Ye Zi

GW25-e3246 Expressions of tnfsf6 and cyp1a1 and screening related genes by GeneChip on peripheral blood mononuclear cells in patients with Acute Myocardial Infarction

Understand the changes in the genes of oxidative stress and the process of cell toxic with myocardial IRI due to before and after operative of PCI in STEMI patients. Observe in a dynamic environment the changes in the mRNA expression of TNFSF6 and CYP1A1 resulting from myocardial IRI and clinical

GW24-e3511 Efficacy and prognosis of low molecular weight heparin (LMWH) in the treatment for the patients with chronic cor pulmonale during acute attack

Objectives To investigate the efficacy and prognosis of low molecular weight heparin (LMWH) in the treatment for the patients with chronic cor pulmonale during acute attack. Methods 320 cases patients with chronic cor pulmonale during acute attack, were at random divided into study group (167 cases) and control group (153 cases) all the patients in two groups were given the same routine treatments such as anti-infection, expectorant, relieving spasm, balancing hydro-electrolytic disorder, low flow oxygen inhalation, and conventional digitals, diuretics, vasodilators therapy. In study group, besides routine treatment, low molecular weight heparin (LMWH) was given. compared clinical features, laboratory results in the two groups before and after the treatment. We followed up these cases during 90 days after treatment, the patients in both groups were observed for comparison of the clinical effect, major adverse events rate, complication, stroke and the death of 90 days. Results Clinical features, laboratory results in study group were markedly improved after the treatment than those in control group (91% VS 82%) (P < 0.05), the patient in control group was associated with an increase numbers of hospitalisation and shorter time interval for readmission for the patients with chronic cor pulmonale during acute attack (P < 0.05). Morbidity from brain stroke is more frequent in control group than those in study group, 11/167 VS 3/153 (P < 0.05). Conclusions Low molecular weight heparin (LMWH) was effective to the patients with chronic cor pulmonale during acute attack.

GW24-e3575 The clinical observation of Atrial Fibrillation on systolic dysfunction of Congestive Heart Failure Patients

Objectives To explore the prevalence, distribution and prognosis of Atrial fibrillation on systolic dysfunction of congestive heart failure (CHF) in hospitalised patients. Methods We reviewed the medical records of 462 unselected consecutive patients with heart failure who were admitted to our Hospital between 1, 2009 to 1, 2010, patients were categorised as having systolic dysfunction with LVEF < 50% based on the results of echocardiography. We compared the 1 years clinical outcomes (stroke, myocardial infarction, unstable angina and cardiovascular death). Results AF was documented in 166 patients (36%), including 87 patients (19%) at baseline and 79 patients (17%) during subsequent follow-up with systolic dysfunction of CHF. The occurrence of AF in patients of heart failure with LVEF < 50% was associated with an increase numbers of hospitalisation and shorter time interval for readmission for CHF(P < 0.05). Conclusions AF occurred in up to 1/3 patients with systolic dysfunction of CHF. The occurrence of AF did not affect the 1 year outcomes in these patients, but increased their numbers of hospitalisation for CHF. Therefore treatment and prevention of AF have important implication in the management of patients with systolic dysfunction of CHF.

GW24-e3147 Management of Myasthenic Crisis and risk factors for prolonged mechanical ventilation

Objectives To evaluate the management of myasthenic crisis (MC) and to analyse the risk factors for prolonged mechanical ventilation. Methods Retrospective review of consecutive patients admitted for MC between January 1994 and December 2011 in the First Affiliated Hospital of Sun Yat-sen University. Risk factors for prolonged mechanical ventilation were analysed retrospectively by age, gender, autoimmune disease, ischemic heart disease, disease duration, precipitating factor, thymoma, pneumonia, atelectasis, high-dose corticosteroid therapy and bacteremia. Results We identified 53 episodes of MC in 38 patients. Five patients died during hospitalisation, the success rate was 90.6%. In the univariate analysis, age (P = 0.024), infectious causes (P = 0.007), concurrent atelectasis (P = 0.011), pneumonia (P = 0.027) and bacteremia (P = 0.046) were significantly related to prolonged mechanical ventilation, while age (P = 0.035), concurrent atelectasis (P = 0.042) and pneumonia (P = 0.025)were statistically significantly linked with prolonged mechanical ventilation in the multivariate analysis. Conclusions Timely opening the airway and applying appropriate mechanical ventilation is the key to successful emergency treatment for MC; plasma exchanges or intravenous immunoglobulin can markedly improve the outcome of MC; elder, concurrent atelectasis and pneumonia are the risk factors for prolonged mechanical ventilation.

