Objective To investigate the changes of pulmonary diffusing capacity and pulmonary capillary blood volume in stable COPD patients with mixed ventilation dysfunction, and explore the possible pathophysiological factors. Methods 159 stable COPD patients with mixed ventilation dysfunction were recruited in the study and 36 normal subjects were recruited as control. The Belgium medisoft box5500 was used to determine the pulmonary ventilation function, lung capacity, and pulmonary diffusing capacity. The measured parameters included forced vital capacity ( FVC) , forced expiratory volume in one second ( FEV1 ) ,maximal voluntary ventilation ( MVV) , vital capacity ( VC) , total lung capacity( TLC) , residual volume ( RV) , minute volume of alveolar ventilation ( VA ) , lung diffusing capacity for carbon monoxide ( DLCO) , pulmonary membrane diffusing capacity for carbon monoxide ( DMCO) , and pulmonary capillary blood volume ( Vc) . The above parameters were compared between the COPD patients and the normal subjects. The relationship was analyzed between DLCO% pred, DMCO% pred, Vc% pred and all the ventilation parameters. Results In stable COPD patients with mixed ventilation dysfunction, all parameters of pulmonary ventilation function, lung capacity, and pulmonary diffusing capacity were significantly different from the normal subjects ( Plt;0. 05 or Plt;0.01) . FVC, VC, VA, and DMCO of the COPD patients were about 66% of the calculated value or more. The average TLC%pred was a little higher than the normal. FEV1 , MVV, DLCO and Vc were abnormally lower which were between 36% ～44% . The average RV%pred was 188% of the predicted value. Obvious correlation could be detected between DLCO% pred, DMCO% pred, Vc%pred and FEV1%pred, FEV1/FVC, TLC% pred, RV%pred, RV/TLC and VA% pred etc.Conclusions In COPD patients with mixed ventilation dysfunction, the pulmonary blood capillary is damaged seriously which lead to a significant decrease of the capacity of pulmonary blood capillary, as well as seriously air distribution disturbance and ventilation/bloodstream mismatch. The Vc decline may develope before the impairment of pulmonary diffusing capacity which may contribute to the damaged of DLCO and DMCO.
ObjectiveTo summarize the research progress of early allograft dysfunction (EAD) predictors after liver transplantation. MethodThe literatures about the studies of predictive predictors of EAD after liver transplantation in recent years were reviewed. ResultsThe EAD was closely related to the prognosis and long-term survival of patients. In recent years, there were some reports of serum uric acid, neutrophil and lymphocyte ratio, von Willebrand factor to protein C ratio, serum brain natriuretic peptide, cytokine, hyaluronic acid, soluble CD163, serum lipid, lactic acid, coagulation factor Ⅴ, serum phosphorus etc. new serum biomarkers for early detection and recognition the occurrence and development of the EAD after liver transplantation. It was possible to intervene EAD early and effectively after liver transplantation. Conclusions Early recognition and prevention of EAD after liver transplantation is particularly important. Although some new predictive indicators have been proposed to predict occurrence of EAD after liver transplantation, relevant studies are lesser and there are still many problems to be solved. Further studies will be conducted to verify clinical application value of these new indicators.
Selective attention promotes the perception of brain to outside world and coordinates the allocation of limited brain resources. It is a cognitive process which relies on the neural activities of attention-related brain network. As one of the important forms of brain activities, neural oscillations are closely related to selective attention. In recent years, the relationship between selective attention and neural oscillations has become a hot issue. The new method that using external rhythmic stimuli to influence neural oscillations, i.e., neural entrainment, provides a promising approach to investigate the relationship between selective attention and neural oscillations. Moreover, it provides a new method to diagnose and even to treat the attention dysfunction. This paper reviewed the research status on the relationship between selective attention and neural oscillations, and focused on the application prospects of neural entrainment in revealing this relationship and diagnosing, even treating the attention dysfunction.
