目的:探讨心脏外科术后患者出现低三碘甲状腺原氨酸（T3）综合征[即正常甲状腺功能病态综合征（ESS）]的影响因素。方法:选取2022年4月至8月于南京市第一医院接受体外循环（CPB）的354例心脏外科手术的成年心脏病患者作为研究对象，根据术后游离三碘甲状腺原氨酸（FT3）水平分为ESS组（FT3 < 2.43 pmol/L，64例）及非ESS组（FT3 ≥ 2.43 pmol/L，290例）。比较两组患者的临床资料，术前血生化、血常规指标及术后乳酸水平，分析影响心脏外科术后患者出现低T3综合征的危险因素。结果:与非ESS组患者比较，ESS组患者的年龄较高[（63 ± 11）岁vs.（66 ± 8）岁，t = 2.904，P = 0.004]，手术时间较长[（4.4 ± 1.1）h vs.（4.8 ± 1.2）h，t = 2.131，P = 0.034]，急性病生理学和长期健康评价（APACHE）Ⅱ评分较高[（12 ± 3）分vs.（14 ± 3）分，t = 3.613，P < 0.001]、糖尿病[19.66%（57/290）vs. 31.25%（20/64），χ2 = 4.141，P = 0.042]及冠状动脉粥样硬化性心脏病（CHD）[48.28%（140/290）vs. 70.31%（45/64），χ2 = 10.205，P = 0.001]占比均较高，术前白蛋白[（40 ± 3）g/L vs.（38 ± 3）g/L，t = 2.229，P = 0.026]及血红蛋白（HGB）[（130 ± 17）g/L vs.（125 ± 19）g/L，t = 2.358，P = 0.019]水平均显著降低。Logistic回归分析显示，APACHEⅡ评分[比值比（OR）= 1.180，95%置信区间（CI）（1.012，1.376），P = 0.035]是心脏术后患者并发低T3综合征的危险因素，而HGB[OR = 0.966，95% CI（0.938，0.995），P = 0.023]为其保护因素。结论:年龄、手术时间、APACHEⅡ评分、糖尿病、CHD、白蛋白及HGB水平与心脏外科术后出现低T3综合征密切相关。APACHEⅡ评分是心脏术后患者并发低T3综合征的危险因素，而HGB为其保护因素。
Chiari畸形又称为Arnold-Chiari畸形，是一种先天性颅颈交界区畸形疾病，以小脑扁桃体下疝为主要特征[1]。Chiari畸形患者的小脑扁桃体下疝压迫延髓，是引起中枢性呼吸暂停的危险因素，如不能做好及时的识别与精准化的复杂管理，则可能危及患者生命[2]。目前Chiari畸形主要分为4种类型[3]，其中合并颈髓弯曲、齿状突内陷、不正常的斜坡颈椎角、寰枢椎融合、颅底凹陷症等，被称为复杂的Chiari畸形。外科手术是临床治疗Chiari畸形的首选方法，尤其是合并寰椎枕骨关节、寰椎枢椎关节不稳定者，后颅窝减压术联合枕颈融合术能够有效恢复寰椎枕骨关节、寰椎枢椎关节稳定性[4]。临床上Chiari畸形合并颅底凹陷、脊柱侧弯且同时累及全段脊髓的空洞症病例较为罕见。2021年8月16日浙江大学医学院附属第一医院收治1例复杂Chiari畸形合并全脊髓空洞的患者，经多学科联合下的手术治疗和精心护理，患者病情好转，并于入院后第57天病情平稳出院。
脓毒症被定义为宿主对感染反应失调引起的危及生命的器官功能障碍[1]，具有较高的发病率和病死率，严重影响危重期患者的生命健康，增加患者的心理及经济负担，导致远期预后不良。据《全球疾病负担研究》估计，2017年脓毒症导致的死亡占全球可预防死亡的近20%[2]。其中，肾脏是脓毒症最常累及的器官之一，大约有60%的脓毒症患者伴发急性肾损伤（acute kidney injury，AKI）。当合并AKI时，脓毒症患者的病死率显著升高[3-4]。同时，与其他原因引起的AKI相比，脓毒症相关急性肾损伤（sepsis associated acute kidney injury，S-AKI）往往预后更差[5]。如未及时识别和处理S-AKI，患者将有可能发展成慢性肾脏病，增加心血管并发症的风险[6]。
Objective:To explore the effect of low-intensity inspiratory muscle training on mechanically ventilated patients.Methods:Eighty-one mechanically ventilated patients admitted to the intensive care unit and high dependency unit of the General Hospital of Southern Theatre Command from March 2020 to June 2022 were selected and randomly divided into a control group (41 patients) and an experimental group (40 patients). Six patients were lost to follow-up in the control group and four patients were lost in the experimental group during the trial, and finally 35 patients and 36 patients were included in the two groups, respectively. The control group was treated with conventional therapy, and the experimental group added inspiratory muscle training with 20% maximal inspiratory pressure (MIP) as the starting threshold load to the conventional therapy. After eight weeks of training, patients were assessed for the MIP, change in exertion spirometry, diaphragm thickness, diaphragm mobility, reintubation rate, in-hospital mortality, and quality of life.Results:After eight weeks of training, the MIP [(29.6 ± 4.8) cmH2O vs. (20.3 ± 5.5) cmH2O, t = 6.402, P < 0.001], exertional lung volume [(1 768 ± 655) mL vs. (1 420 ± 420) mL, t = 4.303, P < 0.001], diaphragm mobility [(0.93 ± 0.44) cm vs. (0.79 ± 0.32) cm, t = 2.313, P = 0.023], and modified Barthel index [15 (5, 19) vs. 10 (2, 14), U = 325.500, P = 0.040] of patients in the experimental group were significantly improved compared with the control group. The diaphragm thickness [(1.47 ± 0.38) mm vs. (1.39 ± 0.45) mm, t = 1.195, P = 0.236], reintubation rate [8.3% (3/36) vs. 11.4% (4/35), P = 0.520], and in-hospital mortality [8.3% (3/36) vs. 5.7% (2/35), P = 0.674] were not statistically significantly different between the experimental and control groups.Conclusion:Low-intensity inspiratory muscle training can significantly improve MIP and exertion spirometry, and may improve diaphragm mobility and quality of life in mechanically ventilated patients.
