Quantifying agitation in sedated ICU patients using heart rate and blood pressure

Agitation is a significant problem in the intensive care unit (ICU), affecting 71% of sedated adult patients during 58% of ICU patient-days (Fraser and Riker 2001 NY Health-Syst. Pharm. 20 17-24). Subjective scale-based assessment methods are currently used to assess the level of patient agitation, but are limited in their accuracy and resolution. This research develops an objective agitation measurement method using heart rate variability (HRV), systolic blood pressure (BP) and blood pressure variability (BPV) data, processed by wavelet transforms and autoregressive signal processing. A fuzzy inference system (FIS) is developed to classify changes in these signals that correlate with observed patient agitation, and combine them into a final agitation level. Proof of concept clinical trials on 13 normal subjects and 5 ICU patients has been performed to verify the validity of this approach in comparison with agitation graded by nursing staff using the Riker sedation-agitation scale (SAS). Results show good correlation with medical staff assessment with no false positive results during calm periods. Clinically, this initial agitation measurement method promises the ability to consistently and objectively quantify patient agitation to enable better management of sedation and agitation through optimized drug delivery leading to reduced length of stay.     

医疗设备2000年问题及对策

文介绍了医疗设备２０００年问题及可能带来的后果,并给出了一种解决方案供参考。     

微小RNA-34a通过下调沉默信息调节因子1的表达介导新生大鼠坏死性小肠结肠炎

目的 探究微小RNA-34a（miR-34a）与新生大鼠坏死性小肠结肠炎（NEC）的关系及miR-34a对沉默信息调节因子1（SIRT1）的具体调节作用。 方法 将40只新生Sprague-Dawley大鼠随机分5组（n=8）,其中A组为对照组,B～E组为实验组。实验组大鼠通过人工喂养、缺氧、冷刺激等方法构建NEC模型,其中B组为NEC模型组,C组为NEC模型+miR-34a干扰片段组,D组为NEC模型+SIRT1激动剂组,E组为NEC模型+miR-34a干扰片段+SIRT1抑制剂组。通过苏木精-伊红染色观察肠组织的形态变化,实时荧光定量逆转录聚合酶链反应检测miR-34a及SIRT1 mRNA的相对表达情况,免疫印迹实验检测SIRT1、炎症细胞因子的蛋白表达情况,酶联免疫吸附实验（Elisa）检测炎症细胞因子及氧化应激因子的浓度水平。 结果 （1）与对照组比较,NEC模型组的miR-34a表达增加（P＜0.001）,SIRT1表达减少（P＜0.001）,促炎因子和促氧化因子浓度增高,抗炎因子和抗氧化因子浓度减低。（2）使用miR-34a干扰片段或SIRT1激动剂降低了miR-34a的表达、增加了SIRT1的表达,从而使促炎因子及促氧化因子浓度降低、抗炎因子及抗氧化因子浓度增加,最终使肠组织损伤减轻,病理评分降低,差别均有统计学意义（P＜0.05）。（3）SIRT1抑制剂使SIRT1表达减少,miR-34a表达增加,逆转miR-34a干扰片段的作用,加重组织损伤,差别均有统计学意义（P＜0.05）。 结论 miR-34a及SIRT1的表达水平与NEC密切相关,调节机制可能是miR-34a通过下调SIRT1的表达,使促炎因子、促氧化因子释放增加,同时使抗炎因子、抗氧化因子释放减少,激发炎症反应,进而导致NEC的发生和发展。     

Cerebral paragonimiasis: A retrospective analysis of 89 cases

Purpose

We reviewed the clinical and follow-up data of 89 cases with cerebral paragonimiasis and summarized the disease characteristics, diagnostic strategies and treatment experience, with an expectation of establishing standard diagnosis and treatment for cerebral paragonimiasis.

Methods

A total of 89 cases (age: 2–64 years) of cerebral paragonimiasis admitted and treated in our hospital in the past 10 years were included in this study. The clinical symptoms were manifested by headache, epilepsy, paralysis, etc. In order to confirm the diagnosis, we performed imaging examinations (e.g., CT and MRI) and laboratory tests (ELISA and eosinophil counting). Seventy-two patients received oral administration of praziquantel only, 16 cases received surgical resection of the lesions and 33 cases received appropriate anti-epileptic therapies. The diagnostic, treatment and follow-up data were statistically analyzed.

Results

Follow-up was performed for 73 cases for a period of 6–48 months and the original symptoms were markedly improved without recurrence. 15 patients were lost to follow-up after discharge. One patient died of epilepticus insult, high fever and convulsions. Although 4 patients still had seizures within 6 months of treatment, seizure frequency was significantly reduced. Histopathological evaluation demonstrated inflammatory changes with esoinophilic infiltration in all 16 patients who underwent surgical resection.

Conclusions

Young patients (age: <18 years) are more likely to have cerebral hemorrhage. SWI imaging contributes to the diagnosis of hemorrhagic lesions. Cerebral paragonimiasis can cause epilepsy, especially grand mal seizures.