Clinical Focus

Critical ultrasound in circulation management of critical ill patients

Jiang Song， Zhang Lina

2017, 32(5): 384-387. doi:10.3969/j.issn.1004-583X.2017.05.002

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The critical ultrasound plays a key role and is of great value in circulation management in ICU. The critical ultrasound can rapidly diagnose the causes of cardiac arrest and acute circulatory failure， and conduct continuous， dynamic and refined ultrasoundguided circulation management， and assess multiple organ perfusion. Critical care specialists can make the critical ultrasound as a powerful tool for management of critically ill patients.

Critical ultrasonography in respiratory therapy for critical ill patients

Ding Xin1，Liu Lixia2，Wang Xiaoting1，Chinese Critical Ultrasound Study Group

2017, 32(5): 388-391,399. doi:10.3969/j.issn.1004-583X.2017.05.003

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The conception of respiratory therapy of critical ill patients has extended from the respiratory support to the management of respiration and circulation. Compared with other traditional imaging tools， critical ultrasonography is simple， realtime， and reproductive， and can focus on multiple goals in the respiratory and circulatory system. The Chinese experts' consensus on CriticalUltrasound promoted by Chinese Critical Ultrasound Study Group (CCUSG) recently provided recommendations supporting the clinical practice. The paper was to describe the current uses of critical ultrasound in the respiratory treatment of critical ill patients， with an emphasis on the diagnosis and treatment of the respiratory disease， and to provide a framework for the practical application of this tool at the bedside.

Critical care ultrasonography in nursing for critical patients

Zhang Qing1，Sun Jianhua1，Liu Lixia2，Guo Na2，Shi Dongyan3，Cao Lan4，Liao Tianzhi5，

2017, 32(5): 392-394. doi:10.3969/j.issn.1004-583X.2017.05.004

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Critical care ultrasonography (CCU)， problemoriented and used at bedside is becoming an important tool for the diagnosis， hemodynamic monitoring of critical illness. However， the use of CCU in critical care nursing is still at early stage. The problem solving in nursing could take advantage of CCU with its ability of displaying visible image， providing of qualitative and/or quantitative index. We hereby made this review aiming to describe ultrasoundguided vascular puncture technique， ultrasoundguided placement of jejunum nutrition tube， ultrasoundassissted lung nursing and bed sore assessment.

Chinese critical care ultrasound: today and tomorrow

Liu Lixia1， Wang Xiaoting2， Chao Yangong3，Zhang Hongmin2， Yin Wanhong4， Zhang Lina5， He Wei6，

2017, 32(5): 395-399. doi:10.3969/j.issn.1004-583X.2017.05.005

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Critical care ultrasound was introduced to China in 2008 by Prof. Liu Dawei. In May 2013, Chinese Critical Care Ultrasound Study Group (CCUSG) was set up in Chengdu. CCUSG conducts standardized training classes throughout China, spreading and popularizing critical care ultrasound concepts and applications. Critical care ultrasound is different from traditional ultrasound. This paper provides a brief overview of the characteristics of critical care ultrasound, the use of critical care ultrasound in clinical practice and its sustainable and innovative development.

Followup of interactive management mode of healthy weight loss using mobile phone APP platform

