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Supervisor: Ministry of Education of the People's Republic of China

Sponsor: Sichuan University

Host unit: Editorial Board of Journal of Sichuan University (Medical Science Edition)

Editor-in-Chief: Yuquan Wei

CN 51-1644/R

ISSN 1672-173X

Postal code: 62-72

Establishment Time: 1959

Address: 17,Section 3,Renmin Nanlu,Chengdu,Sichuan,610041,People's Republic of China

Tel: 028-85501320

Email: scuxbyxb@scu.edu.cn


Critical Care Ultrasound(CCUS)is the one of the ultrasound technologies which integrates the bedside ultrasound application into daily clinical practice in critical care medicine. It has multiple roles, at first is a non-invasive monitoring tool to measure variables that can reflect the essence of the disease, and then is a comprehensive visualized tool to evaluate the pathophysiological status and structural changes of organs, which facilitates the critical care providers to know more about the patients and provides more reliable evidence to promote the accuracy and efficiency of the diagnosis, the clinical decision-making and the treatment of the critically ill. Therefore, the critical care ultrasound has been used as one of the core technologies of critical care. The characteristics and advantages of CCUS destine it as an orientation and instruction of visualized diagnosis and treatment. We devote ourselves to explore methods of integrating the application of CCUS into clinical management of critically ill, and establish specific approaches and workflows to standardize the clinical practice of clinicians and reduce medical errors. Therefore, a new diagnostic and treatment pattern can be developed, which is called visualized critical care. It is a care pattern of critical illness based on the CCUS visualization evidence including the pathophysiological status and other informations. This article will carefully discuss the connotation of CCUS, the unique clinical value in critically ill patients, and the value of visualized critical care approaches in acute respiratory and circulatory collapse and shock management, etc..
Objective The aim of this study is to explore the diagnostic and therapeutic accuracy of pathophysiology and clinic oriented critical care ultrasound exam (POCCUE) protocol in acute respiratory and circulatory compromise of critically ill patients. Methods Prospectively included patients with acute respiratory and circulatory compromise from ICU of West China Hospital of Sichuan University from March to April 2018. The POCCUE protocol designed according to the pathophysiological changes of acute respiratory and circulatory disorders includes: the first part is the acquiring an ultrasound section and measuring corresponding indicators including pulmonary and echocardiographic indicators; the second part is a comprehensive analysis according to the former examination which evaluates the pathophysiological changes of acute respiratory and circulatory disorders, and then establish the initial etiology diagnosis and start treatment. The clinical value of the POCCUE protocol, including the accuracy of diagnosis, and the differences in treatment was verified by comparing the clinical outcome with the traditional treatment group. Results A total of 82 subjects were used for statistics. Compare with the traditional group, POCCUE can notably increase the diagnostic and therapeutic accuracy of clinic and pathophysiology (diagnostic accuracy: 93.90% vs. 68.29%, P < 0.01; therapeutic accuracy: 93.90% vs. 62.20%, P < 0.01). Conclusion The POCCUE has a higher accuracy of diagnosis and treatment for patients with acute respiratory and circulatory compromise.
Objective To explore whether ultrasound abnormalities in the non-gravity dependent areas (area 1-2) of the lungs are associated with poor prognosis in patients with shock and on mechanical ventilation. Methods We retrospectively analyzed the data of lung ultrasound from 181 patients with shock from Apr. 2016 to Nov. 2017. The patients were divided into the survival group and the non-survival group according to the 28 d outcome. Single factor and multivariate Cox regression were used to analyze the relationship between lung ultrasound score of the overall and each area and the 28 d mortality.Kaplan-Meier curve was used to analyze the relationship between the severity of ultrasound lesions in area 1-2 and the prognosis at 28 d. Results 169 patients were included.There were 106 males (62.7%) and 63 females (37.3%).There were 90 patients in the survivel group and 79 patients in the non-survival group.Single factor Cox regression analysis found that adjusting the age, acute physiology and chronic health evaluation (APACHE) Ⅱ score, lactate level, urine output per hour, application of vasoactive agent, oxygenation index, lungs ultrasound score of area 1-6, area 1-2 and area 3-4 were associated with 28 d mortality. Multivariate Cox regression revealed that lung ultrasound score of area 1-2 was the independent risk factor of 28 d mortality, as well as APACHE Ⅱ score and lactate level. The Kaplan-Meier curve found that the more severe the lesion in area 1-2, the lower the survival rate at 28 d. Conclusion Lung ultrasound score of area 1-2 in patients with shock and on mechanical ventilation may be a predictor of poor prognosis at 28 d.
