Objective To investigate the effects of repetitive transcranial magnetic stimulation(rTMS)on cognitive function and intestinal microflora in maintenance hemodialysis(MHD)patients with subjective cognitive decline(SCD).Methods 33 MHD patients with SCD at the First Affiliated Hospital of Xian Jiaotong University from July 2022 to July 2023 were selected and randomly assigned to an intervention group(rTMS group)and a sham stimulation group(Sham group)in a 1:1 ratio.The cognitive function and 16srRNA bioinformatics analysis of fecal DNA samples before and after the intervention were compared between two groups.Results After intervention,the MMSE score of the rTMS group was significantly higher than that of the Sham group(P=0.037),mainly due to differences in recall ability dimensions(P=0.039).After intervention,the SCD-Q9 score in the rTMS group was significantly lower than that in the Sham group(P=0.018),mainly due to differences in daily activity memory ability(P=0.037).After intervention,there was no significant difference in α-diversity and β-diversity between the two groups.After the intervention,the top five bacte-rial family in both groups all were Bacteroidaceae、Lachnospiraceae、Enterobacteriaceae、Ruminococcaceae、Prevotellaceae,accounting for about more than 75％.The top five bacterial genus in both groups all were Bacteroides、Escherichia-Shigel-la、Faecalibacterium、Prevotella、Roseburia,accounting for about more than 50％.LEfSe analysis was used to screen for the main differential microbiota.At the family level,there were 5 different microbiota among them,Marinifilaceae,Fla-vobacteraceae,RF39,Carnobacteriaceae were more abundant in the rTMS group,and Wohlfahrtiimondaceae was more a-bundant in the Sham group.There were 17 different microbiota at the genus level,with higher abundance of Faecalibacte-rium,and Odoribacter in the rTMS group,and higher abundance of Erysipelatoclostridium in the Sham group.Conclusion rTMS therapy may alter the cognitive function of MHD patients with SCD,enhance their memory ability,and regulate the differential microbiota associated with SCD,suggesting that this treatment may affect cognitive function during SCD by regulating the microbiota.
Objective To explore the risk factors of ptosis in patients with cataract(CAT)after phacoemulsifica-tion(PHACO)combined with intraocular lens implantation(ILI)surgery.Methods Monocular CAT patients(216 ca-ses,216 eyes)who underwent PHACO and ILI in our hospital from June 2018 to November 2021 were selected as the re-search subjects.The clinical efficacy of the surgery was analyzed.According to the occurrence of ptosis after surgery,they were divided into a ptosis group(54 cases)and a non-ptosis group(162 cases).The clinical data and surgery-related indicators of the two groups were compared and analyzed.Multivariate Logistic regression analysis was performed to ana-lyze the risk factors for postoperative ptosis,and a risk scoring model was established to evaluate the model.Results Compared with before operation,the best corrected visual acuity,intraocular pressure,anterior chamber depth and anterior cham-ber angle opening of CAT patients after PHACO combined with ILI surgery were significantly improved(P<0.05).The results of multivariate Logistic regression analysis showed that age(70 years old,peribulbar anesthesia,7-gauge an-esthesia injection needle,adrenalin mixed in anesthesia,the use of superior rectus traction line during operation,and the use of eyelid opener during operation were all independent risk factors for postoperative ptosis(P<0.05).Scores are weighted according to the regression coefficient β,and X-tile software is used to obtain the score cutoff value,and the risk scoring model divides patients with postoperative ptosis into three groups:low-risk(≤81 points),intermediate-risk(>81 points and(112 points)and high-risk groups(>112 points).The model evaluation results show that the risk sco-ring model has good discrimination,accuracy and validity,and is safe,reliable and practical.Conclusion PHACO com-bined with ILI surgery can effectively improve the condition of CAT patients.Age(70 years old),peribulbar anesthesia,7-gauge anesthesia injection needle,epinephrine mixed in anesthesia,intraoperative use of superior rectus traction line,and intraoperative use of eyelid opener are all independent risk factors for postoperative ptosis.
Objective To investigate the chromosomal characteristics of children with global developmental delay(GDD)and analyze the influencing factors of prognosis of children.Methods 181 children with GDD admitted to Chil-dren's Hospital of Hebei Province from January 2018 to May 2021 were selected as the research subjects.All the chil-dren received whole exome sequencing+copy number variations(CNVs)detection,and their chromosomes were ana-lyzed.All children were followed up for 1 year,and were divided into poor prognosis group and good prognosis group ac-cording to their prognosis.The baseline data of children in the two groups were compared to analyze the influencing fac-tors of prognosis of GDD children.Results CNVs were detected in 59 of 181 children with GDD.The detection rate was 32.60%.Among them,the pathogenic CNVs were 25.41%,the probable pathogenic CNVs were 5.52%,the clinically unknown CNVs were 1.66%,and the benign CNVs were 67.40%.After 1 year follow-up,142(78.45%)of 181 chil-dren had poor prognosis after treatment.The age of first diagnosis in the poor prognosis group was higher than that in the good prognosis group,and the proportion of neonatal jaundice,premature delivery and neonatal hypoxic ischemic en-cephalopathy(HIE).The pathogenic CNVs in the poor prognosis group was higher than that in the good prognosis group,the difference was statistically significant(P<0.05).There was no statistical significant difference in other base-line data between groups(P>0.05).Through Logistic regression analysis,the results showed that,old age at first di-agnosis,neonatal jaundice,premature delivery,HIE and pathogenic CNVs were the risk factors for poor prognosis in children with GDD(OR>1,P<0.05).Conclusion Chromosomal analysis by whole exome sequencing+CNVs can i-dentify the genetic etiology of GDD children,and the possible risk factors for the prognosis of GDD children are age at first diagnosis,neonatal jaundice,preterm birth,HIE and pathogenic CNVs.
