Objective
To investigate and analyze the effect of different mechanical ventilation modes in the treatment of severe chest injury complicated with acute respiratory distress syndrome in the elderly.
Methods
From July 2016 to July 2018, 92 elderly patients with severe chest injury complicated with acute respiratory distress syndrome who were treated in Shengzhou Hospital of Traditional Chinese Medicine were selected in the research.The patients were divided into control group and observation group by envelope-type grouping, with 46 cases in each group.The control group received synchronous intermittent command ventilation combined with positive end-expiratory pressure ventilation, and the observation group was given continuous positive airway pressure ventilation combined with pressure support ventilation.The clinical efficacy, respiratory pattern parameters and blood gas indicators of the two groups were compared.
Results
The total clinical improvement rate of the observation group was 97.83%, which of the control group was 93.48%, the difference was not statistically significant (χ2=0.426, P>0.05). The MV, SaO2 and PaO2 in the observation group were significantly higher than those in the control group, while PIP and PaCO2 in the observation group were significantly lower than those in the control group, the differences were statistically significant (t=13.022, 18.622, 10.605, 27.238, 11.746, all P<0.05). All the blood and gas indicators in the observation group were significantly better than those in the control group (t=6.166, 2.766, 6.905, all P<0.05).
Conclusion
Synchronous intermittent command ventilation combined with positive end-expiratory pressure ventilation and continuous positive airway pressure combined with pressure support ventilation in the treatment of elderly patients with severe chest injury combined with acute respiratory distress syndrome can achieve an ideal clinical effect.
Key words:
Ventilators, mechanical; Respiration, artificial; Respiratory distress syndrome, adult; Thoracic, injuries; Blood gas analysis; Aged
To summarize the experience of treatment in 32 critical severe acute respiratory syndrome (SARS) patients.The age of 32 patients ranged from 19 to 72 years, the average was 43.06 years. Among them, 13 patients were having serious primary diseases, i.e. cardio-cerebral-vascular disease in 9 patients, diabetes in 2 patients, renal dysfunction in 1 patient, and chronic obstructive pulmonary disease (COPD) in 1 patient. The treatment included antiviral agents, glucocorticoid, mechanical ventilation, antibiotics and immunologic enhancement, etc. Cure rate, mortality and complications were analyzed.Among 32 patients, 24 were cured, 2 died of respiratory failure, 6 died of their primary diseases, and the overall mortality was 25.00 percent. Superimposed infection occurred in 12 patients, and among 17 patients who required noninvasive ventilation, 3 patients were complicated by lung injury (mediastinal emphysema, pneumothorax). In addition, hyperglycemia was found in 4 patients, upper intestinal hemorrhage occurred in another 4 patients and cardiac failure occurred in 6 patients.The treatment of the pre-existing diseases should be emphasized in the treatment of critical SARS. Glucocorticoid should not be used for a long-term. Vigilance should be paid to avoid lung injury during mechanical ventilation.
Knowledge concerning nutritional status of patients with chronic kidney disease (CKD) is limited. Nutritional Risk Screening-2002 (NRS-2002) has been used to evaluate the nutritional aspects of patients according to the recommendation of European Society for Clinical Nutrition and Metabolism. Here we aim to assess the prevalence and characteristics of nutritional risk in CKD patients by using NRS-2002. NRS-2002 scores of 292 CDK patients were recorded in first 24 hours subsequent to their admission to hospital. All patients have never been on dialysis. BMI, weight and various biochemical parameters were also characterized for these patients. Possible correlations between these parameters and NRS-2002 score were investigated. The overall prevalence of nutritional risk was 44.9% (53.6% in CKD stage 4-5 patients and 38.3% in stage 1-3 patients). Statistically significant differences were found in serum Albumin, Haemoglobin B, and lymphocyte counts between patients with or without increased nutritional risk. Under the situation that attending physicians were completely unaware of NRS-2002 scores, only 35.1% of the patients at risk received nutritional support. The nutritional risk status was associated with CKD stages but independent from primary diagnosis type. More attention should be paid to the nutritional status in CKD patients (including early stage patients). We recommended using NRS-2002 for nutritional risk assessment among non-dialysis CKD patients in routine clinical practice. 目前人们对于慢性肾脏病患者（CKD）的营养状况了解非常有限。根据欧洲 临床营养与代谢协会推荐，营养风险筛查标准NRS-2002 已被广泛应用于评估 其他疾病患者的营养风险。本研究旨在利用NRS-2002 评估CKD 患者的营养 风险。我们针对292 例未经过透析的CDK 患者进行了NRS-2002 评估，记录 了他们的体重指数（BMI）和各种生化指标，并对NRS-2002 评分与各种指标 之间的相关性进行了分析。在所有样本中，处于营养风险状态的患者比例为 44.9%（CKD 4-5 级患者中比例为53.6%，1-3 级为38.3%）。血清白蛋白、血 红蛋白B 和淋巴细胞计数与患者的营养风险状态显著相关。在主治医师未得 知NRS-2002 评分的状况下，仅有35.1%存在营养风险的患者接受了营养支持 治疗。患者的营养风险状况与其初诊类型无关。本研究结果表明，临床实践 中应该重视CKD 患者（包括早期病人）的营养状况，及时给予营养治疗。我 们建议针对非透析的CKD 患者使用NRS-2002 进行营养风险评估。.
