Non-invasive prediction model for high-risk esophageal varices in the Chinese population

BACKGROUND There are two types of esophageal varices(EVs):high-risk EVs(HEVs)and lowrisk EVs,and HEVs pose a greater threat to patient life than low-risk EVs.The diagnosis of EVs is mainly conducted by gastroscopy,which can cause discomfort to patients,or by non-invasive prediction models.A number of noninvasive models for predicting EVs have been reported;however,those that are based on the formula for calculation of liver and spleen volume in HEVs have not been reported.AIM To establish a non-invasive prediction model based on the formula for liver and spleen volume for predicting HEVs in patients with viral cirrhosis.METHODS Data from 86 EV patients with viral cirrhosis were collected.Actual liver and spleen volumes of the patients were determined by computed tomography,and their calculated liver and spleen volumes were calculated by standard formulas.Other imaging and biochemical data were determined.The impact of each parameter on HEVs was analyzed by univariate and multivariate analyses,the data from which were employed to establish a non-invasive prediction model.Then the established prediction model was compared with other previous prediction models.Finally,the discriminating ability,calibration ability,and clinical efficacy of the new model was verified in both the modeling group and the external validation group.RESULTS Data from univariate and multivariate analyses indicated that the liver-spleen volume ratio,spleen volume change rate,and aspartate aminotransferase were correlated with HEVs.These indexes were successfully used to establish the noninvasive prediction model.The comparison of the models showed that the established model could better predict HEVs compared with previous models.The discriminating ability,calibration ability,and clinical efficacy of the new model were affirmed.CONCLUSION The non-invasive prediction model for predicting HEVs in patients with viral cirrhosis was successfully established.The new model is reliable for predicting HEVs and has clinical applicability.

Changes of microcirculation in healthy volunteers and patients with septic shock in Xining

Objective: The purpose of this study is to investigate the characteristic of microcirculation in healthy volunteers and patients with septic shock in both Xining(2 260 m) and Nanjing(10 m). Methods: A total of 62 cases, 33 healthy volunteers, 22 cases in Xining,(2 260 m above sea level) and 11 cases in Nanjing(10 m above sea level); and 29 septic shock, 13 cases in Xining and 16 cases in Nanjing were collected. The total vessel density(TVD), perfused vessel density(PVD), proportion of perfused vessel(PPV) and microcirculation flow index(MFI) of both healthy volunteers and septic shock had been investigated by using sidestream dark field(SDF). Analyzed and managed the image data by using AVA3.0 software. Results: In the healthy volunteers in Xining area(22 cases),the volume of TVD(15.59 ± 2.58 mm/mm^2), PVD(15.58 ± 2.58 mm/mm^2) and PPV(96.60% ± 4.63%) were significant higher than the volume of TVD(10.0 ± 2.10 mm/mm^2), PVD(10.81 ± 2.38 mm/mm^2) and PPV(84.24% ± 8.00%) of the volunteers(11 cases) in Nanjing(11 cases). But the MFI(2.17 ± 0.31) of the healthy volunteers in the Xining was significant lower(P<0.05) than the MFI(3.21 ± 0.34) in the healthy volunteers of Nanjing. In the septic shock group(13 cases) in the Xining, the volume of TVD(5.44 ± 1.94 mm/mm^2), PVD(4.18 ± 1.61 mm/mm^2), PPV(42.14%± 5.38%) and MFI(1.05 ± 0.32) compared with the volume of the healthy volunteers in Xining, the TVD(15.59 ± 2.58 mm/mm^2), PVD(5.58 ± 2.58 mm/mm^2), PPV(96.60% ± 4.63%) and MFI(2.17 ± 0.30) were significant lower(P<0.05). In the healthy volunteers compare with septic shock group in Nanjing area, the TVD(6.80±1.72 vs 10.00±2.10, P<0.05), PVD(5.86±1.58 vs10.81±2.38,P<0.05), PPV(45.42±4.86 vs 84.24±4.86, P<0.05), MFI(1.28±0.28 vs 3.21±0.34 P<0.05), there was significant decreased. In the septic shock group in the Xining compared with the septic shock in Nanjing, there was no significant difference. 10 of 13 patients with septic shock were survived in Xining. 13 of 16 patients with septic shock were survived in Nanjing. Conclusion: The changes of physiological and pathophysiological characteristic in microcirculation induced by hypoxia would be useful for clinical treatment of septic shock at high altitude.

