Objective:To investigate the correlation between the expressions of microRNA (miR)-29c-3p, miR-378a-3p and serum inflammatory factors, myocardial injury indexes and echocardiographic indexes in sepsis patients with myocardial injury, and analyze the value of prognosis evaluation.Methods:Prospective research methods were used. Two hundred and eighty-six patients with sepsis in Handan Central Hospital from February 2019 to October 2021 were selected. The serum levels of miR-29c-3p and miR-378a-3p were detected by polymerase chain reaction, and serum Troponin I (TnI), creatine kinase isoenzyme MB (CK-MB), myoglobin (Mb), B-type brain natriuretic peptide (BNP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β (IL-1β) and procalcitonin (PCT) were detected. The left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), stroke output (SV), cardiac output (CO) and the ratio of early diastolic maximum mitral valve velocity to atrial systolic maximum velocity (E/A) were measured by echocardiography. Serum TnI≥0.15 μg/L was defined as myocardial injury, the survival status within 28 d of hospitalization in patients with myocardial injury was recorded, and the acute physiology and chronic health Ⅱ evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) were evaluated. Pearson method was used for correlation analysis; Multivariate Logistic regression was used to analyze the independent risk factors of death within 28 d of hospitalization in sepsis patients with myocardial injury; the receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of miR-29c-3p and miR-378a-3p in predicting the death within 28 d of hospitalization in septic patents with myocardial injury patients.Results:Among 286 patients with sepsis, 131 had myocardial injury (myocardial injury group), and 155 had no myocardial injury (non-myocardial injury group). The miR-29c-3p, Mb, CK-MB, BNP, TnI, TNF-α, IL-6, IL-1β, PCT, CRP, LVEDD and LVESD in myocardial injury group were significantly higher than those in non-myocardial injury group: 5.02 ± 1.69 vs. 2.01 ± 0.57, (102.35 ± 23.56) μg/L vs. (32.15 ± 9.12) μg/L, (25.01 ± 6.09) U/L vs. (13.02 ± 4.16) U/L, (905.23 ± 135.49) ng/L vs. (92.31 ± 26.35) ng/L, (0.23 ± 0.05) μg/L vs. (0.12 ± 0.02) μg/L, (13.41 ± 3.71) μg/L vs. (3.26 ± 0.95) μg/L, (9.02 ± 2.46) ng/L vs. (4.18 ± 1.03) ng/L, (71.45 ± 15.29) ng/L vs. (30.02 ± 6.39) ng/L, (1.05 ± 0.21) μg/L vs. (0.72 ± 0.13) μg/L, (21.35 ± 6.13) mg/L vs. (16.23 ± 4.57) mg/L, (37.45 ± 3.39) mm vs. (34.01 ± 2.15) mm and (50.12 ± 3.49) mm vs. (44.17 ± 3.02) mm, the miR-378a-3p, LVEF, SV, CO and E/A were significantly lower than those in non-myocardial injury group: 1.67 ± 0.36 vs. 3.02 ± 0.79, (46.32 ± 3.26)% vs. (56.24 ± 4.98)%, (48.21 ± 2.81) ml vs. (56.02 ± 3.49) ml, (3.11 ± 0.29) L/min vs. (4.15 ± 0.31) L/min and 0.98 ± 0.21 vs. 1.19 ± 0.32, and there were statistical differences ( P<0.01). Pearson correlation analysis result showed that miR-29c-3p was positive correlation with TNF-α, IL-6, IL-1β, PCT, CRP, Mb, CK-MB, BNP, TnI, LVEDD and LVESD in sepsis patients with myocardial injury ( P<0.01 or <0.05), and it was negative correlation with LVEF, SV, CO and E/A ( P<0.01); miR-378a-3p was negative correlation with TNF-α, IL-6, IL-1β, PCT, CRP, Mb, CK-MB, BNP, TnI, LVEDD and LVESD ( P<0.01 or <0.05), and it was positive correlation with LVEF, SV, CO and E/A P<0.01). Among 131 sepsis patients with myocardial injury, 55 patients died within 28 d of hospitalization (death subgroup), and 76 patients survived (survival subgroup). The mechanical ventilation rate, continuous renal replacement therapy rate, APACHE Ⅱ, SOFA, miR-29c-3p, Mb, CK-MB, TnI, BNP, TNF-α, IL-6, IL-1β, PCT, CRP, LVEDD and LVESD in death subgroup were significantly higher than those in survival subgroup, the miR-378a-3p, LVEF, SV, CO and E/A were significantly lower than those in survival subgroup, and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that APACHE Ⅱ, TnI, miR-29c-3p were independent risk factors for death within 28 d of hospitalization in sepsis patients with myocardial injury ( OR = 1.203, 2.451 and 1.394; 95% CI 1.085 to 1.334, 1.498 to 4.008 and 1.141 to 1.702; P<0.01); and the miR-378a-3p an independent protective factor for death within 28 d of hospitalization in sepsis patients with myocardial injury ( OR = 0.367, 95% CI 0.217 to 0.622, P<0.01). ROC curve analysis result show that the best cut-off values of miR-29c-3p and miR-378a-3p for predicting the death within 28 d of hospitalization in sepsis patients with myocardial injury were 5.00 and 1.65; the area under the curve of miR-29c-3p combined with miR-378a-3p for predicting the death within 28 d of hospitalization in septic patients with myocardial injury was significantly larger than that of the two separate applications (0.890 vs. 0.695 and 0.732), with a sensitivity of 87.0%, a specificity of 87.3%, and an accuracy of 86.8%. Conclusions:The expression of serum miR-29c-3p is increased and the expression of miR-378a-3p is decreased in sepsis patients with myocardial injury. The expressions of miR-29c-3p and miR-378a-3p are related to the degree of myocardial injury, echocardiogram indexes, the levels of inflammatory factors and prognosis. The miR-29c-3p and miR-378a-3p can be used as potential prognostic indexes for sepsis patients with myocardial injury.

