined as the time from inclusion until first extubation, was the primary endpoint. Secondary endpoints were total duration of mechanical ventilation, the length of intensive care unit (ICU) stay, the number of reintubations, the mortality rate in the ICU, the number of noninvasive ventilations, the number of complications in the ICU, and the number of ventilator-associated pneumonia cases. RESULTS: The weaning duration was reduced with the computer-driven weaning as compared with the usual protocol (median 29.0 hours vs. 45.5 hours, P = 0.044). Total duration of mechanical ventilation and duration of the ICU stay did not differ between the CDW and PW groups. There was no difference in the number of reintubations between the CDW and PW groups (3 and 4 patients, P = 0.732). The study groups showed comparable numbers of tracheostomy, self-extubations, ventilator-associated pneumonia, and non-invasive ventilation. Mortality in the ICU was similar in the CDW and the PW groups (21.1% vs. 20.0%, P = 0.935). CONCLUSION: The computer-driven automated weaning system can reduce weaning duration in difficult-to-wean patients as compared with a physician-controlled weaning protocol.
Chinese medical journal 05/2013; 126(10):1814-1818. · 0.86 Impact Factor
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Zhonghua wei zhong bing ji jiu yi xue. 03/2013; 25(3):190-2.
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ABSTRACT: The fast development of next-generation sequencing technology presents a major computational challenge for data processing and analysis. A fast algorithm, de Bruijn graph has been successfully used for genome DNA de novo assembly; nevertheless, its performance for transcriptome assembly is unclear. In this study, we used both simulated and real RNA-Seq data, from either artificial RNA templates or human transcripts, to evaluate five de novo assemblers, ABySS, Mira, Trinity, Velvet and Oases. Of these assemblers, ABySS, Trinity, Velvet and Oases are all based on de Bruijn graph, and Mira uses an overlap graph algorithm. Various numbers of RNA short reads were selected from the External RNA Control Consortium (ERCC) data and human chromosome 22. A number of statistics were then calculated for the resulting contigs from each assembler. Each experiment was repeated multiple times to obtain the mean statistics and standard error estimate. Trinity had relative good performance for both ERCC and human data, but it may not consistently generate full length transcripts. ABySS was the fastest method but its assembly quality was low. Mira gave a good rate for mapping its contigs onto human chromosome 22, but its computational speed is not satisfactory. Our results suggest that transcript assembly remains a challenge problem for bioinformatics society. Therefore, a novel assembler is in need for assembling transcriptome data generated by next generation sequencing technique.
Science China. Life sciences 02/2013; 56(2):156-62. · 2.02 Impact Factor
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ABSTRACT: To compare cell suspension examination with histopathology in detecting spermatozoa in the testicular tissue of non-obstructive azoospermia (NOA) patients, and to investigate the reliability of sperm retrieval and appropriate therapeutic options when the results of the two methods are inconsistent.
A total of 1 112 NOA patients underwent testicular sperm extraction (TESE), their testicular tissues subjected to cell suspension examination and histopathology, respectively.
The consistency rate of the two methods was 92.63%, with the sperm detection rate of 41.82% and non-sperm detection rate of 50.81%. Sperm were retrieved from 96.0% (24/25) of the patients on the day of oval retrieval, in whom sperm were found in cell suspension examination but not in histopathology. After intracytoplasmic sperm injection (ICSI), pregnancy was achieved in 8 cases (33.33%), abortion occurred in 4 (16.67%), and non-pregnancy in 12 (50.0%).
Cell suspension examination combined with histopathology for detecting sperm in the testicular tissue of NOA patients gives instant, accurate, reliable and consistent results, and therefore insures successful sperm retrieval for NOA patients during the IVF cycle. In case of inconsistency between the results of the two methods, cell suspension examination is more helpful for clinical therapeutic option.
Zhonghua nan ke xue = National journal of andrology 01/2013; 19(1):68-71.
