Objective To estimate the relative effect of early vs. late tracheotomy on clinical end-points in unselected intensive care unit （ICU） patients undergoing mechanical ventilation. Methods We searched electronic data...Objective To estimate the relative effect of early vs. late tracheotomy on clinical end-points in unselected intensive care unit （ICU） patients undergoing mechanical ventilation. Methods We searched electronic databases （up to February 27, 2013） for both randomized control trials and observational studies satisfying the predefined inclusion criteria.展开更多
AIM： To investigate factors predicting failure of percutaneous endoscopic gastrostomy （PEG） to eliminate gastroesophageal reflux （GER）. METHODS： Twenty-nine consecutive mechanically ventilated patients were inve...AIM： To investigate factors predicting failure of percutaneous endoscopic gastrostomy （PEG） to eliminate gastroesophageal reflux （GER）. METHODS： Twenty-nine consecutive mechanically ventilated patients were investigated. Patients were evaluated for GER by pH-metry pre-PEG and on the 7th post-PEG day. Endoscopic and histologic evidence of reflux esophagitis was also carried out. A beneficial response to PEG was considered when pH-metry on the 7th post-PEG day showed that GER was below 4%. RESULTS： Seventeen patients responded （RESP group） and 12 did not respond （N-RESP） to PEG. The mean age, sex, weight and APACHE II score were similar in both groups. GER （%） values were similar in both groups at baseline, but were significantly reduced in the RESP group compared with the N-RESP group on the 7th post-PEG day [2.5 （0.6-3.8） vs 8.1 （7.4-9.2, P 〈 0.001）]. Reflux esophagitis and the gastroesophageal flap valve （GEFV） grading differed significantly between the two groups （P = 0.031 and P = 0.020, respectively）. Histology revealed no significant differences between the two groups.CONCLUSION： Endoscopic grading of GEFV and the presence of severe reflux esophagitis are predisposing factors for failure of PEG to reduce GER in mechanically ventilated patients.展开更多
Research on the distribution of smoke in tunnels is significant for the fire emergency rescue after an operating metro train catches fire. A dynamic grid technique was adopted to research the law of smoke flow diffusi...Research on the distribution of smoke in tunnels is significant for the fire emergency rescue after an operating metro train catches fire. A dynamic grid technique was adopted to research the law of smoke flow diffusion inside the tunnel when the bottom of a metro train was on fire and to compare the effect of longitudinal ventilation modes on the smoke motion when the burning train stopped. Research results show that the slipstream curves around the train obtained by numerical simulation are consistent with experimental data. When the train decelerates, the smoke flow first extends to the tail of the train. With the decrease of the train's speed, the smoke flow diffuses to the head of the train. After the train stops, the slipstream around the train formed in the process of train operation plays a leading role in the smoke diffusion in the tunnel. The smoke flow quickly diffuses to the domain in front of the train. After forward mechanical ventilation is provided, the smoke flow inside the tunnel continues to diffuse downstream. When reverse mechanical ventilation operates, the smoke in front of the train flows back rapidly and diffuses to the rear of the train.展开更多
AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures ...AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures for 22,21 and 37 h,respectively,The patients underwent 3-4 operations after sustaining their injuries,Mechanical ventilation,intermittent hemodialysis and other treatments were also provided.The patients showed signs of peritoneal irritation on postoperative days 10-38.Small intestinal necrosis was confirmed by emergency laparotomy,and for each patient,part of the small bowel was removed.RESULTS:Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively.The third patient who performed 4 operations was discharged and made a full recovery.Three patients had the following common characteristics:(1) Multiple severe trauma events with no direct penetrating gastrointestinal injury;(2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment;(3) Progressive abdominal pain and tenderness,and peritoneal irritation was present on post-traumatic days 10-38;(4) Abdominal operations confirmed segment ulcer,necrosis of the small intestine,hyperplasia and stiffness of the intestinal wall;and(5) Pathological examinations suggested submucosal hemorrhage,necrosis,fibrosis and hyalinization of the vascular wall.Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.CONCLUSION:Intestinal necrosis is strongly associated with stress from trauma and post-traumatic complications;timely exploratory laparotomy maybe an effective method for preventing and treating stressinduced intestinal necrosis.展开更多
Objective： To explore the role of polymorphonuclear neutrophils （PMN） activation in lung injury following cardiopulmonary bypass （CPB）. Methods： Twenty four cases of patients with rheumatic heart disease were en...Objective： To explore the role of polymorphonuclear neutrophils （PMN） activation in lung injury following cardiopulmonary bypass （CPB）. Methods： Twenty four cases of patients with rheumatic heart disease were enrolled in this study to detect the situation of PMN activation and the degree of lung injury. Bronchoalveolar lavage fluid （BALF） and blood samples were collected just after anaesthesia and 4 h postoperatively. Related clinic data were recorded. Results： This cohort included 4 male and 20 female with age ranging from 29 to 69 years old, and body mass from 37 to 73 kg. Mean cardiopulmonary bypass time was （106.46±33.58） rain, mean cross clamp time was （77.58_＋28.02） rain, and mean mechanical