Lung-protective ventilation is a cornerstone of modern mechanical ventilation, yet real-world adherence to lung-protective targets remains suboptimal. While previous studies have established the physiological benefits of low tidal volume and driving pressure, clinical implementation is hindered by limited monitoring granularity and lack of real-time actionable feedback. This trial aims to evaluate whether a real-time, cloud-based algorithmic feedback platform can improve lung-protective ventilation delivery and contribute to better clinical outcomes in mechanically ventilated patients with ARDS. This multicentre, parallel-group, open-label randomised controlled trial will enrol 208 adult mechanically ventilated ICU patients with ARDS from nine adult ICUs across tertiary academic hospitals and regional referral centres in multiple provinces and municipalities in mainland China. Participants will be randomly assigned in blocks to receive either standard monitoring (Control group) or real-time respiratory mechanics feedback through a cloud-based platform (Intervention group). The intervention group will receive real-time alerts for lasting 72 h and ventilator reports every 24 h, integrating tidal volume, plateau pressure, driving pressure, mechanical power, and detected patient–ventilator asynchrony events. The primary outcome is the lung-protective ventilation achievement rate, defined as compliance with VT < 8 mL/kg predicted body weight, driving pressure < 15 cmH₂O, plateau pressure < 30 cmH₂O, and mechanical power < 17 J/min during the first 72 h after randomisation. Secondary outcomes include ventilator-free days at day 28, ICU length of stay, ventilator-associated complications, inflammatory biomarkers, clinician satisfaction, and predefined safety outcomes, including severe hypoxemia, severe hypercapnia/acidemia, barotrauma, and hemodynamic instability temporally associated with ventilator adjustments. This study is, to our knowledge, among the first multicentre randomised controlled trials to evaluate a real-time algorithmic feedback platform designed to enhance lung-protective ventilation. The intervention is designed to provide continuous bedside feedback on ventilation mechanics and may enable more timely and standardised clinical adjustments, with the potential to facilitate lung-protective ventilation delivery. Triaiontl registration ClinicalTrials.gov Identifier NCT07307066 (Registration Date: 2025/12/02).

Background Strategies that specifically target the integrated stress response (ISR) as a therapeutic approach in sepsis remain largely unexplored. This study aimed to identify and validate ISR-related biomarkers in sepsis. Methods This study used 529 ISR-related genes (ISRRGs) alongside sepsis datasets. First, differentially expressed gene between sepsis and normal samples, key module genes associated with sepsis, and ISRRGs were intersected to identify candidate genes. Next, biomarkers were selected through three machine learning methods. Subsequently, enrichment analysis, immune infiltration analysis, regulatory network analysis, and drug prediction were conducted. Finally, the biomarkers were experimentally validated using RT-qPCR. Results Four biomarkers of sepsis (DYRK2, BCL2, NUP93, and NFATC2) were identified; collectively, these biomarkers are associated with the enrichment of translation initiation in sepsis. A total of 783 significantly upregulated pathways and 1203 significantly downregulated pathways were identified. These biomarkers were co-regulated by multiple microRNAs and transcription factors. Importantly, 726 drugs were predicted to interact with these biomarkers. Additionally, RT-qPCR results demonstrated that the expression levels of DYRK2, BCL2, NUP93, and NFATC2 differed significantly between sepsis and normal samples. Conclusion DYRK2, BCL2, NUP93, and NFATC2 were identified as biomarkers of sepsis, offering new diagnostic and therapeutic targets for its treatment.

