Acute kidney injury (AKI) occurs in 30%–70% of critically ill patients. Multiple organ failure (MOF), which is most often secondary to hypotension and septicemia, is a global public health problem. The prognosis of patients is poor. Currently, there is no specific therapeutic method. Finding new therapeutic targets is significant to improve the prognosis of AKI patients. This study explores expressions and related mechanisms of miR-212 and Kruppel-like factor 4 (KLF4) in rats with AKI. Sixty Wistar rats were randomly divided into 6 groups: Control group, sham operation group, model group, miR-212-agomir group, miR-212-antagomir group, miR-212-agomir+APTO-253 (joint group), n = 10. The expressions of miR-212, KLF4, inflammatory factors [tumor necrosis factor α (TNF-α), interleukin 6 (IL-6)], oxidative stress factors [superoxide dismutase (SOD), malondialdehyde (MDA)], and apoptosis-related proteins (bax, bcl-2) in renal tissue of rats were detected, and the relationship between miR-212 and KLF4 and the severity of AKI in rats were analyzed. The expression level of miR-212 increased (P < 0.05) and the expression level of KLF4 decreased (P < 0.05) in renal tissue of rats with AKI. miR-212 was negatively correlated with KLF4 expression (P < 0.05). MiR-212 was positively correlated with expressions of TNF-α, IL-6, MDA, and bax (P < 0.05), negatively correlated with expressions of SOD and bcl-2 (P < 0.05), KLF4 was negatively correlated with expressions of TNF-α, IL-6, MDA and bax (P < 0.05), and positively correlated with expressions of SOD and bcl-2 (P < 0.05). MiR-212 mimics can inhibit the luciferase activity of Wt-KLF4 (P < 0.05), and miR-212 inhibitor can promote the luciferase activity of Wt-KLF4 (P < 0.05). Down-regulation of miR-212 plays a protective role by targeting up-regulation of KLF4 to inhibit renal tissue inflammation, oxidative stress, and apoptosis in rats with AKI, which may be a potential target for clinical treatment of AKI in the future.

目的:探讨重症监护室(ICU)重症社区获得性肺炎(SCAP)老年患者血小板、凝血功能指标及血清可溶性髓样细胞触发受体-1(sTREM-1)变化及临床意义.方法:选取我院2019年1月至2020年1月ICU收治的94例SCAP患者为SCAP组,根据28 d内生存情况将SCAP患者分为死亡组(n=18)与存活组(n=76).比较两组PLT、凝血功能指标及血清sTREM-1水平,多因素逐步Logistic回归分析SCAP患者预后不良影响因素,ROC曲线分析PLT、凝血功能指标及血清sTREM-1水平对老年SCAP患者不良预后的预测价值.结果:死亡组PLT明显低于存活组,凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FIB)、D-Dimer、sTREM-1水平明显高于存活组(P＜0.05).多因素逐步Logistic回归分析显示,机械通气时间＞15 d和高PT、APTT、FIB、D-Dimer、sTREM-1水平为SCAP患者预后不良危险因素,高氧合指数、PLT为保护因素(P＜0.05).ROC曲线显示,PLT+ PT+ APTT+ FIB+ D-Dimer+sTREM-1联合预测老年SCAP患者不良预后的曲线下面积(AUC)明显大于各指标单独预测(P＜0.05).结论:预后不良老年SCAP患者PLT明显降低,PT、APTT、FIB、D-Dimer、sTREM-1水平明显提升,联合检测能提升不良预后预测价值.

目的 探讨对医学生急危重症临床技能和实践能力的培养,培养医学生看待疾病和患者的整体观念及正确的临床思维过程.方法 选择锦州医科大学2013级23、24班麻醉专业学生,每班为一组,23班为实验组,24班为对照组.实验组采用病例跟踪法,通过病例跟踪方式教授学生如何针对不同的急危重症患者制定相应的治疗方案,对照组采用传统教学方法,通过问卷调查、 理论考试与医学模拟考核的方法来评价两组学生的教学效果.结果 实验组与对照组理论考试成绩差异无统计学意义;实验组学生在急危重症病例急救技能操作考核的成绩高于对照组(P<0.05);问卷调查结果也对教学改革予以肯定(P<0.05).结论 病例跟踪法教学模式通过改进教学方法,使医学生在急危重症临床技能和实践技能的掌握程度得到提高,能力得到强化,有效地提高了急危重症医学教学质量,增强了急危重症医学生临床急救能力.