Abstract: Objective To compare the multiple organ dysfunction score (MODS), the sequential organ failure assessment (SOFA), the acute physiology, age, and chronic health evaluation system Ⅱ(APACHE Ⅱ), the acute physiology, age, and chronic health evaluation system Ⅲ(APACHE Ⅲ) in evaluating risks for patients after cardiac surgery, in order to provide better treatment and prediction of prognosis after cardiac operation. Methods A prospective study was carried out on 1 935 cardiac postoperative patients, including 1 050 males and 885 females, enrolled in cardiac postoperative intensive care unitof Anzhen hospital between October 2007 and April 2008. The age of the patients ranged from 18 to 86 years with the mean age of 53.96 years. The patients underwent the surgery because of various cardiac diseases including coronary heart disease, valve disease, congenital heart disease, aortic aneurysm, pericardial disease, atrial fibrillation, and pulmonary embolism. We used MODS, SOFA, APACHE Ⅱ, and APACHE Ⅲ respectively to calculate the value of the first day after operation, the maximum value during the first three days, the maximum value, and the change of the value between the third day and the first day for every patient, and then we compared the calibration and discrimination of these different systems using HosmerLemeshow goodnessoffit analysis and Receiver Operating Characteristic (ROC) curve. Results There were 47 perioperative deaths because of circulating system failure, respiration failure, kidney failure, liver failure or nervous system diseases. The death rate was 2.43%. In discrimination analysis, the area under the curve (AUC) in ROC of the first day value after operation, the maximum value, the maximum value during the first three days, and the change of value between the third day and the first day for MODS were respectively 0.747, 0.901, 0.892, and 0.786; for SOFA were respectively 0.736, 0.891, 0.880, and 0.798; for APACHE Ⅱ were respectively 0.699, 0.848, 0,827, and 0.562; for APACHE Ⅲ were respectively 0.721, 0.872, 0.869, and 0.587. In calibration analysis, we compared the χ2 value of the first day value, the maximum value, the maximum value during the first 3 days, and the change of value between the third day and the first day of these systems. χ2 value of MODS was 4.712, 5.905, 5.384, and 13.215; χ2 value of SOFA was 8.673, 3.189, 3.111, and 14.225; χ2 value of APACHE Ⅱ was 15.688, 10.132, 8.061, and 42.253; χ2 value of APACHE Ⅲ was 13.608, 11.196, 19.310, and 47.576. AUC value of MODS and SOFA were all larger than those of APACHE Ⅱ and APACHE Ⅲ (Plt;0.05); AUC value of APACHE Ⅱ was smaller than that of APACHE Ⅲ (Plt;0.05). Conclusion MODS, SOFA, APACHE Ⅱ and APACHE Ⅲ are all applicable in evaluating risks for patients after cardiac surgery. However, MODS and SOFA are better than APACHE Ⅱ、APACHE Ⅲ in predicting mortality after cardiac surgery. In cardiac surgery, the complicated APACHE Ⅱ and APACHE Ⅲ systems can be replaced by MODS and SOFA systems which are simpler for use.
Objective To summarize the clinical manifestations, diagnosis and treatment of severe primary graft dysfunction ( PGD grade 3 ) in early stage after lung transplantation. Methods From September 2002 to December 2010, there were 10 patients with severe PGD ( grade 3) in early stage after lung transplantation ( LTx) in 100 patients with end-stage lung disease underwent LTx in Wuxi People’s Hospital. In which there were 2 cases with chronic obstructive pulmonary disease, 4 with idiopathic pulmonary fibrosis,1 case with lung tuberculosis, 1 case with silicosis, 2 cases with bronchiectasis. There were 7 patients with single LTx [ 3 cases with extracorporeal membrane oxygenation ( ECMO) support] and 3 patients with bilateral LTx ( 1 case with ECMO support) . Results The surgical procedures of these 10 patients were successful, however severe PGD occurred on 1-5 days after operation. 4 cases died of respiratory failure with negative fluid balance and mechanical ventilation support, and 2 cases recovered. 4 cases underwent ECMO support, in which 2 cases successfully weaned from ECMO and discharged from hospital, others died of multiple organ failure.Conclusions Severe PGD is one of the fatal early complication after lung transplantation. Early diagnosis and treatment are very important to improve the perioperative mortality rate.
The prevalence of developmental delay (DD) in children worldwide is still on the rise, and its causes are complex and diverse, causing varying degrees of impact on the development of the sensory nervous system in the brain of children. Sensory integration training is a treatment method that applies sensory stimulation and comprehensive activities. It is currently widely used in children with DD. This therapy can effectively improve the development and integration of the sensory system in children with DD. It also enhances the individual’s ability to adapt to external stimuli, promoting their development in language, motor, and cognitive functions. This article explores the relevant mechanisms of sensory integration training and DD, as well as the current status and effects of its application in DD children, in order to promote the development and progress of related research fields.