ObjectivesTo analyzed the clinical characteristics and treatment modalities of heat stroke (HS) and to identify risk factors for a poor prognosis of HS and provide reference suggestions for its treatment and prevention.Measurements and main resultsWe enrolled a total of 247 patients, with hypertension, diabetes, and psychosis being the top three comorbidities associated with HS. The incidence of HS was higher among males and older individuals. Compared to the control group, the poor prognosis group experienced higher temperatures, a higher incidence of cerebral edema, and gastrointestinal bleeding (all p < 0.05). The poor prognosis group had significantly higher blood pH, HCO3-, Lac, Scr, AST, ALT, DBIL, CKMB, PT, DD, and PLT (all p < 0.05). Furthermore, logistic regression analysis revealed that Lac, Scr, and APACHE II were risk factors for poor prognosis (p < 0.05). The AUC values for the combined diagnostic model were 0.848 (95% CI: 0.781–0.914). Male morbidity, the number of patients with combined hypertension, the prognosis, and the APACHE II score and ALT level were all greater (p < 0.05) in the CHS group. The Kaplan–Meier analysis revealed that the CHS group had a significantly higher mortality rate than the EHS group.ConclusionA high incidence of hypertension, diabetes, psychosis, men, and older persons may be associated with HS. HS patients with high blood cell counts, impaired coagulation, liver and kidney diseases, and those with a specific type of CHS may face a poor prognosis. In patients with heart failure, APACHE II, Lac, and Scr were independent risk factors for a poor prognosis.

目的:探究负载化疗药物阿霉素(doxorubicin,DOX)的聚多巴胺包裹纳米金粒子用于化疗与光热协同治疗在骨肉瘤中的应用效果.方法:分别合成纳米金粒子(Au)、聚多巴胺包裹的纳米金粒子(Au@PDA)及载药后的纳米粒子(Au@PDA@DOX).利用高倍透射电镜表征其形貌;利用动态光散射仪检测其粒径;利用近红外热成像仪表征其光热转换效能;考察药物的载药率及体外释放情况.体外的抗肿瘤实验中,将骨肉瘤MG-63细胞分为5组:PBS对照组、游离DOX组、Au@PDA+激光组、Au@PDA@DOX组和Au@PDA@DOX+激光组.采用CCK-8法及活死细胞染色检测各实验组对骨肉瘤MG-63细胞的杀伤效果,使用电感耦合等离子体质谱(ICP-MS)去检测骨肉瘤对Au@PDA@DOX和Au@PDA的摄取情况,使用荧光倒置显微镜观察各组细胞凋亡情况.结果:成功制备出粒径为(13.3±0.8)nm的纳米金粒子,使用聚多巴胺包裹的纳米金粒子粒径为(185.6±6.0)nm,负载DOX后粒径增大到了(288.0±6.2)nm,载药量为(12.8±0.8)％,在酸条件下,DOX的释放速度加快;细胞吞噬实验表明MG-63细胞对Au@PDA@DOX纳米粒子的吞噬量高于Au@PDA纳米粒子;单一治疗及光热治疗与化疗协同杀伤MG-63细胞的能力评估结果表明,联合作用的效果大于单一治疗.结论:负载DOX的Au@PDA纳米系统表现出良好的光热效应,能够抑制MG-63细胞的生长.该纳米系统实现了化疗与光热协同作用,可用于骨肉瘤的治疗.