Objective:To explore the protective effect and mechanism of sodium butyrate on cardio-brain injury after cardiopulmonary resuscitation in pigs.Methods:A total of 24 large white healthy male pigs were divided into a sham operation group (n = 6), a cardiopulmonary resuscitation group (n = 10) and a sodium butyrate group (n = 8) by a random number method. In the sham operation group, only tracheal intubation and arteriovenous catheterization were performed, and induced ventricular fibrillation and cardiopulmonary resuscitation were not performed. Cardiac arrest and cardiopulmonary resuscitation models were prepared by electrical stimulation for 9 min and cardiopulmonary resuscitation for 6 min. At 5 min after successful resuscitation, the sodium butyrate group was injected 75 mg/kg of sodium butyrate through the femoral vein for 1 h. Sham operation and cardiopulmonary resuscitation groups were given the same amount of isotonic NaCl solution by the same method. Serum levels of cardiac troponin I (cTnI), creatine kinase MB (CK-MB), neuron specific enolase (NSE) and S100 calcium-binding protein B (S100B) were measured by the enzyme-linked immunosorbent assay (ELISA) before cardiac arrest and at 1, 2, 4, and 24 h after resuscitation. At 24 h after resuscitation, the expression levels of microtubule-associated protein 1 light chain 3 (LC3) and ubiquitin-binding protein 62 (p62) in the cardiac muscle and cerebral cortex tissue were detected by western-blotting, and the apoptosis rate was detected by the TUNEL method.Results:In the cardiopulmonary resuscitation group, nine pigs were successfully resuscitated, seven of which survived to 24 h. In the sodium butyrate group, seven pigs were resuscitated successfully, and all survived to 24 h. There was no significant difference in the success of 24-h resuscitation among the three groups (χ2 = 3.381, P = 0.184). At 1, 2, 4 and 24 h after resuscitation, serum cTnI (F = 62.736, 201.265, 330.083, 643.538; all P < 0.001), CK-MB (F = 90.380, 181.548, 669.657, 707.485; all P < 0.001), NSE (F = 92.302, 125.730, 590.627, 1 130.372; all P < 0.001) and S100B (F = 42.831, 152.004, 295.517, 1 023.409; all P < 0.001) were observed and compared in the three groups, and the differences were statistically significant. Compared with the sham operation group, the cTnI, CK-MB, NSE and S100B levels in serum were significantly increased at 2, 4 and 24 h after resuscitation in the cardiopulmonary resuscitation group and sodium butyrate group, which were highest in the cardiopulmonary resuscitation group (all P < 0.05). At 24 h after resuscitation, the levels of autophagy markers LC3 (F = 81.671, 49.204; both P < 0.001) and p62 (F = 127.620, 65.594; both P < 0.001) and the apoptosis rate (F = 116.750, 249.105; both P < 0.001) in cardiomyocytes and cerebral cortex cells were observed and compared in the three groups, and the differences were statistically significant. Compared with the sham operation group, the LC3 expression and apoptosis index were increased, and the p62 expression was decreased in myocardium and cerebral cortex of pigs in the cardiopulmonary resuscitation group and sodium butyrate group at 24 h after resuscitation (all P < 0.05). However, compared with the cardiopulmonary resuscitation group, the LC3 expression and apoptosis index were decreased, and the p62 expression was increased in the myocardium and cerebral cortex in the sodium butyrate group at 24 h after resuscitation (all P < 0.05).Conclusion:Sodium butyrate has a protective effect on cardio-brain injury after resuscitation of cardiac arrest, and the mechanism may be related to inhibition of autophagy and apoptosis.