This study was carried out to evaluate the clinical efficacy of proprotein convertase chymotrypsin 9 (PCSK9) inhibitors in multi-branch lesions in coronary artery disease with substandard lipid-lowering effects.This retrospective study collected the clinical data of 100 patients with multiple coronary artery diseases admitted to our hospital between May 2020 and August 2022 for analysis. The eligible patients were assigned to either a PCSK9 inhibitor group or a control group at a ratio of 1:1 by their dosing regimens, with 50 cases in each group. Outcome measures for the clinical efficacy of PCSK9 inhibitors included lipid levels, low-density lipoprotein cholesterol (LDL-C) changes, serum concentrations of coronary artery disease-related inflammatory factors, improvement of angina questionnaire scores, adverse reactions, and major cardiovascular adverse events.PCSK9 inhibitors resulted in significantly lower serum concentrations of total cholesterol (TC), LDL-C, and ApoB and higher high-density lipoprotein cholesterol (HDL-C) levels versus conventional lipid-lowering medication (P < .05). The two arms exhibited similar serum concentrations of triglyceride (TG) and ApoA1 after treatment (P > .05). With LDL-C<1.4 mmol/L as the cut-off for desirable blood lipid levels, 47 (94%) patients reached the standard after in the PCSK9 inhibitors group, while no eligible cases were reported in the control group (P < .05). PCSK9 inhibitors provided a marked reduction in the serum concentrations of high-sensitivity C-reactive protein in the patients. Patients had higher angina stability (AS), angina flare (AF), physical limitation (PL), and treatment satisfaction (TS) scores after PCSK9 inhibitor administration versus after conventional medication (P < .05). PCSK9 inhibitors were associated with a significantly lower incidence of adverse cardiovascular events (10%) versus conventional medication (42%) (P < .05).PCSK9 inhibitors significantly improve the LDL-C concentrations of patients with multiple lesions of coronary artery disease who have failed to meet lipid-lowering targets, this enables physicians to more effectively manage patients' cholesterol levels, consequently reducing their cardiovascular risk. Moreover, these inhibitors have the potential to enhance patients' quality of life by alleviating relieve angina symptoms. These findings offer valuable insights into managing multi-branch coronary artery disease.
Gastrointestinal stromal tumor(GIST) originates from interstitial cells of Cajal(ICCs). Tyrosine kinase inhibitors(TKI) such as imatinib and sunitinib, are effective agents besides surgery. However some GIST can become primarily or secondarily resistant to those drugs. The difference in gene mutation types and secondary gene mutation is the main cause. When the GIST is proved to be drug resistance, reasonable personal treatment strategies based on individualized medicine should be made to improve outcomes and quality of life.
Colorectal cancer (CRC) is one of the most common cancers worldwide. Sphingosine kinase 1 (SphK1), which phosphorylates sphingosine to sphingosine-1-phosphate (S1P), is overexpressed in various types of cancers and may act as an oncogene in tumorigenesis. However, little is known about the role of SphK1 in CRC patients. We studied the expression of SphK1 in 85 cases of CRC tissues by immunohistochemistry, qRT-PCR, and western blot. We also evaluated the effect of SphK1 on cell proliferation and invasion by MTT and transwell invasion assay. SphK1 is overexpressed in CRC tissues and cell lines, and upregulation of SphK1 correlated significantly with the following parameters: lymph node metastasis, liver metastasis, and advanced TNM stage. SphK1 knockdown results in inhibition of cancer cell proliferation. Inhibition of CRC cell migration and invasion is also evident through reversal of EMT by increases in E-cadherin expression and decreases in vimentin expression. In conclusion, SphK1 is associated with the proliferation and invasiveness of CRC cells and the SphK1 gene may contribute to a novel therapeutic approach against CRC.
Esophageal granular cell tumor (GCT) is a rare benign tumor with malignant potential. With wide application of endoscopic techniques, the esophageal GCT discovery rate and treatment strategy has changed. This study was to preliminarily evaluate outcomes of endoscopic diagnosis and treatment for esophageal GCT. Fourteen patients (eight men, six women; median age, 48.5 years) with esophageal GCT diagnosed and treated by esophageal endoscopy. Esophagoscopy, endoscopic ultrasound (EUS), and endoscopic submucosal dissection (ESD) techniques were employed in diagnosis and resection. Esophageal GCTs are tumors which arise from the submucosal layer, and vary in color but with a yellowish color on endoscopy being most common. On EUS, features were homogenous (ten cases) or mildly heterogeneous (four cases) hypoechoic solid pattern originating from the muscularis mucosa (six cases) or submucosal layer (eight cases) of the esophageal wall. Tumors ranged from 4 to 26 mm (mean 12.1 mm). ESD was performed in all patients without complication. Clinical diagnosis was confirmed by pathology and immunohistochemical examination (positive for S-100 and vimentin). The en bloc resection rate was 92.9% (13/14) pathologically. Operation time was 25 to 60 minutes, mean 38.2 ± 10.1 minutes. No recurrence was observed during a mean follow-up of 16.6 ± 12.7 (range, 4 to 40) months. Esophagoscopy and EUS increased the esophageal GCT discovery rate, and its features were summarized. Minimally invasive ESD is feasible and safe for excisional biopsy, providing pathological diagnosis and treatment.
Nature Communications 5: Article number: 4999 (2014); Published: 23 September 2014; Updated: 10 April 2018 The original version of this Article had an incorrect volume number of 4; it should have been 5. This has now been corrected in both the PDF and HTML versions of the Article.
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