目的 观察老年2型糖尿病(type 2 diabetes mellitus, T2DM)合并临床甲状腺功能减退(overt hypothyroidism,OH)及亚临床甲状腺功能减退(subclinical hypothyroidism, SCH)患者血清apelin水平变化,探讨血清apelin与老年T2DM患者发生OH、SCH的关系.方法 老年T2DM患者175例,根据甲状腺功能分为OH组54例、SCH组59例和正常组62例.检测3组血清空腹血糖(fasting plasma glucose, FPG)、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)、三酰甘油(triacylglycerol, TG)、总胆固醇(total cholesterol, TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、游离甲状腺素(free thyroxine,FT4)、游离三碘甲状腺原氨酸(free triiodothyronine, FT3)、促甲状腺激素(thyroid-stimulating hormone, TSH)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody, TPOAb)、甲状腺球蛋白抗体(thyroglobulin antibody, TgAb)、apelin水平;Pearson相关法分析老年T2DM患者血清apelin水平与糖脂代谢、甲状腺功能指标的相关性;多重线性回归分析老年T2DM患者血清apelin水平的影响因素;多因素logistic回归分析老年T2DM患者发生OH或SCH的影响因素.结果 OH组、SCH组血清FPG[(9.23±1.95)、(9.10±1.83) mmol/L]、 HbA1 c[(10.13±1.47)％、(9.39±1.28)％]、TG[(2.71±1.35)、 (2.52±1.04) mmol/L]、TC[(7.31±1.92)、(6.09±1.64) mmol/L]、 TSH[(62.58±21.35)、(7.29±1.74)u/L] 、apelin[(483.19±43.05)、(401.29±40.18)pg/L]水平均高于正常组[FPG(8.11±1.59) mmol/L、HbA1 c(8.12±1.03)％、TG(1.83±0.76) mmol/L、 TC (4.77±1.18) mmol/L、 TSH(1.83±0.62) u/L、 apelin(327.91±30.42) pg/L],HDL-C水平[(1.06±0.26)、(1.17±0.21) mmol/L]低于正常组[(1.32±0.23) mmol/L](P＜0.05);OH组血清LDL-C、TPOAb、TgAb水平均高于正常组(P＜0.05),FT4、 FT3水平均低于正常组(P＜0.05);SCH组血清LDL-C、 FT4、 FT3、 TPOAb、 TgAb水平与正常组比较差异均无统计学意义(P＞0.05);OH组血清HbA1 c、TC、TSH、TPOAb、TgAb、 apelin水平均高于SCH组(P＜0.05), HDL-C、 FT4、 FT3水平均低于SCH组(P＜0.05),FPG、TG、LDL-C水平与SCH组比较差异均无统计学意义(P＞0.05).老年T2DM患者血清apelin水平与FPG(r=0.228,P=0.007)、 HbA1c(r=0.359, P=0.005)、TG(r=0.491, P=0.001)、TC(r=0.528, P＜0.001)、TSH(r=0.662,P＜0.001)水平呈正相关,与FT4(r=-0.601,P＜0.001)、FT3(r=-0.546,P＜0.001)水平呈负相关,与LDL-C、H DL-C、 TPOAb、 TgAb水平无线性相关(P＞0.05). FPG、TC、TSH正向影响老年T2DM患者血清apelin水平,FT4负向影响老年T2DM患者血清apelin水平(P＜0.05).血清FPG、TC、 HDL-C、FT4 、FT3 、TSH、TPOAb、TgAb、apelin是T2DM患者发生OH或SCH的影响因素(P＜0.05).结论 老年T2DM合并OH或SCH患者血清apelin水平明显升高,且与糖脂代谢、甲状腺功能有关,是老年T2DM患者发生OH或SCH的危险因素.

目的 探讨维格列汀对糖尿病足溃疡(DFU)大鼠创面的愈合潜力.方法 90只健康SD大鼠随机分为9组,即空白组(3、6、9d组)、模型组(3、6、9d组)、维格列汀组(3、6、9d组),每组各10只.除空白组外,其余大鼠采用高糖高脂饲料+链脲佐菌(STZ)诱发大鼠DFU模型,造模成功后24 h,空白组和模型组灌胃双蒸水(10 mg/kg),维格列汀组按57 mg/kg剂量灌胃,分别于给药后的3、6、9 d,处死大鼠,取创面组织.采用苏木精-伊红染色(HE)观察创面组织病理变化;酶联免疫吸附法(ELISA)检测血清肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)水平;免疫组织化学法检测创面组织血管内皮细胞生长因子(VEGF)、表皮细胞生长因子(EGF)、E-钙黏蛋白(E-cadherin)、碱性成纤维细胞生长因子(bFGF)表达.结果 与空白组相比,模型组大鼠创面组织明显坏死脱落,血清IL-6、TNF-α水平在3、6、9d时均明显升高(P<0.05),创面组织EGF、VEGF、bFGF、E-cadherin表达明显降低(P<0.05);与模型组比较,维格列汀治疗3、6、9d可明显降低IL-6、TNF-α水平,明显升高EGF、VEGF、E-cadherin表达(P<0.05).结论 维格列汀对糖尿病足溃疡创面延迟愈合具有潜在作用,可抑制炎性因子、增加血管再生因子及再上皮化因子发挥其潜能,促进创面愈合.

