Measuring the ratio of femoral vein diameter to femoral artery diameter by ultrasound to estimate volume status

Background

Currently, the accepted effective method for assessing blood volume status, such as measuring central venous pressure (CVP) and mean pulmonary artery pressure (mPAP), is invasive. The purpose of this study was to explore the feasibility and validity of the ratio of the femoral vein diameter (FVD) to the femoral artery diameter (FAD) for predicting CVP and mPAP and to calculate the cut-off value for the FVD/FAD ratio to help judge a patient’s fluid volume status.

Methods

In this study, 130 patients were divided into two groups: in group A, the FVD, FAD, and CVP were measured, and in group B, the FVD, FAD, and mPAP were measured. We measured the FVD and FAD by ultrasound. We monitored CVP by a central venous catheter and mPAP by a Swan-Ganz floating catheter. Pearson correlation coefficients were calculated. The best cut-off value for the FVD/FAD ratio for predicting CVP and mPAP was obtained according to the receiver operating characteristic (ROC) curve.

Results

The FVD/FAD ratio was strongly correlated with CVP (R = 0.87, P < 0.0000) and mPAP (R = 0.73, P < 0.0000). According to the ROC curve, an FVD/FAD ratio ≥ 1.495 had the best test characteristics to predict a CVP ≥ 12 cmH₂O, and an FVD/FAD ratio ≤ 1.467 had the best test characteristics to predict a CVP ≤ 10 cmH₂O. An FVD/FAD ratio ≥ 2.03 had the best test characteristics to predict an mPAP ≥ 25 mmHg. According to the simple linear regression curve of the FVD/FAD ratio and CVP, when the predicted CVP ≤ 5 cmH₂O, the FVD/FAD ratio was ≤ 0.854.

Conclusion

In this study, the measurement of the FVD/FAD ratio obtained via ultrasound was strongly correlated with CVP and mPAP, providing a non-invasive method for quickly and reliably assessing blood volume status and providing good clinical support.

Protease-Activated Receptor 2 (PAR-2) Antagonist AZ3451 Mitigates Oxidized Low-Density Lipoprotein (Ox-LDL)-Induced Damage and Endothelial Inflammation

Oxidized low-density lipoprotein (ox-LDL)-induced endothelial dysfunction plays an important role in the initiation and development of cardiovascular diseases, especially atherosclerosis (AS). Protease-activated receptor 2 (PAR-2) is a receptor for inflammatory proteases. However, the biological function of PAR-2 in endothelial cells and the pathophysiological process of AS are still unknown. In the current study, we found that treatment with ox-LDL increased the gene and protein expressions of PAR-2 in EA.hy926 endothelial cells. Interestingly, we found that antagonism of PAR-2 with its specific antagonist AZ3451 could ameliorate ox-LDL-induced lactate dehydrogenase (LDH) release. Treatment with AZ3451 considerably improved the mitochondrial function by restoring the mitochondrial membrane potential and increasing the levels of intracellular adenosine triphosphate (ATP). Also, we found that AZ3451 attenuated ox-LDL-induced expression and production of pro-inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and interleukin-8 (IL-8). Treatment with AZ3451 also mitigated the expression of matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9). Notably, our results demonstrated that the presence of AZ3451 alleviated ox-LDL-induced expression of the endothelial cell adhesion molecules vascular cell adhesion molecule-1 (VCAM-1) and intercellular cell adhesion molecule-1 (ICAM-1). Mechanistically, we found that AZ3451 attenuated ox-LDL-induced activation of nuclear factor-κB (NF-κB) by reducing the levels of intracellular NF-κB p65 and the luciferase activity of NF-κB promoter. Based on these findings, we conclude that PAR-2 might become a novel therapeutic target for the treatment of AS.

[A preliminary investigation of the clinical characteristics of community acquired pneumonia with concomitant pulmonary embolism]

Objective: To understanding the clinical characteristics of the patients of pneumonia concomitant with acute pulmonary embolism, and the early identification of high-risk patients. Methods: Retrospective analysis of hospitalized patients with confirmed diagnosis of community acquired pneumonia (CAP) with concomitant pulmonary embolism (PE) within a period of 5 years. Patients hospitalized with CAP alone in the same period were included in the control group in a ratio of 1∶2 according to the principle of gender and age. The demographic characteristics, clinical feature, laboratory examination, radiographic and other clinical data of these 2 groups of patients were studied. Statistical analysis was performed by Chi-square test, Kruskal-Wallis test and logistic regression. Results: Thirty-nine patients with CAP combined with PE and 78 patients with CAP alone were included. Compared to patients with CAP alone, dyspnea (21/39 vs 21/78, P=0.004), a history of heart disease (10/39 vs 8/78, P=0.031), and a history of connective tissue diseases (3/39 vs 0/78, P=0.035) were more common to seen in patients with CAP combined with PE. D-dimer [2 222(854, 3 539) ng/ml vs 295(168, 707) ng/ml, P=0.000], arterial PH value (7.5±0.5 vs 7.4±0.4, P=0.022), BNP [103.9(48.7, 236.8) pg/ml vs 98.4(44.8, 246.3) pg/ml, P=0.028] and incidence of lower extremity venous thrombosis (18/39 vs 3/41, P=0.000) were higher in patients with CAP combined with PE, while arterial partial pressure of CO₂ [(35.3±6.2) mmHg vs (38.4±4.4) mmHg, P=0.009, 1 mmHg=0.133 kPa] was lower. Logistic regression analysis showed that D-dimer (P=0.000) and dyspnea (P=0.033) were associated with the risk of PE. Conclusion: When patients with CAP represent dyspnea or have a history of heart disease or connective tissue diseases concomitant PE should be considered for differential diagnosis. Determination of D-dimer, arterial PH value, arterial partial pressure of CO₂, BNP and ultrasonography of lower extremities had important implications for the diagnosis of pneumonia complicated with acute pulmonary embolism.