Objective To discuss the clinical significances of soluble receptor for advanced glycation end-products ( sRAGE)in bronchoscopy alveolus lavage fluid( BALF)in patients with COPD. Methods A total of 40 patients with COPD who were admitted to the department of intensive care unit of the First Hospital Affiliated to Liaoning Medical University from Oc-tober 2012 to May 2013,were selected as the COPD group,meanwhile 40 patients with non-COPD were selected as the non-COPD group,and these COPD patients were divided into mild group(12 cases),moderate group(10 cases),severe group (10 cases),very severe group(8 cases). The sRAGE concentrations in BALF were detected by enzyme-linked immunosor-bent assay(ELISA). Results The concentration of sRAGE in BALF of patients in the COPD group(191 ±71)ng/L was sig-nificantly higher than that in the non-COPD group(55 ±56)ng/L(t=9. 44,P<0. 001). The concentration of sRAGE in BALF of COPD patients in the mild group,moderate group,severe group and very severe group was(111 ± 44) ng/L,(184 ±45)ng/L,(226 ±34)ng/L,and(273 ±30)ng/L,respectively,there were significant differences in concentration of sRAGE among these groups(F=30. 48,P<0. 001),and the concentration of sRAGE in very severe COPD group was signifi-cantly higher than that in severe COPD group,the concentration of sRAGE in severe COPD group was significantly higher than that in moderate group,the concentration of sRAGE in moderate group was significantly higher than that in mild group( P <0. 05 ) . Linear correlation analysis results showed that the concentration of sRAGE in BALF of COPD patients were negatively cor-related with FEV1%(r= -0. 738,P <0. 05). Conclusion The concentration of sRAGE in BALF of COPD patients was higher than that of non-COPD patients;The concentration of sRAGE in BALF is related to severity of COPD,it could be used as an index of the prognosis evaluation of COPD.

OBJECTIVE To establish an HPLC method to simultaneous determine three components in compound tinidazole carrier suppositories.METHODS A Diamonsil-C18(200 mm×4.6 mm,5 μm) column was used;the mobile phase was the mixture of methanol-water-triethylamine(60∶40∶0.5)(adjusted by phosphoric acid to pH 4.0),the flow rate was 1.0 mL?min?1,the UV detector was operated at 260 nm,injection volume was 20 μL;column temperature was 25 ℃.RESULTS The linear ranges of three components in compound tinidazole carrier suppositories tinidazole,clotrimazole,chlorhexidine acetate were 40–??600,32–480,1.6–24 μg?mL?1(r=0.999 9).The average recoveries respectively were 99.81%,100.2%,100.3%,and RSDs respectively were 0.37%,0.2% and 0.4%(n=9).CONCLUSION This method can simultaneously determine three components.It is easy and fast with accurate and reliable results.

OBJECTIVE:To prepare the Compound tinidazole carrier suppositories (CTS) and investigate the quality of it.METHODS:CTS were prepared with tinidazole,clotrimazole and chlorhexidine acetate as main components using glycerogelatinas matrix;the contents of 3 components were determined by HPLC;the dissolution test of suppositories in vitro was conducted bypaddle method with hydrochloric acid as medium,and the dissolution parameters Td and m were calculated and tested. The stability of suppositories was detected in 6-month accelerated test. RESULTS:The contents of sample were in line with the standard;there was no significant difference in the interior-group and inter-group(P0.05);and no obvious change was found in stability test within 6 months. CONCLUSION:CTS are reasonable in formulation,feasible in technology and stable in quality.

Objective To study antibiotic activity of compound tinidazole carrier supositories against anaerobic bacteria,fungus and bacterium in vitro.Methods Compared with the results of the complex prescription carrier suppositeries,metronidzaole,tinidazole,coltrimaxole and chlorhexidine acetate,the minimum inhibitary concentrations(MIC)of compound tinidazle carrier suppolitories against anaerobic bacteria,fungus and bacterium were determined with agar dilution method.Results Compound tinidazole carrier suppositories showed a strong antibiotic activity against Bacteroides fragilis.Fusobacterium mucleatum,Peptostreptococcus anaerobius,Staphylococcus aureus(SA),Escherichia coli,Pseudomousa aeruginosa,gonococcus and Candia albicans,with MIC of 0.0625,0.5,0.125,16,128,64,8,16μg/mL,respectively.For Bacteroides Fragilis,Fusobacterium mucleatum,Peptostreptococus anaerobius,the MIC of compound tinidazole carrier suppositories was lower than that of the complex prescription carder suppository.Conclusion Tinidazole carrier suppository is of broad antibiotic spectrum,high activity in vitro and low toxicity in gynecological inflamation treatment.