Jiao Huanli1a， Liu Shuhong2， Zhang Qing1a， Song Kun1a， Wang Bangmao1b

2017, 32(5): 400-404. doi:10.3969/j.issn.1004-583X.2017.05.006

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ObjectiveTo explore the feasibility of the mobile phone APP service platform for carrying out the interactive management and followup of patients with weight loss in order to provide the basis for clinical practice. MethodsA total of 30 men and 30 women were selected from the center for physical examination and healthy weight loss management， age from 26 to 64 years (average age of 46.2±10.6 years). The 60 participants were randomly divided into two groups.Each group was 30 participants and balanced in the gender ratio.The participants in two groups were all given a very low carbohydrate diet with exercise method for weight loss for three months， including the test group of mobile phone APP for interactive followup management control group with routine followup for nine months. The weight loss compliance and weight loss effect between groups were comparatively analyzed. After six months of weight loss intervention， the degree of weight loss rebound was compared between the two groups. Results
Compared with the outpatient group， the mobile phone APP weight management mode greatly improved the compliance of the customers， and enhaned the customers′ self weight management ability; After three months of healthy weight loss，the two groups of subjects showed differenr improvement in， BMI， fatty liver， blood lipid， blood glucose， blood pressure， CAP and other indicators were improved in different degrees， while weight loss in the APP group was better than that in the outpatient group compared with the initial (P<0.05). At six months after self management， the indicators of two groups had certain degree of rebound， the degree of rebound in APP group was lower than that of outpatient group(P<0.05). ConclusionThe mobile phone APP in healthy weight loss interactive management is an effective means of health weight management， diet and exercise compliance can effectively improve the weight， the ability to prevent the rebound and self management， it is worthy of popularization and application.

graS gene and cell ultrastructure analysis of five methicillinresistant Staphylococcus aureus with reduced susceptibility to vancomycin

Li Jing1， Liu Xiaolei2，Qiang Cuixin2， Shi Lei3， Zhao Jianhong2

2017, 32(5): 405-408,412. doi:10.3969/j.issn.1004-583X.2017.05.007

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ObjectiveThe methicillinresistant Staphylococcus aureus (MRSA) with reduced susceptibility to vancomycin which were selected during mutant prevention concentration(MPC) determination were characterized to compare the changes in the graS gene and cell ultrastructure.MethodsThe strains selected were characterized by pulsedfield gel electrophoresis (PFGE) and SauPCR assay. The graS gene was detected by polymerase chain reaction method; Denaturing gradient gel electrophoresis (DGGE) was used to probe for mutations in the graS gene. The electron microscopy was used to compare the differences on cell wall.ResultsCompared with the parental strains， some strains with reduced susceptibility to vancomycin had different DNA profiles by SauPCR assay and PFGE. Electron microscopy showed that the mutant strains had slightly thicker cell walls than those of the wildtype strains. DDGE was used to probe for mutations in the graS gene， but no different banding patterns were observed on the electrophoretogram spectrum. ConclusionThe strains with reduced susceptibility to vancomycin were not caused by genetic mutations of graS， there may be mutations in genes other than the graS gene or existence of other resistant mechanisms.

Urine monocyte chemoattractant protein1 in HenochSchonlein purpura children with nephritis

Shen Mengjiao1， Dai Xiahua2， Wang Jiapei1， Zheng Jika2， Di Yazhen2，Zhong Shiling2， Ying Qianqian1， Fu Shiwei1

2017, 32(5): 409-412. doi:10.3969/j.issn.1004-583X.2017.05.008

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ObjectiveTo investigate urinary monocyte chemoattractant protein1 (MCP1) level and clinical significance in HenochSchonlein purpura（HSP） children with nephritis. MethodsAccording to whether combined with HenochSchonlein purpura nephritis (HSPN)， 153 HSP children were grouped into HSP group (n=72) and HSPN group (n=81). According to total urine protein in 24 hours(TUPr)，HSPN group was further divided into mild proteinuria group(n=28)(TUPr＜25 mg/kg)，moderate proteinuria group (n=32)(25 mg/kg≤TUPr＜50 mg/kg) and severe proteinuria group (n=21)(TUPr≥50 mg/kg). Meanwhile， 45 healthy children were enrolled as control group. The level of urinary MCP1 was measured by enzymelinked immunosorbent assay. At the same time，the levels of serum creatinine， blood urea nitrogen(BUN)， urinary α1micro globulin(α1MG)， microalbumin(mAlb)， immuno globulin G (IgG)， transferrin (TRF) and TUPr were detected for their associations with MCP1.ResultsUrinary MCP1 was significantly higher in HSPN group in comparison with HSP group and control group(P＜0.05)， but no significant difference was found between HSP group and control group(P＞0.05).With the increase of TUPr， urine MCP1 concentration in HSPN groups showed an obviously increasing trend. Urinary MCP1 correlated positively with urinary α1MG， mAlb， IgG， TRF and TUPr in HSPN， whereas it had no significant correlation with serum BUN and creatinine.ConclusionMCP1 increase in children with HSPN was correlated with proteinuria. And MCP1 played an important role in pathological process of HSP lesion.