目的 探究维格列汀对实验性糖尿病足溃疡创面的愈合作用及其机制.方法 45只健康SD大鼠随机分为3组,即空白组、模型组和维格列汀组,每组15只.采用高糖高脂饲料+链脲佐菌诱发大鼠糖尿病足溃疡模型,造模成功后24 h,空白组和模型组予以等量生理盐水(2 ml/100 g)灌胃,维格列汀组按57 mg/kg剂量灌胃,分别于给药3,6,9 d,每组各取5只大鼠处死,取创面组织.采用HE染色观察创面组织病理变化.生化分析血糖、TC、TG、HDL和LDL浓度.ELISA检测创面组织TNF-α、IL-6和IL-1β 水平.Western blot检测创面组织Nrf2、Keap1、collagen-Ⅰ、TGF-β 和 α-SMA蛋白表达.结果 与空白组相比,模型组大鼠创面组织明显坏死脱落,给药6,9 d模型组TC、HDL、LDL、IL-1β、IL-6、TNF-α水平明显升高(均P<0.05),创面组织Nrf2、collagen-Ⅰ、TGF-β和α-SMA蛋白表达明显降低(均P<0.05).给药9 d,与模型组比较,维格列汀组HDL、LDL、IL-1β、IL-6、TNF-α水平明显降低(均P<0.05),Nrf2、collagen-Ⅰ、TGF-β和 α-SMA蛋白表达明显升高(均P<0.05).结论 维格列汀对糖尿病足溃疡创面延迟愈合具有潜在作用,可抑制炎症标志物、影响Nrf2途径,促进创面愈合.

目的 分析弥漫性轴索损伤患者颅脑CT表现及与GCS评分、临床预后的关系.方法 选取2018年1月至2019年4月南充市中心医院神经外科收治的90例弥漫性轴索损伤患者,收集患者临床及影像学资料.观察记录患者CT的表现,观察病灶是否累及脑中线部位,并将其分为累及组和不累及组;记录患者的临床预后情况及GCS计分.结果 CT检查下显示90例弥漫性轴索损伤患者,其中42例患者病灶累及脑中线部位,48例患者病灶未累及脑中线部位.病灶累及脑中线部位组与病灶未累及脑中线部位组的临床预后比较差异有统计学意义(P<0.05),病灶未累及脑中线部位组患者的临床预后显著优于病灶累及脑中线组的患者;病灶累及脑中线部位组与病灶累及脑中线部位组的GCS计分比较差异有统计学意义(P<0.05),病灶累及脑中线部位组患者的GCS计分情况比病灶未累及脑中线组严重,计分更低.结论 颅脑CT检查是临床上诊断弥漫性轴索损伤的重要方法,可为临床上早期诊断和治疗提供丰富的信息.其次DAI的病灶累及脑中线部位的患者其临床预后差并且GCS计分较低,可为临床提供重要参考价值.

BACKGROUND:Despite advances in therapeutic strategies and critical care management, septic encephalopathy (SE) is still a leading cause of infection-associated death in intensive care units (ICUs). Vitexin, a flavonoids compound, exerts and anti-inflammatory effect through inhibition of proinflammatory cytokines and signaling pathways. This study aimed to explore the anti-inflammatory effects of vitexin in SE and the underlying mechanisms.METHODS:An SE-inducedC57BL/6 mouse model was established via cecal ligation and puncture (CLP). Western blotting was performed to evaluate the protein expression levels of Chemokine (C-X-C motif) ligand 1 (CXCL1), fractalkine (CX3CL1), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, NF-κB p65, p-NF-κB p65, and tumor necrosis factor-α (TNF-α). Flow cytometry was used to detect the expressions ofCD11a/CD18, CD11b/CD18, ICAM-1, and adherent leukocyte. The expression of ICAM-1 was detected by immunohistochemistry. An enzyme-linked immunosorbent assay was performed to evaluate the expression of monocyte chemotactic protein-1 (MCP-1), Interleukin (IL)-6, IL-8, and IL-10.RESULTS:In this study, we found that vitexin significantly downregulated the expression of brain endothelial chemokines CXCL1 and CX3CL1 in CLP mice, exerting a potential anti-inflammatory against SE. Our data also showed that vitexin alleviated SE primarily by relying on reducing leukocyte-endothelial adhesion via the mediation of adhesion molecules. Moreover, vitexin suppressed the expression of proinflammatory cytokines, such as MCP-1, IL-6, IL-8, TNF-α, and NF-κB p65, in the CLP mice, while the expression of the anti-inflammatory cytokine IL-10 was elevated.CONCLUSIONS:Overall, our study demonstrated the protective effect vitexin exerts in SE by reducing leukocyte-endothelial adhesion and inflammatory response. These findings offer a molecular basis for the potential application of vitexin in the treatment of SE and other inflammatory-mediated and immunemediated disorders.