Objective To explore the correlation between nuclear magnetic resonance(MRI)perfusion parameters and collagen V(Type V collagen 2 chain,COL5A2),galectin-Galactoside lectin-3(Galectin-3)and the diagnostic value of esophageal cancer.Methods A total of 100 patients with suspected esophageal cancer admitted to our hospital from December 2020 to December 2021 were selected.With endoscopic and biopsy pathological examination as the gold stand-ard,55 patients with esophageal cancer were finally diagnosed as the observation group,and the other 45 patients with esophagitis lesions were the control group.All patients underwent magnetic resonance imaging and the levels of COL5A2 and Galectin-3 were determined.MRI perfusion parameters of the two groups were compared.The correlation between MRI perfusion parameters and tumor markers in patients with esophageal cancer was analyzed,and the diagnostic value of MRI perfusion parameters for esophageal cancer was analyzed.Results Compared to the benign group,levels of Ktrans,Kep and Ve were higher in the malignant group(P<0.05).In contrast to patients with stage Ⅰ-Ⅱ oesophageal cancer,patients with Ktrans,Kep,and Ve levels were higher in stage Ⅲ and oesophageal cancer(P<0.05).In contrast to patients with stage Ⅰ-Ⅱ oesophageal cancer,higher levels of COL5 A2 and Galectin-3 in Ⅲ and stage esophageal cancer were higher(P<0.05);Ktrans,Kep,Ve,COL5A2,and Galectin-3 in oesophageal cancer patients were all positively associated with disease stage(P<0.05).Ktrans,Kep,and Ve were all positively correlated with COL5A2 and Galectin-3 levels(P<0.05).In contrast to the single diagnosis of magnetic resonance imaging,COL5A2、Galectin-3,combined diagnosis had a high predictive value for oesophageal cancer(P<0.05).Conclusion MRI perfusion parameters have some correlation with COL5A2 and Galectin-3 in esophageal cancer patients,and have certain diagnostic value for patients of different sta-ges.
Objective To investigate the role of urotoxin Indoxyl sulfate(IS)in inducing oxidative stress and fibro-sis factors in HK-2 cells through organic anion transporter-3(OAT-3).Methods Human normal renal tubular epithelial(HK-2)cells were subcultured.After cells grown with 80%～90%density,the experiment was divided into control group(Control)and IS treatment group(IS)cultured with 250 μmol of IS for 24h.At the same time,the expression of OAT-3 was further silenced with small interfering RNA(siRNA).RT-PCR and western blot was performed to analyze the mRNA and protein levels of oxidative stress(Nox-4)and fibrosis factors(CollagenI,TGF-β1,Smad-3,α-SMA).Fi-nally,HK-2 cells were pre-treated with antioxidant N-acetylcysteine(NAC)and stimulated with 250 μmol of IS for 24 h.Results RT-PCR results showed that after HK-2 cells were stimulated with IS of 250 μ mol for 24h,IS significantly increased oxidative stress(Nox-4)and fibrosis factors(Collagen I,TGF-β1,Smad-3,α-SMA)in HK-2 cells(P<0.01).After OAT-3 silenced by siRNA in HK-2 cells,the mRNA and protein expression levels of oxidative stress and fibrosis factors induced by IS were significantly decreased(P<0.001).It is suggested that IS can induce their high expression through OAT-3.After HK-2 cells were pretreated with N-acetylcysteine(NAC)and stimulated with IS for 24h,it was found that NAC effectively inhibited IS induced mRNA and protein high expressions of Nox-4,Collagen I,TGF-β1,Smad-3,and α-SMA(p<0.01),showed that IS promoted the high expression of fibrosis factors in HK-2 cells through the high expression of oxidative stress.Conclusion IS uptaken by OAT-3 in HK-2 cells induces high expressions of oxi-dative stress and fibrosis factors.