Dyslipidemia analysis in Tibetan and Han adult populations of Qinghai Province

Wang Xiaozhou， Bian Huiping， Xu Xiaolong， Geng Deng， Chen Qiuhong

2017, 32(5): 413-415,420. doi:10.3969/j.issn.1004-583X.2017.05.009

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ObjectiveTo investigate the differences in serum lipid levels between Tibetan and Han residents in Qinghai province and to provide evidence for the prevention and treatment of dyslipidemia.MethodsA total of 7 185 participants (Tibetan 3 343，Han 3 842) were enrolled in this study. Fasting plasma levels of total cholesterol (TC)，triglyceride(TG)，highdensity lipoprotein cholesterol (HDLC)， and lowdensity lipoprotein cholesterol (LDLC) were tested.ResultsThe overall prevalence of dyslipidemia was 49.1%， which was higher than that in plains at home. The prevalence rate in Tibetan was lower than that in Han residents(45.3% vs 52.3%). The rate of dyslipidemia increased with age both in Tibetan and Han residents.Moreover， the rate of dyslipidemia was higher in males than in females before 55 years old(P<0.05).TC and LDLC levels in Tibetan were higher than those in Han residents(P<0.05)， while TG and HDLC levels were significantly lower(P<0.05). The majority of Tibetans was hypercholesterolemia， the Han nationality was hypertriglyceridemia. However， the incidence of low HDLC in two groups were the lowest.ConclusionCompared with plain areas of China， the prevalence of dyslipidemia was higher in QinghaiTibet plateau. Tibetans had higher TC and LDLC while the Han nationality had higher TG. The prevalence of dyslipidemia was different in age， nationality and sex. In order to reduce the prevalence rate， more attention should be paid to the screening and prevention of dyslipidemia in the high altitude area.

Clinical analysis of drypainful type malignant peritoneal mesothelioma

Sun Ningning， Zheng Guoqi， Song Hui， Wei Sichen， Yang Yuxin

2017, 32(5): 416-420. doi:10.3969/j.issn.1004-583X.2017.05.010

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ObjectiveTo retrospectively analyze the clinical characteristics in patients with drypainful type (nonascitic) malignant peritoneal mesothelioma (MPeM). MethodsThe clinical data of 7 cases with drypainful type MPeM were collected during the past 6.5 years， which were confirmed by clinical manifestations， imaging characteristics and pathologic features. The incidence， asbestos exposure history， clinical manifestations， imaging features， pathological types and immunohistochemical results were analyzed respectively. ResultsIn the 7 cases， there were 1 male and 6 female patients which were accounted for 14.3% and 85.7%，respectively. The average age was 55.5 years old (age range from 28 to 71 years old). There was a definite history of significant asbestos exposure in 6 patients (85.7%). Local abdominal pain (7 cases) and abdominal mass (3 cases) were the main clinical symptoms. CT imaging characteristics: abdominal and/or cavity single (5 cases) or multiple mass (2 cases)， accompanied by the surrounding viscera invasion (3 cases)， local peritoneal thickening (1 case)， pleural plaque (3 cases)， without ascites， lymph node enlargement and distant organ metastasis. Laparotomy was the major means of diagnosis， followed by the peritoneal biopsy guided by ultrasound. Epithelial type was the main pthological type (57.1%)， followed by mixed and sarcoma type. ConclusionDrypainful type MPeM is extremely rare.and the clinical manifestations are nonspecific. Asbestos exposure history and CT findings with abdominal and/or cavity mass with asbestos plaques and local peritoneal thickening could suggest the possibility of drypainful type MPeM， However， the confirmed diagnosis depends on pathological cytology and immunohistochemistry.

