ObjectiveTo investigate the blood pressure level and prevalence of hypertension in middle-aged people with positive family history of hypertension in Chengdu area, compare the differences between middle-aged people with positive family history of hypertension and middle-aged people with negative family history of hypertension, and explore the influencing factors of hypertension in middle-aged people with positive family history of hypertension.MethodsFrom September 2013 to March 2014, the stratified sampling method was used to survey 3 096 middle-aged people aged 40-59 years in Chengdu. Their height, weight, blood pressure, blood glucose, and blood lipids were measured. Questionnaire surveys were conducted using a uniformly designed questionnaire. The blood pressure levels and hypertension prevalences were compared between people with and without positive family history of hypertension. The influencing factors of hypertension in middle-aged people with positive family history of hypertension were analyzed using multiple logistic regression.ResultsThere were significant differences between the middle-aged people with positive family history of hypertension and the ones with negative family history of hypertension in systolic blood pressure [(137.4±22.4) vs. (118.0±11.3) mm Hg (1 mm Hg=0.133 kPa), P<0.001], diastolic blood pressure [(84.1±12.2) vs. (73.9±7.7) mm Hg, P<0.001], and prevalence of hypertension (28.6% vs. 22.2%, P<0.001). Ageing [odds ratio (OR)=1.107, 95% confidence interval (CI) (1.071, 1.144), P<0.001], monthly personal income ≥3 000 yuan [OR=1.566, 95%CI (1.003, 2.445), P=0.048], and abdominal obesity [OR=1.658, 95%CI (1.091, 2.520), P=0.018] were the risk factors for hypertension in middle-aged males with positive family history. Ageing [OR=2.257, 95%CI (1.202, 4.025), P=0.026] and overweight or obesity [OR=2.365, 95%CI (1.653, 3.385), P<0.001] were the risk factors, and physical exercise [OR=0.529, 95%CI (0.304, 0.918), P=0.024] was the protective factor for hypertension in middle-aged females with positive family history.ConclusionsThe prevalence of hypertension is high in middle-aged population with positive family history of hypertension in Chengdu and is significantly higher than that in the ones with negative family history of hypertension. Strengthening health education on hypertension-related knowledge, and reasonably controlling waist circumference and body weight may have positive significance in preventing or delaying the occurrence of hypertension in people with positive family history of hypertension.
Without artificial airway though oral, nasal or airway incision, the bi-level positive airway pressure (Bi-PAP) has been widely employed for respiratory patients. In an effort to investigate the therapeutic effects and measures for the respiratory patients under the noninvasive Bi-PAP ventilation, a therapy system model was designed for virtual ventilation experiments. In this system model, it includes a sub-model of noninvasive Bi-PAP respirator, a sub-model of respiratory patient, and a sub-model of the breath circuit and mask. And based on the Matlab Simulink, a simulation platform for the noninvasive Bi-PAP therapy system was developed to conduct the virtual experiments in simulated respiratory patient with no spontaneous breathing (NSB), chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS). The simulated outputs such as the respiratory flows, pressures, volumes, etc, were collected and compared to the outputs which were obtained in the physical experiments with the active servo lung. By statistically analyzed with SPSS, the results demonstrated that there was no significant difference (P > 0.1) and was in high similarity (R > 0.7) between the data collected in simulations and physical experiments. The therapy system model of noninvasive Bi-PAP is probably applied for simulating the practical clinical experiment, and maybe conveniently applied to study the technology of noninvasive Bi-PAP for clinicians.