Objective To investigate the prognosis and risk factors of cardiac surgical patients with preoperative renal dysfunction，and evaluate the accuracy of estimated glomerular filtration rate （eGFR） as a predictor of adverse outcomes. Methods A total of 2 151 adult patients undergoing cardiac surgery in Renji Hospital，School of Medicine of Shanghai Jiaotong University from January 2005 to December 2009 were included in this study. There were 1 267 male patientsand 884 female patients with their average age of 58.7 （18-99）years. Clinical characteristics of patients with preoperative renal dysfunction，severity of postoperative acute kidney injury （AKI）and patients’ outcomes were analyzed. Multivariate logistic regression was performed to analyze perioperative risk factors of postoperative AKI. Receiver operating characteristic（ROC） curve was used to evaluate the accuracy of eGFR to predict patients undergoing postoperative renal replacement therapy （RRT） and in-hospital death. Results A total of 221 patients （10.27%） had preoperative renal dysfunction，among whom 124 patients （56.11%） developed postoperative AKI. Patients with preoperative renal dysfunction were older，had more comorbidities including hypertension and diabetes mellitus，were more likely to receive postoperative RRT，and had worse outcomes. Patients with decreased preoperative eGFR had significantly higher in-hospital mortality. Patients with preoperative renal dysfunction who developed postoperative AKI had the worst prognosis. Multivariate logistic regression showed that hypertension （OR=4.497，P=0.003），postoperative central venous pressure （CVP） ＜6 cm H2O （OR=16.410，P=0.000） and postoperative CVP＞14 cm H2O （OR= 5.178，P=0.013） were independent predictors of postoperative AKI for patients with preoperative renal dysfunction. The areas under the ROC curves of eGFR to predict in-hospital mortality and postoperative RRT were 0.691 and 0.704 respectively （95% CI 0.630-0.752，P=0.000；95% CI 0.614-0.795，P=0.001）. Conclusion Patients with preoperative renal dysfunction are older，have more comorbidities，higher likelihood to develop postoperative AKI and worse prognosis. Hypertension，postoperative CVP＜6 cm H2O and postoperative CVP＞14 cm H2O are independent predictors of postoperative AKI for patients with preoperative renal dysfunction. We believe eGFR can accurately predict the risk of adverse kidney outcomes and in-hospital death of patients undergoing cardiac surgery.
Objective To evaluate the effectiveness of fluid therapy on an early goal-directed approach to resuscitation basis and the standard fluid therapy of adequate resuscitation on the prognosis of severe acute pancreatitis （SAP）in early stage. Methods The clinical data of SAP patients admitted to surgical intensive care unit within 72 h after onset of symptoms from January 2000 to November 2011 were analyzed retrospectively. A total of 97 patients with a confirmed diagnosis of SAP were divided into two groups based on whether adopting the early goal-directed fluid resuscitation strategies or not. Patients admitted from January 2000 to December 2004 did not adopt the early goal-directed fluid resuscitation strategies，therefore，being allocated into standard fluid therapy group （n=34）； patients admitted from January 2005 to November 2011 adopted the early goal-directed fluid resuscitation strategies and who were allocated into early goal-directed fluid therapy group （n=63）. With the exception of the fluid therapy strategies，the two group patients received standard treatment for SAP. The acute physiology and chronic health evaluation Ⅱ score （APACHEⅡ） and multiple organ dysfunction score （Marshall）， rate of multiple organ dysfunction syndrome （MODS） within the first week after admission，pancreatic infection rate，and in-hospital mortality were compared between the two groups. Results Compared with the standard fluid therapy group on day 3 after admission，APACHEⅡ score and Marshall score decreased significantly in the early goal-directed fluid therapy group （APACHEⅡ score：7.38±4.01 versus 11.35±4.27， P=0.011；Marshall score：4.13±2.06 versus 6.82±3.15， P=0.016）. In addition，patients in the early goal-directed fluid therapy group experienced a trend toward lower rates of MODS with the first week after admission，pancreatic infection，and in-hospital mortality （rate of MODS：46.0% versus 61.8%，P=0.139；rate of pancreatic infection：31.7% versus 44.1%， P=0.226；in-hospital mortality：15.8% versus 23.5%，P=0.355） that did not reach statistical significance. Conclusion Although early goal-directed fluid therapy for SAP in acute response stage may have ameliorated the patient’s condition and improved outcome to a certain degree，carefully designed human clinical trials should be performed in a randomized controlled manner to assess the role of such fluid resuscitation in SAP.