Objective To analyze the changes of estrogens before and after artificial cycle frozen embryo transfer(FET)and their relationship with treatment outcomes.Methods A total of 105 patients undergoing artificial cycle FET were enrolled from January 2021 to January 2022.According to pregnancy outcomes after treatment,they were divided into pregnancy group(47 cases)and non-pregnancy group(58 cases).Before and after FET,levels of estrogen[estradiol(E2),progesterone(P)]and endometrial blood flow parameters were detected.The predictive efficiency of estrogens for pregnancy outcomes was evaluated by ROC curves.The relationship between estrogens and endometrial blood flow pa-rameters was analyzed by Pearson correlation analysis.Results The levels of serum E2 and P in pregnancy group were significantly higher than those in non-pregnancy group(P<0.05).After FET,there was no significant difference in VI between the two groups(P>0.05),but FI and VFI in pregnancy group were significantly higher than those in non-preg-nancy group(P<0.05).AUC of E2 at 7d after FET for predicting pregnancy outcomes was 0.929,significantly better than that before FET(0.860)and at 14d after FET(0.839)(P<0.05).AUC of P at 7d after FET for predicting preg-nancy outcomes was 0.793,without significant difference compared with that before FET(0.823)and at 14d after FET(0.746)(P>0.05).The levels of serum E2 and P at 7d after FET were negatively correlated with uterine VI level at 1d after FET,while positively correlated with FI and VFI levels(P<0.05).Conclusion The levels of estrogens signifi-cantly increase after artificial cycle FET.Serum E2 and P have good predictive value for pregnancy outcomes.
Objective To investigate the epidemiology and mutation characteristics of pres/s gene in patients with hepatitis B virus(HBV)infection with double positive HBsAg and anti HBS(anti HBS)in Kunming area.Methods From May 2018 to April 2022,438 patients with chronic HBV infection who quantitatively detected two and a half pairs of hepatitis B in our hospital and outpatient department were selected as the research objects.202 HBsAg(+)/anti HBS(+)double positive patients were taken as the experimental group,and 236 HBsAg(+)/anti HBS(-)patients were taken as the control group.The difference of clinical data between the two groups were analyzed.The full-length se-quence of pres/s gene was amplified by nested polymerase chain reaction,and the genotype was determined and the muta-tion characteristics of pres/s gene were analyzed.Results The prevalence rate of patients in the experimental group is higher in the population aged<10 and above 80,while the prevalence rate of patients in the control group is higher in the population aged 20-49.Compared with the control group,the age of patients in the experimental group,the propor-tion of HBsAg<250iu/ml,the infection of type C HBV and the proportion of hepatitis B carriers were significantly in-creased(P<0.05).A total of 132 HBsAg(+)/anti HBS(+)samples were successfully amplified and sequenced,in-cluding 81 B-type genes and 51 C-type genes;In HBsAg(+)/anti HBS(-)samples,there were 110 cases of B-type gene and 65 cases of C-type gene.In patients with type B gene,the mutation rate of N-terminal region in double positive group was significantly higher than that in single positive group(P<0.05).In patients with type C gene,compared with the single positive group,the mutation rates of MHR,a determinant and N-terminal region in the double positive group were significantly increased(P<0.05).Among 81 patients with type B gene,14(17.28%)had deletion mutation of pres gene,and 19(37.25%)had deletion mutation of pres gene in 51 patients with type C gene,but no deletion mutation of pres gene was found in the single positive group.Conclusion HBsAg/anti HBS double positive HBV infection is common in HBsAg positive people aged<10 and above 80.The rates of HBsAg mutation and PreS gene deletion muta-tion in double positive patients were higher than those in single positive patients,suggesting that double positive HBsAg/anti HBs may be related to HBsAg mutation and PreS gene mutation.
Objective To explore the high-risk factors of renal injury after treatment of acute paraquat poisoning and establish a prediction model of prognostic risk and provide data reference for determining the high-risk factors of renal injury after treatment of acute paraquat poisoning and predicting the prognostic effect.Methods The clinical data of 200 patients hospitalized in Guangzhou 12th people's hospital due to acute paraquat from September 2017 to April 2021 were studied.The patients were divided into groups according to whether they had acute renal injury during the course of treat-ment.The general sociological data,clinical indicators,disease history,epidemiological data of the two groups were compared and analyzed.Clinical data such as imaging examination were included in univariate and multivariate logistic re-gression analysis to explore its high-risk factors.The statistically significant indexes in the results of multivariate logistic regression analysis were included in the nomogram to establish the prediction and early warning model of prognostic effect.Results Among 200 patients with acute paraquat poisoning,154 patients had acute renal injury,and the incidence was 77.00%.Among the patients with acute renal injury,41 cases had a good prognosis,accounting for 26.62%,and 113 cases had a poor prognosis,accounting for 73.37%.Multivariate logistic regression analysis showed that age(OR= 3.547,95%CI:2.108～9.723),paraquat dose(OR=12.425,95%CI:5.294～19.837),time from poisoning to ad-mission(OR=8.659,95%CI:4.123～12.346),Apache Ⅱ(OR=4.821,95%CI:2.163～9.825),complicated with serious diseases(OR=8.518,95%CI:3.327～11.637),plasma lactic acid(OR=2.225,95%CI:1.037～4.338)pa-tients with acidosis(OR=3.634,95%CI:2.317～10.527)and ion disorder(OR=3.725,95%CI:1.525～8.658)were more likely to have poor prognosis of renal injury.Treatment measures should be taken to ensure the prognostic effect.Hemoglobin(OR=0.753,95%CI:0.418～0.939)was a protective factor for the prognosis of renal injury caused by acute paraquat poisoning.Conclusion Among the patients with renal injury after acute paraquat poisoning,the elderly and AKI patients with serious diseases has a poor prognosis.Higher dosage,later medical treatment time are in-dependent risk factors for the poor prognosis of AKI patients after acute paraquat poisoning.Hemoglobin is a protective factor for the prognosis of AKI patients.Early detection and treatment are helpful to improve the prognosis.