Objective To investigate the relationship between fluid management oriented by critical care ultrasound and prognosis in patients with shock. Methods We analyzed the data of a randomized controlled trial called Critical Care Ultrasound Oriented Shock Treatment (CCUSOST) in the Department of Critical Care Medicine, West China Hospital retrospectively. 77 patients in the critical care ultrasound oriented treatment group (experimental group) and 70 patients in the conventionally treated group as control were included in the statistics, to evaluate the relationship between fluid intake and prognosis. Univariate and multivariate logistic regression analyses were used to analyze risk factors for ICU mortality. Results The baseline indexes of the patients in the experimental group and the control group were consistent. The ICU mortality of the experimental group was significantly lower than that of the control group (P < 0.05).The fluid intake in the stabilization and de-escalation phases was less than the the control group (P < 0.05). We divided these shock patients into survival group (92 cases) and non-survival (55 cases) according to whether they died in ICU, and the univariate analysis for ICU mortality showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, SOFA score, Lac, hourly urine output, total fluid intake, fluid intake in the salvage and optimization stages, fluid intake in the stabilization and de-escalation stages were significantly different (P < 0.05) between survivers and non-survivers. Multivariete analysis showed that the fluid intake during the salvage and optimization phases, fluid intake in the stabilization and de-escalation phases were independent risk factors for ICU mortality. Conclusion Critical care ultrasound oriented shock fluid management could reduce fluid intake of stabilization and de-escalation phases, and improved adverse outcome; whether the fluid intake during stabilization and de-escalation phases, or the fluid intake during the salvage and optimization phases, both were associated with patient prognosis.
Objective To evaluate the correlation of Fast-track extubation ultrasound score (FTEUS) and clinical multi-organ information indicators in post-cardiac surgery patients. Methods prospectively recruit post-cardiac surgery patients who were about to extubating from Febuary 2019 to September 2019. A fast-track extubation ultrasound score protocol (FTE-USP) was developed on the basis of the conventional fast-track extubation standard precisely and individualized. Cardiac, pulmonary and inferior vena cava ultrasound examinations were performed by specially trained observers, video data were saved, FTE-USP was used for scoring, Kendall consistency coefficient was used to meature the interobserver consistency. The correlation between the FTEUS and the patients' clinical indicators was evaluated. Results A total of 207 patients were recruited in the study, including 89 males and 118 females, aged (54.63±11.80) years. The FTEUS was performed at bedside with a mean time of (8.23±2.08) min, Kendall consistency coefficient is 0.941. With the increase of the total score of FTEUS, the incidence of clinical adverse events increased (especially the arrhythmia), and there were significant changes in liver, kidney, heart, lung and other organ function indicators, among which serum creatinine level, serum cystatin C level, serum NT-pro-brain natriuretic peptide, length of stay in intensive care unit, non-invasive mechanical ventilation time after extubation, and incidence of arrhythmia were positively correlated with FTEUS (P < 0.05).With FTEUS increased to 5 points, the incidence of arrhythmia (14/24, 58.3%), cardiopulmonary resuscitation (2/24, 8.3%) and weaning failure (2/24, 8.3%) increased. Conclusion FTE-USP integrates multi-organ informations, can be performed quickly at the bedside and alerts adverse events. It has the potential to be applied to assist clinical decision-making in post-cardiac surgery patients before extubation.
Objective To explore the feasibility and effectiveness of gastric antrum cross-sectional area (CSA) mearsured by bedside ultrasound for predicting early feeding intolerance (FI) in critically ill patients. Methods The data were extracted from a multicenter prospective observation study between February 2018 to December 2018. A bivariate logistic regression model was established to identify the correlation between the gastric antrum cross-sectional area (CSA) and the feeding intolerance (FI). Draw the ROC curve to get the best cut-off value. Results This study comprises 150 patients. The mean age was (58.63±16.45) yr., the average APACHE Ⅱ score was 17.43±6.99. The incidence of FI for three days (72 h-FI%) was 28.0%. The multivariate analysis demonstrated that the Day 2 CSA-right lateral decubitus (RLD) was an independent risk factor for FI-day 2 (P=0.033), Day 3 CSA -RLD was an independent risk factor for FI-day 3 (P=0.016). Patients with day 3 CSA-RLD ≥7.092 cm2 had significantly higher rates of FI (P=0.001). Conclusion Gastric antrum cross-sectional area measured by ultrasound can predict feeding intolerance during early enteral nutrition. When the Day 3 CSA-RLD is greater than 7.092 cm2, the incidence of feeding intolerance is significantly increased.
