Table of Content

20 July 2019, Volume 34 Issue 7

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Critical renal ultrasound: evaluation of renal hemodynamics

Wang Xiaoting, Wang Guangjian, Zhang Hongmin, Chinese Critical Ultrasound Study Group

2019, 34(7):  581-583.  doi:10.3969/j.issn.1004-583X.2019.07.001

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In  recent years,  the evaluation of organ hemodynamics has gradually become a hot topic. As one of the most vulnerable organs to shock,  the hemodynamic evaluation of kidney has been paid more and more attention. Because of its dynamic,  realtime and repeatable characteristics,  critical ultrasound can take into account of structure and perfusion,  and it provide a new concept and method for the evaluation of organ hemodynamics in critically ill patients. This paper focuses on the application and significance of critical ultrasound in renal hemodynamic evaluation,  including pulse Doppler renal resistance index,  color Doppler flow imaging combined with color flow quantitative technique and contrastenhanced ultrasound and other content.

Intraabdominal hypertension and renal perfusion

Liu Yang, He Wei, Chinese Critical Ultrasound Study Group

2019, 34(7):  584-589.  doi:renal insufficiency；intra-abdominal hypertension；renal blood flow；renal perfusion

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Intraabdominal hypertension affects renal blood flow and perfusion through a series of mechanisms,  resulting in a series of pathophysiological changes,  which start from local blood flow disorders,  and end with  serious organ failure. It is important to understand the physiology of renal blood flow and perfusion as well as the pathophysiology of renal hemodynamic changes in patients with intraabdominal hypertension,  which is helpful for early identification of renal insufficiency caused  by  intraabdominal hypertension. Ultrasound,  CT,  and MRI can be  adopted to evaluate the changes of renal blood flow and perfusion in early stage,  and promote early intervention,  which are of  great clinical significance for early diagnosis and protection of renal function in acute kidney injury caused by intraabdominal hypertension.

Renal perfusion pressure: what is appropriate？

Hu Chenghuan, Zhang Lina, Chinese Critical Ultrasound Study Group

2019, 34(7):  590-594.  doi:10.3969/j.issn.1004-583X.2019.07.003

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Kidney is the organ with the most abundant blood supply. It has a strong ability of selfregulation of blood flow, which makes the blood flow of kidney relatively stable when the arterial pressure changes in a certain range.Various causes, which range from inflammation, sepsis, insufficient capacity,  obstruction to ischemiareperfusion injury and surgery, can lead to impaired autonomic regulation of renal blood flow.  At this time, small fluctuation of arterial blood pressure may lead to obvious fluctuation of glomerular filtration rate, contributing to acute renal function damage.Therefore, the monitoring of renal perfusion is of significant importance.Renal perfusion can be monitored by renal ultrasound such as color  Doppler, renal blood flow spectrum,  contrastenhanced ultrasound，and tissue oxygen monitoring such as near infrared spectroscopy, magnetic resonance imaging tissue oxygen monitoring in clinic.Due to various potential diseases and basic disease status, the optimal blood pressure for each patient is different to ensure adequate renal perfusion pressure.Clinical practice prefers lower central venous pressure,  and the titration and individualized therapy strategies guided by renal blood flow perfusion to regulate body volume status and renal perfusion pressure.

Sepsisinduced acute kidney injury: a disease of the microcirculation

Liu Lixia1, Wang Xiaoting2, Chao Yangong3, Zhang Hongmin2, Wu Jun4, Yin Wanhong5, Zhang Lina6,He Wei7, Zhu Ran8, Ding Xin2, Zhang Qian1, Hu Zhenjie1, Chinese Critical Ultrasound Study Group

2019, 34(7):  595-598.  doi:10.3969/j.issn.1004-583X.2019.07.004

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The renal hemodynamics in sepsis induced acute kidney injury (AKI) is characterized by renal macro and microcirculation separation. In  such case, renal blood flow is normal or even enhanced,  while the renal microcirculation is in a state of  ischemia and hypoxia because of the intrarenal blood shunt,  heterogeneity,  stasis and obstruction. This phenomenon suggests that septic AKI belongs to microcirculation  disease,  and “microcirculation perfusion guided” strategy should be a therapeutic goal in future.