Objective To investigate the dynamic changes of blood lactate(Lac),cardiac troponin I(cTnI),cardi-ac troponin T(cTnT)and coagulation indexes in patients with sepsis and their relationship with disease severity and sur-vival.Methods 129 patients with sepsis who were treated in our hospital from March 2019 to March 2022 were retro-spectively selected.They were divided into the two groups according to whether shock occurred within 24 hours after ad-mission.48 patients with shock were septic shock group,and 81 patients without shock were septic shock group.The peripheral blood Lac,cTnI,cTnT,activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT)and fibrinogen(Fib)were examined.Results The scores of Lac,cTnI,cTnT,APTT,PT,TT and A-PACHE Ⅱ in the septic shock group were(9.10±1.08)mmol/L,(10.40±1.18)μ g/L,(11.18±1.72)μ g/L,(41.58±6.03)s,(16.30±2.18)s,(20.50±2.71)s and(17.05±2.50)respectively,which were significantly higher than those in the sepsis group(P<0.05),while the Fib was(2.51±0.81)g/L,which was significantly lower than that in the sepsis group(P<0.05).Lac,cTnI,cTnT,APTT,PT,TT were positively correlated with APACHE Ⅱ score(P<0.05),while Fib was positively correlated with APACHE Ⅱ score(P<0.05).Lac,cTnI,cTnT,APTT,PT and TT in septic shock and sepsis patients at 24h and 72h after treatment were significantly higher than those before treat-ment(P<0.05),while Fib was significantly lower than those before treatment(P<0.05).The changes of Lac,cTnI,cTnT,APTT,PT,TT and Fib in dead patients with septic shock before and after treatment were significantly higher than those in survivors(P<0.05).The area under the ROC curve of predicting death in septic shock patients by the change values of Lac,cTnI,cTnT,PT,TT and Fib before and after treatment in septic shock patients was 0.940,0.684,0.688,0.724,0.726 and 0.690,respectively(P<0.05).Conclusion The more serious the sepsis patients are,the worse their blood lactic acid,troponin and blood coagulation indicators are,and the indicators continued to worsen be-fore and after treatment.The changes of blood lactic acid,troponin and coagulation indexes before and after treatment have certain application value in predicting the prognosis of septic shock patients.
Objective To explore the value of coronary CT angiography(CCTA)quantitative evaluation of myo-cardial bridge(MB)on the degree of mural coronary artery compression.Methods The clinical data of patients with MB confirmed by CCTA in the hospital from August 2017 to March 2022 were retrospectively collected.The differences in general data,left anterior descending artery(LAD),transluminal attenuation gradient(TAG),TAG corrected value(TAGs),mural coronary artery(MCA)-contrast opacification difference(MCA-COD)and MB depth and length were detected and compared among patients with different degrees of systolic compression(no compression group,mild com-pression group,significant compression group).Receiver operating characteristic(ROC)curve was used to analyze the efficiency of TAGs and MCA-COD on quantitatively evaluating MB significant systolic compression.Results From the aspects of general data,there were no statistical differences in gender,age,clinical symptoms,and high-risk factors a-mong no compression group,mild compression group and significant compression group(P>0.05).Comparisons of CCTA parameters showed that the TAG and TAGs of patients with MB were successively reduced with the increase of degree of systolic compression while the MCA-COD was enhanced in turn,and the TAG,TAGs,and MCA-COD were significantly different among different groups(P<0.05),but the differences in MB depth and MB length among the dif-ferent groups were not statistically significant(P>0.05).In terms of efficiency of TAG-related parameters in the quantitative evaluation of MB significant systolic compression,ROC curve results showed that the AUCs of TAGs and MCA-COD on quanti-tatively evaluating the significant systolic compression of MB were 0.844 and 0.815(P<0.05),the AUC of the combination of the two was 0.935(P<0.05),and the combined evaluation had higher efficiency.Conclusion CCTA can be used to quantita-tively evaluate the degree of systolic compression in patients with MB,and the combined evaluation with TAGs and MCA-COD has high efficiency on the significant systolic compression of MB,which can provide more accurate guidance for clinical diagnosis.