ObjectiveTo systematically evaluate the benefits and harms of intraoperative positive end-expiratory pressure (PEEP) to all adult patients suffered surgery, especially on the postoperative mortality and pulmonary outcomes. MethodsWe electronically searched PubMed, EMbase, The Cochrane library (Issue 3, 2012), CBM, CNKI from inception to January 2013, for randomized controlled trials (RCTs) about PEEP for the prevention of pulmonary complications. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality of the included studies. Then meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 8 RCTs involving 336 patients were finally included. The results of meta-analysis showed that there was no difference between two groups in mortality (OR=0.95, 95%CI 0.13 to 6.92, P=0.96). However, the PEEP group had a higher PaO2/FiO2 the first day after surgery (MD=22.98, 95%CI 4.40 to 41.55, P=0.02), while there was no difference 2-3 days after surgery (MD=12.59, 95%CI-6.78 to 31.96, P=0.31). Meanwhile, postoperative atelectasis was less in the PEEP group (OR=0.27, 95%CI 0.08 to 0.9, P=0.03). ConclusionChoosing PEEP mode during general anaesthesia may improve postoperative oxygenation index in the first day after surgery, and reduce pulmonary complications, which has a protective effect on patients pulmonary function. However, it has no marked influence on the prognosis. Because of the limited quality and sampling size of the induced studies, this conclusion still needs to be further proved by more large-scale, multicenter and perspective RCTs.
Objectives To systematically review the influence of positive margin on outcome after partial nephrectomy (PN). Methods CCRCT, PubMed, EMbase, Sinomed, WanFang Data and CNKI databases were electronically searched to collect clinical studies on influence of positive margin on outcome after PN from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.4 software. Results A total of 22 cohort studies involving 20 822 patients were included. The results of meta-analysis showed that positive margin after PN could increase the rate of postoperative local recurrence (OR=4.18, 95%CI 2.88 to 6.05, P<0.000 01), distant metastasis (OR=5.28, 95%CI 2.84 to 9.81,P<0.000 01) and total mortality (OR=1.54, 95%CI 1.19 to 1.99,P=0.0010). However, there were no differences on overall survival (OR=0.64, 95% CI 0.34 to 1.19, P=0.16), distant metastasis free survival (OR=0.70, 95%CI 0.26 to 1.84, P=0.46), cancer specific survival (OR=0.43, 95% CI 0.06 to 3.01, P=0.40) and disease-free survival (OR=0.81, 95%CI 0.35 to 1.85, P=0.61) between two groups. Conclusions Current evidence suggests that positive margin after PN may be associated with tumor progression, however, it may not affect patient survival. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To investigate the effects of mechanical ventilation( MV) via different tidal volume ( VT) in combination with positive end expiratory pressure( PEEP) on dogs with acute lung injury( ALI) . Methods Dog model of oleic acid-induced ALI was established. And after that animals were randomized into different MV groups ( included low VT group, VT =6 mL/kg; and high VT group, VT =20 mL/kg) and ventilated for 6 h with a PEEP of 10 cmH2O. Arterial blood gas wasmeasured before, during and after ALI model was established ( at 1 h,2 h, 4 h and 6 h during MV) . The albumin concentration in BALF and pathological change of the lung tissue were evaluated in order to determine the lung injury while animals were sacrificed after 6 h MV. Results ALI model was successfully established ( 2. 50 ±0. 80) hours after oleic acid injection. Arterial pH decreased much severer in the low VT group than the high VT group( P lt;0. 01) . PaO2 and SaO2 in ventilation groups decreased after modeling but increased after MV, and PaO2 and SaO2 were significantly higher in the low VT group than the high VT group after 6 h MV( P lt;0. 05) . PaCO2 fluctuated less in the high VT group, while it increased significantly in the low VT group after MV( P lt; 0. 01) . Oxygenation index( PaO2 /FiO2 ) was lowered after modeling( P lt; 0. 01) , decreased to about 190 mm Hg after 1 h MV. And PaO2 /FiO2 in low VT group was significantly higher than the high VT group after 6 h MV( P lt; 0. 05) . BALF albumin concentration and the lung injury score in the low VT group were both significantly lower than the high VT group( both P lt; 0. 05) . Conclusions Ventilation with PEEP could improve the oxygenation of ALI dogs, and low VT ventilation improves the oxygenation better than high VT. Otherwise, low VT could induce hypercapnia and ameliorate lung injury caused by high VT MV.