Ticagrelor and clopidogrel on PCI perioperative hsCRP in patients with acute coronary syndrome

Liu Xiaoyu，Jia Guowei，Sun Rongguo，Ma Bocong，Zhao Ming，Zhang Hongbin，Zhang Wei

2017, 32(5): 421-424. doi:10.3969/j.issn.1004-583X.2017.05.011

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ObjectiveTo investigate the effect of ticagrelor and clopidogrel on perioperative high sense C reactive protein(hsCRP) and shortterm efficacy and safety in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI). MethodsTotally 379 patients with ACS undergoing PCI were randomized into ticagrilor group（n=189） and clopidogrel group（n=190）. Ticagrilor group（180 mg loading dose，90 mg maintanining dose，twice daily）and clopidogrel group（600 mg loading dose，75 mg maintanining dose，once daily）. HsCRP and cTnI were detected in 24 hours before and after PCI procedure. All patients were followed up for three months，and adverse events were observed. ResultsThere were no significant difference in the baseline data between two groups. The ratio of hsCRP elevation after PCI in ticagrelor group was lower compared with that in clopidogrel group（33.3% vs 63.6%，P<0.01）.There was no significant difference in perioperative myocardial infarction between two groups（15.3% vs 16.3%，P=0.796）. In the postoperative one month followup， the patients in ticagrelor group showed significantly lower MACCE rate compared with that in clopidogrel group（P=0.033）.There was no significant difference in bleeding events between two groups（P＞0.05）.ConclusionIn patients with ACS undergoing PCI， ticagrelor significantly reduces the elevation of hsCRP during PCI procedure as compared with clopidogrel，which suggests ticagrelor significantly inhibits the inflammation in PCI procedure.

Softchannel minimally invasive intracranial hematoma evacuation combined with alteplase on hypertensive cerebellar hemorrhage

Li Wenting， Chen Yongjun， Jiang Fusheng， Liu Xijin

2017, 32(5): 425-428. doi:10.3969/j.issn.1004-583X.2017.05.012

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ObjectiveTo compare the efficacy and safety of soft and hard channel minimally invasive hematoma evacuation combined with two thrombolytic drugs in treatment of hypertensive cerebellar hemorrhage. MethodsForty patients with hypertensive cerebellar hemorrhage hospitalized in the hospital were enrolled. Two thrombolytic drugs (alteplase and urokinase) were used to assist two minimally invasive surgical therapies， the patients were randomized into four groups， each group 10 cases， and the cases were collected for clinical analysis. Hematoma volume and brain edema volume， the changes to the National Institutes of Health Stroke Scale (NIHSS)， the changes to Glasgow Outcome Scale (GOS)， and the changes to ADL Barthel Index (BI) of four groups were analyzed before and after treatment. Results The clearance of hematoma， NIHSS score and BI score in softchannel 1 group were statistically significant compared with those in the other three groups. In GOS score， softchannel 1 group was statistically different compared with only hardchannel 1 group. The length of hospital stay in softchannel 1 group was statistically significant compared with that in two hardchannel groups. ConclusionThe therapy can improve the remedy rate of cerebellar hemorrhage.