Objective:To establish a decision tree model based on the synthetic minority over-sampling technique (SMOTE) algorithm for the prediction of post-operative 30-day death in patients undergoing surgery with cardiovascular events.Methods:A total of 3 086 Chinese patients undergoing surgery with cardiovascular events (the history of ischemic heart disease and/or congestive heart failure) admitted to the Singapore General Hospital for operation from 2012 to 2016 were enrolled, and their clinical information, history of diseases and surgical scores were extracted. The original data was reconstructed by the SMOTE algorithm, and predictors were selected by best subset regression. Data was divided into a training group and a validation group by the ratio of 7 ∶ 3, of which the training group was used to establish the decision tree model and the validation group was used for internal verification.Results:The mortality rate was 3.0% (93/3 086) at 30 days after surgery and 4.5% (140/3 086) of patients were admitted to ICU at 24 h after surgery. The best subset regression analysis showed age > 75 years [odds ratio (OR) = 1.033, 95% confidence interval (CI) (1.024, 1.042), P < 0.001], anemia severity [OR = 1.368, 95%CI (1.211, 1.546), P < 0.001], chronic kidney disease stage > 2 [OR = 1.381, 95%CI (1.277, 1.494), P < 0.001], preoperative blood transfusion [OR = 4.496, 95%CI (3.268, 6.185), P < 0.001], surgical types [OR = 3.344, 95%CI (2.752, 4.064), P < 0.001], red blood cell distribution width > 15.7% [OR = 2.097, 95%CI (1.658, 2.652), P < 0.001] and American Society of Anesthesiologists classification > 2 [OR = 3.362, 95%CI (2.734, 4.135), P < 0.001] were risk factors for 30-day death after surgery in patients with cardiovascular events. The above seven predictors were selected to build a decision tree model. The results showed that the area under the receiver operating characteristic curve of the decision tree model was 0.853 [95%CI (0.837, 0.868), P < 0.001], and the sensitivity and specificity were 0.765 and 0.756 respectively in the training group; the area under the receiver operating characteristic curve of the decision tree model was 0.858 [95%CI (0.834, 0.882), P < 0.001], and the sensitivity and specificity were 0.938 and 0.612 respectively in the validation group, with good overall discrimination.Conclusions:The risk of post-operative 30-day death in patients with cardiovascular events is an issue of unbalanced data classification, with minor cases for outcomes. In this study, the SMOTE algorithm was adopted avoiding the poor clinical applicability caused by the overfitting in conventional modeling. At the same time, the decision tree model presents visual, convenient and personalized characteristics, which is a useful clinical prediction tool for physicians.
Objective:To systematically evaluate the effect of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with intra-aortic balloon pumping (IABP) on the mortality of patients with cardiogenic diseases.Methods:Systematic searches were conducted in PubMed, the Cochrane Library, Embase, Web of Science, Wanfang data, CNKI and CBM to collect articles about using VA-ECMO combined with IABP to treat patients with cardiogenic diseases published up to April 2022. Two reviewers independently screened articles, extracted data and evaluated quality, and then the meta-analysis was performed using Stata 17 software.Results:A total of 15 528 patients were enrolled in 84 studies, of which 8 520 patients received VA-ECMO combined with IABP (experimental group) and 7 008 patients only received VA-ECMO (control group). Meta-analysis showed that as compared with the control group, the 30-d mortality/inpatient mortality [relative risk (RR) = 0.86, 95% confidence interval (CI) (0.83, 0.89), Z = 8.64, P < 0.000 01] and the incidence of neurological complications [RR = 0.70, 95%CI (0.54, 0.90), Z = 2.78, P = 0.005] decreased remarkably, and the success rate of weaning from ECMO [RR = 1.35, 95%CI (1.28, 1.42), Z = 11.89, P < 0.000 01] increased obviously in the experimental group. Subgroup analysis showed that the 30-d mortality/inpatient mortality in patients with heart-related mixed diseases [RR = 0.85, 95%CI (0.81, 0.90), Z = 5.99, P < 0.000 01] and in patients with acute coronary syndrome (ACS) [RR = 0.68, 95%CI (0.63, 0.74), Z = 9.21, P < 0.000 01] and the incidence of mixed neurological complications [RR = 0.58, 95%CI (0.40, 0.84), Z = 2.90, P = 0.004] were much lower, and the success rate of weaning from ECMO in patients with postcardiotomy [RR = 1.22, 95%CI (1.10, 1.34), Z = 3.88, P = 0.000 1] and heart-related mixed diseases [RR = 1.45, 95%CI (1.37, 1.53), Z = 12.51, P < 0.000 01] were much higher in the experimental group than those in the control group.Conclusion:Compared with VA-ECMO alone, VA-ECMO combined with IABP can reduce 30-d mortality/inpatient mortality in patients with heart-related mixed diseases and ACS, increase the success rate of weaning from ECMO in patients with postcardiotomy and heart-related mixed diseases, and reduce mixed neurological complications.