EFFECT OF CONTINUOUS OPENING AIRWAY IN EMERGENCE CARDIOPULMONARY RESUSCITATION

Objectives To explore effect of continuous opening airway in emergence cardiopulmonary resuscitation which can hopefully lead to the development of more effective ways to open airway in short period of time. Methods 94consecutive cases of patients with acute cardiac-pulmo arrest that require emergency cardiopulmonary resuscitation at the EICU and emergency observation room of our hospital during 11 May 2010 and. 2 September 2012 all cases were randomly divided into continuous opening airway implementation group and conventional group. The studies was performed in accordance with guidelines as prescribed in the International cardiopulmonary resuscitation 2010 guidelines, in applying cardiopulmonary resuscitation, monitoring and recording recovery process and the physical signs, as well as observing the general progress and use of respirator. Results Evidently more patients in the implementation group had iris shrinking to normal during the resuscitation process than those in the conventional group p<0.05). This group also requires less time in returning to natural breathing than the conventional group. Additionally, the same group required more frequent use of SIMG+PSV or PEEP p<0.05). Conclusions Applying continuous opening airway in an effective and well-organised manner positively contribute to cardiopulmonary resuscitation and prognosis of patients.

VALUE OF D-DIMER FOR DETECTION OF ACUTE AORTIC DISSECTION

Objectives The purpose of this research was to assess the value of several plasma biomarkers in the detection of acute aortic dissection (AAD). Methods From 2006 to 2011, 118 consecutive patients with established AAD, 94 consecutive patients with chronic aortic aneurysms scheduled for elective surgery in our hospital and 98 normal subjects were evaluated for plasma D-dimer, C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (BNP). Results All AAD patients showed significantly higher elevated D-dimer values compared to both the chronic aneurysm patients as well as the normal subjects (p<0.0001); A cut-off value of 850 ng/ml was effective in distinguishing AAD from the other two groups, with a sensitivity of 90% and a specificity of 62%. Plasma CRP and BNP values in AAD or chronic aortic aneurysms were much higher than in the normal controls (p<0.0001 and p=0.0016, respectively), but these parameters did not show significant differences between AAD and chronic aortic aneurysms (p=0.32). Conclusions D-dimer can be used as a ‘rule-out’ test in patients with suspected AAD and, unlike CRP and BNP, it seems could help making a differential diagnosis between AAD and chronic aortic aneurysms.

SCREENING RELATED GENES BY GENECHIP ON PERIPHERAL BLOOD MONONUCLEAR CELLS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION (STEMI) AND EXPRESSIONS OF TNFSF6 AND CYP1A1