Terahertz Transmission Imaging with 2.52 THz Continuous Wave

In this article, two terahertz transmission imaging systems are built with a 2.52 THz continuous wave laser and two types of sensors. One is array scanning system using a 124×124 pyro-electric array camera as the detector; the other is a point-wise scanning system utilizing a Golay cell as the detector. The imaging speed and quality is briefly analyzed. Terahertz （THz） imaging results demonstrate that the array scanning system has higher imaging speed with lower resolution. The point-wise scanning system has higher imaging quality with lower speed.

Venovenous extra-corporeal membrane oxygenation for severe acute respiratory distress syndrome: a matched cohort study

Background:Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing,the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear.Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS.Methods:We conducted a multi-center,retrospective,cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018.Patients with severe ARDS who received W-ECMO support were included.The detailed demographic data and physiologic data were used to match ARDS patients without ECMO.The primary endpoint was the 28-day mortality.Results:Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study.The acute physiology and chronic health evaluation Ⅱ score was 23.1 ± 6.3 in the ECMO group and 24.8 ± 8.5 in the control group (P =0.1195).The sequential organ failure assessment score was 12.8 ± 3.4 in the ECMO group and 13.7 ± 3.5 in the control group (P =0.0848).The 28-day mortality of patients with ECMO support was 39.4%,and that of the control group was 55.6%.The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P =0.0097).Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]:1.006;95% confidence interval [CI]:1.001-1.013;P =0.030) and duration of mechanical ventilation before ECMO (HR:3.299;95% CI:1.264-8.609;P =0.034).Conclusions:This study showed that ECMO improved the survival of patients with severe ARDS.The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death.

Role of immunodeficiency in Acinetobacter baumannii associated pneumonia in mice

Background:Acinetobacter baumannii(A.baumannii)has become one of the most important opportunistic pathogens inducing nosocomial pneumonia and increasing mortality in critically ill patients recently.The interaction between A.baumannii infection and immune response can influence the prognosis of A.baumannii related pneumonia.The target of the present study was to investigate the role of immunodeficiency in A.baumannii induced pneumonia.Methods:Male BALB/c mice were randomly divided into the normal immunity control(NIC)group,normal immunity infection(NIA)group,immune compromised control(CIC)group,and immune compromised infection(CIA)group(n=15 for each group).Intraperitoneal injection of cyclophosphamide and intranasal instillation of A.baumannii solution were used to induce compromised immunity and murine pneumonia,respectively.The mice were sacrificed at 6 and 24 h later and the specimens were collected for further tests.Seven-day mortality of mice was also assessed.Results:After A.baumannii stimulation,the recruitment of neutrophils in mice with normal immunity increased sharply(P=0.030 at 6 h),while there was no significant raise of neutrophil counts in mice with compromised immune condition(P=0.092 at 6 h,P=0.772 at 24 h).The Th cell polarization presented with pulmonary interleukin(IL)-4 and interferon(IFN)-γlevel in response to the A.baumannii in CIA group were significantly depressed in comparison with in NIA group(IFN-γ:P=0.003 at 6 h;P=0.001 at 24 h;IL-4:P<0.001 at 6 h;P<0.001 at 24 h).The pulmonary conventional dendritic cell accumulation was even found to be inhibited after A.baumannii infection in immunocompromised mice(P=0.033).Correspondingly,A.baumannii associated pneumonia in mice with compromised immunity caused more early stage death,more severe histopathological impairment in lung.Conclusion:A.baumannii could frustrate the immune response in immunocompromised conditions,and this reduced immune response is related to more severe lung injury and worse outcome in A.baumannii induced pneumonia.