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ABSTRACT: The differentiation of mesenchymal stem cells (MSCs) into type II alveolar epithelial (AT II) cells in vivo and in vitro, is critical for reepithelization and recovery in acute lung injury (ALI), but the mechanisms responsible for differentiation are unclear. In the present study, we investigated the role of the canonical wnt pathway in the differentiation of mouse bone marrow-derived MSCs (mMSCs) into AT II cells. Using a modified co-culture system with murine lung epithelial-12 (MLE-12) cells and small airway growth media (SAGM) to efficiently drive mMSCs differentiation, we found that GSK 3β and β-catenin in the canonical wnt pathway were up-regulated during differentiation. The levels of surfactant protein (SP) C, SPB and SPD, the specific markers of AT II cells, correspondingly increased in mMSCs when Wnt3a or LiCl was added to the co-culture system to activate wnt/β-catenin signaling. The expression of these factors was depressed to some extent by inhibiting the pathway with the addition of DKK 1. The differentiation rate of mMSCs also depends on their abilities to accumulate and survive in inflammatory tissue. Our results suggested that the activation of wnt/β-catenin signaling promoted mMSCs migration towards ALI mouse-derived-lung tissue in a Transwell assay, and ameliorated the cell death and the reduction of Bcl-2/Bax induced by H(2) O(2) , which simultaneously caused reduced GSK 3β and β-catenin in mMSCs. These data supports a potential mechanism for the differentiation of mMSCs into AT II cells involving canonical wnt pathway activation, which may be significant to their application in ALI. J. Cell. Physiol. © 2012 Wiley Periodicals, Inc.
Journal of Cellular Physiology 11/2012; · 3.87 Impact Factor
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ABSTRACT: OBJECTIVE: To explore the effects of FLT3 signaling on the accumulation and maturation of pulmonary conventional dendritic cells (cDCs) and determine whether or not the inhibition of FLT3 signaling may attenuate acute lung inflammation/injury (ALI). METHODS: C57BL/6 mice were pretreated separately with FLT3-ligand (FLT3L) and lestaurtinib for 5 days. Murine model of ALI was subsequently induced by an intra-tracheal instillation of lipopolysaccharide (LPS) and lung specimens were harvested 24 hours later. The accumulation and maturation status of pulmonary cDCs were assessed by flow cytometry. Lung myeloperoxidase (MPO) activity was measured to evaluate the infiltration of neutrophils. The ratio between transcription factors T-bet and GATA-3 mRNA was determined to estimate the balance of Th1/Th2 response. Lung injury was estimated by lung wet weight/body weight ratio (LWW/BW) and histopathological assessment. RESULTS: LPS challenge resulted in rapid accumulation and maturation of pulmonary cDCs. FLT3L pretreatment further stimulated the accumulation and maturation of pulmonary cDCs, leading to a marked deterioration of LWW/BW and lung histopathological changes. Meanwhile, the lung MPO activity and T-bet/GATA-3 mRNA ratio were boosted by the administration of FLT3L. In contrast, the lestaurtinib pretreatment inhibited the accumulation and maturation of pulmonary cDCs, leading to a significant improvement of LWW/BW and lung histopathological changes. The administration of lestaurtinib also suppressed the lung MPO activity and T-bet/GATA-3 mRNA ratio in the lung. CONCLUSIONS: FLT3 signaling attenuates ALI by regulating the accumulation and maturation of pulmonary cDCs, indicating a potential pharmacotherapy for ALI.
Zhonghua yi xue za zhi 11/2012; 92(43):3079-3084.
