Zhan Hong

Effects of therapeutic hypothermia on coagulopathy and microcirculation after cardiopulmonary resuscitation in rabbits

OBJECTIVE The aim of this study was to investigate the effects of therapeutic hypothermia (TH) on coagulopathy and cerebral microcirculation disorder after cardiopulmonary resuscitation (CPR) in rabbits. METHODS Cardiac ventricular fibrillation was induced by alternating current in 24 New Zealand rabbits, and hypothermia was induced by surface cooling or normothermia (NT) was maintained for 12 hours after the return of spontaneous circulation (ROSC). Several physiologic indexes were measured before CPR and at 4, 8, and 12 hours after ROSC. The microcirculation flow in the cerebral cortex was measured with a PERIMED Multichannel Laser Doppler system (Perimid, Sweden), and glomerular fibrin deposition was determined by microscopy. RESULTS Compared with the NT group, the prothrombin time, activated partial thromboplastin time, and international normalized ratio in the TH group were increased; there were no differences in anti-thrombin-III, protein C, and d-dimer indexes. The microcirculation flow in the cerebral cortex before CPR and after ROSC at 4, 8, and 12 hours was 401.60 ± 11.76, 258.86 ± 34.58, 317.59 ± 23.36, and 371.98 ± 5.79 mL/min, respectively, in the NT group, and 398.18 ± 12.91, 336.19 ± 19.27, 347.76 ± 13.80, and 383.78 ± 3.29 mL/min, respectively, in the TH group. There were apparent disparities at each checkpoint after ROSC in these 2 groups (4 hours: P = .001; 8 hours: P = .011; 12 hours: P = .009). The Pearson correlation test showed that the microcirculation flow in the cerebral cortex was positively correlated with activated partial thromboplastin time after ROSC (4 hours: r = 0.503, P = .033; 8 hours: r = 0.565, P = .035; 12 hours: r = 0.774, P = .009), but not with other coagulation parameters. CONCLUSIONS Therapeutic hypothermia might cause coagulant dysfunction but concomitantly improves the microcirculation flow in the cerebral cortex, which might be an effect of TH that results in cerebral protection.

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.

GW24-e3586 Medical and surgical treatment of a Takayasu disease on bilateral ocular ischaemic syndrome: a case report and review of the literatures

Objectives Bilateral ocular ischaemic syndrome has rarely been reported as the initial presenting symptom of Takayasu arteritis (TA). To report the medical and surgical treatment of a Takayasu disease associated occlusion of left subclavian artery, brachiocephalic trunk and left carotid artery. Methods A 16-year old lady with no known systemic illness presented to the ophthalmology department of a tertiary hospital in the locality with the complaints of an insidious onset of gradually progressive visual loss since 1 week. She also complained of giddiness, fainting and tinnitus. A general physical examination revealed feeble upper limb pulses and pulseless in the bilateral carotid artery. There was no audible murmur. Other systems were normal. On admission, her white blood cell count was 16,340/mm3, platelets 411 × 109/L, haemoglobin 12.2 gm/dL, her erythrocyte sedimentation rate was 13 mm/h, and CRP 3.21 mg/L. The carotid and vertebral arteries’ Doppler showed bilateral carotid artery occlusion with normal vertebral arteries, and computed tomography of her head did not demonstrate any abnormalities. Computed tomography Angiography (CTA) and digital subtraction Angiography (DSA) demonstrated occlusion of the proximal segment of the left subclavian artery, brachiocephalic trunk and left carotid artery as well right vertebral artery stenosis. Results Methylprednisolone (2 mg·kg-1·d-1) was administered intravenously the day after admission to suppress inflammatory arteritis. The patient received ascending aorto-bilateral carotid artery bypass on 5 Sep 2011, Postoperative steroid and immunosuppressive therapy were administered for this patient because of her erythrocyte sedimentation rate was 45 mm/h. Postoperative CTA one week after the procedure revealed good patency of the bypass grafts. The patient was followed up after 18 month, Her symptoms were gradually improved with a decrease in ESR and CRP. Conclusions the pathogenesis of TA remains to be elucidated, It is now hypothesised that an unknown stimulus triggers the expression of the 65 kDa Heat-shock protein in the aortic tissue and induces the Major Histocompatibility Class I Chain-Related A (MICA) on vascular cells, The γδ T cells and NK cells play a more important role of this pathways [1]. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgery should be avoided in the acute phase, for it was associated with a high morbidity of complication and reconstructions occluded [2]. Bypass operation is optimal for brachiocephalic-vessel involvement in TA [3]. Postoperative steroid therapy is strongly recommended for the patient associated with clinical and serological signs of an active phase. In conclusion, a combination of medical and surgical treatment is necessary for optimal management of TA.