该文介绍了可用于四肢根部离断毁损伤的多用途充气加压包扎装置.该装置由长方形加压包扎区、术带区(4条束带)和其他附加装置组成,束带可根据需要利用末端的插扣快速连接和收紧;可用于四肢根部离断毁损伤创面加压包扎、皮肤软组织开放性损伤创面加压及下肢长骨临时外固定、多发肋骨骨折外固定、骨盆骨折外固定等场景;具有适形性好、创面加压均匀,充气快捷、压力可控,携行轻便、使用简单及节约敷料、可重复使用等优点,适用于战现场急救.

目的:观察急性胰腺炎使用畅胰通腑汤配合西药治疗后疗效及预后分析.方法:选择我院收治的胰腺炎患者110例,随机分为西药组和中西组各55例,其中西药组给予常规治疗,中西组在此基础上加用畅胰通腑汤进行治疗,两组患者均治疗至出院.观察两组治疗效果,计算总有效率;观察比较两组腹胀、腹痛、压痛平均消失时间及平均住院天数;检测治疗前后血淀粉酶及尿淀粉酶含量变化情况,及白介素-6(IL-6)、白介素-8(IL-8)水平变化情况;并在治疗结束3个月后进行随访调查,统计复发情况及复发率.结果:治疗后,中西组总有效率为81.82％,明显高于西药组70.91％,差异有统计学意义(P＜0.05).治疗后,中西组腹胀消失时间(7.88 ±2.23)天、腹痛消失时间(2.76±1.15)天、压痛消失时间(3.11±1.97)天、住院天数(14.42±3.44)天,明显低于西药组(13.36±2.28)天、(6.33±2.06)天、(6.52±2.10)天、(18.76±4.03)天,差异有统计学意义(P＜0.05).治疗前,两组血淀粉酶及尿淀粉酶含量变化差异无统计学意义(P＞0.05);治疗后,两组血淀粉酶及尿淀粉酶含量,均低于治疗前差异有统计学意义(P＜0.05).治疗后,中西组血淀粉酶及尿淀粉酶含量,均显著低于西药组,差异有统计学意义(P＜0.05).治疗前,两组白介素-6(IL-6)、白介素-8(IL-8)水平变化差异无统计学意义(P＞0.05);治疗后,两组白介素-6(IL-6)、白介素-8(IL-8)水平,均低于治疗前差异有统计学意义(P＜0.05).治疗后,中西组白介素-6(IL-6)、白介素-8(IL-8)水平,均显著低于西药组,差异有统计学意义(P＜0.05).治疗结束3个月后,中西组复发率为9.09％,明显低于西药组23.64％,差异有统计学意义(P＜0.05).结论:畅胰通腑汤配合西药治疗急性胰腺炎疗效较好,预后良好.