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ABSTRACT: Respiratory dendritic cells (DCs), especially conventional DCs (cDCs), are critically involved in the induction phase of the immune response in the respiratory system. However, little information concerning cDC kinetics in acute lung injury (ALI) is available. In this study, we have used a murine model of LPS-induced ALI to examine the kinetics and phenotype of respiratory, circulating and splenic cDCs. cDCs in the lung, blood, and spleen and the IL-6 level in the lung were detected at 6, 12 and 24 h after PBS or LPS challenge. In the ALI group, a rapid cDCs accumulation in the lung was observed, and there were highly significant correlations between the frequency of respiratory cDCs or the percentage of cDC expressing CD80 and the IL-6 concentration. However, the frequency of peripheral blood cDCs decreased rapidly in ALI mice, followed by a marked expansion. In addition, splenic cDCs only showed a transient expansion in ALI. cDCs within the blood, lungs and spleens had undergone a modest maturation in the ALI group. Our findings demonstrate that LPS-induced ALI provokes a dynamic and distinct distribution as well as phenotype changes in pulmonary, circulatory and splenic cDC populations. Lung cDCs may participate in the early inflammatory response to ALI.
Molecular Biology Reports 10/2012; · 2.93 Impact Factor
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ABSTRACT: Conventional dendritic cells (cDCs) have been reported to participate in the pathophysiology of acute lung injury (ALI). Fms-like tyrosine kinase 3 (FLT3) signaling represents a highly specific pathway for the manipulation of cDCs in vivo. The purpose of this study was to clarify the effect of FLT3 signaling on the accumulation and maturation of pulmonary cDCs, and whether inhibition of FLT3 signaling may attenuate acute lung inflammation and lung injury. C57BL/6 mice were pretreated with FLT3-ligand (FLT3L) and lestaurtinib separately for five consecutive days. A murine model of ALI was subsequently generated by intra-tracheal instillation of lipopolysaccharide (LPS) and lung specimens were harvested 24 h later. Flow cytometry was conducted to measure the accumulation and maturation of pulmonary cDCs. IL-6, IFN-γ, IL-4, MPO activity and transcription factor T-bet/GATA-3 mRNA ratio were quantified to evaluate lung inflammation. Lung injury was estimated by lung wet weight/body weight ratio (LWW/BW) and histopathological analysis. LPS challenge resulted in rapid accumulation and maturation of pulmonary cDCs. FLT3L pretreatment further stimulated the accumulation and maturation of pulmonary cDCs, leading to a markedly increased LWW/BW and aggravated lung histopathology. Meanwhile, lung MPO activity, T-bet/GATA-3 mRNA ratio and concentrations of IL-6 and IFN-γ were elevated by FLT3L administration. In contrast, lestaurtinib pretreatment inhibited the accumulation and maturation of pulmonary cDCs, leading to a significantly decreased LWW/BW and improved lung histopathology. Lestaurtinib administration also suppressed lung MPO activity, T-bet/GATA-3 mRNA ratio and production of IL-6 and IFN-γ. Our findings show that FLT3 signaling ameliorates ALI by regulating the accumulation and maturation of pulmonary cDCs, suggesting an innovative pharmacotherapy for ALI.
Apmis 10/2012; 120(10):808-18. · 1.99 Impact Factor
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ABSTRACT: To evaluate the effects and safety of closed tracheal suction system(CTSS) versus open tracheal suction system (OTSS) for mechanically ventilated patients.
All randomized controlled trials (RCTs) comparing CTSS with OTSS for mechanically ventilated patients home and abroad were identified via manual and computer retrieval. All related data were extracted. Meta analysis was conducted using the statistical software RevMan 5.1 on the basis of strict quality evaluation with the methods recommended by the Cochrane Collaboration.
Fifty-one related papers were found and 12 RCTs involving 1205 patients in CTSS group and 1179 patients in OTSS group were included. The results of meta analysis showed that CTSS was associated with a significant reduction in the duration of mechanical ventilation (WMD = -0.73, 95%CI -1.07 - -0.40, P < 0.0001), but the incidence of ventilator associated pneumonia and microbial colonization, mortality and length of ICU stay exhibited no difference between the two groups (P > 0.05). However, compared with OTSS, CTSS reduced the incidence of arrhythmia (RR = 0.23, 95%CI 0.07 - 0.74, P = 0.01) and minimized the disturbance to heart rate (WMD = -1.97, 95%CI -3.03 - -0.91, P = 0.0003), mean arterial pressure (WMD = -2.01, 95%CI -3.02 - -1.01, P < 0.0001) and oxygen saturation (SpO2) (WMD = -1.00, 95%CI -1.14 - -0.86, P < 0.000 01).