ventilation time was （24.17±30.90） h. Postoperative PaO2/FiO2 decreased significantly than that during preoperation （P=0.000）. The postoperative WBC counts in peripheral blood and in BALF were both increased significantly than those during preoperation. And the postoperative rates of PMN in BALF were also increased significantly. Postoperative neutriphil elastase （NE） and myeloperoxidase （MPO） released from inflammatory ceils were increased significantly （P=0.000） both in plasma and BALF. The postoperative yon Willebrand factor （vWF） concentration in plasma was also increased significantly （P=0.000）. The postoperative concentration of sLPI in plasma was decreased, whereas it was increased significantly in BALF. Furthermore, there was a negative correlation between NE and PaO2/FiO2 both in BALF and in plasma. A negative correlation was present between vWF in plasma and PaO2/FiO2. A positive correlation was found between sLPI in plasma and PaO2/FiO2. Conclusion： PMN is recruited and activated after CPB and released large quantity of proteases, and lead to lung injury, sLPI is an important protective factor against inflammatory injury.展开更多
In a golf course located at El Kantaoui, Sousse, Tunisia, this study was carried out over a sandy soil grassy sward to investigate the effects of mechanical aeration （perforation of the sward with an aerators machine...In a golf course located at El Kantaoui, Sousse, Tunisia, this study was carried out over a sandy soil grassy sward to investigate the effects of mechanical aeration （perforation of the sward with an aerators machine called ＂Vertidrain＂） on its compaction and hydraulic conductivity. For this purpose, many soil cores were extracted using a 1.6 e.g. m effective width Verti-Drain aerator equipped with hollow spades spaced 65 e.g. mm apart. Aeration was performed at a rate of 350 holes/m2. Soil resistance to penetration and permeability were determined at the initial state before aeration as well as 10, 20, and 30 days after aeration. Compared to the initial state, the results showed that mechanical aeration greatly affects the grassy sward ground by reducing its resistance to penetration as 35% and 43% decrease in penetration resistance were noticed at 5 e.g. cm depth 10 and 20 days after aeration, respectively. Also, resistance to penetration decreased by 41% and 48% at 15 e.g. cm depth during the same two periods of time with a relatively constant moisture content. However, soil resistance to penetration at 5 and 15 e.g. cm depths only decreased by 21% and 26%, respectively. Regarding the soil hydraulic conductivity measured after aeration, a significant improvement at the 1% level with the method of variance analysis, was observed compared to that at the initial state （4.9 e.g. cm hl）. Indeed, the hydraulic conductivity was 12.5, 13, and 14.1 e.g. cm h-1 10, 20, and 30 days after aeration, respectively.展开更多
文摘Objective To estimate the relative effect of early vs. late tracheotomy on clinical end-points in unselected intensive care unit （ICU） patients undergoing mechanical ventilation. Methods We searched electronic databases （up to February 27, 2013） for both randomized control trials and observational studies satisfying the predefined inclusion criteria.
文摘AIM： To investigate factors predicting failure of percutaneous endoscopic gastrostomy （PEG） to eliminate gastroesophageal reflux （GER）. METHODS： Twenty-nine consecutive mechanically ventilated patients were investigated. Patients were evaluated for GER by pH-metry pre-PEG and on the 7th post-PEG day. Endoscopic and histologic evidence of reflux esophagitis was also carried out. A beneficial response to PEG was considered when pH-metry on the 7th post-PEG day showed that GER was below 4%. RESULTS： Seventeen patients responded （RESP group） and 12 did not respond （N-RESP） to PEG. The mean age, sex, weight and APACHE II score were similar in both groups. GER （%） values were similar in both groups at baseline, but were significantly reduced in the RESP group compared with the N-RESP group on the 7th post-PEG day [2.5 （0.6-3.8） vs 8.1 （7.4-9.2, P 〈 0.001）]. Reflux esophagitis and the gastroesophageal flap valve （GEFV） grading differed significantly between the two groups （P = 0.031 and P = 0.020, respectively）. Histology revealed no significant differences between the two groups.CONCLUSION： Endoscopic grading of GEFV and the presence of severe reflux esophagitis are predisposing factors for failure of PEG to reduce GER in mechanically ventilated patients.
基金Project(U1134203)supported by the Major Program of the National Natural Science Foundation of ChinaProject(51105384)supported by the National Natural Science Foundation of China
文摘Research on the distribution of smoke in tunnels is significant for the fire emergency rescue after an operating metro train catches fire. A dynamic grid technique was adopted to research the law of smoke flow diffusion inside the tunnel when the bottom of a metro train was on fire and to compare the effect of longitudinal ventilation modes on the smoke motion when the burning train stopped. Research results show that the slipstream curves around the train obtained by numerical simulation are consistent with experimental data. When the train decelerates, the smoke flow first extends to the tail of the train. With the decrease of the train's speed, the smoke flow diffuses to the head of the train. After the train stops, the slipstream around the train formed in the process of train operation plays a leading role in the smoke diffusion in the tunnel. The smoke flow quickly diffuses to the domain in front of the train. After forward mechanical ventilation is provided, the smoke flow inside the tunnel continues to diffuse downstream. When reverse mechanical ventilation operates, the smoke in front of the train flows back rapidly and diffuses to the rear of the train.