目的:探讨脑栓通胶囊联合注射用阿替普酶治疗急性脑梗死的疗效,及对患者血清N-末端脑钠肽前体(NT-proBNP)、肿瘤坏死因子-α(TNF-α)水平的影响.方法:90例急性脑梗死患者随机分为两组各45例.对照组在基础治疗同时给予注射用阿替普酶治疗,观察组在对照组基础上再加用脑栓通胶囊治疗.治疗14 d后,比观察两组临床疗效和药品不良反应发生情况,比较两组治疗前后改良Rankin量表(mRS)和神经功能缺损评分量表(NIHSS)评分,以及血清NT-proBNP与TNF-α水平变化情况.结果:观察组临床有效率为93.33％,明显高于对照组的75.56％(P＜0.05).治疗后,两组患者的NIHSS评分和mRS评分,以及血清NT-proBNP、TNF-α水平均较前明显降低(P＜0.05);且观察组上述指标均明显优于对照组(P＜0.05).两组药品不良反应发生率(8.87％vs.17.78％)无明显差异(P＞0.05).结论:脑栓通胶囊联合注射用阿替普酶治疗急性脑梗死临床疗效显著,能有效改善患者神经功能,降低血清NT-proBNP、TNF-α水平,且安全性较高,值得临床应用推广.

ObjectiveTo investigate the risk factors of anxiety and depression as well as the predictive role of anxiety/depression in prognosis in postoperative non⁃small cell lung cancer （NSCLC） patients.Methods316 NSCLC patients who underwent resection were consecutively enrolled and 300 gender/age⁃matched healthy subjects as healthy controls（HCs） was recruited.The anxiety and depression were assessed using the Hospital Anxiety and Depression Scale-Anxiety/Depression （HADS⁃A/D） in NSCLC patients at discharge after surgery and enrollment.The NSCLC patients were followed up to death or 36 months.ResultsThe HADS⁃A score，anxiety rate and severity were higher in NSCLC patients than those in HCs.The HADS⁃D score，depression rate and severity were also higher in NSCLC patients than those in HCs.Furthermore，in NSCLC patients， anxiety was affected by sex，marital status，diabetes，pathological differentiation，tumor size，lymph node （LYN） metastasis，TNM stage.Depression was affected by sex，education level，diabetes，pathological differentiation，TNM stage.Moreover，NSCLC patients with anxiety had shorter disease⁃free survival （DFS） and overall survival （OS） than those without anxiety.NSCLC patients with depression also presented shorter DFS and OS than those without depression.ConclusionsAnxiety and depression were prevalent in NSCLC patients after surgery，and they could predict poor prognosis.