Compared with OTSS, CTSS could reduce disturbance to respiratory and circulatory system by sputum suction and shorten the duration of mechanical ventilation. However, CTSS has no advantage in prevention of ventilator associated pneumonia or microbial colonization, nor does it shorten the length of ICU stay or improve the outcome of mechanically ventilated patients.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 10/2012; 51(10):763-8.
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ABSTRACT: To detect the changes of central venous-to-arterial carbon dioxide difference (P(cv-a)CO(2)) during early goal-directed therapy (EGDT) in patients with septic shock and evaluate its' value in predicting adequate resuscitation and prognosis.
From April 2009 to October 2010, 26 septic shock patients were enrolled in the study. EGDT was performed in all the patients immediately after enrollment. According to the whether they achieved early goal with in the 6 hour or not, patients were separated to EGDT achievement and un-achievement groups. At the onset and after the 6 hours EGDT, mean arterial pressure (MAP), cardiac index (CI), central venous oxygen saturation (ScvO(2)), oxygen delivery (DO(2)), oxygen comsumption (VO(2)), oxygen extraction ratio (O(2) ext), lactate, P(cv-a)CO(2) were recorded. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and 28 day mortality were compared between 2 groups.
There were no significant difference of age and sex between the 15 patients who achieved early goals and 11 patients who did not. EGDT un-achievement patients had higher APACHE II score (21 ± 5) and 28 day mortality (9/11) when compared with EGDT achievement patients (t = 2.985, χ(2) = 4.547, P < 0.05). In EGDT un-achievement group, MAP, CI, DO(2), VO(2), O(2)ext, ScvO(2), Lac, P(cv-a)CO(2) were comparable between the onset and 6 hours after EGDT. However, in EGDT achievement group, MAP ((90 ± 9) mmHg (1 mmHg = 0.133 kPa)), CI ((4.0 ± 1.8) L×min(-1)×m(-2)), DO(2) ((596 ± 274) ml×min(-1)×m(-2)), ScvO(2) (76.9% ± 4.1%) increased, and P(cv-a)CO(2) ((4.2 ± 2.7) mmHg) decreased significantly after 6 hours of EGDT (t values were -3.393, -2.985, -2.103 and -3.195 respectively, all P < 0.05). The changes of P(cv-a)CO(2) between the onset and 6 hours after EGDT, demonstrated high value for predictability of outcome, according to the area under the ROC curve (AUC) was 0.839 (P = 0.004). As a predictor for death, increasing of P(cv-a)CO(2) after 6 hours of EGDT has a sensibility of 100% and specificity of 60%.
Increasing of P(cv-a)CO(2) after EGDT purports inadequate tissue perfusion in patients with septic shock. Changes of P(cv-a)CO(2) during EGDT demonstrated a useful tool to evaluate adequate resuscitation and prognosis.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2012; 50(10):918-22.
