Non-critical Group Research Articles

Correlations between coagulation function and pediatric critical illness score in children with severe pneumonia

Objective To investigate the relationship between coagulation function and pediatric critical illness scores (PCIS) in children with severe pneumonia.Methods The PCIS were collected in 152 children with severe pneumonia (pneumonia group) admitted in our pediatric intensive care unit from Jan 2010 to Jul 2011,and 20 healthy children in the same period were selected as the healthy control group.The coagulation indicators of children in both groups were detected and the relationship between coagulation markers and severity of pneumonia was analyzed.Results There were significant differences in platelet count,fibrinogen,D-Dimer,soluble P-selectin between pneumonia group and healthy control goup [(185.74 ±116.26) × 109/L vs (287.10 ±90.01) × 109/L,(3.51 ±0.50) g/L vs (3.15 ±0.15) g/L,(1.39 ±2.18) μg/ml vs (0.36 ± 0.07) μ g/ml,(110.07 ± 83.47) ng/ml vs (33.74 ± 9.47) ng/ml,P ＜ 0.05].There were positive correlation between soluble P-selectin,D-Dimer and severity of disease and negative correlation between platelet count and severity of disease in children with severe pneumonia.Regression equation:y =1.154 +0.003 × soluble P-selectin + 0.089 × D-Dimer-0.001 × platelet count (P ＜ 0.05).As the children's critical condition getting worse,soluble P-selectin and D-Dimer levels increased (P ＜ 0.05).Hatelet count showed no significant difference between critical group and extremely critical group,which was significantly lower than that in non-critical group (P ＜ 0.05).Conclusion Soluble P-selectin,D-Dimer,and platelet count are associated with the severity of pneumonia.The children with severe pneumonia are easy to have coagulation disturbance. Key words: Blood coagulation disorders; Pediatric intensive care unit; Pneumonia; Pediatric critical illness scores

The role of CT pulmonary angiography in the diagnosis and prognosis of pulmonary embolism and correlation with blood gas values

To analyze the value of CT pulmonary angiography (CTPA) in assessing the severity of pulmonary embolism (PE), and to investigate the correlations of the parameters from CTPA with blood gas values. Forty-four PE patients were classified into 19 critical and 25 non-critical patients, and 37 subjects without PE were defined as control group. Right ventricular (RV) and left ventricular (LV) maximal short axis, RV to LV (RV/LV), superior vena cava and pulmonary artery diameter, obstruction index, leftward bowing of interventricular septum, reflux of contrast medium into inferior vena cava were compared among the 3 groups. The correlations of these parameters with blood gas values were investigated. There were significant differences in RV, LV, RV/LV, superior vena cava and pulmonary artery diameter, leftward bowing of interventricular septum, reflux of contrast medium into inferior vena cava when compared among 3 groups (P < 0.05). However, significant differences were detected in RV, LV and RV/LV between critical [(53 ± 8) mm, (35 ± 6) mm, 1.56 ± 0.50] and non-critical group [(45 ± 7) mm, (43 ± 9) mm, 1.09 ± 0.31] (RV: t = 3.44, P < 0.05; LV: t = 3.08, P < 0.05; RV/LV: t = 4.62, P < 0.05), critical group and group without PE [(40 ± 7) mm, (43 ± 9) mm, 0.96 ± 0.23] (RV: t = 5.76, P < 0.05; LV: t = 3.40, P < 0.05; RV/LV: t = 6.33, P < 0.05). Superior vena cava diameter and pulmonary artery diameter were significantly different between critical group [(24 ± 4) mm, (33 ± 4) mm] and group without PE [(21 ± 4) mm, (29 ± 4) mm] (t = 2.80, P < 0.05; t = 3.98, P < 0.05). Pulmonary artery diameter in non-critical group (31 ± 5) mm was significantly different from group without PE (t = 2.59, P = 0.03). Reflux of contrast medium into inferior vena cava showed significant difference between critical group and group without PE (χ(2) = 5.54, P = 0.02). There was significant difference in obstruction index between critical (76 ± 24)% and non-critical group (52 ± 34)% (t = -2.75, P = 0.01). Obstruction index and RV/LV were negatively correlated with PaO(2) (r = -0.525, -0.502), while positively correlated with P((A-a))O(2) (r = 0.753, 0.630). Blood gas values differed significantly between above and below the 60%, 70% and 80% cutoff values of obstruction index. Superior vena cava and pulmonary artery diameter, reflux of contrast medium into inferior vena cava can be used as indirect evidence in the diagnosis of PE, while obstruction index, RV, LV, RV/LV and leftward bowing of interventricular septum can be applied as indicators of severity of PE. The severity of the obstruction index and RV/LV assessed using CTPA are significantly correlated to the blood gas values.

The effects of significant coronary stenosis and percutaneous coronary intervention on aortic stiffness

Although aortic stiffness (AS) is a strong predictor of cardiovascular events, its value is unknown in patients who have coronary stenosis and undergo percutaneous coronary intervention (PCI). Our hypothesis was that AS might provide additional information about coronary hemodynamic status. In this context, we investigated the effects of coronary stenosis and PCI on AS. The study included 107 patients undergoing coronary angiography. The patients were divided into three groups based on the angiographic results: 39 patients with significant lesions (≥50%) formed the 'critical group' and 38 patients with nonsignificant lesions (<50%) formed the 'noncritical group'. The control group (30 patients) had normal angiograms. Aortic stiffness was determined using the carotid-femoral aortic pulse wave velocity (PWV) method. All patients in the critical group underwent successful PCI and repeat PWV measurements. All baseline characteristics were similar in the three groups except for the mean PWV, which was significantly higher (9.4±2.2 m/sec) in the critical group compared to the control group (5.7±1.1 m/sec) and the noncritical group (5.8±1.1 m/sec) (p<0.0001). The latter two groups had similar PWV values (p=0.6). After PCI, the mean PWV decreased significantly by 24.4% to 7.1±2.0 m/sec (p=0.002); however, it was still significantly higher than that of the control group (p<0.0001). In correlation analysis, PWV showed significant correlations with age (r=0.412, p=0.01), systolic blood pressure (r=0.342, p<0.01), and hemoglobin (r=-0.370, p=0.02). Multiple logistic regression analysis showed that PWV was a predictor for significant stenosis [Exp(B) 3.960, 95% CI 2.014-7.786]. Our findings suggest that significant coronary stenosis is associated with significantly increased AS and successful PCI improves AS to some extent.