Objective To study the impact of atypical protein kinase Cι (PKCι) isoform PKC on the pancreatic cancer cells towards the tumoricidal effect of cytokine-induced killer (CIK) cells and explore its mechanisms. Methods CIK cells were prepared by inducing mononuclear cells isolated from the peripheral blood of healthy people with interleukin-2 (IL-2), interferon (IFN) and CD3 mAb and subsequently co-cultured with pancreatic epithelial cell HPDE6-C7, pancreatic cancer cells MiaPaCa and PANC-1 with or without PKC inhibitor named sodium thiomalate (ATM). All cells were divided into control group, ATM group, co-culture group with CIK and co-culture group with CIK+ATM. Cell count was used to detect the growth of each group from 1 to 8 d. Flow cytometry was used to detect the death rate of the cell lines after 48 h cell culture in each group. The small hairpin RNA (shRNA) was used for PKCι knockdown and the recombinant plasmid transfection was for PKCι overexpression in pancreatic cancer cells. Western blot and real-time fluorescent quantitative PCR (qRT-PCR) were utilized to determine the expression of PKCι protein and the impact on gene expression of transforming growth factor-β (TGF-β), a downstream effector modulated by PKC. Different mass concentrations of TGF-β (1, 10, 20 ng/mL) were added into the co-culture of MiaPaCa and PANC-1 with CIK. The cell death rate was detected by flow cytometry 48 h later, so as to explore the possible mechanisms of the impact of PKCι on the tumoricidal effects of CIK cells. Results ATM and CIK were shown to suppress the growth and induce apoptosis or death of pancreatic cancer cells, meanwhile, ATM can enhance the tumoricidal effect of CIK on pancreatic cancer cells. Moreover, we found that PKCι knockdown in pancreatic cancer cells can down-regulate the gene expression of TGF-β. In return, PKCι overexpression in pancreatic cancer cells can increase the gene expression of TGF-β. The death rate of cancer cells with 10, 20 ng/mL TGF-β was lower compared with the control group (P < 0.05). Conclusions PKCι knockdown in pancreatic cancer cells can not only inhibit the growth of pancreatic cancer cells, but also enhance the tumoricidal effects of CIK on cancer cells. The possible mechanism of PKCι is to affect the immune escape of tumor cells by regulating the expression of TGF-β.
Objective To detect the effects and mechanism of asprosin (Asp) and spartin on the injury of mice cardiac microvascular endothelial cells (CMECs) induced by high glucose. Methods The cultured CMECs were divided into 2 groups, one group is normal group (5.5 mmol/L glucose in the medium) and another is HG group (30 mmol/L glucose in the medium). Real-time PCR (qRT-PCR) and Western blot were respectively used to detect the mRNA level of spastic paraplegia 20 (SPG20) and protein expression of spartin in CMECs. Upregulation or downregulation of the expression of spartin was achieved via transfection with adenovirus (Ad) or small interfering RNA (siRNA) respectively. CMECs with downregulation of spartin expression were firstly treated with anti-oxidant N-acetylcysteine (NAC) or Asp respectively for 48 h, and then were interfered with 30 mmol/L glucose for 24 h afterward. The apoptosis of cell was detected by flow cytometry. Nitric oxide (NO) production was detected by NO probe and ELISA kit. The intracellular reactive oxygen species (ROS) levels were tested by DHE staining and ELISA kit. Type 2 diabetic model mice were established and then divided into T2DM group and T2DM+Asp group. After the model mice were established successfully (random blood glucose was more than 16.7 mmol/L), Asp (1 μg/g) was intraperitoneally injected once a day. After 2 weeks, mice echocardiography was performed to test cardiac diastolic function. The integrity of the microvascular endothelium was observed by scanning electron microscopy. Results Compared with the normal group, the mRNA level of SPG20 and protein expression of spartin in mice CMECs of HG group were significantly reduced (P < 0.05). Under the condition of high glucose, Ad transfection induced significant decrease of the intracellular ROS level and the apoptosis level of the CMECs (P < 0.05), while NO increased after Ad transfection. In contrast, siRNA intervention resulted in opposite effect. In addition, the antioxidant NAC partly reversed the above changes caused by downregulating spartin. Asp upregulated the level of SPG20 mRNA and spartin protein expression in CMECs, reduced ROS production, reduced apoptosis and increased NO production. However, intervention effects of Asp, such as decreasing of ROS production, inhibiting apoptosis of CMECs and increasing of NO production, were partly reversed in spartin downregulated cells. In vivo, we found that Asp can improve cardiac function and increase the integrity and smoothness of cardiac microvascular endothelium in type 2 diabetic mice. Conclusion Asp can inhibit oxidative stress in mice CMECs through upregulating spartin signaling pathway, thereby alleviating the damage of microvascular endothelium in diabetic heart.