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ABSTRACT: BACKGROUND: Sepsis could induce indirect acute lung injury(ALI), and pulmonary vasomotor dysfunction. While low tidal volume is advocated for treatment of ALI patients. However, there is no evidence for low tidal volume that it could mitigate pulmonary vasomotor dysfunction in indirect ALI. Our study is to evaluate whether low tidal volume ventilation could protect the pulmonary vascular function in indirect lipopolysaccharide (LPS) induced acute lung injury rats. METHODS: An indirect ALI rat model was induced by intravenous infusion of LPS. Thirty rats (n = 6 in each group) were randomly divided into (1)Control group; (2) ALI group; (3) LV group (tidal volume of 6mL/kg); (4) MV group (tidal volume of 12mL/kg); (5)VLV group (tidal volume of 3mL/kg). Mean arterial pressure and blood gas analysis were monitored every 2 hours throughout the experiment. Lung tissues and pulmonary artery rings were immediately harvested after the rats were bled to be killed to detect the contents of endothelin-1 (ET-1), endothelial nitric oxide synthase (eNOS) and TNF-alpha. Acetylcholine (Ach)-induced endothelium-dependent and sodium nitroprusside (SNP)-induced endothelium-independent relaxation of isolated pulmonary artery rings were measured by tensiometry. RESULTS: There was no difference within groups concerning blood pressure, PaCO2 and SNP-induced endothelium-independent relaxation of pulmonary artery rings. Compared with MV group, LV group significantly reduced LPS-induced expression of ET-1 level (113.79 +/- 7.33pg/mL vs. 152.52 +/- 12.75pg/mL, P < 0.05) and TNF-alpha (3305.09 +/- 334.29pg/mL vs.4144.07 +/- 608.21pg/mL, P < 0.05), increased the expression of eNOS (IOD: 15032.05 +/- 5925.07 vs. 11454.32 +/- 6035.47, P < 0.05). While Ach (10-7mol/L-10-4mol/L)-induced vasodilatation was ameliorated 30% more in LV group than in MV group. CONCLUSIONS: Low tidal volume could protect the pulmonary vasodilative function during indirect ALI by decreasing vasoconstrictor factors, increasing expressions of vasodilator factors in pulmonary endothelial cells, and inhibiting inflammation injuries.
Respiratory research 09/2012; 13(1):77. · 3.36 Impact Factor
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ABSTRACT: To investigate the effect of stress dose glucocorticoid on patients with acute respiratory distress syndrome (ARDS) combined with critical illness-related corticosteroid insufficiency (CIRCI).
All early ARDS patients combined with CIRCI were screened by an adrenal corticotrophic hormone (ACTH) test and randomly divided into treatment group (hydrocortisone 100 mg intravenous, 3 times/day, consecutively for 7 days, n = 12) and control group (equivalent normal saline, n = 14). General clinical data, changes of arterial blood gas, hemodynamics and respiratory mechanics were observed and recorded at admission and at 7 days after treatment. Ventilator-free and shock-free days, ICU stay within 28 days after admission were recorded and 28-day mortality was used as judge prognosis index.
CIRCI rate in 45 early ARDS patients was 57.8% (26 patients), and the shock rate was markedly higher in ARDS patients with CIRCI than patients without CIRCI (46.2% vs 5/19). There were no significant differences in baseline parameters, oxygenation and illness severity between the treatment and control groups, except for markedly lower lactic level in the treatment group [2.7(1.2, 3.9) mmol/L vs 4.6(2.5, 6.3) mmol/L, P < 0.05]. After 7 days of treatment, PaO2/FiO2 markedly increased, while heart rate obviously decreased in the both groups. Compared with the control group, survival time of patients was significantly longer and shock rate of the patients was markedly lower in treatment group within 28 days (5/12 vs 10/14, P < 0.05). The 28-day mortality, which were adjusted by baseline arterial lactic, was lower in the treatment group (2.6/12) than in the control group (5.8/14) while with no significant difference (P > 0.05). There was no significant difference in complication incidence between the two groups.
Stress dose glucocorticoid could reduce shock incidence and prolong survival time, and has a tendency of lower 28-day mortality in early ARDS patients combined with CIRCI.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 08/2012; 51(8):599-603.