自2019年12月以来，全国各省、市及地区陆续发现不明原因肺炎[1-2]，即新型冠状病毒感染（以下简称新冠感染）。经病原检测，新冠感染由一种新型β属冠状病毒引起，国际病毒分类委员会将该病毒命名为"严重急性呼吸综合征冠状病毒2型（severe acute respiratory syndrome coronavirus-2，SARS-CoV-2）"，其具有较强的传染性，可导致病情恶化迅速，并对患者的呼吸系统造成极大的伤害[3]。多组临床研究数据表明，急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）是新冠感染主要的并发症之一[1，3-4]。
目的:研究血清细胞因子及呼出气一氧化氮（FeNO）在哮喘-慢性阻塞性肺疾病重叠综合征（ACOS）患者中的临床诊治意义。方法:将浙江萧山医院呼吸内科2021年1月至2023年1月收治的65例患者分为支气管哮喘（BA）组（18例），慢性阻塞性肺疾病（COPD）组（18例），ACOS组（29例）。检测3组患者间血清免疫球蛋白E（IgE）、嗜酸性粒细胞（EOS）、中性粒细胞（NE）、FeNO及细胞因子白细胞介素4（IL-4）、IL-5、IL-6、IL-10、IL-13、IL-17、IL-18、肿瘤坏死因子α（TNF-α）水平。采用Pearson相关分析探究FeNO与IgE、EOS、NE及各细胞因子间的相关性。结果:3组患者间IgE（F = 3.343，P = 0.042）、EOS（F = 6.186，P = 0.004）、FeNO（F = 6.560，P = 0.003）、IL-4（F = 10.524，P<0.001）、IL-6（F = 4.637，P = 0.013）、IL-10（F = 2.451，P = 0.018）及TNF-α（F = 11.554，P<0.001）水平比较，差异均有统计学意义。且与COPD组比较，BA组和ACOS组患者的IgE[（129 ± 78）× 103、（250 ± 181）× 103、（238 ± 179）× 103 IU/L]、EOS[（0.12 ± 0.09）× 109/L、（0.35 ± 0.20）× 109/L、（0.25 ± 0.24）× 109/L]、FeNO[（23 ± 8）× 10-9、（49 ± 31）× 10-9、（36 ± 19）× 10-9]、IL-4[（0.029 ± 0.016）、（0.663 ± 0.517）、（0.859 ± 0.815）ng/L]水平均显著升高（P均<0.05），ACOS组TNF-α水平均显著低于COPD组及BA组[（6 ± 4）、（11 ± 3）、（9 ± 4）ng/L，P均<0.05]。Pearson相关分析发现，FeNO与EOS（r = 0.478，P<0.001）、IL-17（r = 0.260，P = 0.036）均呈正相关。结论:ACOS患者的IL-4、IgE、EOS、FeNO水平与BA患者相仿，且高于COPD患者；ACOS患者的TNF-α水平均显著低于单纯BA患者和单纯COPD患者，且FeNO水平与EOS、IL-17均呈正相关。
目的:探讨经鼻高流量氧疗（HFNC）与无创机械通气（NIV）在严重创伤术后轻中度低氧血症患者中的临床效果。方法:选取中国人民解放军联勤保障部队第九〇八医院2020年4月至2022年5月收治的180例严重创伤术后轻中度低氧血症患者，根据不同呼吸支持方式分为HFNC组和NIV组，每组各90例。比较两组患者的呼吸功能、呼吸困难感受与舒适度、不良事件及预后情况。结果:拔管后24 h，HFNC组和NIV组患者呼吸频率（t = 11.799、10.520，P均<0.001）、动脉血二氧化碳分压（t = 4.641、4.509，P均<0.001）水平均较治疗前显著降低，动脉血氧分压水平较治疗前显著升高（t = 40.290、36.197，P均<0.001）。治疗后1、24、48 h，HFNC组患者Brog呼吸困难评分均低于NIV组（t = 2.117、2.206、2.284，P = 0.036、0.029、0.024），而改良Kolcaba舒适状况评分均高于NIV组（t = 5.293、5.544、4.470，P均<0.001）。HFNC组不良事件发生率较NIV组显著降低[3.33%（3/90）vs. 11.11%（10/90），χ2 = 4.063，P = 0.044]。HFNC组患者28 d再插管率[2.22%（2/90）vs. 10.00%（9/90），χ2 = 4.745，P = 0.029]和拔管后24 h急性病生理学和长期健康评价Ⅱ评分[（18.8 ± 1.4）分vs.（20.3 ± 1.5）分，t = 7.017，P<0.001]均低于NIV组，入住ICU时间[（5.1 ± 0.4）d vs.（6.2 ± 0.5）d，t = 10.267，P<0.001]及住院时间[（15.6 ± 1.2）d vs.（16.8 ± 1.3）d，t = 5.662，P<0.001]均短于NIV组；而两组28 d病死率[1.11%（1/90）vs. 3.33%（3/90），χ2 = 1.023，P = 0.312]比较，差异无统计学意义。结论:在严重创伤术后轻中度低氧血症患者的治疗中，HFNC与NIV均可有效改善患者呼吸功能，但前者呼吸困难感受更轻、舒适度更高，更有助于减少不良事件的发生，进一步改善患者预后。
国内将由器械供应商租借给医院且可重复使用的不常规器械定义为外来器械[1-2]。美国将通过租赁或签订试用器械协议而拥有使用权的关键或半关键器械定义为外来器械[3]。随着外科手术技术的不断革新，手术器械也随之不断创新、变化。医院为提高手术成功率和器械使用率、降低医疗成本，许多特殊器械由医院向器械供应商租赁使用，这导致了同一器械包在各个医疗机构间轮换使用的现象[4]。这种现象使得外来器械的清洗消毒质量难以得到保障，让医疗护理质量和患者安全存在巨大隐患。为此，本研究通过回顾国内外文献，综述外来器械管理的现状、难点和影响因素，以期为保障外来器械的安全使用提供参考依据，降低手术感染风险。
椎基底动脉延长扩张症（vertebrobasilar dolichoectasia，VBD）是一种以椎基底动脉异常延长、扩张、扭曲为特征的进展性动脉疾病，随之出现血流动力学改变及凝血功能障碍，诱发血栓和微小栓塞形成。目前研究认为，VBD与急性缺血性脑卒中可能有一定的相关性[1]。本研究回顾性分析南京医科大学第一附属医院（江苏省人民医院）急诊中心近两年急诊卒中绿色通道评估的急性卒中患者，发现13例缺血性脑卒中患者的血管病变表现均为VBD。该血管病变临床上多为头晕、步态不稳及锥体束症状。目前，对其导致的急性缺血性脑卒中患者的治疗策略尚无明确指南推荐。本中心严格根据缺血性脑卒中早期处理原则，符合溶栓适应证的患者予以积极溶栓，现报道如下。
