To evaluate the value of lung ultrasonography score (LUS) on assessing extravascular lung water (EVLW) and prognosis in patients with acute respiratory distress syndrome (ARDS).The clinical data of 46 patients meeting ARDS Berlin definition admitted to intensive care unit (ICU) of Ningbo Yinzhou People's Hospital from July 2016 to December 2019 were retrospectively collected. The general data, vital signs, blood lactic acid (Lac), oxygenation index (OI), LUS, extravascular lung water index (EVLWI), sequential organ failure assessment (SOFA) score, clinical pulmonary infection score (CPIS) and the length of ICU stay were collected. According to the prognosis of patients during ICU treatment, the patients were divided into survival group and non-survival group, and the clinical characteristics between the two groups were compared. The correlation between LUS and OI, EVLWI, SOFA, and CPIS were analyzed by Pearson correlation analysis. Receiver operator characteristic (ROC) curve was plotted to determine the prognostic value of LUS for ARDS patients during ICU treatment.Forty-six patients were enrolled in the analysis, of whom 32 patients survived (69.6%), and 14 patients died (30.4%) during ICU treatment. There was no significant difference in gender, age, left ventricular ejection fraction (LVEF) or heart rate (HR) between the two groups. Compared with the survival group, the mean arterial pressure (MAP) and OI in the non-survival group were significantly lowered [MAP (mmHg, 1 mmHg = 0.133 kPa): 57.48±33.34 vs. 85.45±19.56, OI (mmHg): 74.50±18.40 vs. 233.06±28.28, both P < 0.05], while Lac, LUS, EVLWI, SOFA and CPIS were significantly increased [Lac (mmol/L): 6.78±2.56 vs. 2.21±1.42, LUS score: 23.57±2.03 vs. 15.58±2.24, EVLWI (mL/kg): 22.93±2.56 vs. 12.96±2.18, SOFA score: 20.21±3.35 vs. 12.43±2.97, CPIS score: 8.07±1.38 vs. 4.59±1.04, all P < 0.01], and the length of ICU stay was significantly shortened (days: 9.33±3.28 vs. 16.89±4.12, P < 0.05]. Pearson correlation analysis showed that a significant negative linear correlation was found between LUS and OI (r = -0.823, P < 0.01), and positive linear correlations were found between LUS and EVLWI, SOFA, CPIS (r values were 0.745, 0.614, 0.757, respectively, all P < 0.01). ROC curve analysis showed that both LUS and EVLWI could predict the prognosis of ARDS patients during ICU treatment, and the areas under ROC curve (AUC) of LUS and EVLWI were 0.936 and 0.991, respectively. When the cut-off of LUS score was 20.5, the sensitivity and specificity were 85.7% and 81.2% respectively.LUS score has a good correlation with EVLWI monitored by pulse index continuous cardiac output (PiCCO), which can reflect lung water content. LUS score can be used as an early prognostic indicator for ARDS patients.
Abstract Arterial pulse waveform analysis has been widely used to reflect physiological changes in the cardiovascular system. This study aimed to comprehensively investigate the changes of waveform characteristics of both photoplethysmographic (PPG) and radial pulses with gestational age during normal pregnancy. PPG and radial pulses were simultaneously recorded from 130 healthy pregnant women at seven gestational time points. After normalizing the arterial pulse waveforms, the abscissa of notch point, the total pulse area and the reflection index were extracted and compared between different measurement points and between the PPG and radial pulses using post-hoc multiple comparisons with Bonferrioni correction. The results showed that the effect of gestational age on all the three waveform characteristics was significant (all p < 0.001) after adjusting for maternal age, heart rate and blood pressures. All the three waveform characteristics demonstrated similar changing trends with gestational age, and they were all significantly different between the measurements from gestational week 12–15 and the others (all p < 0.05, except for the PPG total pulse area between the first and second measurement points). In conclusion, this study has comprehensively quantified similar changes of both PPG and radial pulse waveform characteristics with gestational age.