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ABSTRACT: INTRODUCTION: Based on the hypothesis that failure of weaning from mechanical ventilation is caused by respiratory demand exceeding the capacity of the respiratory muscles, we evaluated whether extubation failure could be characterized by increased respiratory drive and impaired efficiency to generate inspiratory pressure and ventilation. METHODS: Airway pressure, flow, volume, breathing frequency, and diaphragm electrical activity were measured in a heterogeneous group of patients deemed ready for a spontaneous breathing trial. Efficiency to convert neuromuscular activity into inspiratory pressure was calculated as the ratio of negative airway pressure and diaphragm electrical activity during an inspiratory occlusion. Efficiency to convert neuromuscular activity into volume was calculated as the ratio of the tidal volume to diaphragm electrical activity. All variables were obtained during a 30-minute spontaneous breathing trial on continuous positive airway pressure (CPAP) of 5 cm H2O and compared between patients for whom extubation succeeded with those for whom either the spontaneous breathing trial failed or for those who passed, but then the extubation failed. RESULTS: Of 52 patients enrolled in the study, 35 (67.3%) were successfully extubated, and 17 (32.7%) were not. Patients for whom it failed had higher diaphragm electrical activity (48%; P < 0.001) and a lower efficiency to convert neuromuscular activity into inspiratory pressure and tidal volume (40% (P < 0.001) and 53% (P < 0.001)), respectively. Neuroventilatory efficiency demonstrated the greatest predictability for weaning success. CONCLUSIONS: This study shows that a mixed group of critically ill patients for whom weaning fails have increased neural respiratory drive and impaired ability to convert neuromuscular activity into tidal ventilation, in part because of diaphragm weakness. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT01065428. ©2012 Liu et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Critical care (London, England) 07/2012; 16(4):R143. · 4.61 Impact Factor
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ABSTRACT: To understand the prevalence of depressive symptoms and associated sexual characteristics among men who have sex with men (MSM) in Foshan, Guangdong province.
Respondent-driven sampling method was used to recruit MSM who were 18 years and older, living in Foshan longer than 6 months. Scales of depression, demographical information, and characteristics of sexual behaviors were collected using a self-designed questionnaire. Respondent-Driven Sampling Analysis Tool and SAS were used to generate crude and estimated population proportion as well as 95% confidence intervals (CI). Multivariate logistic regression was performed to explore potential factors associated with depressive symptoms.
Among 249 respondents, the mean age (standard deviation) was 31.9 (8.5) years, with 43.5% of them having had 7-9 years of education while 25.9% had 10-12 years. 49.7% of the respondents were currently married. 56.7% of them had bisexual orientation. 42.3% of them met their sex partners in parks/toilets and 63.3% of them had their first sex with a female. The estimated prevalence of depressive symptoms was 34.8% (28.2-42.3) among MSM in Foshan. Younger age, lower education levels, only had oral sex, and regularly meetingr sexual partners in parks were associated with depressive symptoms, with the adjusted odd ratio (95%CI) as 3.31 (1.39-7.86), 2.23 (1.01-4.93), 3.09 (1.10-8.70) and 2.38 (1.20-4.75), respectively.
Depression related symptoms might associate with the demographical and sexual characteristics of MSM in Foshan, suggesting that psychological interventions should involve components as demographical and sexual characteristics.
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 05/2012; 33(5):483-7.
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ABSTRACT: To evaluate the effect of transdermal agent of PZQ on infection of Schistosoma japonicum in different developmental stages and the early period of re-infection.
All Kunming mice in the experiment groups were infected with 40 +/- 2 Schistosoma japonicum cercariae. The mice which were infected once and re-infected were treated by abdominal transdermal agent of praziquantel. Control groups were set for all of the experiment groups. All of the mice were dissected 42 d after the infection, and the worm reduction rate, egg reduction rate and miracidium hatching reduction rate were calculated. In addition, the dynamic changes of IgG antibody in sera of the mice were detected by ELISA in different time of primary infection and re-infection.
The worm reduction rates of 1, 7, 14, 21 and 28 d after the infection were 48.9%, 0%, 28.8%, 84.3% and 70.2%, respectively, and those of 1 d and 14 d after re-infection were 85.6% and 90.8%, respectively. After the primary infection, the specific IgG level gradually increased with the prolongation of time, and the ratio of P/N of specific anti-ESA of IgG was significantly raised after re-infection.
The transdermal agent of praziquantel is effective to Schistosoma japonicum at developmental stages, and the effect to schistosomula at early period of re-infection is more significant.
Zhongguo xue xi chong bing fang zhi za zhi = Chinese journal of schistosomiasis control. 04/2012; 24(2):155-9.