Choice of vasoactive drugs in sepsis associated acute kidney injur

Chao Yangong, Chinese Critical Ultrasound Study Group

2019, 34(7):  599-603.  doi:10.3969/j.issn.1004-583X.2019.07.005

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Acute kidney injury (AKI) is closely related to sepsis and is associated with higher hospital mortality. Influencing factors of sepsisrelated AKI include hemodynamic changes, inflammation and direct damage to renal tubular epithelium. In this article, we begin with the epidemiological and pathophysiological mechanisms of sepsisrelated AKI, focusing on the renal hemodynamic changes associated with sepsis, and elaborate on the selection of vasoactive drugs including norepinephrine, epinephrine, vasopressin, dopamine and phenylephrine. It is expected to be helpful to young doctors in related fields.

Fluid overload and acute kidney injury

Yin Wanhong, Chinese Critical Ultrasound Study Group

2019, 34(7):  604-607.  doi:10.3969/j.issn.1004-583X.2019.07.006

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The kidney is an important  “hemodynamic organ”  that is highly susceptible to hemodynamic disorders as well as various diseases. And  hemodynamic disorders  can evoke or aggravate acute kidney injury (AKI),  among which fluid overload is one of the most common and key factors. It can be  caused by AKI, or be the  root of the occurrence and  deterioration of AKI. Fluid overload may contribute to the occurrence or further progression of AKI through a variety of mechanisms,  and  lead to multiple organ disorders. Fluid overload  prevention and control should be advocated throughout the entire disease course.

Assessment of renal recoverability after acute kidney injury

Yao Yulong1, Li Yiran2, Wu Jun3, Chinese Critical Ultrasound Study Group

2019, 34(7):  608-613.  doi:10.3969/j.issn.1004-583X.2019.07.007

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Acute kidney injury is a common complication of critically ill patients,  and itsrecovery is closely related to the shortterm and longterm prognosis. Taking effective monitoring measures to judge its reversibility and the influencing factors is the key to implement effective interventions and improve the prognosis. Renal recoverability rests on many factors such as types and extent of injury,  local renal factors and systemic conditions. In order to facilitate clinical practice,  the article explores  its risk factors,  clinical information,  pathology,  molecular markers,  imaging methods,  renal blood flow status and other aspects.

Appropriate application of furosemide stress test

Zhu Ran, Chinese Critical Ultrasound Study Group

2019, 34(7):  614-616.  doi:10.3969/j.issn.1004-583X.2019.07.008

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Acute kidney injury is common in intensive care units and will significantly increase the mortality of critically ill patients. Evaluation of renal reservation function is important and helpful in initiation of renal replacement therapy and predicting the prognosis. Furosemide stress test has been used for decades since it helps optimize  volume status in acute kidney injury patients and to predict kidney prognosis,  and it can exempt some patients from renal replacement therapy. However,  there is no standardization for furosemide stress test,  and there is a large variation in the choice of patients, the choice of timing, and the choice of dosage and infusion methods. The author reviewed clinical trials in this field and discussed about how to appropriately use furosemide stress test in clinical practice.

Clinical efficacy of mechanical thrombectomy and intravenous thrombolysis to  acute aortic occlusive stroke

Huang Debo, Mao Xianquan, Xu Zhenqiang, Feng Guokuan, Xu Fuguan, He Yuyan

2019, 34(7):  617-621.  doi:10.3969/j.issn.1004-583X.2019.07.009

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Objective  To investigate the safety and clinical efficacy of mechanical thrombectomy to acute aortic occlusive stroke. Methods  Sixtyfive patients with acute aortic occlusive stroke who admitted to the hospital from April 2016 to April 2019 were divided into   mechanical thrombectomy group (35 patients) and intravenous thrombolysis group(30 patients).  Comparison was performed in the baseline data,  recanalization rate,  NIHSS score at 24 h and 14 d after treatment,  90day neurological recovery score (90 d mRS),  intracranial hemorrhage during treatment transformation,  clinical mortality to evaluate the efficacy and safety between  two groups. Results  The NIHSS scores of  mechanical thrombectomy group were significantly lower than those of  intravenous thrombolysis group at 24 h and 14 d after treatment (P<0.05). The 90 d mRS of mechanical thrombectomy group（54.28%）   was significantly higher than that of intravenous thrombolysis group(24.33%)(P＜0.05）.The recanalization rate of mechanical thrombectomy group(85.7%) was significantly higher than that of intravenous thrombolysis group(16.67%)(P＜0.05). Conclusion  The clinical efficacy of  mechanical thrombectomy to  acute aortic occlusive stroke is better than that of intravenous thrombolysis.