Objective To retrospectively reviewed our experience of the surgical and perioperative treatment of patients suffering from critical Marfan syndrome with severe left ventricular dysfunction and to evaluate its therapeutic effect and prognosis. Methods Between January 2012 and October 2016, 15 patients diagnosed with Marfan syndrome combined with severe left ventricular dysfunction (left ventricular ejection fraction≤40% or left ventricular end diastolic diameter≥75 mm) underwent operations for aortic root aneurysm in Zhujiang Hospital and Guangdong General Hospital. Among them, 11 were males and 4 were females with a mean age of 32.9±8.7 years ranging from 19 to 55 years. Five patients with aortic dissection underwent Bentall procedure and total arch reconstruction with stent graft implantation. Two patients underwent Bentall procedure and hemi-arch replacement, seven patients underwent Bentall procedure and one patient underwent Cabrol procedure. Concomitant procedures included mitral valve repair in 12 patients, mitral valve replacement in 3 patients and tricuspid valve repair in 12 patients. Results There were 11 patients (73.3%) receiving intra-aortic balloon pumping implantation. One (6.7%) in-hospital death occurred. The left ventricular end diastolic diameter decreased from 80.5±7.4 mm to 58.3±6.0 mm (P<0.05) and the left ventricular ejection fraction improved from 37.3%±5.2% to 46.3%±4.4% 3 months postoperatively (P<0.05). The left ventricular end diastolic diameter decreased from 80.5±7.4 mm to 53.7±3.6 mm (P<0.05) and the left ventricular ejection fraction improved from 37.3%±5.2% to 57.7%±4.2% after one year (P<0.05). No death and reoperation occurred in the follow-up. Conclusion Although the patients with Marfan syndrome and severe left ventricular dysfunction usually have a high surgical mortality, the key to satisfactory outcomes of severe Marfan syndrome is adequate preoperative preparation, complete correction of all vascular lesions during the operation, application of circulatory auxiliary device and perioperative strict and long-term ICU monitoring.
ObjectiveTo assess the effectiveness of phrenic nerve electrical stimulation (PNES) on extubation outcomes in intensive care unit (ICU) patients undergoing mechanical ventilation using a meta-analysis approach. Methods A comprehensive search was conducted on the Cochrane Library, PubMed, Web of Science, Embase, and China National Knowledge Infrastructure (CNKI) for randomized controlled trials (RCTs) published from database inception to December 2023, evaluating the effect of PNES on extubation outcomes in ICU patients receiving mechanical ventilation. The control group received standard rehabilitation measures, while the intervention group received PNES in addition to standard rehabilitation. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias. Meta-analysis was performed using RevMan5.4 software. Results Nine RCTs were included in the final analysis. The quality assessment indicated that one study was rated as Grade A and eight as Grade B, reflecting relatively high study quality. Meta-analysis results demonstrated that PNES significantly improved extubation success rates [relative risk (RR)=1.33, 95%CI 1.09 - 1.62, P=0.006], maximal inspiratory pressure (MIP) [mean difference (MD)=1.36, 95%CI 0.46 - 2.27, P=0.003], and diaphragmatic thickness fraction (DTF) (MD=7.11, 95%CI 0.53 - 13.69, P=0.03) compared with the control group. PNES also significantly reduced the duration of mechanical ventilation (MD=–2.23, 95%CI –3.07- –1.38, P<0.000 01), re-intubation rates (RR=0.35, 95%CI 0.15 - 0.85, P=0.02), and rapid shallow breathing index (RSBI) (MD=–11.57, 95%CI –18.51 - –4.62, P=0.001). Additionally, PNES shortened ICU length of stay (MD=–4.03, 95%CI –5.95 - –2.11, P<0.000 1), with all differences being statistically significant. Conclusion PNES effectively reduces the duration of mechanical ventilation and ICU length of stay, decreases re-intubation rates and RSBI, and improves extubation success, MIP, and DTF in ICU patients. Future high-quality, large-scale, multi-center RCTs are needed to further validate these findings.