Risk factors in peritoneal dialysis patients with acute stroke

Zou Yun， Zhou Hua

2017, 32(5): 429-431,436. doi:10.3969/j.issn.1004-583X.2017.05.013

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ObjectiveTo investigate the risk factors in patients with acute stroke receiving peritoneal dialysis（PD）. MethodsThe clinical data of 129 cases with endstage renal disease receiving continuous ambulatory peritoneal dialysis(CAPD) for more than 3 months were collected for retrospective analysis. A total of 25 cases in PD with acute stroke were chosen as study group while the other 104 cases in peritoneal dialysis without stroke served as control group. The clinical data included age， body mass index(BMI)， duration of PD， hypertension， hemoglobin， serum albumin(Alb)， blood urea nitrogen(BUN)， serum creatinine(Scr)， corrected serum calcium， serum phosphate， serum intact parathyroid hormone(iPTH)， total cholesterol， triglycerides，PD type and Kt/V and their relationships with stroke were analyzed.ResultsThe levels of Alb， BUN， iPTH and Kt/V in study group were significantly lower than those in control group， while age and triglycerides were significantly higher (P<0.05). Multivariate logistic regression analysis showed that age (P=0.044)， hypertension(P=0.007)， Alb(P=0.009)， PD type(P=0.005) and triglycerides (P=0.005) were independent risk or protective factors for stroke in PD patients. Hypertension (P=0.007) and triglycerides (P=0.034) were independent risk factors for cerebral hemorrhage or cerebral hematoma in PD patients. Age (P=0.021) and Alb (P=0.025) were independent risk or protective factors for cerebral infarction in PD patients. ConclusionThe high morbidity of stroke in PD patients has close correlation with uncontrolled hypertension， low serum albumin， lipid metabolism disorder， iPTH and incomplete dialysis. Low calcium dialysate improves calcium phosphate metabolism and calcium overload， it can significantly reduce the incidence of stroke in endstage renal patients receiving PD.

Withdrawing mechanical ventilation in acute exacerbation and type Ⅱ respiratory failure in chronic obstructive pulmonary disease with acute heart failure

Wang Jianjun， Dong Haishan， Wen Lirong

2017, 32(5): 432-436. doi:10.3969/j.issn.1004-583X.2017.05.014

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ObjectiveTo investigate the different methods of withdrawing mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease（AECOPD）with type Ⅱ respiratory failure and acute heart failure (HF). Methods A prospective，randomized，doubleblinded tudy was performed in 42 AECOPD patients with type Ⅱ respiratory failure and HF suffering from mechanical ventilation，and the patients were randomly divided into two groups， including 20 cases in study group A and 22 cases in study group B.The patients in study group A got early extubation and sequential noninvasive mechanical ventilation switched by pulmonary infection control window(PIC window)，while those in study group B after spontaneous breathing trial(SBT) had immediate extubation and received sequential noninvasive mechanical ventilation. The duration of invasive mechanical ventilation，48 hourintubation rate，the duration of ICU stay，the total duration of ventilatory，inhospital mortality， rate of ventilatorassociated pneumonia(VAP) and the duration of hospital stay were compared between two groups. ResultsThe duration of invasive mechanical ventilation，48 hourintubation rate，the duration of ICU stay，inhospital mortality and rate of ventilatorassociated pneumonia(VAP) were not significantly different between two groups（P＞0.05）.The total duration of ventilatory（t=2.135，P=0.039） and the duration of hospital stay（t=2.098，P=0.042） were significantly different between two groups（P＜0.05）.ConclusionThe comparison showed no benefit for PIC window at withdrawing sequential noninvasive and invasive mechanical ventilation with SBT's sequential noninvasive and invasive mechanical ventilation. The total duration of ventilation and the duration of hospital stay in study group A were longer in study group B.