Objective To explore the molecular mechanism of Camellia japonica flower extract in inhibiting the proliferation,migration and invasion of glioma cell line SW1088 through regulating the expression of miR-526b-3p and in-hibiting phosphatidylinositol 3 kinase(PI3K)/protein kinase B(AKT)signaling pathway.Methods Logarithmic SW1088 cells were collected and treated with 30,60 and 120 mg/L camellia japonica flower extract.The cells were clas-sified as low-dose group,medium-dose group and high-dose group,and normal culture SW1088 cells were used as control group.SW1088 cells were divided into miR-NC group,miR-526b-3p group,anti-miR-NC+high-dose group and anti-miR-526b-3p+high-dose group.MTT,Transwell and Western blot were used to detect cell proliferation activity,migra-tion and invasion,respectively.The protein expression levels of CyclinD1,matrix metalloproteinases 2(MMP2),matrix metalloproteinases 9(MMP9),phosphorylated PI3K(p-PI3K),and phosphorylated AKT(p-AKT)were measured.qRT-PCR was used to detect the relative expression of miR-526b-3p.Results Camellia japonica flower extract or overex-pression of miR-526b-3p could reduce the proliferation activity of glioma cells SW1088,and reduce the number of cell mi-gration and invasion,as well as the protein levels of CyclinD1,MMP2 and MMP9,and increase the relative expression level of miR-526b-3p.In addition,the levels of p-PI3K and p-AKT protein in SW1088 cells were decreased in the high-dose group.Inhibition of miR-526b-3p could weaken the effects of camellia japonica flower extract on proliferation,mi-gration and invasion of glioma cells SW1088 and PI3K/AKT signaling pathway.Conclusion Camellia japonica flower ex-tract may inhibit the proliferation,migration and invasion of glioma cell line SW1088 by regulating miR-526b-3p/PI3K/AKT signaling pathway.
Objective To investigate the influences of propofol on cognitive impairment,nuclear factor E2-related factor 2(Nrf2)pathway and receptor for advanced glycation end product/nuclear factor-κB(RAGE/NF-κB)signaling pathway in rats with Parkinson's disease(PD).Methods PD rat model was established by intraperitoneal injection of MPTP.The rats were divided into control group(Control group),model group(PD group),low and high dose propofol treatment groups(Propofol-L group,Propofol-H group,25 and 50 mg/kg propofol intraperitoneal injection),according to the method of random number table.Morris water maze test and Y-maze test were performed to detect cognitive func-tion in rats.HE staining was used to observe the pathological changes in the substantia nigra.The levels of oxidative stress factors and inflammatory factors and the protein expressions of tyrosine hydroxylase(TH),RAGE,p-NF-κB p65,Nrf2 and HO-1 in the substantia nigra were detected.Results Compared with the control group,the escape latency of the PD group increased,the percentage of residence time in the target quadrant,the number of crossing the target quad-rant,and the rate of spontaneous alternation were significantly reduced(P<0.05),the pathological changes occurred in brain tissue,the MDA activity,the levels of TNF-α and IL-1β,and the protein expressions of RAGE,p-NF-κB p65 in the substantia nigra were significantly increased,and the activities CAT of SOD and the protein expressions of TH,Nrf2 and HO-1 were significantly decreased(P<0.05).Compared with PD group,the escape latency of rats in Propofo-L and Propofo-H groups was decreased,the percentage of retention time in the target quadrant,the number of crossing the target quadrant and the spontaneous alternations rate were increased significantly(P<0.05),and the lesions of brain tis-sue were reduced.MDA activity,TNF-α and IL-1β levels,RAGE and P-NF-κB p65 protein expression were significantly decreased in the substantia nigra,while CAT and SOD activities and TH,Nrf2 and HO-1 protein expressions were sig-nificantly increased in a dose-dependent manner(P<0.05).Conclusion Propofol can improve cognitive impairment in PD rats,and its mechanism may be related to the activation of Nrf2 signaling pathway and the inhibition of RAGE/NF-κB signaling pathway.
Coronavirus disease 2019(COVID-19)caused a global pandemic and high mortality in the last 3 years.Venous thromboembolism(VTE)was common complication in patients with COVID-19.SARS-CoV-2 infection caused cytokine release,immunocytes activation,and procoagulation cascade activation.These contributed to endothelialitis and vascular injury,and affected the coagulation system and caused coagulopathy.Studies have observed that antithrombotic treament in patients with COVID-19 might decrease ratio of organ support and improve survival.However,the optimal regimens,dosage,and duration of anticoagulation for COVID-19 remains unclear.Therapeutic dose anticoagulation was recommended in non-critically ill patients with COVID-19 who have low risk of bleeding according to recent guidelines.As risk of VTE was more complicated in critically ill patients with COVID-19,anticoagulation treatment was more chal-lenging in these patients.At the early stage of COVID-19,increased anticoagulation intensity was recommended.How-ever,no confirmative evidence of the benefit of therapeutic anticoagulation for critically ill patients with COVID-19 has been found.Emerging clinical trials have suggested that therapeutic dose anticoagulation was not superior to standard-dose anticoagulation.In this review,we summarize new insights into the risk factors,mechanisms,and use of anticoagu-lants in patients with COVID-19.