侵袭性皮肤型毛霉菌感染是一种侵袭性真菌病，毛霉菌进入真皮、侵入血管引起血栓[1]，最终可导致肌肉坏死、截肢等不良结局，真菌孢子还可经血行播散，引起肺部、肾脏的继发感染，病死率达40% ~ 80%[2-3]，该病好发于免疫功能严重受损的患者，具有发病率低、进展速度快、病死率高的特点，早期诊断困难，极易误诊和漏诊[4]。异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）是造血系统各种恶性疾病或非恶性增殖性疾病常见的治疗方法之一[5]。在围移植期，患者因自身疾病及免疫抑制剂治疗等原因，免疫功能受损、重建延迟，机会性感染概率增加。移植后的免疫缺陷状态容易引发严重感染及移植物抗宿主病（graft-versus-host disease，GvHD）等并发症[6]。Allo-HSCT术后继发侵袭性毛霉菌感染较为罕见，严重影响患者预后。浙江大学医学院附属第一医院于2022年7月收治1例allo-HSCT术后继发侵袭性皮肤型毛霉菌感染的患者，及时诊断并经多学科联合诊治及护理后成功救治，住院69 d，病情趋于稳定出院。现将护理体会报告如下。
免疫球蛋白G4相关性疾病（immunoglobulin-G4 related diseases，IgG4-RD）是一种较罕见的以血清IgG4升高为特征，由免疫介导并累及多器官或组织的慢性炎症伴纤维化疾病，好发于中老年男性，目前确切的病因不明。现将南京医科大学附属南京医院1例IgG4-RD合并血流感染致多器官功能障碍患者的救治经过报道如下。
急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）是重症学科面临的"大敌"之一[1]，由直接损伤和间接损伤引起[2]，采用柏林诊断定义[3]。ARDS患者占所有重症患者的10.4%，重度ARDS占23.4%，且重度ARDS患者住院病死率高达46.1%[3-4]。近年来随着体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）技术的进一步成熟，重度ARDS患者接受ECMO治疗的比例迅速增加[5]，尤其是静脉-静脉体外膜肺氧合（veno-venous extracorporeal membrane oxygenation，VV-ECMO）在改善重度ARDS患者肺功能和提供超保护性通气方面的作用日益得到重视[6]。驱动压（driving pressure，DP）是呼吸系统扩张的直接动力，无自主呼吸时，DP=平台压-呼气末正压，其在ARDS患者肺保护通气中的作用显著。而在ECMO治疗期间，机械通气呼吸参数的设定还未有明确定论，现就DP在应用ECMO治疗的ARDS患者中的研究进展进行论述。
Objective:To screen key pathogenic genes in septic cardiomyopathy (SCM) by bioinformatics analysis.Methods:The GSE79962 dataset was downloaded from the gene expression omnibus (GEO). The dataset contained genome-wide expression levels of heart gene profiles from patients who had died of sepsis and from healthy donors. The differentially expressed genes (DEGs) were screened and analyzed using an online GEO2R analysis tool, and the functional enrichment analysis of DEGs was carried out using the DAVID 6.8 database. The protein-protein interaction (PPI) network analysis was performed using the STRING database, and the CytoHubba software was used to screen the top 10 key genes.Results:A total of 228 DEGs were identified from the GSE79962 dataset, including 156 up-regulated genes and 72 down-regulated genes. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis of 228 DEGs showed that DEGs mainly involved three GO functional annotations (including two cellular component pathways and a biological process pathway) and three KEGG pathways (including a metabolic pathway, an olfactory transduction, and a neuroendocrine gland). The PPI network screened out 10 key genes, five of which were up-regulated, including nucleolar complex protein 3 homolog (NOC3L), SDA1 domain containing 1 (SDAD1), patched 1 (PTCH1), clathrin heavy chain (CLTC), and inhibitor of nuclear factor kappa B kinase subunit beta (IKBKB), and five of which were down-regulated, including WD repeat domains (WDR4, WDR36, and WDR82), transmembrane and coiled-coil domains 1 (TMCO1), and Toll like receptor 9 (TLR9).Conclusion:NOC3L, SDAD1, PTCH1, CLTC, IKBKB, WDR4, WDR36, WDR82, TMCO1, and TLR9 are key pathogenic genes of SCM, and in-depth study of these genes, especially family of WDR genes, can be conducted to further clarify the occurrence and development mechanism of SCM.