目的评估血浆微小RNA-103（miR-103）和RNA-107（miR-107）对脓毒症患病死亡风险的预判,并探讨其与脓毒症患者疾病严重程度及预后有关联的因素。方法选取2016年1月至2019年6月接受治疗的脓毒症患者120例（脓毒症组）,入院24 h之内收集血液样本;选取同期健康对照者120例（健康对照组）,入组时收集血液样本,并分离血液样本中血浆。采用反转录-荧光定量聚合酶链式反应检测所有受试者血浆miR-103和miR-107的表达水平。采用酶联免疫吸附试剂盒检测脓毒症组血浆中某些炎症因子的表达水平。收集脓毒症组临床指标并计算其28 d死亡率。采用受试者工作曲线（ROC）对临床辅助诊断的预判分析,采用Cox?s回归模型分析脓毒血症死亡的关联因素。结果 miR-103和miR-107在脓毒症组表达水平相比健康对照组均降低,且可作为脓毒症临床诊断的辅助指标,其曲线下面积（AUC）分别为0.893（95%CI:0.854～0.933）及0.941（95%CI:0.913～0.968）。脓毒症组miR-103和miR-107表达水平与急性生理和慢性健康状态II评分、序贯器官功能衰竭评分、血清肌酐、C-反应蛋白、肿瘤坏死因子-α、白介素-1β、白介素-6及白介素-8均呈负相关,与白蛋白呈正相关。此外,miR-103和miR-107在脓毒症死亡患者中表达水平较脓毒症存活患者降低。多元Cox?s回归分析结果显示,miR-103表达是预测脓毒症组28 d死亡率的独立因素。结论 miR-103和miR-107低表达与脓毒症相关,并与脓毒症患者疾病严重程度及28 d死亡率相关。

目的:探究大株红景天注射液对脓毒症相关性脑病患者疗效和血清、脑脊液中S100B蛋白的影响.方法:选取2017-02-01-2018-03-15期间入住我院EICU的54例脓毒症相关性脑病患者作为研究对象,随机分为对照组(27例)和治疗组(27例).对照组给予规范化治疗,治疗组在对照组基础上加用大株红景天注射液,观察并记录相关指标变化,运用统计学方法进行分析.结果:治疗组临床疗效(住院病死率、住院时间、APACHEⅡ、GCS、MMSE、ADL)优于对照组,除住院病死率外,两组其余指标比较差异均有统计学意义(P＜0.05).治疗组治疗第1、3、7天血清和脑脊液中的S100B蛋白浓度均低于对照组,其中两组治疗第7天血清中S100B蛋白浓度比较差异具有统计学意义(P＜0.05),两组治疗第3、7天脑脊液中S100B蛋白浓度比较差异具有统计学意义(P＜0.05).治疗组治疗第3、7天血清中的TNF-α浓度比较均低于对照组,差异有统计学意义(P＜0.05).结论:大株红景天注射液辅助治疗可降低脓毒症相关性脑病患者血清和脑脊液中S100B蛋白浓度,减轻炎症反应,提高临床疗效,降低病死率.

目的:探讨大株红景天注射液治疗急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的疗效以及对呼出气冷凝液(EBC)中VEGF-A的影响.方法:选取本院EICU 2015 03-2017-06期间行机械通气的ARDS患者72例为研究对象,入选病例随机分为两组,其中对照组36例,大株红景天治疗组36例.对照组给予监测血流动力学、呼吸机辅助呼吸等针对ALI/ARDS的常规规范化治疗,治疗组在此规范化治疗基础上加用大株红景天注射液治疗7d,观察记录相关指标变化,并运用统计学方法分析得出结果.结果:两组第5、7天临床疗效比较,治疗组氧合指数、肺损伤评分、C反应蛋白均优于对照组,其中第5d的氧合指数和肺损伤评分两组之间比较差异有统计学意义(P＜0.05),C反应蛋白比较差异无统计学意义;第7天氧合指数、C反应蛋白和肺损伤评分比较差异有统计学意义(P＜0.05).两组第5、7天EBC中VEGF-A浓度比较差异有统计学意义(P＜0.05),A-PACHEⅡ评分比较差异无统计学意义.两组累积病死率比较,5d以前比较差异无统计学意义,5d以后比较差异有统计学意义(P＜0.05).结论:大株红景天注射液增加行机械通气的ALI/ARDS患者EBC中VEGF-A浓度、提高临床疗效、减少病死率.但影响ALI/ARDS患者预后的因素较多,有关EBC中VEGF-A浓度评估疾病预后,仍需进一步基础研究.