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ABSTRACT: Elevated dead space fraction (the ratio of dead space to tidal volume [V(D)/V(T)]) is a feature of ARDS. PEEP can partially reverse atelectasis, prevent alveoli recollapse, and improve lung compliance and gas exchange in patients with ARDS. However, whether V(D)/V(T) variables have a close relationship with PEEP and collapse alveolar recruitment remains under recognized. Meanwhile, few clinicians titrate PEEP in consideration of changes in V(D)/V(T). Therefore, we performed the study to evaluate V(D)/V(T), arterial oxygenation, and compliance changes during PEEP titration following lung recruitment in ARDS patients.
Twenty-three ARDS patients ventilated in volume-controlled mode were enrolled in the study. Sustained inflation (40 cm H(2)O, 30 s) was used as a recruitment maneuver, followed by decremental PEEP changes from 20 to 6 cm H(2)O, in steps of 2 cm H(2)O, and then to 0 cm H(2)O. V(D)/V(T), pulmonary mechanics parameters, gas exchange parameters, and hemodynamic parameters were recorded after 20 min at each PEEP step.
Compared with V(D)/V(T) at the PEEP levels of 20 cm H(2)O and 0 cm H(2)O, V(D)/V(T) was significantly lower at 12 cm H(2)O (P = .02), and compliance of the static respiratory system (C(RS)) was significantly higher at pressure step 12/10 cm H(2)O (P < .001). Compared with P(aCO(2)) at the PEEP level of 20 cm H(2)O, P(aCO(2)) was significantly lower at 12 cm H(2)O (P < .001). Arterial oxygenation values and functional residual capacity were reduced gradually during PEEP, decreasing from 20 cm H(2)O to 0 cm H(2)O.
A significant change of V(D)/V(T), compliance and arterial oxygenation could be induced by PEEP titration in subjects with ARDS. Optimal PEEP in these subjects was 12 cm H(2)O, because at this pressure level the highest compliance in conjunction with the lowest V(D)/V(T) indicated a maximum amount of effectively expanded alveoli. Monitoring of V(D)/V(T) was useful for detecting lung collapse and for establishing open-lung PEEP after a recruitment maneuver.
Respiratory care 03/2012; 57(10):1578-85. · 2.01 Impact Factor
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Wen-Hao Tang,
Hui Jiang,
Lu-Lin Ma,
Kai Hong,
Qun Zhong,
Chi-Sun Yang,
Lian-Ming Zhao,
De-Feng Liu,
Jia-Ming Mao, Yi Yang,
Qian Chen,
Ren-Pei Yuan,
Xin Zhang,
Bin Li,
Nan Wei
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ABSTRACT: To investigate the relationship of sperm morphology with reproductive hormones in infertile men and the pathogenesis of teratozoospermia.
This study included 90 infertile men aged 25 - 40 years. We measured their testis volumes using the Prader orchidometer, conducted routine semen analyses according to the WHO laboratory standard, and determined the concentrations of reproductive hormones and sex hormone-binding globulin (SHBG) by chemiluminescence and the levels of free testosterone (FT) and bioavailable testosterone (BioT).
All the subjects showed normal sperm concentration. Based on the results of semen morphology analysis, the 90 infertile men were equally divided into groups 1 (morphologically normal sperm <4%), 2 (morphologically normal sperm > or = 4% and <10%), and 3 (morphologically normal sperm > or = 10%), with no significant differences in age among the three groups (P>0.05). The volumes of the left testis were (14.27 +/- 3.65) ml, (16.90 +/- 3.57) ml and (14.57 +/- 3.57) ml, respectively (P = 0.006 group 1 vs group 2, P = 0.741 group 1 vs group 3, P = 0.014 group 2 vs group 3), and those of the right testis were (14.60 +/- 3.70) ml, (16.60 +/- 3.35) ml and (14.67 +/- 3.54) ml, respectively (P = 0.050). There were no significant differences among the three groups in prolactin, follicle-stimulating hormone, luteinising hormone, estradiol, total testosterone and SHBG, (P>0.05). The levels of serum FT were (0.25 +/- 0.07) nmol/L, (0.29 +/- 0.07) nmol/L and (0.31 +/- 0.13) nmol/L (P = 0.086 group 1 vs group 2, P= 0.010 group 1 vs group 3, P= 0.364 group 2 vs group 3), and those of BioT were (5.81 +/- 1.58) nmol/L, (6.78 +/- 1.55) nmol/L and (7.29 +/- 3.02) nmol/L, respectively (P = 0.086 group 1 vs group 2, P = 0.010 group 1 vs group 3, P = 0.364 group 2 vs group 3). The percentage of morphologically normal sperm was positively correlated with the levels of serum FT and BioT (P<0.05).
