Ching Wang Hsu

Post-injury baicalein improves histological and functional outcomes and reduces inflammatory cytokines after experimental traumatic brain injury.

Traumatic brain injury (TBI) triggers a complex series of inflammatory responses that contribute to secondary tissue damage. The aim of this study was to investigate the effect of baicalein, a flavonoid possessing potent anti‐inflammatory properties, on functional and histological outcomes and inflammatory cytokine expression, following TBI in rats.

Interpretation and Use of Natriuretic Peptides in Non-Congestive Heart Failure Settings

Natriuretic peptides (NPs) have been found to be useful markers in differentiating acute dyspneic patients presenting to the emergency department (ED) and emerged as potent prognostic markers for patients with congestive heart failure (CHF). The best-established and widely used clinical application of BNP and NT-proBNP testing is for the emergent diagnosis of CHF in patients presenting with acute dyspnea. Nevertheless, elevated NPs levels can be found in many circumstances involving left ventricular (LV) dysfunction or hypertrophy; right ventricular (RV) dysfunction secondary to pulmonary diseases; cardiac inflammatory or infectious diseases; endocrinology diseases and high output status without decreased LV ejection fraction. Even in the absence of significant clinical evidence of volume overload or LV dysfunction, markedly elevated NP levels can be found in patients with multiple comorbidities with a certain degree of prognostic value. Potential clinical applications of NPs are expanded accompanied by emerging reports regarding screening the presence of secondary cardiac dysfunction; monitoring the therapeutic responses, risk stratifications and providing prognostic values in many settings. Clinicians need to have expanded knowledge regarding the interpretation of elevated NPs levels and potential clinical applications of NPs. Clinicians should recognize that currently the only reasonable application for routine practice is limited to differentiation of acute dyspnea, rule-out-diagnostic-tests, monitoring of therapeutic responses and prognosis of acute or decompensated CHF. The rationales as well the potential applications of NPs in these settings are discussed in this review article.

Therapeutic Effects of Baicalin on Lipopolysaccharide-Induced Acute Lung Injury in Rats

Baicalin is a flavonoid present in many traditional Chinese medicines. A number of studies show that baicalin has anti-inflammatory actions and protects against a variety of tissue and organ injuries. The effect of baicalin in lipopolysaccharide (LPS)-induced acute lung injury is not well studied. In this study, typically acute lung injury was induced in rat by intratracheal injection of LPS, which increased lactate dehydrogenase activity and protein content in bronchoalveolar lavage fluid, wet/dry lung weight ratio, Evans blue dye leakage, and neutrophil infiltration. Baicalin (20 mg/kg) was administrated 1 hour before or 30 min after LPS injection. Both pre and post-treatment with baicalin attenuated the increase of these parameters and improved histological finding. Our results suggest that baicalin has a therapeutic effect on LPS-induced acute lung injury.

Pyogenic liver abscess treated by percutaneous catheter drainage: MDCT measurement for treatment outcome

OBJECTIVE To analyze multidetector computed tomographic (MDCT) parameters in patients with pyogenic liver abscess (PLA), and to identify which parameters can be predicted percutaneous catheter drainage (PCD) treatment outcome. MATERIALS AND METHODS Clinical, laboratory and MDCT findings of 175 patients with PLA who had undergone PCD were retrospectively reviewed. All abscesses shown on MDCT were evaluated for size, margin, attenuation values, location, number of large (>3cm) abscesses, presence of a cystic component, presence of gas, and the shortest length to the liver capsule. Univariate and multivariate analyses of the MDCT parameters that affect PCD treatment outcome was performed. For continuous data of MDCT parameters (abscess size and the shortest length), we used receiver-operating-characteristic (ROC) curve to determine the optimal cut-off values. RESULTS PCD was failed in 32 patients and the overall failure rate was 18.28%. Multivariate analysis revealed that PCD failure was predicted by the presence of gas (odds ratio [OR], 42.67), a large abscess (OR 1.21), low minimal attenuation values (OR 1.02), wide range of attenuation values (OR 1.01), a shorter length to the liver capsule (OR 0.09) and lack of a cystic component (OR 0.09) of the PLA. ROC curve showed that the shortest length less than 0.25cm and an abscess size greater than 7.3cm were the optimal cut-off values predicting PCD treatment failure. CONCLUSION Among these MDCT parameters, gas formation within PLA was the most important predictor for PCD failure. Surgical intervention might be considered early in high-risk patients of PCD failure.

Baicalin attenuates air embolism-induced acute lung injury in rat isolated lungs.

Background and purpose:  Baicalin has been reported to have anti‐inflammatory effects and protect against various tissue injuries. However, the effect of baicalin on air embolism‐induced acute lung injury has not been tested yet.