1 S100B蛋白1.1 S100B蛋白概述S100B蛋白因在中性饱和硫酸铵的溶解度为100%而得名,是一种脑特异性钙结合蛋白,广泛存在中枢系统内。该蛋白是多基因编码的,由α和β2种亚基组成的蛋白分子量为21KD酸性钙结合蛋白。主要由神经胶质细胞合成分泌,尤其是星形胶质细胞和少突质细胞,通过其足突分布于毛细血管

百草枯(paraquat,PQ,1,1-二甲基-4,4-联吡啶阳离子盐),是目前世界范围内应用最广泛、非选择性的触灭型除草剂之一.近年来,随着百草枯的普及与使用,百草枯中毒也日趋增多.百草枯中毒易引发多脏器损伤甚至功能衰竭(MOF),目前在治疗上尚无特效解毒剂,常规对症处理效果极差,临床病死率高,可达60％以上,且存活者预后极差[1-2].本文选择2010-2013年入组的84例急性百草枯中毒患者,通过用大株红景天联合血液灌流及常规治疗,取得了良好的临床疗效,现将结果报告如下.

Objetive To report the clinical application of pediatric toe with toe antegrade arterial nerve pedicle flap. Methods January 2008-2013 June 8 cases of patients with toe-side (belly)application to re-pair the same defect toe toe antegrade arterial nerve pedicle flap flap.Defects in three cases in which the toe,toe abdominal defect five cases,the area of skin defect size 1.0 cm ×1.5 cm~1.2 cm ×1.8 cm.Age 3~12 years (mean age 5 years old). Results All flaps survived,no vein crisis occurred.After January-six months of fol-low-up,full flap shape,color,line-like scar just for the subject area,toe feels normal,all cold and sore toe ca-ses,children with normal gait. Conclusion Toe with toe antegrade arterial nerve pedicle flap is a good method to repair pediatric toe toe (abdomen)defect.

毗虫啉是一种新型的硝基亚甲基类的内吸杀虫剂,具有胃毒和触杀作用.其杀虫机制主要是选择性抑制昆虫神经系统烟碱型乙酰胆碱受体,阻断昆虫神经系统的正常传导,导致昆虫麻痹进而死亡.吡虫啉对人畜均有一定毒害.急性重度吡虫啉中毒病情凶险,死亡率高.彻底清除体内吡虫啉可明显提高重度中毒患者的抢救成功率.序贯消化道净化联合血液灌流治疗急性重度吡虫啉中毒疗效显著.

Objective To compare the repairment effect of digit tip injury and pulp loss by three kinds of pedicle skin flap in long-term. Then the result will provide the best choice for digit tip injury and pulp loss. Methods The cases which had the digit tip injury and pulp loss repaired by two types of digital artery flapwere divided into 3 group, group 1 was anterograde digital artery flaps. Group 2 was pedicle of dorsal digital artery flaps of middle segment, group 3 was pedicel of dorsal digital artery flap of Proximal finger. 30 cases of each group were followed up for 4.5 years. A contrastive analysis of 9 index were made. This comparison consists of the satisfaction of the flaps. Results All patients were satisfactory with the effect, There was difference between group 1 and group 2 andgroup 3. The difference consist of stereognosis, two point discrim-pination, cases of chills, sweat, appearance of the donor sites. Group 2 and group 3 had difference in cases of chills. No significant difference between the three groups in other aspects. Conclusion These are good methods for using 3 different flaps to repair digit injury and pulp loss in long period. Good results coverd all the groups. Comparison of comprehensive indexes, anterograde digital artery flaps is the first choice of treatment then the pedicel of dorsal digital artery flaps of middle segment, at last pedicel of dorsal digital artery flap of Proximal finger.

