ObjectiveTo investigate the clinical characteristics and factors associated with herpes simplex virus keratitis.MethodsPatients with herpes simplex virus keratitis who came to our hospital from January 2018 to June 2022 were selected and divided into a good prognosis group and a poor prognosis group according to their prognosis. The clinical data of the two groups were compared, and univariate/multivariate logistic regression was used to analyze the factors influencing the poor prognosis of herpes simplex virus keratitis.ResultsA one-way analysis of variance showed that, compared with the good prognosis group, the poor prognosis group had more elderly patients and a longer course of disease, and the difference was statistically significant (p < 0.05). There were significant differences in the types of patients between the two groups (p < 0.05). Univariate logistic regression analysis also showed that age (≥65 years) (OR: 1.557, 95%CI: 1.081–2.183, p < 0.05), course of disease (> 7 months) (OR: 1.303, 95%CI: 1.003–1.829, p < 0.05), epithelial type (OR: 2.321, 95%CI: 1.198–4.321, p < 0.05), and stromal type (OR: 2.536, 95%CI: 1.672–3.871, p < 0.05) were risk factors for poor prognosis. Multivariate logistic regression analysis showed that age (≥65 years) (OR: 1.656, 95%CI: 1.168–2.357, p < 0.05) and course of disease (> 7 months) (OR: 1.461, 95%CI: 1.031–2.001, p < 0.05) were independent risk factors for the prognosis of herpes simplex keratitis.ConclusionThe clinical symptoms of herpes simplex virus keratitis include corneal opacity, corneal posterior elastic layer folds, corneal infiltration, posterior corneal mass, corneal edema, and ocular pain. Age and course of disease are important factors in the prognosis of herpes simplex virus keratitis.

Background In the ICU ward, septic cirrhotic patients are susceptible to suffering from sepsis-associated encephalopathy and/or hepatic encephalopathy, which are two common neurological complications in such patients. However, the mutual pathogenesis between sepsis-associated and hepatic encephalopathies remains unclear. We aimed to identify the mutual hub genes, explore effective diagnostic biomarkers and therapeutic targets for the two common encephalopathies and provide novel, promising insights into the clinical management of such septic cirrhotic patients. Methods The precious human post-mortem cerebral tissues were deprived of the GSE135838, GSE57193, and GSE41919 datasets, downloaded from the Gene Expression Omnibus database. Furthermore, we identified differentially expressed genes and screened hub genes with weighted gene co-expression network analysis. The hub genes were then subjected to Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway functional enrichment analyses, and protein-protein interaction networks were constructed. Receiver operating characteristic curves and correlation analyses were set up for the hub genes. Finally, we explored principal and common signaling pathways by using Gene Set Enrichment Analysis and the association between the hub genes and immune cell subtype distribution by using CIBERSORT algorithm. Results We identified seven hub genes— GPR4 , SOCS3 , BAG3 , ZFP36 , CDKN1A , ADAMTS9 , and GADD45B —by using differentially expressed gene analysis and weighted gene co-expression network analysis method. The AUCs of these genes were all greater than 0.7 in the receiver operating characteristic curves analysis. The Gene Set Enrichment Analysis results demonstrated that mutual signaling pathways were mainly enriched in hypoxia and inflammatory response. CIBERSORT indicated that these seven hub genes were closely related to innate and adaptive immune cells. Conclusions We identified seven hub genes with promising diagnostic value and therapeutic targets in septic cirrhotic patients with sepsis-associated encephalopathy and/or hepatic encephalopathy. Hypoxia, inflammatory, and immunoreaction responses may share the common downstream pathways of the two common encephalopathies, for which earlier recognition and timely intervention are crucial for management of such septic cirrhotic patients in ICU.