Objective To observe the effect of Tanreqing combined with methylprednisolone on children with se-vere mycoplasma pneumonia(SMPP)and the effect of T lymphocyte subsets.Methods 112 children with SMPP in our hospital were randomly divided into the two groups.The control group(n=56)was treated with methylprednisolone,meanwhile,the observation group(n=56)was additionally administered Tanreqing.The efficacy(each time index)and the safety of the two groups were compared.The T cell subsets before and after treatment were analyzed.Results The effective rate of observation group(94.64%)was significantly different from that of control group(75.0%)(P<0.01).The time of fever reduction(5.24±1.53)d,cough disappearance(6.97±3.26)d,lung rales subside(5.83±1.39)d and lung shadow disappearance(7.93±2.46)d in the observation group were significantly shortened compared with the con-trol group(6.87±2.15)d,(9.79±3.73)d,(7.79±1.46)d,(11.04±4.82)d,with statistically significant difference(P<0.01).The CD3+,CD4+ and CD4+/CD8+ in the two groups were higher than those before treatment,but CD8+ was lower.The indexes of the observation group were(39.21±9.56)%,(34.28±6.43)%,(1.45±0.57)%,and compared with the control group(6.87±2.15)d,(9.79±3.73)d,(7.79±1.46)d,(11.04±4.82)d,the index changes were more prominent,with statistically significant difference(P<0.05).Moreover,there was no difference in adverse reactions in both groups(P>0.05).Conclusion Tanreqing combined with methylprednisolone significantly improves the clinical ef-ficacy of SMPP in children,and effectively improves the cellular immune function of children.
Objective To investigate the value of IVC-CI and NT-proBNP in fluid management of elderly patients with septic shock.Methods 103 patients with septic shock treated in the emergency department of Huangpu branch of the Ninth People's Hospital Affiliated to the Medical College of Shanghai Jiaotong University from June 2020 to Decem-ber 2021 were prospectively selected as the research objects.All the enrolled patients were treated as early as possible ac-cording to the 2018 International Sepsis cluster treatment guidelines,and the early curative effect was evaluated 6 hours later.Patients were divided into standard group and non-standard group according to whether they reached the recovery goal.The clinical data,severity score,rehydration volume,inferior vena cava related parameters,respiratory parameters and hemodynamic indexes of the two groups were compared.The diagnostic value of IVC-CI in reaching the standard of fluid resuscitation in elderly patients with septic shock was analyzed by ROC curve.Results The course of disease in the substandard group was significantly longer than that in the substandard group(P<0.05),but there was no significant difference between the two groups in the use time of vasoactive drugs and the type of rehydration(P>0.05).After treatment,the Apache Ⅱ score of patients in the standard group was significantly lower than that in the non-standard group,and the values of 24h fluid intake,24h urine volume,minimum inspiratory end vena cava diameter(IVCmin),maximum expiratory end vena cava diameter(IVCmax),minimum diameter of inferior vena cava(IVCi),maximum diam-eter of inferior vena cava(IVCe)were significantly higher than those in the non-standard group.The heart rate was sig-nificantly lower than that in the non-standard group(P<0.05).The lactate clearance rate,mean arterial pressure(map)and central venous pressure(CVP)in the standard group were significantly higher than those in the non-standard group(P<0.05).The area of ROC curve for the diagnosis of fluid resuscitation in elderly septic shock patients by CVP was 0.804(95%CI:0.727～0.881,P<0.001),the critical value was 7.92 mmHg,the sensitivity was 72.36%,and the specificity was 69.47%.The ROC curve area of IVC-CI in diagnosis of elderly septic shock patients with fluid resuscita-tion reaching the standard was 0.873(95%CI:0.816～0.932,P<0.001),the critical value was 19.11%,the sensi-tivity was 79.17%,and the specificity was 70.83%.The ROC curve area of NT proBNP in diagnosing the elderly septic shock patients with fluid resuscitation reaching the standard was 0.889(95%CI:0.831～0.946,P<0.05),the critical value was 961.24 pg/ml,the sensitivity was 84.72%,and the specificity was 74.22%.The area of the ROC curve of CVP+IVC-CI+NT proBNP in the diagnosis of elderly septic shock patients with fluid resuscitation reaching the standard was 0.923(95%CI:0.877～0.994,P<0.05),the sensitivity was 87.52%,and the specificity was 76.39%.The ROC curve area of CVP+IVC-CI+NT proBNP was significantly higher than that of CVP,IVC-CI and NT proBNP alone(P<0.05).Conclusion After treatment,CVP,IVC-CI,NT-proBNP as a bedside,non-invasive examination means,are safe and effective.They can reflect the change of volume status before and after liquid therapy,help improve the pa-tient's respiratory parameters and hemodynamic indicators,and have good predictive effect and high sensitivity on the elderly septic shock patients'fluid resuscitation.