The aim of this study is to investigate the prevalence and outcome of tricuspid regurgitation (TR) in the Chinese population.The echocardiography database, including 134,874 patients at our heart center from 2010 to 2012, was retrospectively analyzed.The rates of mild, moderate, and severe TR were 2.96, 2.22, and 1.39%, respectively. Of these patients, 4.86% had primary TR, 91.41% had functional TR, and 3.73% had unexplained TR. The rate of TR was increased in elders (odds ratio: 1.038 for 1 year's increment; 95% confidence interval: 1.037-1.040; p < 0.001) and females (odds ratio: 1.386; 95% confidence interval: 1.327-1.448, p < 0.001). The major etiologies of TR were left-sided valve heart disease (VHD) and dilated cardiomyopathy. The survival rate of severe TR patients with pulmonary artery hypertension (PAH) was lower than in those without PAH (p < 0.0001). There was a positive association between the prevalence of TR and impaired left ventricular ejection fraction. Compared to the non-left-sided VHD group, the left-sided VHD group had a better prognosis among severe TR patients. The 5-year survival rates were 79.69, 71.12, and 77.01% in the groups of left-sided VHD, non-left-sided VHD, and all patients.Patients with severe TR have a bad prognosis, especially those with non-left-sided VHD and those with PAH.
Objective
To explore the clinical significance of the heart rate viability decrease in the elderly patients with multiple organ disorders.
Methods
Two hundred and fifty-nine elderly patients with multiple organ disorders, with underlying diseases as coronary heart disease, hypertension, diabetes, cerebrovascular disease, chronic obstructive pulmonary disease, chronic bronchitis and malignant tumor were enrolled in this study, a retrospective analysis was made on the dynamic electrocardiogram data of the research objects.According to SDNN, 123 cases were assigned into the normal HRV group (SDNN≥100ms); 50 cases were divided into the moderately decreased HRV group (50ms≤SDNN<100ms), and 36 cases were divided into the severely decreased HRV group(SDNN<50ms). The average heart rate within 24 hours, clinical diagnosis, and discharge record of the three groups were analyzed.
Results
As HRV decreased, SDNN decreased gradually (normal HRV group 116 (104~131) ms, moderately decreased HRV group 85 (67.5~91) ms, severely decreased HRV group 40 (35~48) ms), the average heart rate within 24 hours gradually increased (normal HRV group 67 (60~76) times/min, moderately decreased HRV group 78(66~84) times/min, severely decreased HRV group 91( 80~112) times/min ), the differences among the three groups were statistically different (P 0.05). The rate of malignant tumor in severely decreased HRV group was 8.3%, significantly higher than that in normal HRV group (0), the difference was statistically significant (P<0.01). In severely decreased HRV group, the rates of chronic obstructive pulmonary disease (25%), chronic renal failure (30.56%), respiratory failure (25%), uremic cardiomyopathy (13.89%), hypoproteinaemia (41.67%) and anemia (41.67%) were significantly higher than those in normal HRV group (1.63%, 0.9%, 0.81%, 0, 6.5%, 8.94%) and moderately decreased HRV group (7%, 11%, 2%, 3%, 11%, 11%), the differences were statistically significant (P<0.05). In moderately decreased HRV group, the rate of chronic renal failure (11%) was higher than that in normal HRV group (0.9%), the difference was statistically significant (P<0.05). Mortality in severely decreased HRV group (41.66%) was significantly higher than that in normal HRV group (2.44%) and moderately decreased HRV group (8%), the difference among the three groups was statistically significant (P<0.05).
Conclusion
For elderly patients with multiple organ disorders, along with severely decreased HRV, they face the risks of severe imbalances of automatic nervous system, fast heart rate, serious illness, poor nutrition, high mortality.
Key words:
Elderly; Multiple Organ Disorders; Dynamic Electrocardiogram; Heart Rate Variability
Background: Phase analysis is a technique used to assess left ventricular mechanical dyssynchrony (LVMD) in nuclear myocardial imaging. Previous studies have found an association between LVMD and myocardial ischemia. We aim to assess the potential diagnostic value of LVMD in terms of myocardial viability, and ability to predict major adverse cardiac events (MACE), using Nitrogen-13 ammonia ECG-gated positron emission tomography (gPET). Methods: Patients with coronary artery disease (CAD) who underwent Nitrogen-13 ammonia and Fluorine-18 FDG myocardial gPET were enrolled, and their gPET imaging data were retrospectively analyzed. Patients were followed up and major adverse cardiac events (MACE) were recorded. The Kruskal-Wallis test and Mann-Whitney U test were performed to compare LVMD parameters among the groups. Binary logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and multiple stepwise analysis curves were applied to identify the relationship between LVMD parameters and myocardial viability. Kaplan–Meier survival curves and the log-rank test were used to look for differences in the incidence of MACE. Results: In total, 79 patients were enrolled and divided into three groups: Group 1 (patients with only viable myocardium, n = 7), Group 2 (patients with more viable myocardium than scar, n = 33), and Group 3 (patients with less viable myocardium than scar, n = 39). All LVMD parameters were significantly different among groups. The median values of systolic phase standard deviation (PSD), systolic phase histogram bandwidth (PHB), diastolic PSD, and diastolic PHB between Group 1 and Group 3, and Group 2 and Group 3 were significantly different. A diastolic PHB of 204.5° was the best cut-off value to predict the presence of myocardial scar. In multiple stepwise analysis models, diastolic PSD, ischemic extent, and New York Heart Association (NYHA) classification were independent predictive factors of viable myocardium and myocardial scar. The incidence of MACE in patients with diastolic PHB > 204.5° was 25.0%, higher than patients with diastolic PHB <204.5° (11.8%), but the difference was not significant. Conclusions: LVMD generated from Nitrogen-13 ammonia ECG-gated myocardial perfusion imaging had added diagnostic value for myocardial viability assessment in CAD patients. LVMD did not show a definite prognostic value.