Objective:To preliminarily clarify the changes of intestinal microecological composition and diversity in patients with sepsis-induced myocardial dysfunction.Methods:A total of 39 subjects were enrolled in this study, including 13 healthy subjects (group A), 12 septic patients without myocardial dysfunction (group B) and 14 patients with sepsis-induced myocardial dysfunction (group C). Blood and feces samples were collected and echocardiography was performed on the day of enrollment. The cardiac troponin T (cTnT), human heart-type fatty acid binding protein (HFABP), N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF) and procalcitonin (PCT) were determined and recorded. The 16S ribosomal DNA (rDNA) sequencing was used to determine the bacterial sequence in the feces, and the composition of microflora among the three groups was compared.Results:The levels of cTnT, HFABP, NT-proBNP, LVEF and PCT among the three groups all showed significant differences (H = 33.279, 24.748, 28.694, 26.552, 27.032; all P < 0.001). Further pairwise comparison found that compared with the group B, the levels of cTnT, HFABP and NT-proBNP in the group C were much higher, while the LVEF level was much lower (all P < 0.05). Alpha diversity analysis showed that the richness [Chao1 index and abundance-based coverage estimator (ACE)] and diversity (Shannon index and Simpson index) of bacterial flora among the three groups all showed significant differences (H = 13.761, 13.761, 19.189, 15.536; all P < 0.05). The richness and diversity of bacterial flora in groups B and C were much lower than those in the group A, and the diversity of bacterial flora in the group C was lowest (all P < 0.05). Beta diversity analysis showed that the similarities of bacterial flora among the three groups all showed significant differences [0.239 (0.147, 0.332), 0.001 (-0.164, 0.049), -0.212 (-0.315, 0.040); H = 22.599, P = 0.001]. The similarities of bacterial flora in groups B and C were statistically significantly different as compared with the group A (both P < 0.05). At the three levels of class, family and genus, the relative abundance of Clostridia, Bacillus, Ruminococcaceae, Lachnospiracea, Ruminococcus and Lachnospiracea_incertae_sedis among the three groups all showed significant differences (H = 23.918, 22.794, 17.265 16.846, 11.862, 16.846; all P < 0.05). The relative abundance of Clostridia, Ruminococcaceae, Lachnospiracea, Ruminococcus and Lachnospiracea_incertae_sedis in groups B and C was much lower than that in the group A, and the relative abundance of Clostridia, Ruminococcaceae and Lachnospiracea in the group C was lowest (all P < 0.05). The relative abundance of Bacillus in groups B and C was much higher than that in the group A, and it was highest in the group B (all P < 0.05).Conclusion:The levels of myocardial injury biomarkers are increased and the diversity of intestinal microbiome is decreased significantly in patients with myocardial dysfunction induced by sepsis, which mainly shows as reduced abundance of Clostridia, Ruminococcaceae and Lachnospiracea, together with increased abundance of Bacillus.