Objectives Patients admitted to our ER and CCU from November 2007 to February 2008. Consisting of 11 patients, 7 males and 4 females, mean age 61.44±13.70 years with a range from 33 to 75 years. All cases are diagnosed based on the AMI diagnosis criteria under Chinese Medical Association in 1999, For patients with normal controls with age, sex matching healthy volunteers 10 people, 7 male and 3 female, the average age 53.00±6.55 (32–61). Acute onset in STEMI group hospital diagnosed after extracting cubits 10 ml were immediately into containing 0.05 ml of heparin without bacteria. After acute onset of emergency PCI and conventional treatment, the third day and the seventh day each pump once again were cubits 10 ml; The comparison group: morning, fasting extraction method 10 ml were cubits under the same approach as that for the patients group. PBMCs separation adopts the lymphocyte separate liquid density gradient centrifugation. Using Human Stress & Toxicity Pathway Finder PCR Array screening method of myocardial IRI related gene changes. The validation of expression of CYP1A1 TNFSF6 by Real time PCR. All data to differences with mean±SD, Value of patients and controls were compared by ANOVA analysis. And correlation analysis method, the related to p < 0.05 to was statistically significant differences. Methods Patients admitted to our ER and CCU from November 2007 to February 2008. Consisting of 11 patients, 7 males and 4 females, mean age 61.44±13.70 years with a range from 33 to 75 years. All cases are diagnosed based on the AMI diagnosis criteria under Chinese Medical Association in 1999, For patients with normal controls with age, sex matching healthy volunteers 10 people, 7 male and 3 female, the average age 53.00±6.55 (32–61). Acute onset in STEMI group hospital diagnosed after extracting cubits 10 ml were immediately into containing 0.05 ml of heparin without bacteria. After acute onset of emergency PCI and conventional treatment, the third day and the seventh day each pump once again were cubits 10 ml; The comparison group: morning, fasting extraction method 10 ml were cubits under the same approach as that for the patients group. PBMCs separation adopts the lymphocyte separate liquid density gradient centrifugation. Using Human Stress & Toxicity Pathway Finder PCR Array screening method of myocardial IRI related gene changes. The validation of expression of CYP1A1 TNFSF6 by Real time PCR. All data to differences with mean±SD, Value of patients and controls were compared by ANOVA analysis, and correlation analysis method, the related to p<0.05 to was statistically significant differences. Results 1. Of the STEMI group, general average STEMI genes that significant changes in 14, which were up regulated the gene expression of significant for 8, were significant down regulated for four genes. The genes expression were up regulated which are cell growth/aging related genes1 (GADD45A), oxidation stress and metabolic related gene 1 (PRDX2), Heat shock related gene 3 (HSPD1, DNAJB1, DNAJB2), and repair DNA damage related gene 1 (RAD50), and apoptosis signal related gene 2 (TNFSF6 TRADD,) Significant down regulated of those genes: the cell proliferation/cancer related gene 1 (CCNG1), oxidation or metabolic stress related gene gene 2 (CAT, CYP1A1), DNA damage and restoration related gene 1 (ATM). 2. The expression of TNFSF6 in STEMI group is higher than of the healthy group and CYP1A1 was lower than the normal value. Conclusions 1. The moderation of multiple genes resulting from myocardial IRI due to after PCI with acute myocardial infarction. It provides a more complete view in the complication and complexity of myocardial IRI gene regulation. 2. The quantitative analysis of TNFSF6 and CYP1A1 genes after myocardial IRI in AMI at various stage. They may be involved in the myocardial ischaemia/reperfusion injury physiopathological process.