GW24-e0805 Mesenchymal Stem Cells down-regulates MIF expression on myocardium in septic mice

Objectives As a novel anti-inflammationary and immuno-regulatory factor, Mesenchymal Stem Cells (MSCs) have recently been applied to treat septic animals in experimental research. Our previous results have shown that MSCs decreased the mortality caused by sepsis, but the exact mechanisms underlying its beneficial effects are not well defined. Since inflammationary injury induced by Migration Inhibitory Factor (MIF), as a late-stage pro-inflammationary factor, is significantly expressed in septic myocardium, we hypothesised that intervention of MSCs could down-regulate its expression on myocardium in septic mice, contributing to its protective outcomes on sepsis. In present study, we aimed to investigate the influence of MSCs on cardiomyocytic MIF expression during sepsis in BALB/c mice. Methods One hundred and Eighty BALB/c mice were randomly assigned into three groups: the sham group (sham group, n = 60), the sepic control group (septic group, n = 60) and the septic MSCs interventing group (septic + MSCs group, n = 60). Sepsis was induced by cecal ligation puncture in mice of the later two groups, while the mice in septic + MSCs group were treated intravenously with 2 x 106 MSCs once a day for three days before cecal ligation puncture. Serum MIF levels, macroscopic and microscopic cardiomyocytic changes were evaluated 12 h (n = 10), 24 h (n = 10), 36 h (n = 10), 48 h (n = 10), 60 h (n = 10) and 72 h (n = 10) post puncture. The levels of MIF mRNA and protein expression in myocardium were detected at the same time points as above by RT-PCR, Immunohistochemical staining and Western Blot, respectively. Results Sepsis caused apparent damages to myocardium in mice with cecal ligation puncture. Compared with sham group and septic group, MSCs attenuated the macroscopic and microscopic injuries in myocardium of septic mice, while serum MIF concentrations at 12 h, 24 h, 36 h, 48 h, 60 h and 72 h post puncture were significantly suppressed following MSCs intervention. The mRNA and protein expression of MIF in myocardium were significantly lower in the septic + MSCs group than in the septic group at the same time points as above, but still higher than the sham group (p < 0.05). Conclusions It is concluded that elevated MIF expression in myocardium may play an important role in pathogenesis of sepsis; MSCs may be taken as a protective option for sepsis treatment; Transcriptional down-regulation of MIF in cardiomyocytes may be one of the molecular mechanisms contributing to the beneficial outcomes following MSCs intervention.

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.

COMPARISON OF TIMI, PURSUIT AND GRACE RISK SCORES IN PATIENTS PRESENTING EMERGENCY DEPARTMENT WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROME

Objectives Risk stratification for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is a difficult challenge for physicians. This study was to compare, the prognostic value of three clinical risk scores, the GRACE, PURSUIT and TIMI score in NSTE-ACS patients. Methods Pub Med was systematically searched for the TIMI, PURSUIT and GRACE risk score studies, especially the UA/NSTEMI studies. 8 eligible studies with 25 247 people were formally appraised. The GRACE scores, PURSUIT scores and TIMI score were subsequently divided into low, intermediate and high equivalent strata to facilitate comparison. The study endpoint was cardiac event in hospital, at short term (30-days) and over longer term (360-day) follow-up. χ2 test and Wilcoxon (Gehan) Statistic were used for statistical analysis where appropriate. Results In-hospital cardiac event rates in all risk scores were of no statistically significant difference. At 30-day follow-up, in low risk group, TIMI performs better than the other two risk scores (TIMI vs PURSUIT, p<0.001; TIMI vs GRACE, p < 0.001; TIMI > PURSUIT, GRACE in event rate); in intermediate group, TIMI performs than the others again (TIMI vs PURSUIT, p<0.001; TIMI vs GRACE p < 0.001; TIMI > PURSUIT, GRACE in event rate); but in the high risk group, PURSUIT performs best (TIMI vs PURSUIT, p=0.023; PURSUIT vs GRACE, p=0.005; PURSUIT>TIMI, GRACE in event rate). At 1-year follow-up, there is no statistical significance among each low risk group; TIMI and PURSUIT performs better in the intermediate group (PURSUIT vs GRACE, p=0.0091; TIMI vs GRACE, p=0.009; PURSUIT, TIMI>GRACE in event rate), but in the high risk group, PURSUIT and GRACE performs better (TIMI vs PURSUIT, p=0.012; TIMI vs GRACE, p < 0.001; GRACE > PURSUIT>TIMI). Conclusions In NSTE-ACS population, TIMI risk score can be widely applied. At 30-day PURSUIT are better than others in the high-risk group. GRACE is superior at long term follow-up in high risk group.