目的:探讨酶联免疫吸附测定（ELISA）与实时荧光定量PCR仪检测在乙型肝炎诊断中的应用。方法:选择2020年10月至2021年10月杭州市富阳区第一人民医院收治的320例乙型肝炎患者作为研究对象。采用ELISA法检查患者的血清标志物表达水平，用实时荧光定量PCR法检测乙型肝炎病毒（HBV）-DNA表达水平。根据ELISA结果将320例乙型肝炎患者分为大三阳组（164例）和小三阳组（156例）。比较两组患者第一次的ELISA检出结果，HBV-DNA阴性、阳性患者例数以及平均HBV-DNA对数含量。根据HBV-DNA检出结果将320例乙型肝炎患者分为HBV-DNA阴性组（134例）和HBV-DNA阳性组（186例），比较两组患者ELISA法和PCR仪检出结果。最后，探讨两种检查方式在HBV中的诊断价值。结果:大三阳组HBV表面抗原（HBsAg）、HBV e抗原（HBeAg）、HBV核心抗体（HBcAb）阳性，HBsAg、HBeAg阳性，HBV-DNA阳性患者占比及平均HBV-DNA对数含量均高于小三阳组；HBsAg、HBV e抗体（HBeAb）、HBcAb阳性，HBsAg、HBeAb阳性患者占比均显著低于小三阳组（P均<0.05）。HBV-DNA阴性组HBsAg、HBeAg、HBcAb阳性患者占比低于HBV-DNA阳性者，HBsAg、HBeAb、HBcAb阳性患者占比高于HBV-DNA阳性组（P均<0.05）。将肝组织病理学检查结果作为金标准，320例患者中活动期171例（53.44%），非活动期149例（46.56%）。ELISA法的特异度（100.00% vs. 89.93%，χ2 = 10.604，P = 0.001）、阳性预测值（100.00% vs. 91.94%，χ2 = 6.444，P = 0.011）均高于PCR仪，敏感度（91.81% vs. 100.00%，χ2 = 6.582，P = 0.010）、阴性预测值（91.41% vs. 100.00%，χ2 = 7.007，P = 0.008）均低于PCR仪。两种检查方式的确诊率比较，差异无统计学意义（95.62% vs. 95.31%，χ2 = 0.054，P = 0.817）。结论:HBV-DNA水平较高者的抗原阳性率更高，不同乙型肝炎患者的ELISA和实时荧光定量PCR仪检出结果存在显著差异，两种检查方式在乙型肝炎检查诊断中各有一定优劣势，检出结果可相互补充解释，利于医生对HBV感染情况及复制、预后情况进行更精准的判断。
Objective:To investigate the prognostic value of serum calcium levels in patients with trauma-induced coagulopathy (TIC).Methods:A retrospective analysis was conducted on the clinical data of 142 patients with TIC who were admitted to the ICU of the First Hospital of Jiaxing between January 2015 and January 2023. According to the prognosis of 28 days after ICU admission, patients were divided into a survival group (80 cases) and a death group (62 cases). The basic data, laboratory examination indexes within 24 h after admission to the ICU and assessment of blood consumption scores of the two groups were compared. Multivariate logistic regression was used to analyze the prognostic risk factors of TIC patients, and a receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of serum calcium in the risk of death in TIC patients. A restricted cubic spline (RCS) was used to evaluate the linear relationship between the first serum calcium level after admission to the ICU and the risk of death in TIC patients.Results:Compared with the survival group, the proportions of low fibrinogen [65.0% (52/80) vs. 88.7% (55/62), χ2 = 3.240, P < 0.001], hyperlactacidemia [65.0% (52/80) vs. 88.7% (55/62), χ2 = 3.240, P < 0.001] and hypocalcaemia [73.8% (59/80) vs. 96.8% (60/62), χ2 = 3.223, P < 0.001] and the serum chlorine level [113 (110, 116) mmol/L vs. 115 (111, 118) mmol/L, Z = 2.350, P = 0.019] were much higher, and the platelet count [118 (84, 148) × 109/L vs. 94 (50, 116) × 109/L, Z = 3.447, P < 0.001] and albumin level [(28 ± 6) g/L vs. (23 ± 8) g/L, t = 3.732, P < 0.001] were much lower in the death group. The multivariate logistic regression analysis indicated that hypocalcaemia [odds ratio (OR) = 5.019, 95% confidence interval (CI) (1.279, 19.690), P = 0.021] and hyperlactacidemia [OR = 3.970, 95%CI (1.353, 11.075), P = 0.012] were risk factors for death in patients with TIC. The ROC curve analysis revealed that the area under the curve for serum calcium was 0.734 [95%CI (0.652, 0.816), P < 0.001], and the best cut-off value was 1.950 mmol/L. The RCS showed that there was a linear relationship between serum calcium and prognosis of TIC patients (P = 0.023), and the risk of death decreased with the increase of serum calcium concentration in the range of 1.603 to 2.130 mmol/L after admission.Conclusion:Hypocalcaemia is an independent risk factor for death in TIC patients; especially when serum calcium is lower than 1.950 mmol/L, it has important value in predicting the risk of death.