Objective To analyze risk factors for acquired weakness in ICU patients. Methods Totally 280 patients admitted to the ICU of Nanchong Central Hospital between June 2015 and September 2018 were enrolled. Among them, 63 patients developed ICU acquired weakness, while 217 patients did not. According to clinical work experience, several direct or indirect factors for ICU acquired weakness, such as gender, age, body mass index (BMI), simplified acute physiology score (SAPS) Ⅱ, acute physiology and chronic health evaluation (APACHE) Ⅱ score, disturbance of consciousness, hypertension, hyperglycemia, department, disseminated intravascular coagulation (DIC), sepsis, septic shock, multiple organ dysfunction syndrome (MODS), long-term bed rest and immobilization, hypoalbuminemia, mechanical ventilation time, application of glucocorticoid, neuromuscular blocker and norepinephrine, and early rehabilitation intervention, were included in the Logistic regression analysis to screen out its influencing factors. Results Univariate Logistic regression analysis showed that female [odds ratio (OR)= 1.514, 95% confidence interval (CI) (1.074, 1.328), P= 0.042], age older than 60 [OR= 1.613, 95%CI (1.142, 2.002), P= 0.042], SAPSⅡ score ≥ 25 [OR= 1.982, 95%CI (1.003, 2.925), P= 0.013], APACHEⅡ score ≥ 8 [OR= 1.770, 95% CI (1.192, 2.742), P = 0.014], hyperglycemia [OR = 1.853, 95%CI (1.035, 2.214), P = 0.015], sepsis [OR = 2.309, 95%CI (1.013, 3.063), P = 0.021], septic shock [OR = 2.106, 95%CI (1.995, 4.947), P = 0.025], MODS [OR = 3.721, 95%CI (1.001, 4.980), P = 0.007], long-term bed rest and immobilization [OR = 4.641, 95% CI (1.932, 5.253), P < 0.001], mechanical ventilation time ≥ 72 h [OR = 3.367, 95%CI (1.635, 4.254), P = 0.005], glucocorticoid [OR = 1.709, 95%CI (1.424, 2.757), P = 0.021], neuromuscle blocker [OR = 2.042, 95%CI (1.331, 4.953), P = 0.011], and early rehabilitation intervention [OR = 0.586, 95% CI (0.953, 1.472), P = 0.037] were associated with ICU acquired weakness. After multivariate Logistic regression analysis, age older than 60 [OR = 1.576, 95% CI (1.095, 1.753), P = 0.038], SAPSⅡ score ≥ 25 [OR = 1.988, 95%CI (1.115, 1.803), P = 0.013], APACHEⅡ score ≥8 [OR = 1.768, 95%CI (1.189, 2.364), P = 0.014], hyperglycemia [OR = 1.680, 95%CI (1.033, 1.689), P = 0.015], sepsis [OR = 1.842, 95%CI (1.011, 1.976), P = 0.010], long-term bed rest and immobilization [OR = 4.745, 95%CI (1.931, 3.470), P < 0.001], mechanical ventilation time ≥ 72 h [OR = 3.353, 95%CI (1.722, 4.314), P = 0.003], and neuromuscle blocker [OR = 1.931, 95%CI (1.247, 2.573), P = 0.005] were independent risk factors, and early rehabilitation intervention [OR = 0.598, 95%CI (0.978, 1.674), P = 0.037] was the protective factor for acquired weakness in ICU patients. Conclusions The risk factors of ICU acquired weakness are complex. It is necessary to strengthen early intervention of high-risk patients, actively control blood glucose and reduce immobilization and mechanical ventilation time, thereby preventing the occurrence of ICU acquired weakness. Key words: ICU acquired weakness; Risk factors; Logistic models

目的 :探讨右美托咪定调控Toll样受体4(TLR4)/髓样分化因子(MyD)88/核转录因子(NF)-κB信号通路(TLR4/My D88/NF-κB)预防重型颅脑损伤患者阵发性交感神经过度兴奋(parox-ysmal sympathetic hyperactivity,PSH)的临床疗效.方法 :选取本院2016年9月 ～2019年5月收治的100例重型颅脑损伤患者为研究对象,随机数字表法分为研究组和对照组各50例,研究组在麻醉诱导前给予1.0μg/kg负荷量的右美托咪定,后续以0.4μg·kg-1·h-1输注,对照组注射等量生理盐水.比较两组PSH发生率 、临床症状 、影像学表现 、机械通气时间 、气管插管/切开时长 、ICU住院时间 、总住院时长以及出院后3个月的GCS评分;同时检测两组治疗后外周血CD14+单核细胞中MyD88的荧光强度 、TLR4、NF-κB表达水平,以及肿瘤坏死因子-α(TNF-α)表达水平.结果 :研究组7 d和3个月时PSH发生率显著低于对照组(P<0.05),且研究组总住院时长 、ICU住院时长 、术中气管切开比例以及机械通气时间均显著低于对照组,GCS评分高于对照组,差异具有统计学意义(P<0.05).另外影像学结果显示两组患者的影像学病灶位置存在一定差异,对照组中患者病灶位于脑室系统及周围的比例高于研究组(P<0.05).两组T1～T3时CD14+PBMC MyD88荧光强度 、TLR4和NK-κB阳性表达率相比T0均显著增高(P<0.05),但研究组患者在T1～T3时MyD88荧光强度 、TLR4和NK-κB阳性表达率相比对照组明显降低(P<0.05).两组T1～T3时血清TNF-α 表达水平相比T0均显著增高(P<0.05),但研究组T1～T3时血清TNF-α 表达水平相比对照组明显降低(P<0.05).结论 :右美托咪定可以通过抑制TLR4/My D88/NF-κB信号通路减少重型颅脑损伤患者机体氧化应激反应,从而有效降低PSH发生风险,改善患者预后.