Clinical observation of thalidomide in treatment of connective tissue  disease associated interstitial lung disease

Zhang Jiahong, Zhou Shuhong, Zhou Jing, Wang Huijuan

2019, 34(7):  622-625.  doi:10.3969/j.issn.1004-583X.2019.07.010

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Objective  To evaluate the efficacy and safety of steroid combined with thalidomide in the treatment of connective tissue disease with interstitial lung fibrosis (CTDILD). Methods  Sixtysix patients were randomly divided into two groups:  control group was given prednisone acetate  and other routine treatment. The combined group took thalidomide  more,  and the course of treatment was six months. Results   The clinical symptoms,  pulmonary function and pulmonary CT improvement in combined group were better than those in control group (P<0.05). In the course of treatment,  there was no significant difference in the incidence of adverse reactions between  two groups (P>0.05). Conclusion  Thalidomide in the treatment of CTDILD can improve the therapeutic effect and has no obvious adverse reactions.

Expression of endothelial cell specific molecule-1 in serum of  non-myocardial infarction patients with coronary heart disease

Zhu Zongcheng, Jin Xiaoqi, Zhen Guanqun, Chen Zhixian, Jin Jing

2019, 34(7):  626-628.  doi:10.3969/j.issn.1004-583X.2019.07.011

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Objective   To investigate the expression and significance of endothelial cell specific molecule1 (ESM1) in serum of nonmyocardial infarction patients with coronary heart disease (CHD). Methods   Forty patients of CHD with nonmyocardial infarction were selected as observation group, and 40 patients with nonCHD  as control group. The serum levels of ESM1 and inflammatory factors related to CHD  in all patients. The relationship between ESM1 content and inflammatory factors with CHD was explored. Results  There were significant differences in the levels of ESM1 and inflammatory factors related to CHD between two groups (P<0.001). Multiple linear regression analysis showed that ESM1 was positively correlated with inflammatory factors VCAM1, TNFα and IL8 (P<0.001). Conclusion  The elevated levels of ESM1 and inflammatory factors in serum of nonmyocardial infarction patients with CHD play an important role in the occurrence of CHD.

Effects of Bifidobacterium triple viable entericcoated capsules on gastrointestinal hormones

Zhang Cheng1，Gao Zeli2

2019, 34(7):  629-632.  doi:10.3969/j.issn.1004-583X.2019.07.012

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Objective  To study the effects of Bifidobacterium triple viable entericcoated capsules on symptoms score,  gastrointestinal hormones and oxidative stress index in irritable bowel syndromeconstipation（IBSC）  patients. Methods  A  total  of  94 patients with IBSC treated in our hospital from January  2018 to December  2018  were selected,  and they were randomly divided into control group(n=47)  and observation group(n=47). The two groups of patients were treated with mosapride in combination with lactulose,  with observation group added with Bifidobacterium triple live enteric capsules,  and control group added with placebo. The clinical efficacy,  clinical symptoms,  gastrointestinal hormones,  5HT and oxidative stress were compared between two groups.Results  In observation group,  the treatment was markedly effective  in 29 cases (61.70%),   and effective in 15 cases (31.91%),  with the total effective rate being 93.62%,  and that of control group being  78.72%(P<0.05). After treatment,  the scores of clinical symptoms in two groups decreased significantly. The scores of abdominal distension,  abdominal pain,  defecation frequency,  stool characteristics and defecation difficulty in observation group were significantly lower than those in control group (P<0.05). After treatment,  the levels of 5HT,  MDA and LPO in two groups also witnessed significance decrease. The levels of 5HT,  MDA and LPO in observation group were lower than those in control group (P<0.05). After treatment,  the levels of gastrointestinal hormones in both groups were improved. The MTL level in observation group was higher than that in control group,  and the levels of VIP and S S were lower than those in control group (P<0.05). Conclusion  Bifidobacterium triple viable capsule combined with lactulose and Mosapride is effective in treatment of IBSC. It can significantly improve clinical symptoms and gastrointestinal hormone levels,  reduce plasma 5HT level and oxidative stress response,  which makes  it is worthy of clinical application.