基金Supported by The Fund of the People's Liberation Army Gen-eral Hospital of Chengdu Command,No.2011YG-B24
文摘AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures for 22,21 and 37 h,respectively,The patients underwent 3-4 operations after sustaining their injuries,Mechanical ventilation,intermittent hemodialysis and other treatments were also provided.The patients showed signs of peritoneal irritation on postoperative days 10-38.Small intestinal necrosis was confirmed by emergency laparotomy,and for each patient,part of the small bowel was removed.RESULTS:Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively.The third patient who performed 4 operations was discharged and made a full recovery.Three patients had the following common characteristics:(1) Multiple severe trauma events with no direct penetrating gastrointestinal injury;(2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment;(3) Progressive abdominal pain and tenderness,and peritoneal irritation was present on post-traumatic days 10-38;(4) Abdominal operations confirmed segment ulcer,necrosis of the small intestine,hyperplasia and stiffness of the intestinal wall;and(5) Pathological examinations suggested submucosal hemorrhage,necrosis,fibrosis and hyalinization of the vascular wall.Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.CONCLUSION:Intestinal necrosis is strongly associated with stress from trauma and post-traumatic complications;timely exploratory laparotomy maybe an effective method for preventing and treating stressinduced intestinal necrosis.
基金Supported by Military Medical and Sanitation ResearchFund (01Z074)
文摘Objective： To explore the role of polymorphonuclear neutrophils （PMN） activation in lung injury following cardiopulmonary bypass （CPB）. Methods： Twenty four cases of patients with rheumatic heart disease were enrolled in this study to detect the situation of PMN activation and the degree of lung injury. Bronchoalveolar lavage fluid （BALF） and blood samples were collected just after anaesthesia and 4 h postoperatively. Related clinic data were recorded. Results： This cohort included 4 male and 20 female with age ranging from 29 to 69 years old, and body mass from 37 to 73 kg. Mean cardiopulmonary bypass time was （106.46±33.58） rain, mean cross clamp time was （77.58_＋28.02） rain, and mean mechanical ventilation time was （24.17±30.90） h. Postoperative PaO2/FiO2 decreased significantly than that during preoperation （P=0.000）. The postoperative WBC counts in peripheral blood and in BALF were both increased significantly than those during preoperation. And the postoperative rates of PMN in BALF were also increased significantly. Postoperative neutriphil elastase （NE） and myeloperoxidase （MPO） released from inflammatory ceils were increased significantly （P=0.000） both in plasma and BALF. The postoperative yon Willebrand factor （vWF） concentration in plasma was also increased significantly （P=0.000）. The postoperative concentration of sLPI in plasma was decreased, whereas it was increased significantly in BALF. Furthermore, there was a negative correlation between NE and PaO2/FiO2 both in BALF and in plasma. A negative correlation was present between vWF in plasma and PaO2/FiO2. A positive correlation was found between sLPI in plasma and PaO2/FiO2. Conclusion： PMN is recruited and activated after CPB and released large quantity of proteases, and lead to lung injury, sLPI is an important protective factor against inflammatory injury.
文摘In a golf course located at El Kantaoui, Sousse, Tunisia, this study was carried out over a sandy soil grassy sward to investigate the effects of mechanical aeration （perforation of the sward with an aerators machine called ＂Vertidrain＂） on its compaction and hydraulic conductivity. For this purpose, many soil cores were extracted using a 1.6 e.g. m effective width Verti-Drain aerator equipped with hollow spades spaced 65 e.g. mm apart. Aeration was performed at a rate of 350 holes/m2. Soil resistance to penetration and permeability were determined at the initial state before aeration as well as 10, 20, and 30 days after aeration. Compared to the initial state, the results showed that mechanical aeration greatly affects the grassy sward ground by reducing its resistance to penetration as 35% and 43% decrease in penetration resistance were noticed at 5 e.g. cm depth 10 and 20 days after aeration, respectively. Also, resistance to penetration decreased by 41% and 48% at 15 e.g. cm depth during the same two periods of time with a relatively constant moisture content. However, soil resistance to penetration at 5 and 15 e.g. cm depths only decreased by 21% and 26%, respectively. Regarding the soil hydraulic conductivity measured after aeration, a significant improvement at the 1% level with the method of variance analysis, was observed compared to that at the initial state （4.9 e.g. cm hl）. Indeed, the hydraulic conductivity was 12.5, 13, and 14.1 e.g. cm h-1 10, 20, and 30 days after aeration, respectively.