Effects of Critical Thinking Strategy Training on Male/Female EFL Learners’ Reading Comprehension

The development of critical thinking (CT) skills has become a key goal for educators in first and second language contexts. There is evidence that the use of such activities has still not become widespread in a number of ELT situations. One reason for this may be lack of awareness about how levels of thinking can be conceptualized in ELT activities. This paper will report on a program designed by the authors at a university in Iran, which used taxonomy of CT skills drawn up by Facione (1990) to probe the effect of critical thinking strategies training on reading comprehension of Iranian EFL students. In so doing, 240 male and female Iranian EFL students were selected and screened into two proficiency levels based on the TOEFL tests. Each proficiency group was divided into critical and non-critical group. The results suggested CT skills significantly affected EFL learners’ reading comprehension performance. However, the effect of critical thinking strategy training didn’t vary across different language proficiency levels. Overall, the findings provide empirical support for the facilitative effect of critical thinking strategy training on reading comprehension performance of EFL learners.

Application of score for neonatal critical degree in transporting high risk infant

目的 通过应用新生儿危重病例评分评价新生儿转运的稳定性,指导转运工作,探讨安全转运的方法.方法 对2002年11月至2005年10月由我院出车转回至NICU并具备完整危重病例评分资料的110例患儿,按新生儿危重病例评分法于转运前、后两次评分,分析转运稳定性及其与预后的关系.结果 非危重组稳定性好,再评分值增加,(P＜0.05);极危重组相对稳定,两次评分无显著性差异,(P＞0.05);危重组稳定性差,再评分值下降,(P＜0.05).转运稳定性差直接影响了患儿预后.结论 基层医院运用新生儿危重病例评分法不仅可作为危重新生儿的转运指征,更有助于上级医院通过评价转运稳定性指导转运工作,使新生儿转运的各个环节更加科学完善,进入良性循环。

Relationship between angiotensin converting enzyme gene insertion/deletion polymorphism and the severe morbidity of neonates

目的 检测血管紧张素转化酶(angiotensin converting enzyme,ACE)基因型,探讨ACE基因插入或缺失多态性与新生儿危重症的关系.方法 451例新生儿分为:正常对照组116例,按新生儿危重病例评分标准将入NICU者于入院第1天分为非危重病组237例和危重病组98例.提取DNA进行基因分型.结果危重病组比正常对照组、非危重病组DD基因型频率高、Ⅱ基因型频率低.DD基因型危重病评分低于ID和Ⅱ(P＜0.01),ID和Ⅱ基因型间无差异(P＞0.05).DD基因型新生儿呼吸窘迫综合征发病率11.5%、新生儿湿肺发病率13.5%,需要呼吸机治疗者18.8%,高于ID+Ⅱ的3.9%、6.2%和8.7%,差异均有统计学意义(P均＜0.05).DD基因型发生代谢性酸中毒17.7%、低钠血症19.8%、低血糖症35.4%,高于ID+Ⅱ的8.4%、11.5%和23.4%,差异均有统计学意义(P均＜0.05).247例早产儿中,发生动脉导管未闭DD基因型21.6%,高于ID+Ⅱ的9.7%(P＜0.05).结论 ACE基因插入或缺失多态性与新生儿危重症有相关性.DD基因型患儿病情相对重,心肺功能适应性相对差。

Power system transient stability using individual machine energy functions

Recent efforts to apply direct methods of transient stability analysis to multimachine power systems have used the so-called "energy functions." These functions describe the system transient energy causing the synchronous generators to depart from the initial equilibrium state, and the power network's ability to absorb this energy so that the synchronous machines may reach a new post-disturbance equilibrium state. Recent results have shown that not all the transient energy contributes to system separation. Indeed it has become increasingly evident that system separation depends on the energy of certain individual machines or groups of machines, which comprise the critical group, and which tend to separate from the rest of the machines (which make up the noncritical group). Thus there is a need for generating energy functions for individual machines (or for groups of machines). Using a center of inertia frame of reference, the energy function <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">V_{i}</tex> for machine <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">i</tex> is derived. A procedure for first swing transient stability assessment is developed using the energy function of individual machines and groups of machines. The method is tested extensively on two realistic power networks (the 20-generator IEEE System and the 17-generator reduced Iowa System). An analytical justification for using the critical energy of individual machines in stability assessment is provided using an invariance principle for ordinary differential equations. Power system transient stability is analyzed using the energy function of the critical group of machines. This energy function is dependent on all state variables of the power system, and satisfies the hypotheses of the invariance theorem of La Salle, enabling us to deduce the asymptotic stability of the post-disturbance equilibrium of the entire power system. It also enables us to obtain an estimate of the domain of attraction of this equilibrium of the entire power system. The methodology advanced herein, which combines computer-aided techniques with analytical tools, yields less conservative results than were obtained in previous works that used total system energy. It is to be noted that the present results are preliminary in the sense that the mechanism of separation of the critical group of machines from the rest of the system needs further investigation.