Objective To explore the effects of dexamethasone on silent information regulator 1(SIRT1)/nuclear factor(NF)-κB signaling pathways in rats undergoing isoflurane anesthesia.Methods A total of 40 SD rats were ran-domly divided into Sham group(no treatment),ISO group(inhalation of 1.4%isoflurane for 4h),5 Dex Iso group(in-traperitoneal injection of 5 mg/kg dexamethasone at 30 minutes before isoflurane inhalation)and 10 Dex Iso group(intra-peritoneal injection of 10 mg/kg dexamethasone at 30 minutes before isoflurane inhalation).The cognitive function of rats was evaluated by Morris water maze test and object position recognition test.The morphological changes of hippocampus were observed by HE staining.The apoptosis of neurons in hippocampus was observed by TUNEL staining.The levels of interleukin-6(IL-6),IL-1β and tumor necrosis factor α(TNF-α)in hippocampus were detected by ELISA.The ex-pressions of cysteine proteinase-3(caspase-3),caspase-9,SIRT1,NF-κB,phosphorylated(p)-NF-κB and NF-κB inhibi-tory protein(IκBα)were detected by Western blot.Results Compared with Sham group,escape latency and object memory time were prolonged on the 3rd-5th day were prolonged,the times of crossing the original platform were reduced,apoptosis rate of hippocampus neurons,the relative expression levels of caspase-3 and caspase-9,and levels of IL-6,IL-1β,TNF-α and p-NF-κB/NF-κB were significantly increased,and expression levels of SIRT1 and IκBα were significantly decreased in ISO group(P<0.05).Compared with ISO group,the escape latency and object memory time were short-ened on the 4rd-5th day,times of crossing the original platform were increased,the apoptosis rate of hippocampus neu-rons,the relative expression levels of caspase-3 and caspase-9,and the levels of IL-6,IL-1β,TNF-α and p-NF-κB/NF-κB were significantly decreased,and the expression levels of SIRT1 and IκBα were significantly increased in 10 Dex Iso group(P<0.05).Conclusion Dexamethasone can improve cognitive dysfunction induced by isoflurane anesthesia and reduce neurons apoptosis in rats,which may be related to regulating SIRT1/NF-κB signaling pathways.
Objective To explore and analyze the correlation between vasoactive intestinal peptide and bone metab-olism and osteoporosis in elderly type 2 diabetic patients.Methods We selected 86 elderly patients with type 2 diabetes who were admitted to our hospital from February 2020 to February 2021.A dual-energy X-ray bone densitometer was used to measure the bone mineral density of the patients,and the patients were divided into type 2 diabetes mellitus com-bined with osteoporosis group 35 cases,type 2 diabetes mellitus combined with osteopenia group 30 cases,and type 2 di-abetes bone mass according to their bone density.There were 21 cases in the normal group.Enzyme-linked immunosor-bent assay was used to determine the level of vasoactive intestinal peptide in the patient's serum,and analyze the rela-tionship between changes in the level and bone metabolism and osteoporosis.Results The levels of vasoactive intestinal peptide,lumbar bone mineral density,femoral neck bone mineral density and PINP in the osteoporosis group and the os-teopenia group were significantly lower than those in the normal bone mass group,while the levels of CTX were signifi-cantly higher than those in the normal bone mass group,and the differences between the groups were statistically signifi-cant(P<0.05).Pearson correlation analysis showed that vasoactive intestinal peptide was positively correlated with PINP(r=0.427,P<0.05)and negatively correlated with CTX(r=-0.369,P<0.05).Vasoactive intestinal peptide was positively correlated with femoral neck BMD(r=0.418,P<0.05).P<0.05),and had a positive correlation with lumbar bone mineral density(r=0.374,P<0.05).Multivariate Logistic regression analysis showed that femoral neck bone mineral density(OR=1.436,95%CI:1.07-1.923),lumbar spine bone mineral density(OR=1.608,95%CI:1.039-2.489),PINP(OR=1.696,95%CI:1.061-2.709),CTX(OR=1.598,95%CI:1.045-2.446),VIP(OR =1.694,95%CI:1.243-2.309)were independent risk factors for bone metabolism and osteoporosis in patients with type 2 diabetes mellitus(P<0.05).Conclusion Vasoactive intestinal peptide is positively correlated with osteoporosis in elderly type 2 diabetic patients,and negatively correlated with bone metabolism.Testing the level of vasoactive intesti-nal peptide can understand the bone mineral density and bone metabolism of type 2 diabetic patients,and then help bone quality Treatment and prevention of porosity.