ObjectiveTo evaluate the effect of positive end-expiratory pressure (PEEP) on respiratory function and hemodynamics in acute lung injury (ALI) with intra-abdominal hypertension (IAH). MethodsSix pigs were anesthetized and received mechanical ventilation (MV). Volume controlled ventilation was set with tidal volumn(VT) of 8 mL/kg,respiratory rate(RR) of 16 bpm,inspired oxygen concentration (FiO2) of 0.40,and PEEP of 5 cm H2O. ALI was induced by repeated lung lavage with diluted hydrochloric acid (pH<2.5) until PaO2/FiO2 declined to 150 mm Hg or less to established ALI model. Intra-abdominal hypertension was induced by an nitrogen inflator to reach intra-abdominal pressure of 20 mm Hg. Respiratory parameters and hemodynamics were continuously recorded at different PEEP levels(5,10,15,and 20 cm H2O). Every level was maintained for one hour. ResultsPaO2/FiO2 in PEEP5,10,15 and 20 were 90±11,102±10,172±23 and 200±34 mm Hg respectively. PaO2/FiO2 in PEEP15 and 20 were significantly higher than those in PEEP5 and 10 (P<0.05). Chest wall compliance (Ccw) in PEEP5,15 and 20 were 26±3,76±15 and 85±14 mL/cm H2O respectively. Ccw in PEEP15 and 20 were significantly higher than those in PEEP5 (P<0.05). There was no significant difference in lung compliance (CL) in different PEEP levels (P>0.05). Plateau pressure(Pplat) in PEEP5,10,15 and 20 were 30±3,31±2,36±2 and 38±4 cm H2O respectively. Pplat in PEEP15 and 20 were significantly higher than those in PEEP5 and 10 (P<0.05). There was no significant difference in Pplat between PEEP15 and 20 (P>0.05). Heart rate (HR) in PEEP5,15 and 20 were 113±17,147±30,and 160±30 beat/min respectively. HR in PEEP15 and 20 were significantly higher than those in PEEP5 (P<0.05). There was no significant difference in HR between PEEP15 and 20 (P>0.05).Cardiac index (CI) in PEEP5 and 20 were 4.5±0.6 and 3.5±0.6 L·min-1·m-2 respectively. CI in PEEP20 was significantly lower than that in PEEP5 (P<0.05). There was no significant difference in CI in PEEP5,10 or 15(P>0.05). Central venous pressure(CVP) in PEEP5,15 and 20 were 12±2,17±2,and 18±3 mm Hg respectively. CVP in PEEP15 and 20 were significantly higher than those in PEEP5 (P<0.05). There was no significant difference in CVP between PEEP15 and 20 (P>0.05). There were no significant differences in MAP,SVRI,ITBVI,GEDI,PVPI,or EVLWI between different PEEP levels. ConclusionConcomitant ALI and IAH can induce great impairments in respiratory physiology. When PEEP is gradually increased,oxygenation and the respiratory function are improved without significant secondary hemodynamic disturbances.
ObjectiveTo explore the effect of positive implication in the operating room on the patient's mental. MethodsA total of 160 patients who received the routine laparoscopic appendectomy surgery from January 2011 to October 2012 were treated with positive implications and conventional appease routine psychological care and the fear, pain, depression and anxiety, and other indicators of the two groups were compared. ResultsThe fear scores in the control group patients were significantly higher than that in the observation group (P<0.05). The patient's perceived pain in the control group was higher than that in the observation group (P<0.05); after nursing intervention, the anxiety and depression levels in the two groups decreased significantly; the observation group had significantly higher satisfaction for the entire course of medical treatment (P<0.05). ConclusionThe positive implication in the operating room can effectively alleviate the patient's fear, anxiety, depression and perceived pain and so on and can contribute to the effect of operation and rehabilitation of the patients.
