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  • Author: Tong-Sheng Wang x
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Tong-Sheng Wang, Xiu-Li Su, Yi-Min Mao and Yu-Xia Sun

Abstract

Background: Despite important advances in the diagnosis and treatment of acute pulmonary embolism (APE), diagnosis of pulmonary embolism (PE) is difficult in patients with chronic obstructive pulmonary disease (COPD) and exacerbation.

Objective: We evaluated PE in patients with chronic obstructive pulmonary disease and exacerbations of unknown origin.

Methods: Two-hundred and eight patients with COPD and severe exacerbations were studied. All patients had CT pulmonary angiography (CTPA) and lower limb ultrasonography. Arterial blood gas measurements, D-dimers and endothelin-1 (ET-1) levels were recorded.

Results: The frequency of PE was 33%. The following were more common in the PE group (χ2 = 4.32-6.79, mean p < 0.05): immobilization ≥ 7 days; a ≥ 1 cm difference in edema of the lower limbs; deep venous thrombosis; syncope; S1Q3T3 syndrome; and a decrease in PaCO2 ≥ 5 mm Hg. Plasma D-dimers and ET-1 levels were significantly higher in the PE group. Risk factors identified from logistic regression analysis were immobilization ≥ 7 days, ≥ 1 cm difference in lower limb edema, and deep venous thrombosis.

Conclusions: Overall, 33% of 208 patients had a PE, and the risk was greater in those who had been immobilized, those who had a ≥ 1 cm difference in edema of the lower limbs, and those who had a deep venous thrombosis.

Open access

Wang Hong, Qi-Sheng Liang, Lan-Ren Cheng, Xiao-Hong Li, Fu Wei, Wen-Tao Dai and Shi-Tong Li

Abstract

Background: Rocuronium is an alternative to succinylcholine for rapid tracheal intubation after major thermal injury and other forms of critical illness that cause denervation changes in skeletal muscle. Rocuronium may decrease the potencies of non-depolarizing muscle relaxants.

Objectives: Examine whether potency of rocuronium changed during the first month after denervation, and investigate the effects of skeletal muscle denervation on potency of rocuronium.

Methods: The denervation mouse model was developed to create denervated individual cells from the flexor digitorum brevis of the hindfoot. The skeletal muscle cells were examined at day 0 in the innervated control and days 1, 4, 7, 14, 21, and 28 in the denervation group. Nicotinic acetylcholine receptors in the cells were activated with 30 M acetylcholine, alone or in combination with various concentrations of rocuronium. Currents were recorded with a whole-cell patch-clamp technique.

Results: Rocuronium reversibly inhibited acetylcholine-activated currents in a dose-dependent fashion at different times after denervation. The inhibition concentration for the half-maximal responses of rocuronium increased 1.2- (p >0.05), 1.8-, 2.8-, 2.3-, 2.1-, and 1.9-fold (p <0.01) at day 1, 4, 7, 14, 21, and 28 after denervation, respectively, compared to that at day 0 after denervation.

Conclusion: Rocuronium dose required to achieve satisfactory clinical effects changed at different durations after skeletal muscle denervation.