PAINLESS AORTIC DISSECTION WITH INITIAL SYMPTOMS OF PARAPLEGIA AND ACUTE RENAL FAILURE: A CASE REPORT

Objectives A 67-year-old man was transferred to the Emergency Department of our hospital for emergent evaluation of paraplegia and oliguria, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, progressive bilateral leg weakness and oliguria 4 days earlier. He gave no history of hypertension, diabetes mellitus or hyperlipidaemia, and had a negative family history of aortic diseases. On initial evaluation, the patient had a blood pressure of 131/71 mm Hg. His oral temperature was 36.4°C, pulse rate was 82 beats/min and respiratory rate was 20/min. He presented complete flaccid paraplegia with oliguria (urinary output <400 ml/d) and urinary retention, loss of pain and temperature sensation, vibration and position sense below the TH7 level bilaterally. Other general physical examinations were unremarkable. Laboratory tests showed a white blood cell count of 19.80×109/l, haemoglobin concentration of 109 g/l, blood urea nitrogen concentration of 50 mmol/l, blood creatinine concentration of 820 µmol/l, sodium concentration of 114 mmol/l, and potassium concentration of 4.6 mmol/l. The liver function tests were normal and other observations were unremarkable. Later thoracic and lumbar MRI revealed swelling of thoracolumbar spinal cord, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischaemia. At the same MR sequences, the double lumen of the descending aorta involving bilateral renal arteries indicated dissection in both sagittal and axial images. The diagnosis of Stanford type B acute aortic dissection was confirmed. When patients present with or develop signs and symptoms of paraplegia without obvious cause, aortic dissection should be considered, even without the presence of characteristic thoracic pain. Methods A 67-year-old man was transferred to the Emergency Department of our hospital for emergent evaluation of paraplegia and oliguria, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, progressive bilateral leg weakness and oliguria 4 days earlier. He gave no history of hypertension, diabetes mellitus or hyperlipidaemia, and had a negative family history of aortic diseases. On initial evaluation, the patient had a blood pressure of 131/71 mm Hg. His oral temperature was 36.4°C, pulse rate was 82 beats/min and respiratory rate was 20/min. He presented complete flaccid paraplegia with oliguria (urinary output<400 ml/d) and urinary retention, loss of pain and temperature sensation, vibration and position sense below the TH7 level bilaterally. Other general physical examinations were unremarkable. Laboratory tests showed a white blood cell count of 19.80×109/l, haemoglobin concentration of 109 g/l, blood urea nitrogen concentration of 50 mmol/l, blood creatinine concentration of 820 µmol/l, sodium concentration of 114 mmol/l, and potassium concentration of 4.6 mmol/l. The liver function tests were normal and other observations were unremarkable. Later thoracic and lumbar MRI revealed swelling of thoracolumbar spinal cord, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischaemia. At the same MR sequences, the double lumen of the descending aorta involving bilateral renal arteries indicated dissection in both sagittal and axial images. The diagnosis of Stanford type B acute aortic dissection was confirmed. When patients present with or develop signs and symptoms of paraplegia without obvious cause, aortic dissection should be considered, even without the presence of characteristic thoracic pain. Results A 67-year-old man was transferred to the Emergency Department of our hospital for emergent evaluation of paraplegia and oliguria, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, progressive bilateral leg weakness and oliguria 4 days earlier. He gave no history of hypertension, diabetes mellitus or hyperlipidaemia, and had a negative family history of aortic diseases. On initial evaluation, the patient had a blood pressure of 131/71 mm Hg. His oral temperature was 36.4°C, pulse rate was 82 beats/min and respiratory rate was 20/min. He presented complete flaccid paraplegia with oliguria (urinary output <400 ml/d) and urinary retention, loss of pain and temperature sensation, vibration and position sense below the TH7 level bilaterally. Other general physical examinations were unremarkable. Laboratory tests showed a white blood cell count of 19.80×109/l, haemoglobin concentration of 109 g/l, blood urea nitrogen concentration of 50 mmol/l, blood creatinine concentration of 820 µmol/l, sodium concentration of 114 mmol/l, and potassium concentration of 4.6 mmol/l. The liver function tests were normal and other observations were unremarkable. Later thoracic and lumbar MRI revealed swelling of thoracolumbar spinal cord, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischaemia. At the same MR sequences, the double lumen of the descending aorta involving bilateral renal arteries indicated dissection in both sagittal and axial images. The diagnosis of Stanford type B acute aortic dissection was confirmed. When patients present with or develop signs and symptoms of paraplegia without obvious cause, aortic dissection should be considered, even without the presence of characteristic thoracic pain. Conclusions A 67-year-old man was transferred to the Emergency Department of our hospital for emergent evaluation of paraplegia and oliguria, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, progressive bilateral leg weakness and oliguria 4 days earlier. He gave no history of hypertension, diabetes mellitus or hyperlipidaemia, and had a negative family history of aortic diseases. On initial evaluation, the patient had a blood pressure of 131/71 mm Hg. His oral temperature was 36.4°C, pulse rate was 82 beats/min and respiratory rate was 20/min. He presented complete flaccid paraplegia with oliguria (urinary output <400 ml/d) and urinary retention, loss of pain and temperature sensation, vibration and position sense below the TH7 level bilaterally. Other general physical examinations were unremarkable. Laboratory tests showed a white blood cell count of 19.80×109/l, haemoglobin concentration of 109 g/l, blood urea nitrogen concentration of 50 mmol/l, blood creatinine concentration of 820 µmol/l, sodium concentration of 114 mmol/l, and potassium concentration of 4.6 mmol/l. The liver function tests were normal and other observations were unremarkable. Later thoracic and lumbar MRI revealed swelling of thoracolumbar spinal cord, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischaemia. At the same MR sequences, the double lumen of the descending aorta involving bilateral renal arteries indicated dissection in both sagittal and axial images. The diagnosis of Stanford type B acute aortic dissection was confirmed. When patients present with or develop signs and symptoms of paraplegia without obvious cause, aortic dissection should be considered, even without the presence of characteristic thoracic pain.