The higher the levels of serum FT and BioT, the higher the percentage of morphologically normal sperm, which suggests that serum FT and BioT might be involved in the pathogenesis of teratozoospermia.
Zhonghua nan ke xue = National journal of andrology 03/2012; 18(3):243-7.
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ABSTRACT: Gene therapy and viral therapy are used for cancer therapy for many years, but the results are less than satisfactory. Our aim was to construct a new recombinant adenovirus which is more efficient to kill hepatocarcinoma cells but more safe to normal cells.
By using the Cancer Targeting Gene-Viro-Therapy strategy, Apoptin, a promising cancer therapeutic gene was inserted into the double-regulated oncolytic adenovirus AD55 in which E1A gene was driven by alpha fetoprotein promoter along with a 55 kDa deletion in E1B gene to form AD55-Apoptin. The anti-tumor effects and safety were examined by western blotting, virus yield assay, real time polymerase chain reaction, 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay, Hoechst33342 staining, Fluorescence-activated cell sorting, xenograft tumor model, Immunohistochemical assay, liver function analysis and Terminal deoxynucleotidyl transferase mediated dUTP Nick End Labeling assay.
The recombinant virus AD55-Apoptin has more significant antitumor effect for hepatocelluar carcinoma cell lines (in vitro) than that of AD55 and even ONYX-015 but no or little impair on normal cell lines. Furthermore, it also shows an obvious in vivo antitumor effect on the Huh-7 liver carcinoma xenograft in nude mice with bigger beginning tumor volume till about 425 mm3 but has no any damage on the function of liver. The induction of apoptosis is involved in AD55-Apoptin induced antitumor effects.
The AD55-Apoptin can be a potential anti-hepatoma agent with remarkable antitumor efficacy as well as higher safety in cancer targeting gene-viro-therapy system.
Journal of Biomedical Science 02/2012; 19:20. · 2.01 Impact Factor
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ABSTRACT: To evaluate the effects of extracorporeal membrane oxygenation (ECMO) on mortality in adult patients with acute respiratory distress syndrome (ARDS).
Literature concerning randomized controlled trials (RCTs), case-control studies and prospective cohort studies from January 1966 to July 2011 on ECMO for the treatment of ARDS patients was retrieved by electronic and manual search. Meta-analysis of the use of ECMO in the treatment of ARDS patients was conducted using the methods recommended by the Cochrane Collaboration's software RevMan 5.0.
Three papers reporting RCTs and 6 papers concerning observational cohort studies of using ECMO in patients with severe ARDS were enrolled for analysis. Meta-analysis of the 3 RCTs (310 patients, 159 of them treated with ECMO) revealed ECMO did not decrease the mortality of ARDS patients [odds ratio (OR)=0.75, 95% confidence interval (95%CI) 0.45-1.24, P = 0.27]. Meta-analysis of the all 9 studies (1058 patients, 386 of them treated with ECMO) revealed ECMO increased the mortality of ARDS patients (OR=1.58, 95%CI 0.94-2.67, P = 0.08).
There is no evidence to prove that ECMO is beneficial in adult patients with ARDS, therefore further investigation with a large sample of high quality RCT is warranted.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 02/2012; 24(2):78-82.