Diagnostic value of autofluorescence bronchoscopy in lung diseases

Tian Linjuan， Liu Wei， Wu Yunping， Wang Caiyun

2017, 32(5): 437-440. doi:10.3969/j.issn.1004-583X.2017.05.015

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ObjectiveTo investigate the diagnostic value of autofluorescence bronchoscopy in lung diseases. MethodsA total of 168 patients were detected by using both white light bronchoscopy(WLB) mode and autofluorescence bronchoscopy(WFB) mode of Pentax SAFE3000 bronchoscopy. Biopsies of the positive regions were taken for pathologic examination. ResultsTotally 128 of 168 patients had abnormal changes in WLB mode， 144 patients had abnormal changes in AFB mode. The pathologic diagnoses for 168 biopsy specimens were as follows: bronchogenic carcinoma in 97 cases， pulmonary inflammation in 40 cases， tuberculosis in 19 cases and pulmonary sarcoidosis in 12 cases. The respective sensitivities of WLB and AFB were 81.44% and 95.88% (χ2=12.071，P=0.000) in bronchogenic carcinoma， and the respective specificities did not show significant difference (χ2=2.250，P=0.134). The differences of sensitivities and specificities of WLB and AFB in pulmonary inflammation， tuberculosis， and pulmonary sarcoidosis were not statistically significant (P>0.05). ConclusionThe value of WLB and AFB in the diagnosis of lung inflammation， tuberculosis and sarcoidosis is equivalent. The sensitivity of AFB in diagnosing lung cancer was higher than WLB.

Medication in patients with bronchial asthma in Rizhao city

Feng Liancai， Wang Li

2017, 32(5): 441-443. doi:10.3969/j.issn.1004-583X.2017.05.016

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ObjectiveTo investigate the medication in patients with bronchial asthma， so as to understand the current status of treatment in bronchial asthma patients in Rizhao city. MethodsA total of 229 patients were selected in a face to face questionnaire survey. The disease identification， history and medication including the kinds， dosage form and time of medication were surveyed. ResultsThe percentages of 229 patients with theophylline and shortacting beta2 receptor agonists (included oral and inhale types) were 78.6% and 68.1%， respectively; The percentage with inhaled corticosteroids（ICS） was 44.5%; The percentage with nonconformal drugs was 36.2%; The average time in patients with oral hormone was longer than that of ICS（P<0.01）; There was statistical significance in age and disease course between nonconformal and conformal drugs （P<0.05）.ConclusionIn Rizhao city， the medication in patients with bronchial asthma was not reasonable; the drugs of theophylline and shortacting beta2 receptor agonists in bronchial asthma were prior to the drugs of ICS. There was still a certain proportion of patients with oral hormone， but patients with nonconformal drugs were older and their disease courses were longer than those with conformal drugs.

Targeted agents for advanced pancreatic cancer: a metaanalysis

Li Xinyan，Li Weichen， Qin Mingyin， Wang Liping

2017, 32(5): 444-448. doi:10.3969/j.issn.1004-583X.2017.05.017

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ObjectiveTo assess whether targeted agents added to gemcitabine has benefit for advanced pancreatic cancer. MethodsBy searching CNKI， PubMed， Cochrane Library and EMBASE databases， data were retrieved from phase Ⅲ clinical randomized controlled trials to compare the efficacy and safety between targeted therapy plus gemcitabine and gemcitabine alone for advanced pancreatic cancer. The primary endpoints included overall survival (OS)， progressionfree survival (PFS)， objective response rate (ORR)， clinical benefit rate (CBR)， and toxicity rate. ResultsThirteen randomized controlled trials involving a total of 6 664 patients were selected for metaanalysis. In the pooled analysis， no statistical difference was found on OS (HR=0.984，95%CI=0.9301.041，P=0.567)， PFS (HR=0.955，95%CI=0.8981.015，P=0.137) and ORR (OR=1.188，95%CI=0.9781.442，P=0.082) for targeted agents plus gemcitabine compared with gemcitabine alone. Targeted agents demonstrated a significant increase on CBR (OR=1.249，95%CI=1.0391.501，P=0.018). The side reactions of medicine， such as grade 34 neutropenia， diarrhoea and rash were significantly increased in targeted agents. ConclusionBased on the outcomes of this analysis， addition of targeted agents can not improve OS and PFS of patients.

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