Assess improvements in effectiveness of cardiopulmonary resuscitation skills based on 2010 CPR guidelines

Objectives Cardiopulmonary resuscitation is the most important technique for the first-aid in the rescue of the patients with cardiac arrest. Many aspects in basic life supporting has been revised in the 2010 CPR guidelines. This research aims to evaluate and analyse the improvement in effectiveness of cardiopulmonary resuscitation skills based on 2010 CPR guidelines in emergency medicine. Methods Sixty clinical training doctors in the First Affiliated Hospital of Sun Yat-Sen University, who were trained in the emergency department from August, 2010 to March, 2011, were taken as the research groups. Among them, 30 doctors assigned to the control group, entered the emergency department before 2010 CPR guidelines was published and were supposed to be trained based on 2005 CPR guidelines and the other 30 doctors assigned to the experimental group, were trained after the 2010 CPR guidelines were published and were trained based on 2010 CPR guidelines. Theory and skill- practice tests were employed to evaluate the training effectiveness after the training course was finished in both groups. Results Total scores of the experimental group are higher than those of the control group (p<0.05). The theory test scores have no significant difference between the two groups (p>0.05), while the experimental group performed better in skill-practice test (p<0.05). More prompt initiation of chest-compression and defibrillation, higher rates and superior quality of chest-compression, as well as better self-evaluation among trainees, are obtained in the experimental group (p<0.05). However, other items including self-protection awareness, airway-opening skills and ventilation quality, are similar between the two groups (p>0.05). Conclusions The study showed that training based on the revised guidelines resulted in improvement in effectiveness of basic life-support procedures in medical staff.

Training effectiveness improvements of cardiopulmonary resuscitation skills based on 2010 CPR guideline in emergency medicine

Objectives Cardiopulmonary resuscitation is the most important technique for the first-aid in the rescue of the patients with cardiac arrest. Many aspects in basic life supporting has been adjusted in 2010 CPR guideline. This research aims to evaluate and analyse the training effectiveness improvements of cardiopulmonary resuscitation skills based on 2010 CPR guideline in emergency medicine. Methods Sixty clinical training doctors in the First Affiliated Hospital of Sun Yat-sen University, who were trained in the emergency department from August, 2010 to March, 2011, were taken as the research groups. Among them, 30 doctors assigned into control group, entered emergency department before 2010 CPR guideline was published and were supposed to be trained based on 2005 CPR guideline and the other 30 doctors assigned into experimental group, were trained after 2010 CPR guideline was published and were trained based on 2010 CPR guideline. Theory and skill- practice tests were employed to evaluate the training effectiveness after the training course was finished in both groups. Results Total scores of the experimental group are higher than those of the control group (p<0.05). The theory test scores have no significant difference between the two groups (p>0.05), while the experimental group acts better in skill-practice test (p<0.05). More prompt initiating of chest-pressing and defibrillation, higher rates and superior quality of chest-pressing, as well as better self-evaluation among trainees, are obtained in the experimental group (p<0.05). However, other items including self-protection awareness, airway-opening skills and ventilation quality, are similar between the two groups (p>0.05). Conclusions It seems helpful to improve training effectiveness of basic life-support procedures in medical staff based on the adjustment of 2010 CPR guideline.