Objective To study the clinical effect of molecular adsorption recirculating system in the treatment of septic liver failure.Methods The clinical data of 15 patients with septic liver failure treated with molecular adsorbent re-circulating system(MARS)or continuous hemodialysis filtration(CVVHDF)were retrospectively analyzed.All patients received anti-infection treatment including treatment for sepsis,basic diseases and complications.The patients were di-vided into MARS group and control group according to the treatment method of blood purification.9 patients in MARS group were treated with MARS for 25 times,with an average of 2.5 times per case.In the control group,6 patients were treated with CVVHDF 14 times,with an average of 2.3 times per patient.The changes of heart rate,mean arterial pres-sure,liver function,renal function,coagulation function,inflammatory factors and treatment effect were compared be-tween the two groups before and after treatment.Results After treatment,in MARS group,after stable heart rate(80.96±10.80 vs 89.29±13.44,P=0.041),mean arterial pressure(82.81±7.21 vs 76.64±10.06,P=0.032),bil-irubin(151.95±45.18 vs 183.41±38.69,P=0.035),inflammatory factor IL-6(55.59±29.90 vs 93.47±61.96,P =0.039),and tumor necrosis factor(TNF)were removed-α(19.92±7.54 vs 28.00±9.87,P=0.014)and interleu-kin-10(12.55±4.56 vs 19.00±10.08,P=0.038)were significantly superior to the control group.There was no sig-nificant difference between MARS group and control group in the clearance of blood ammonia,lactic acid,urea,creati-nine and other small molecular substances(P>0.05).There was no significant difference between MARS group and control group in the influence of coagulation function(platelet,PT-INR)(P>0.05).In terms of treatment effect,MARS group was better than the control group(64.00%vs 28.60%,P=0.034).Conclusion Compared with CVVH-DF,MARS treatment for septic liver failure has better hemodynamic stability and more comprehensive toxin clearance.It can not only remove protein-bound toxins,but also remove water-soluble small and medium molecular toxins.It is safe in coagulation and has better clinical efficacy.
Low back pain(LBP)is a common clinical symptom and one of the leading causes of disability and dys-function.Degenerative lesions account for the majority of the causes of LBP caused by bone and joint,among which in-tervertebral disc regression is the main trigger,and also involves the lesions of lumbar facet joints,sacroiliac joints,and coccyx.Treatment ranged from conservative to surgical,with pain relief as an outcome for most patients,but no struc-tural repair.In view of the regenerative repair potential of platelet-rich plasma(PRP)therapy and its wide clinical appli-cation,this article reviews the research related to PRP and LBP,aiming to explore the efficacy and safety of PRP in the treatment of LBP and related parameter indicators,and accelerate the progress of treatment.
Objective To observe the effect of ultrasound guided continuous femoral nerve block combined with single local infiltration anesthesia of hip joint capsule on the analgesia before hip replacement in the elderly and its influ-ence on stress indicators and pain mediators.Methods A total of 98 elderly patients who underwent hip replacement in our hospital from January 2018 to March 2022 were selected and divided into the two groups by random number method.The control group received a single local infiltration anesthesia of the hip joint capsule,while the observation group re-ceived ultrasound-guided continuous femoral nerve block combined with a single local infiltration anesthesia of the hip joint capsule.The surgical conditions(sensory block time,postoperative ambulation time,pain recovery time,etc.)were compared between the two groups,and the visual analog(VAS)score was used to evaluate the pain degree of the two groups at different times after the operation,and the two groups were recorded from 0 to 24 hours after the opera-tion.,Opioid doses within 24-48h,and differences in stress indicators[blood glucose,C-reactive protein(CRP)]and pain mediators[5-hydroxytryptamine(5-HT),substance P(SP)]before and after surgery were detected between the two groups.Results The recovery time of sensory block and pain in the observation group was longer than that in the control group,and the time of getting out of bed and hospitalization after operation was shorter than that in the control group.The VAS scores at rest and exercise at 6h,12h,24h and 48h after operation were lower than those in the control group.The time of awakening and laryngeal tube removal had no statistical significance compared with the control group(P>0.05).Before surgery,there was no statistical significance in the comparison of stress indicators and pain mediators between the two groups(P>0.05).At 48 hours after operation,blood glucose,CRP,5-HT and SP in the observation group were higher than those before operation,and the above indexes in the observation group were lower than those in the control group at 48 hours after operation,with statistical significance(P<0.05).The dose of opioids in the observa-tion group was significantly lower than that in the control group within 0-24h and 24-48h after operation,with statistical significance(P<0.05).No anesthesia-related adverse reactions occurred in 98 patients after operation.Conclusion Ul-trasound-guided continuous femoral nerve block combined with a single session of local infiltration of the hip joint capsule can reduce the stress response and release of pain substances in elderly patients undergoing hip arthroplasty,thereby re-ducing postoperative pain,reducing the application of opioids,and promoting Postoperative recovery.