Clinical effect of double plasma absorption combined with plasma exchange  therapy in  acuteonchronic liver failure

Qin Hua, Wei Li

2019, 34(7):  633-636.  doi:10.3969/j.issn.1004-583X.2019.07.013

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Objective   To investigate the efficacy and safety of double plasma absorption(DPMAS) combined with plasma exchange (PE) in the treatment of acuteonchronic liver failure.Methods   Totally 69 cases of acuteonchronic liver failure treated with artificial liver treatment  were  retrospectively analyzed since January 2016  to December 2018. The patients were divided into combination group with 32 patients(DPMAS combined with PE)and control group with 37 patients(PE alone). Changes in laboratory tests,  clinical effection and adverse reaction before  and after different modes of treatment were compared. Results  The two groups showed no significant differences in the effectiveness and 12week survival rate. After treatment,  the levels of TBil, ALB and TBA in combination group were significantly improved than those of control group. There were significant  differences in liver function and blood coagulation function before and after treatment between two groups. Conclusion  The treatment of DPMAS  combined with PE  can improve liver  function and blood coagulation function  in comparison with simple PE.

Association study between liver inflammation and HBeAg quantification

Zhu Ping1, Lu Yufeng2a, Wang Li3, Wang Hong2b, Yang Li2b,

2019, 34(7):  637-640.  doi:10.3969/j.issn.1004-583X.2019.07.014

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Objective  To discuss the correlation of chronic hepatitis B patients between liver inflammation and serum HBeAg quantification. Methods  All 296 HBeAgpositive CHB patients received liver biopsy  under ultrasound guidance,  the scoring was based on viral hepatitis inflammatory activity standard (grade, G),  and serum HBeAg quantification were quantified after serum was isolated on the same day. The three subgroups were divided according to the serum HBeAg quantification. Results  Along with the progress of liver inflammation from G1 to G2,  G3/G4,  serum HBeAg level gradually decreased, the serum HBeAg quantification had negative correlation with liver inflammation (r=-0.513, P＜0.01). Conclusion  HBeAg quantification may become a noninvasive diagnostic marker of liver inflammation degree in CHB patients.

Relationship between gross tumor volume and prognosis of patients with #br# esophageal cancer  detected by chest enhanced CT scan before radiotherapy

Li Xinhai, Wang Longqing, Li Hongwei

2019, 34(7):  641-645.  doi:10.3969/j.issn.1004-583X.2019.07.015

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Objective  To  investigate the relationship between gross tumor volume (GTVT) and prognosis of esophageal cancer patients undergoing radical radiotherapy detected by chest enhanced multislice spiral CT (MSCT) scan. Methods  A retrospective analysis  was performed in 392 patients with esophageal cancer who underwent radical radiotherapy. The relationship between GTVT and its clinical T stage and clinical TNM staging were analyzed. The relationship between GTVT and patient prognosis was analyzed.Results  The GTVT of the whole group was 7.55222.33 cm3 (median 45.88  cm3),  which was closely correlated with clinical T stage and TNM stage (r=0.673,  0.596,  P=0.000).According to the analysis result of ROC curve,  the best cutoff value was obtained when the value of GTVT  was 50.00  cm3.Multivariate analysis showed that the patients'  age,  clinical TNM staging and GTVT were independent factors affecting overall survival （OS）(P=0.000, 0.002, 0.014);  and the patients' lesion,  clinical TNM staging and GTVT was the independent factor influencing the patients' diseasefree survival （DFS）(P=0.020, 0.013, 0.006). Conclusion  The size of GTVT detected by chest MSCT scan before radiotherapy can predict the prognosis of esophageal cancer patients,  and the prognosis of patients with smaller GTVT is better.

Applied value of the score of pulsed wave Doppler ultrasonography joint Apgar in diagnosis of  hypoxicischemic encephalopathy

Wei Xiaohong1, Shang Hong1, Zhou Lizhu1, Yang Xiaoyan1, Zhang Jianwei1, Zhang Xuefan2