Sepsis survivors present long-term cognitive deficits. The present study was to investigate the effect of early administration of high-dose vitamin C on cognitive function in septic rats and explore its possible cerebral protective mechanism. Rat sepsis models were established by cecal ligation and puncture (CLP). Ten days after surgery, the Morris water maze test was performed to evaluate the behavior and cognitive function. Histopathologic changes in the hippocampus were evaluated by nissl staining. The inflammatory cytokines, activities of antioxidant enzymes (superoxide dismutase or SOD) and oxidative products (malondialdehyde or MDA) in the serum and hippocampus were tested 24 h after surgery. The activity of matrix metalloproteinase-9 (MMP-9) and expressions of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1(HO-1) in the hippocampus were measured 24 h after surgery. Compared with the sham group in the Morris water maze test, the escape latency of sepsis rats was significantly (P = 0.001) prolonged in the navigation test, whereas the frequency to cross the platform and the time spent in the target quadrant were significantly (P = 0.003) reduced. High-dose vitamin C significantly decreased the escape latency (P = 0.01), but increased the time spent in the target quadrant (P = 0.04) and the frequency to cross the platform (P = 0.19). In the CLP+ saline group, the pyramidal neurons were reduced and distributed sparsely and disorderly, the levels of inflammatory cytokines of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 in the serum and hippocampus were significantly increased (P = 0.000), the blood brain barrier (BBB) permeability in the hippocampus was significantly (P = 0.000) increased, the activities of SOD in the serum and hippocampus were significantly (P = 0.000 and P = 0.03, respectively) diminished while the levels of MDA in the serum and hippocampus were significantly (P = 0.007) increased. High-dose vitamin C mitigated hippocampus histopathologic changes, reduced systemic inflammation and neuroinflammation, attenuated BBB disruption, inhibited oxidative stress in brain tissue, and up-regulated the expression of nuclear and total Nrf2 and HO-1. High-dose vitamin C significantly (P < 0.05) decreased the levels of tumor necrosis factor- (TNF)-α, interleukin-6 (IL-6), MDA in the serum and hippocampus, and the activity of MMP-9 in the hippocampus, but significantly (P < 0.05) increased the levels of SOD, the anti-inflammatory cytokine (IL-10) in the serum and hippocampus, and nuclear and total Nrf2, and HO-1 in the hippocampus. In conclusion, high-dose vitamin C can improve cognition impairment in septic rats, and the possible protective mechanism may be related to inhibition of inflammatory factors, alleviation of oxidative stress, and activation of the Nrf2/HO-1 pathway.

Objective: To observe and explore the effects of different tidal volume (VT) ventilation on right ventricular (RV) function in patients with critical respiratory failure. Methods: Consecutive respiratory failure patients who were treated with invasive ventilator over 24 h in the Department of Critical Care Medicine at the Fourth Hospital of Hebei Medical University from June to December in 2015 were enrolled in this study.Clinical data including patients' vital signs, ventilator parameters and RV echocardiography were collected within 6 h (D0), day1(D1), day2 (D2) and day3 (D3) after ventilation started.According to the VT, patients with acute respiratory distress syndrome (ARDS) were assigned to low VT group [S6, ≤6 ml/kg predicted body weight (PBW)] and high VT group (L6, >6 ml/kg PBW), while non-ARDS patients were also assigned to low VT group (S8, ≤8 ml/kg PBW) and high VT group (L8, >8 ml/kg PBW). Results: A total of 84 patients were enrolled in this study.44.2% ARDS patients and 58.5% non-ARDS patients were in low VT groups.After ventilation, tricuspid annulus plane systolic excursion(TAPSE)decreased progressively in S6 [from 18.30(16.70, 20.70) mm to 17.55(15.70, 19.50) mm, P=0.001], L6 [from 19.50(17.00, 21.00) mm to 16.30(15.00, 18.00) mm P=0.001], S8[from 18.00(16.00, 21.00) mm to 16.50(15.50, 18.00) mm, P=0.001] and L8 [from 19.00(17.50, 21.50) mm to 16.35(15.15, 17.00) mm, P=0.001] groups.However, TAPSE decreased less in small VT groups (S6 and S8) than those of in large VT groups (S8 and L8) without significant differences.There were not statistical differences between different VT groups in terms of ventilation days, including right ventricle area/left ventricle area (RV(area)/LV(area)), TAPSE, peak mitral flow velocity of the early rapid filling wave (E), peak mitral flow velocity of the late rapid filling wave (A), early diastolic velocity of the tricuspid annulus (e'), pulmonary artery systolic pressure, inferior vena cava diameter (all P>0.05). Compared to L6 group, low VT (S6 group) resulted in decreased mortality at 28 days [1/19 vs 37.5%(9/24), P=0.014]. There were not statistical differences between different VT groups in terms of ventilation days, length of intensive care unit stay, length of hospital stay (all P>0.05). Logistic regression analysis showed that VT could be the independent factor of TAPSE (OR=1.104, 95%CI 0.100-1.003, P=0.049). Conclusions: Positive pressure mechanical ventilation resulted in RV systolic dysfunction .Lower VT may have the protective effect on RV function. Trial registration: Chinese Clinical Trial Registry, ChiCTR-POC-15007563.