Beta‐trace protein ( BTP ) has emerged as a novel biomarker of cardiovascular risk. However, the level of circulating BTP in pregnancy‐induced hypertension ( PIH ) is still unknown. The aim of this study was to determine the concentration of serum BTP in healthy pregnant women and patients with PIH . No significant difference was found in the serum concentration of BTP in patients with a normal pregnancy. In contrast, serum BTP levels in women with PIH (n=46) were significantly higher than those in women with normal pregnancy (n=57). Receiver operating characteristic analysis revealed that using a serum BTP value of 321.3 ng/ mL as a cutoff produced a sensitivity of 91.3% and a specificity of 89.5%. Taken together, these findings suggest that a higher serum BTP concentration in PIH patients compared with those with normal pregnancy and serum BTP might be a novel biomarker in the diagnosis of PIH .
Abstract Bipolar disorder (BD) patients often demonstrate poor socialization that may stem from a lower capacity for empathy. We examined the associated neurophysiological abnormalities by comparing event-related potentials (ERP) between 30 BD patients in different states and 23 healthy controls (HCs, matched for age, sex, and education) during a pain empathy task. Subjects were presented pictures depicting pain or neutral images and asked to judge whether the person shown felt pain (pain task) and to identify the affected side (laterality task) during ERP recording. Amplitude of pain-empathy related P3 (450–550 ms) of patients versus HCs was reduced in painful but not neutral conditions in occipital areas [(mean (95% confidence interval), BD vs. HCs: 4.260 (2.927, 5.594) vs. 6.396 (4.868, 7.924)] only in pain task. Similarly, P3 (550–650 ms) was reduced in central areas [4.305 (3.029, 5.581) vs. 6.611 (5.149, 8.073)]. Current source density in anterior cingulate cortex differed between pain-depicting and neutral conditions in HCs but not patients. Manic severity was negatively correlated with P3 difference waves (pain – neutral) in frontal and central areas (Pearson r = −0.497, P = 0.005; r = −0.377, P = 0.040). Electrophysiological correlates of empathy processing are reduced in BD depending on manic symptom severity.
Objective
To explore the clinical features and recurrence rates of acute pulmonary embolism (APE) with type 2 diabetes mellitus(DM2).
Methods
126 patients with acute pulmonary embolism were retrospectively analysed from January 2010 to December 2015. All patients were divided into two groups:observation group (APE with DM2,43 cases) and control group(APE without DM2,83 cases).The differences of clinical manifestations, complications,laboratory results,thrombus localizations,risk stratification and the recurrence rates of acute pulmonary embolism were analysed between the two groups.
Results
There were no significant differences in age,sex and clinical manifestations between the two groups. The combination of respiratory failure,coronary heart disease and pneumonia were more frequently seen in observation group(P<0.05). The level of creatine kinase, lactate dehydrogenase, fasting blood glucose,cTnI,NT-pro-BNP, CREA were obviously higher than control group(P<0.05). A higher risk stratification and recurrence rate were observed in the bservation group(P<0.05).
Conclusion
Patients with acute pulmonary embolism and type 2 diabetes mellitus are more serious and more affected by complications and a higher recurrence rate,thus,we should give more attention to these patients and reduce the recurrence rate.
Key words:
Pulmonary embolism; Type 2 diabetes mellitus; Recurrence rate
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