2019, 34(7):  646-650.  doi:10.3969/j.issn.1004-583X.2019.07.016

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Objective   To explore the applied value of bedside pulsed wave Doppler ultrasonography joint Apgar score in the diagnosis of hypoxicischemic encephalopathy(HIE). Methods   A total of 411 normal newborn infants and 168 newborn infants with HIE were divided into three groups（newborn infants of gestational age of less than 28 weeks are not involved due to lack of enough cases）: namely，the gestational age of over 38 weeks,  gestational age of 35 to 38 weeks and gestational age of 28 to 35 weeks. Statistical analysis was done about the callosomarginal artery and middle celebral artery of peak flow velocity (Vmax),  final diastolic velocity(Vmin) and resistance index(RI) of each group,  including the 1 minute and 5 minutes of Apgar score. Results  The contrasting data in Vmin and RI of the normally newborn infants and abnormally newborn infants in the other three groups were statistically significant(P<0.05). As time passed by,  RI of both normal infants and abnormal infants showed decrease tendency,  part of which had statistical significance(P<0.05),  while the Apgar scores were all statistically significant(P<0.05). Conclusion  Pulsed wave Doppler ultrasonograhy and Apgar score are of great applied value in the diagnosis of hypoxicischemic encephalopathy in clinical treatment.  The two combined,  early diagnostic accuracy will be greatly improved.

Effect of special enrichment on  the  elderly  with  depression  at nursing homes

Fu Conghui1, Chen Mei1, Zhang Xiaofeng1, Liu Xinli1, Cui Yanping1, Shen Zhiqiang1, Wu Yi2, Jia Jie2, Xu Ying1

2019, 34(7):  651-654.  doi:10.3969/j.issn.1004-583X.2019.07.017

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Objective   To explore the effect of special enrichment on the elderly with depression at nursing homes. Methods  Seventyfour hospitalized elderly over 60 years, who conformed to the rating standard of the simple version of the Geriatric Depression Scale (GDS15)  and met the admission criteria were randomly divided into special enriched environment group (36 cases) and traditional enriched environment group (38 cases).The traditional enriched environment group trained once a day for 1 hour,  5 days a week for 12 weeks.On the basis of traditional enriched environment training,  the special enriched environment group emphasized the importance of interesting,  individualized and active participation in the training content,  once a day for 1 hour,  5 days a week for 12 weeks.The followup was evaluated 1 week before treatment,  4 weeks,  12 weeks and 3 months after treatment.Results   After 12 weeks of intervention,  QOLI score of the special enriched environment group was improved compared with before treatment (P<0.05); GDS15 score of the short version of the international general depression scale for the aged was improved compared with before intervention (P<0.05); after 4 weeks of intervention,  the special enriched circle was improved compared with before intervention (P<0.05). After 12 weeks and 3 months of treatment,  GDS15 score in special enriched environment group improved significantly compared with traditional enriched environment group (P<0.05).QOLI scores were different from those of  traditional enriched environment group (P<0.05).Conclusion   The special rich environment can effectively improve the depressive state of longterm hospitalized elderly,  and quality of life.

Correlation between rashes and EGFR antibody response to colorectal cancer

Wang Qing1, Liu Baorui2

2019, 34(7):  655-663.  doi:10.3969/j.issn.1004-583X.2019.07.018

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Objective  Ontreatment markers such as skin toxicity was frequent and early phenomenon in antiepidermal growthfactor receptor (EGFR)monoclonal antibody (MoAb) treatment process for colorectal cancer patients,  However,  it is still unclear  if it is a considerable marker to make treatment decision. This study aimed to uncover this issue. Methods  Literature search for relevant studies was conducted on pubmed,  Embase and other databases from their inception through Oct,  2018. The metaanalysis was then performed with STATA 12.0. The hazard ratio(HR) was calculated with a 95%  condidence intrerval(CI).Results  The presences of skin toxicity in the ongoing antiEGFR treatment was associated with longer OS (HR=0.512，95%CI［0.443,0.58］，P<0.01)  and PFS (HR=0.587，95%CI［0.512, 0.662］，P<0.01).  On the other hand, the early clinical remission rate of KRAS mutation patients treated with EGFR MoAb was significantly higher than that of KRAS wild type patients (OR=3.029, 95%CI［2.474, 3.708］, P<0.01).Conclusion  Skin toxicity was one of prognostic factors in colorectal cancer patients. Given that skin toxicity appears to have little impact on quality of life, ontreatment markers could be potentially useful for treatment decision.

Subacute primary Bcell lymphoma of primary central nervous system with symmetrical lesions: a case report and literature review

Yu Yuehua， Zhao Dehao

2019, 34(7):  664-667.  doi:10.3969/j.issn.1004-583X.2019.07.019

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Primary central nervous system lymphoma (PCNSL) is a rare tumor involving only the central nervous system. The lesions are mostly single in patients with normal immune function,  but often multiple in patients with immunodeficiency. This article reports  a case of subacute lymphoma of the central nervous system with normal immune function and rare bilateral symmetrical lesions of the frontal lobe and corpus callosum.