Use and interpretation of cardiac troponins in the ED

Cardiac troponins (cTn) are frequently assessed in patients presenting at the emergency department (ED) with chest pain and various diseases in which myocardial injury may be involved. Cardiac troponins are no longer only used for diagnostic investigations in acute coronary syndrome but may also provide valuable information regarding screening, prognosis, and risk stratification and help to guide therapeutic planning and ED dispositioning of patients with many different types of critical illnesses. Elevation of cTn is usually related to myocardial damage but is not synonymous with acute coronary syndrome. Other etiologies should be considered in the differential diagnosis of a patient presenting with atypical symptoms and elevated cTn, as accurate diagnosis will affect both the initial treatment as well as the initial triage. A thorough knowledge of how to interpret the implications of elevated cTn will allow ED physicians to expand their list of differential diagnoses, facilitate risk stratification and ED disposition, and avoid potential iatrogenic complications resulting from inappropriate interventional therapies.

The Role of Mild Hypothermia in Air Embolism–induced Acute Lung Injury

BACKGROUND: Mild hypothermia has become an important treatment for ischemic brain injury. However, the role of mild hypothermia in air embolism–induced lung injury has not been explored. In this study, we investigated whether treatment with mild hypothermia before and synchronous with air infusion can attenuate acute lung injury induced by air embolism. METHODS: In this rat model study (Sprague-Dawley rats), pulmonary air embolism was induced by venous infusion of air at a rate of 25 &mgr;L/min for 40 minutes. Control animals received no air infusion. The rats were randomly assigned to 2 control groups of normothermia (37°C) and mild hypothermia (34°C) and 3 air embolism groups of mild hypothermia induced before air infusion, normothermia with air infusion, and mild hypothermia induced synchronous with air infusion. At the end of the experiment, the variables of lung injury were assessed. RESULTS: Air infusion elicited a significant increase in lung wet/dry weight ratio and protein, lactate dehydrogenase, and tumor necrosis factor-&agr; concentration of the bronchoalveolar lavage fluid. Myeloperoxidase activity, neutrophil infiltration, and interstitial edema in lung tissue were also significantly increased. In addition, nuclear factor-&kgr;B activity was significantly increased in the lungs. Treatment with mild hypothermia before air infusion reduced increases in these variables, whereas mild hypothermia synchronous with air infusion had no significant effect on them. CONCLUSIONS: Our study suggests that mild hypothermia before air infusion decreases air embolism–induced acute lung injury. The protective mechanism seems to be the inhibition of inflammation.

Acute ruptured appendicitis and peritonitis with pseudomyocardial infarction.

Acute abdominal conditions unexpectedly present with electrocardiographic changes. However, the presence of electrocardiographic changes and misleading clinical manifestations may obscure true etiology and delay surgical interventions. We present a patient who developed ruptured appendicitis with peritonitis manifested as acute inferior wall myocardial infarction-like electrocardiographic changes. A thorough physical examination and early echocardiographic evaluation helped to differentiate this pseudomyocardial infarction. A 64-multidetector-row computed tomography of the abdomen showed ruptured retrocecal appendicitis, and emergent appendectomy was done. Normalization of ST segments was observed after surgery.

Bradyarrhythmia caused by ginseng in a patient with chronic kidney disease.

One of the most popularly used Chinese herbal medicines (CHMs) is ginseng, which is a highly valued herb in the Far East and has gained popularity in the West during the last decades. Ginseng has been reported to have pharmacological effects, including modulation of immune response and anticancer, antiaging, anti-amnestic, cardiovascular protective, and wound-healing effects. It is known that ingestion of ginseng can cause false-positive reading in certain digoxin immunoassays; however, bradyarrhythmiacaused by ginseng-associated digitalis glycoside–like effect has not been reported before. We propose that Asian ginseng could exhibit cardiac glycoside-like cardiovascular effects in susceptible patients. Here, we present a patient who had chronic renal insufficiency who developed atrial fibrillation (AF) with slow ventricular rate after taking Asian ginseng for 1 week. An 83-year-old woman presented to the emergency department because of dizziness and general weakness for 1 day. She denied having any systemic illness before. She had been well until 1 month earlier, when she got a cold and started to take ginseng preparation. On arrival, her blood pressure was 101/52 mm Hg, pulse rate was 42 beats/min, and body temperature was 36.3°C. Physical examination disclosed irregular, slow heartbeat and grade II systolic murmur over the left lower sternum border. Results of focused neurological examinations were normal. The electrocardiogram demonstrated AF with slow ventricular rate and left ventricular hypertrophy. Her chest radiography disclosed only mild cardiomegaly. The results of laboratory examinations revealed the following: hemoglobin, 8.9 g/dL; blood urea nitrogen, 59 mg/dL; creatinine, 4.3 mg/dL; sodium, 133 mmol/L; potassium, 4.0 mmol/L; magnesium, 3.3 mg/dL; and free calcium, 4.09 mg/dL. The results of the remaining tests, including 0735-6757/

Acute Pulmonary Edema Caused by Choking in An Adult Patient

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