Identifying Risks for Persistent Postconcussive Symptoms in a Pediatric Emergency Department: An Examination of a Clinical Risk Score

OBJECTIVE

External examination of a clinical risk score to predict persistent postconcussive symptoms (PPCS) in a pediatric emergency department (ED).

METHODS

Prospective cohort study of 5- to 18-year-old patients diagnosed with an acute concussion. Risk factors were collected at diagnosis and participants (n = 85) were followed to determine PPCS 30 days postinjury. Univariate logistic regression analyses were completed to examine associations of risk factors with PPCS.

RESULTS

Headache and total clinical risk score were associated with increased odds of PPCS in the univariate analyses, OR 3.37 (95% CI 1.02, 11.10) and OR 1.25 (95% CI 1.02, 1.52), respectively. Additionally, teenage age group, history of prolonged concussions, and risk group trended toward association with PPCS, OR 4.79 (95% CI 0.93, 24.7), OR 3.41 (95% CI 0.88, 13.20), and OR 2.23 (95% CI 0.88, 5.66), respectively.

CONCLUSION

Our study supports the use of multiple variables of a clinical risk score to assist with ED risk stratification for pediatric patients at risk for PPCS.

[Identification of major gene and polygene mixed inheritance model and estimation of genetic parameters of a quantitative trait from F2 progeny]

It has been proved by many field experiments and QTL mapping results that among genes affecting some quantitative traits there are some major genes with larger genetic effect and some polygenes with smaller genetic effect. For such traits, the distribution of segregating population demonstrates multimodality, and this is the characteristic of the mixture of more than one distributions. Mixture distribution models have been used extensively as models in a wide variety of practical situations where data can be viewed as arising from two or more populations mixed in certain proportions. Akaike's Information Criterion(AIC) has been used to identify the existence of major genes affecting quantitative traits. Under the existence of major genes, the genetic effects of these genes and their genetic variance were estimated through segregation analysis. The genotype of major gene of F2 individuals of were determined by clustering using Bayesian criterion. With P1, P2, F1 and F2 populations, the likelihood ratio test was used to test the existence of polygenes. In the end, the inheritance of soybean flowering date is analyzed. One major gene was found in F2 population derived from Guludou x Shanghaihongmangzao.

Soybean Disease Loss Estimates for the Top 10 Soybean Producing Countries in 1994

Soybean disease loss estimates were compiled for the 1994 harvested crop from the 10 countries with the greatest soybean production. The objective was to document the major soybean disease problems in these countries and any recent changes in the severity of individual soybean diseases. Total yield losses caused by Heterodera glycines in these 10 countries were greater than those caused by any other disease. Next in order of importance were stem canker, brown spot, and charcoal rot. The total yield loss due to disease during 1994 in these countries was 14.99 million metric tons, valued at $3.31 billion. Methods used to estimate soybean disease losses were field surveys, plant disease diagnostic clinic samples, variety trial data, information from field workers and university extension staff, research plots, grower demonstrations, and private crop consultant reports. Yield loss estimates due to a particular disease varied by country. For example, yield losses due to rust were reported from China and Indonesia, but no losses due to this disease were reported from any of the remaining eight countries. Soybean disease control research and extension efforts are needed to provide more effective preventive and therapeutic disease management strategies and systems to producers.

Effect of SR 59026A, a new 5-HT(1A) receptor agonist, on sexual activity in male rats

The effect of SR 59026A, a new selective 5-HT(1A) receptor agonist, was evaluated on sexual behaviour of male rats in different experimental conditions. SR 59026A (1-10mg/kg p.o.) stimulated the copulatory behaviour of sexually experienced rats, as evidenced by a decrease in the number of pre-ejaculatory mounts and intromissions and a shortening of the ejaculation latency. SR 59026A also facilitated the sexual behaviour of naive male rats characterized by a low level of sexual performance: over the same dose range, the percentage of naive males that copulated was significantly increased and the ejaculation latency reduced. In experiments designed to evaluate the onset of sexual satiation, SR 59026A (1 and 3mg/kg) increased significantly the number of ejaculations and delayed the time of sexual satiation. Finally, in agreement with studies on other 5-HT(1A) receptor agonists, SR 59026A did not modify the occurrence of spontaneous erections in isolated male rats. Therefore, the present study shows that SR 59026A improves the sexual performance of male rats in a number of different experimental models, and the compound may prove to be of interest for the treatment of certain states of human male sexual dysfunction.