脓毒症是由于感染引起的全身炎症反应所导致的一种复杂的临床综合征.其进展可导致一个或多个脏器功能不全或衰竭,甚至死亡.脓毒症时导致的内毒素血症,致使血浆内皮素-1(ET-1)水平增高,引起明显而持久的血管收缩效应,减少组织器官血液灌注,最终导致多器官功能障碍甚至衰竭.2009-10-2012-03,我们运用血必净注射液治疗脓毒症50例,并与西药常规治疗50例对照观察,结果如下.

OBJECTIVE To observe clinical effect of Eight methods of treat early type 2 diabetes.METHODS 90 patients with early type 2 diabetes from December 2009 to May 2011 were selected for the research,and randomly divided into the Chinese medicine treatment group,the acarbose treatment group and the control group with 30 cases in each group.The Chinese medicine treatment group was treated by Eight methods of Fan's method.Each group was treated for 6 months,and observed before and after the treatment.RESULTS The effective rates were 83.3% in the Chinese medicine treatment group reached,and 80% in the acarbose treatment group.There was no significant difference(P﹥0.05);the effective rates of the 2 groups were higher than that of the control group.There was significant difference(P﹤0.05).CONCLUSION Eight methods of Fan's method is significantly effective.

目的观察血必净注射液对脓毒症患者肾功能的影响。方法 80例脓毒症患者随机分为对照组和治疗组,每组40例。对照组40例给予常规西医综合治疗,治疗组40例在综合治疗基础上加用血必净注射液治疗;分别检测2组患者治疗前及治疗后第1、3、5天BUN、CREA化验指标。结果 2组在治疗前BUN、CREA值差异无统计学意义(P>0.01);治疗后2组BUN、CREA均下降(P<0.01),治疗组用药后5 d的BUN、CREA下降趋势较对照组差异有统计学意义(P<0.01)。结论血必净注射液对脓毒症患者肾功能有保护作用。

目的观察血必净注射液对脓毒症患者凝血功能及肾功能的影响。方法 160例脓毒症患者随机分为两组,对照组80例给予常规西医综合治疗,治疗组80例在综合治疗基础上加用血必净注射液治疗;分别检测两组患者治疗前及治疗后第1、3、5日PT、APTT、FBG、D-Dimer、BUN、CREA各项指标。结果血必净治疗组血肌酐水平及凝血功能各项指标均较对照组有显著差异。结论血必净注射液对脓毒症患者凝血功能及肾功能有保护作用。

泪小管断裂是眼外伤常见的疾病,内眦部睑部外伤常伴有泪小管断裂,如不如期吻合,可造成泪溢并影响美观.我院2004年7月至2007年7月共收治外伤性泪小管断裂42例,均行泪小管断裂吻合术,报告如下.

患者,女,51岁.主诉:咳嗽、咳痰半月余,胸闷气短1周,加重2小时,于2008年5月20日19:25人我院重症监护病房(ICU).患者半月前出现发热、咳嗽、咳痰,就诊于所在工厂医院,胸片示.

患者,男,77岁,因鼻出血伴牙龈出血39天,发热、咳嗽1天,呼吸困难7小时于2006年8月31日由血液科转入ICU.缘于39天前无明显诱因出现乏力、鼻出血、牙龈出血,在血液科确诊为多发性骨髓瘤.3天前开始给予MP(马法仑、泼尼松)方案化疗,1天前出现发热、咳嗽,体温最高达38.5 ℃,7小时前出现呼吸困难,血氧监测显示:血氧饱和度80%;血气分析:pH 7.243、动脉血二氧化碳分压23.5 mm Hg、动脉血氧分压40 mm Hg、碱过剩 -13.3 mmol/L、吸氧浓度40%,以Ⅰ型呼吸衰竭转入ICU 科.