Objective:To explore the pathogenesis and acupuncture treatment effects of neutrophil homing and extracellular trapping net in rats with ventilator-associated pneumonia (VAP).Methods:Thirty Sprague-Dawley rats were divided into a control group, a model group, an acupuncture group, an acupuncture + CXCR4 inhibitor group, and an acupuncture + neutrophil extracellular traps (NETs) inhibitor group, with six rats in each group. Rats in the control group were only exposed to the trachea and kept spontaneous breathing. In the model group, the trachea was exposed and Klebsiella pneumoniae was injected into the trachea after anesthesia. After 72 hours, the rats were intubated and connected with a small animal ventilator. High tidal volume ventilation was performed 2-3 times every 30 minutes for five hours daily for two days. Rats in the acupuncture group were treated with acupuncture after 30 minutes of successful modeling. Rats in the acupuncture + CXCR4 inhibitor group were intraperitoneally injected with CXCR4 inhibitor at a dose of 2.5 mg/kg based on body weight half an hour before bacterial injection on the first day. Rats in the acupuncture + NETs inhibitor group received intrathecal injection of NETs inhibitor at a dose of 0.8 μM/290-340 g based on body weight in 0.5-1.0 h before mechanical ventilation. Flow cytometry was used to detect the neutrophil trends in lung tissue, hematoxylin-eosin (HE) staining to observe the lung tissue pathology, and immunohistochemical staining to observe the citrullinated histone H3 (Cit-H3) and myeloperoxidase (MPO) expression levels.Results:The expression level of CD11b + CD62L in the control group, model group, acupuncture group and acupuncture + CXCR4 inhibitor group was significantly different (F = 25.150, P < 0.001). Further pairwise comparison showed that the expression level of CD62L + CD11b in the model group was significantly higher than that in the control group (P < 0.05). Compared with the model group, the expression level of CD62L + CD11b in the acupuncture + CXCR4 inhibitor group was significantly decreased (P < 0.05). HE staining showed that there was no obvious congestion, hemorrhage, edema, and neutrophil infiltration in the lung tissue of rats in the control group. Rats in the model group had obvious edema, hyperemia, and hemorrhage, with a large number of infiltrating inflammatory cells. The congestion and edema of alveoli and airway mucosa were reduced, and the infiltration of inflammatory cells was decreased in the acupuncture group. The congestion and edema of alveoli and airway mucosa and the infiltration of inflammatory cells were significantly reduced in the acupuncture + NETs inhibitor group. The lung injury score and the expression levels of Cit-H3 and MPO in the control group, model group, acupuncture group and acupuncture + NETs inhibitor group were compared, and their differences were statistically significant (F = 51.723, 227.370, 570.097; all P < 0.001). Further pairwise comparison showed that compared with the control group, the expression levels of Cit-H3 and MPO in the model group were significantly increased, and the inflammatory infiltration of lung tissue was more severe (all P < 0.05). Compared with the model group, the expression levels of Cit-H3 and MPO in the acupuncture group and acupuncture + NETs inhibitor group were significantly decreased, and the inflammatory infiltration in lung tissue was significantly reduced, especially in the acupuncture + NETs inhibitor group (all P < 0.05).Conclusions:There are neutrophil homing and excessive formation of NETs in rats with VAP. Acupuncture has no obvious inhibitory effect on neutrophil homing, but it can inhibit the excessive formation of NETs by regulating the expression of Cit-H3 and MPO, thereby reducing the inflammatory response. At the same time, acupuncture combined with CXCR4 inhibitor can significantly improve the homing of neutrophils, and their combination of NETs inhibitor has a more significant regulatory effect on NETs and a stronger improvement effect on the inflammatory response of lung tissue.