Objective To clarify the relationship between hypoxia stress and the microRNA-155 released from lung cancer cells, to reveal the possible mechanism of brain metastases of lung cancer. Methods The hypoxia model of A549 lung cancer cells was established. Lung cancer cells were cultured under the hypoxia condition or normal oxygen condition as control for 0.5, 2, 4, 8, 12 and 24 h immunofluorescence and Western blot methods were used to determine the expression level of heat shock protein 70 (hsp70) in lung cancer cells. Hsp70 overexpressed lung cancer cell line was established, the levels of microRNA-155 in A549 and hsp70 overexpressed A549 cell culture medium were determined by qRT-PCR.An in vitro blood-brain barrier model was established, and was treated with A549 cell culture medium collected at different hypoxia time points. Horseradish peroxidase (HRP) was used to detect the changes of permeability of the in vitro blood-brain barrier model, automatic cell technical instrument was used to count A549 lung cancer cells in the culture medium in under Transwell room. Culture mediums of A549 lung cancer cells collected at different hypoxia time points were injected into rats via tail vein, Western blot was used to analyze the expression of occludin in brain tissue, Evans blue was used to detect the change of blood-brain barrier permeability in animals. Results When lung cancer cells were hypoxic cultured for 8 h, both the expression level of hsp70 in lung cancer cells and microRNA-155 in culture medium reached the highest level (P < 0.05). Compared with A549 cells, the enhancement of microRNA-155 level in culture medium of hsp70 overexpressed cell was more notably under hypoxia condition. At the same time, the permeability of blood-brain barrier was the highest, and the number of lung cancer cells crossed the blood-brain barrier model was the most. In animal experiment, after injection the lung cancer cell culture fluid with hypoxia 8 h, the tight junction protein occludin expression in blood-brain barrier was lowest, and the permeability of blood-brain barrier was the largest. Conclusion Hypoxia can cause the increase of hsp70 production in lung cancer cells. Increased hsp70 promotes the synthesis and release of microRNA-155, which in turn leads to reduced expression of occludin protein in the blood-brain barrier, resulting in increased permeability of the blood-brain barrier and eventually causing lung cancer cells to metastasize into the brain.
Objective To investigate the regulatory effect and its mechanism of chrysophanol (CP) on renal injury and immune response in immunoglobin A (IgA) nephropathy rats. Methods IgA nephropathy rat model was established by the method of lipopolysaccharide + bovine serum protein + carbon tetrachloride. Then the rats were randomly divided into 5 groups: control group, IgA group, IgA+low, medium and high dose of CP groups(2.5, 5 and 10 mg/kg for each group respectively). IgA+CP groups were intraperitoneally injected with different doses of chrysophanol once a day for 4 weeks, and the control group and IgA group were given isovolumetric saline. Urine protein content, serum creatinine and urea nitrogen were detected at 24 h after the administration of drugs. Kidney histopathological damage and apoptosis were measured by HE and TUNEL staining. The expression levels of Caspase-3 and Caspase-9 were detected by RT-PCR and Western blot; The contents of malondialdehyde (MDA), superoxide dismutase (SOD) and (glutathione peroxidase, Gpx) were detected by enzyme-linked immunosorbent assay (ELISA). The expression of interleukin-1β, -6 (IL-1β, IL-6) and tumor necrosis factor (TNF-α) in serum and kidney tissue were measured by ELISA and Western blot, respectively. The mRNA and protein expression levels of toll-like receptro 4 (TLR4), nuclear factor-κB P65 (NF-κB P65) were also detected by RT-PCR and Western blot, and vascular cell adherin molecule (VCAM-1) protein level was deteted by Western blot. Results In IgA nephropathy rats, the administration of CP reduced proteinuria, serum creatinine and urea nitrogen in a dose-dependent manner (P < 0.01). It also improved the pathological damage of kidney tissue, reduced the apoptosis rate (P < 0.01), and decreased the mRNA and protein expression levels of apoptosis-related proteins Caspase-3 and Caspase-9 (P < 0.01). CP inhibited MDA production while increased the activities of antioxidant enzymes Gpx and SOD (P < 0.01), and decreased the levels of serum and protein expression of IL-1β, IL-6 and TNF-α (P < 0.01), as well as the expression levels of TLR4, NF-κB P65 and VCAM-1 (P < 0.01). Conclusion Chrysophanol could play a protective role in IgA nephropathy rats, and its mechanism may be related to alleviating kidney injury and regulating immune response.

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