ObjectiveTo investigate the diagnostic value of lateral chromatography for cryptococcal capsular polysaccharide antigen in cryptococcal infection.MethodsThe data of patients who detected cryptococcal capsular polysaccharide antigen in West China Hospital of Sichuan University in 2018 were collected. The sensitivity, specificity, positive predictive value and negative predictive value of cryptococcal capsular polysaccharide antigen detected by lateral chromatography were analyzed. The samples with positive lateral chromatography and definite clinical diagnosis were compared with the results of ink staining and fungal culture.ResultsA total of 721 cases were detected. The sensitivity, specificity, positive predictive value and negative predictive value of lateral chromatography detection were 100.00%, 99.39%, 93.93%, 100.00%, respectively. The positive rates of ink staining, fungal culture and cryptococcal capsular polysaccharide antigen for cryptococcal infection were 63.46%, 48.00% and 100.00%, respectively. Sixty-two patients were clinically diagnosed, including 45 cases of cryptococcal meningitis (72.58%), 16 cases of cryptococcal pneumonia (25.81%), and 1 case of bone cryptococcal infection (1.61%).ConclusionsLateral chromatography detection for cryptococcal capsular polysaccharide antigen shows well performing sensitivity and specificity in the diagnosis of cryptococcal infection. Considering its rapid and simple pre-operation, cryptococcal capsular polysaccharide antigen detection with lateral chromatography has good application value for early diagosis of cryptococcal infection.
ObjectiveTo investigate different levels of positive end-expiratory pressure (PEEP) on respiratory function and hemodynamics in patients with acute respiratory distress syndrome (ARDS) complicated with intra-abdominal hypertension(IAH). MethodsThirty patients with moderate ARDS admitted in ICU between January 2012 and December 2014 were recruited in the study. They were divided into three groups according to intra-abdominal pressure (IAP),including 10 patients with normal abdominal pressure as a normal IAP group,10 patients with IAP of 12-15 mm Hg as an IAPⅠ group,and 10 patients with IAP of 16-20 mm Hg as an IAPⅡ group. The optimal level of PEEP was titrated according to the best oxygenation methods. The changes of oxygenation index (OI),respiratory mechanics and hemodynamics before and after the optimal level of PEEP were monitored and compared in all groups. The 28-day mortality and ICU stay were also compared. ResultsThe OI after titration was significantly improved compared to baseline in all groups (all P<0.01). The OI after titration in the IAPⅡ group was significantly higher than that in other two groups (all P<0.05). The static lung compliance (Cst) after titration significantly improved than baseline in all groups(all P<0.05),but no significant difference was revealed among three groups (all P>0.05). In the IAPⅡ group,the levels of PEEP,IAP,blood lactate,heart rate and airway plateau pressure after titration were significantly increased than baseline but higher than those in other two groups(all P<0.05),while the level of mean arterial pressure was significantly decreased and significantly lower than those in other two groups(all P<0.01). Meanwhile,the ICU stay was longest in the IAPⅡ group (P<0.01). There was no significant difference in 28-day mortality among three groups(all P>0.05). ConclusionsPEEP can significantly improve oxygenation in patients with ARDS complicated with IAH. The higher the IAP is,the higher the PEEP level is required. However the higher PEEP will significantly increase IAP which will cause adverse impacts on hemodynamics and can not improve the prognosis.
Simulation of the human biological lung is a crucial method for medical professionals to learn and practice the use of new pulmonary interventional diagnostic and therapeutic devices. The study on ventilation effects of the simulation under positive pressure ventilation mode provide valuable guidance for clinical ventilation treatment. This study focused on establishing an electrical simulation ventilation model, which aims to address the complexities in parameter configuration and slow display of air pressure and airflow waveforms in simulating the human biological lung under positive pressure ventilation mode. A simulated ventilation experiment was conducted under pressure-regulated volume control (PRVC) positive pressure ventilation mode, and the resulting ventilation waveform was compared with that of normal adults. The experimental findings indicated that the average error of the main reference index moisture value was 9.8% under PRVC positive pressure ventilation mode, effectively simulating the ventilatory effect observed in normal adults. So the established electrical simulation ventilation model is feasible, and provides a foundation for further research on the simulation of human biological lung positive pressure ventilation experimental platform.