Objetive To report the effect and clinical applications of using antegrade digital artery flaps from the same finger to repair digit injury and pulp loss. Methods From January 2009 to December 201 2.46 cases of the digit fingertip injury and finger pulp defect were treated with anterograde digital artery flaps transfer form the same finger,there were 25 cases of them which preserve nail bed.there were 24 cases of finger tip in-gury and 31 cases of pulp defect.The defect scopes were 0.5 cm ×1 .0 cm to 0.8 cm ×1 .0 cm the age ranged from 2 to 1 1 years,the average age was 5 .8 years. Results All flaps survived after operation,there was no vascular crisis.1 0 cases with nail bed and 1 0cases without nail bed which were followed up from 1 to 3 years. The flaps had good appearance and texture and sweat,here were just few string sign on the donor and receient sites.The nails of 1 6 cases which preserve nail bed grew normally without nail bed partial andnail deformity,4 cases of they have longitudinal ridge or nail stripes.Two point discrimination were normal.fine touch and func-tion of finger motion were obtained. Conclusion When the indication under control it is a better method for repair of finger tip defect and finger pulp loss by the digital neurovascular antegrade flaps from the same finger.

手是人类重要的劳动和感觉器官，兼有美学功能，指端感觉灵敏。指端（腹）缺损在手外伤中占有较大比例［1］，处理不当不仅会影响手的功能和美观，也给患者的生活造成心理压力。作者对2006年1月-2012年12月收治的64例（其中小儿18例）末节皮肤缺损的患者应用重建感觉的中节指动脉终末背侧支筋膜蒂皮瓣进行修复，取得了满意的效果，现报告如下。

目的：分析急诊收治高龄肺栓塞患者临床资料，探讨其危险因素及临床特点。方法回顾性分析2005年-2012年经我院急诊确诊老年性肺栓塞患者19例，将其分为高龄组(年龄≥80岁)9例及对照组(年龄65岁~79岁)10例，两者在危险因素、临床资料、诊断与治疗措施上进行对比研究。结果危险因素，高龄组仅卧床指标高于对照组(P<0.01)；高血压、脑卒中、2型糖尿病等未见明显高于高龄组(P>0.05)；两组在性别、临床症状、D 二聚体、PTCA充盈缺损等无统计学意义(P>0.05)。治疗措施上两组患者无特殊差异。结论高龄肺栓塞患者危险因素繁杂，临床表现呈多样性，其误诊率高，应引起一线医师重视。

目的：总结小儿指背侧指动脉逆行皮瓣修复同指中、末节皮肤缺损的临床应用。方法2009年1月至2013年1月对20例手指中、末节皮肤缺损的小儿患者应用重建感觉的指背侧指动脉逆行皮瓣修复。中节皮肤缺损8例，末节皮肤缺损12例，皮肤缺损面积0.6 cm×1.2 cm~1.0 cm×1.5 cm。结果皮瓣全部成活，术后出现静脉危象3例。其中14例经6个月~1年的随访，8例大于6岁的患者两点辨别觉平均为5.5 mm。皮瓣外观饱满，深感觉恢复，手指无活动障碍，供区无明显瘢痕。结论重建感觉的指背侧指动脉逆行皮瓣是修复小儿手指中、末节皮肤较大面积缺损的好方法。

目的 回顾性分析序贯消化道净化联合血液灌流治疗急性重度有机磷农药中毒的疗效.方法 从2009年1月～2011年12月收治的中毒病例中筛选64例急性有机磷农药重度中毒患者,分为实验组和对照组各32例.两组均采用电动洗胃机导泻、清洁局部皮肤、毛发,常规使用抗胆碱药阿托品、胆碱酯酶复能剂氯解磷定及并发症防治等措施.实验组在常规治疗的基础上进行持续胃灌洗、导泻,并联合床旁血液灌流治疗.观察两组患者胆碱酯酶恢复至50％以上所需时间、住院天数、阿托品总量、氯解磷定总量、中间综合征例数、多脏器功能衰竭例数、机械通气发生率及机械通气时间、治愈率.结果 实验组胆碱酯酶恢复至50％以上所需时间、住院天数明显缩短,阿托品总量和氯解磷定总量减少,中间综合征、多脏器功能衰竭例数明显减少,机械通气发生率明显减少,机械通气时间明显缩短,治愈率明显升高(P＜0.05).结论 序贯消化道净化联合血液灌流治疗急性重度有机磷农药中毒疗效明显.