目的 观察不同时期肠内营养在重症急性胰腺炎患者肠道屏障功能中的作用.方法 2014年1月～2017年7月在我院就诊的110例重症急性胰腺炎患者,按数字随机表法分为两组,每组55例.EEN组为入院24～72 h给予早期肠内营养,EN组入院3～7 d给予肠内营养.观察治疗前、治疗14 d后实验室指标如白细胞计数、血淀粉酶、C-反应蛋白、肿瘤坏死因子的变化;肠黏膜功能指标D-乳酸、血清二胺氧化酶、尿乳果糖/甘露醇值、内毒素的变化;记录肠鸣音恢复时间、肛门排气排便时间及并发症发生率.结果 EEN组患者治疗14 d后较EN组实验室指标、肠黏膜功能指标降低,差异有统计学意义(P<0.05);EEN组肠鸣音恢复时间、肛门排气排便时间短于EN组,差异有统计学意义(P<0.05);EEN组并发症发生率低于EN组,无患者退出及死亡.结论 入院后24～72 h内行肠内营养,有益于受损区域肠上皮细胞的恢复,维护肠黏膜屏障的完整性,降低感染发生率.

Acute respiratory distress syndrome (ARDS) has been the major cause of acute respiratory failure in critical patients and one of the leading causes of death worldwide for several decades. Th17 cells are involved in the occurrence and progression of ARDS. Furthermore, histone acetyltransferase (HAT) p300 is a transcriptional coactivator, and its activity is closely related to cancer and inflammatory diseases. p300 and histone deacetylase 1 (HDAC1) interact with and stabilize the nuclear transcription factor retinoic acid-related orphan receptor gamma t (RORγt) and participate in the regulation of RORγt-mediated IL-17 transcription in T helper 17 (Th17) cell differentiation by acetylation and deacetylation. However, the effect of p300 on RORγt and Th17 cells in ARDS is not well reported. Therefore, we aimed to investigate the clinical features of p300 and its effect on RORγt and Th17 cells in patients with ARDS as well as in lipopolysaccharide-induced acute lung injury (ALI) mouse models. Overexpression of p300 and RORγt mRNA was found in the peripheral blood mononuclear cells from patients with ARDS, especially among non-survivors, compared to that in healthy individuals (P < 0.05). Moreover, the decline of FOXP3 mRNA level correlated with survival and increased RORγt mRNA levels corelated with infection (P < 0.05). Immunohistochemical analysis revealed high p300 and RORγt expression in ALI mouse lung tissues. Inhibitor-mediated knockdown of p300 reduced lung tissue inflammation and lung injury score (P < 0.05). Western blotting and ELISA revealed that p300 inhibitor caused a decrease in the mRNA and protein levels of RORγt as well as interleukin 17 (IL-17) production in ALI mouse lung tissues (P < 0.05). Thus, our findings suggest that p300 may play a key role in ARDS by positively regulating RORγt transcription and is a potential new immunotherapy target for ARDS.

Objective To analyze the related factors of infection around the prosthesis of patients with ad-vanced age after hip and knee arthroplasty, in order to provide evidence for the control of postoperative infection of pa-tients with advanced age. Methods A total of 31 patients of advanced age with infection around the prosthesis after hip and knee arthroplasty, who admitted to Intensive Care Unit (ICU) of our hospital from January 2013 to October 2015, were selected as the observation group. At the same time, 31 patients without infection were selected as the control group. Then the ages, body mass index (BMI) value, operation time, serum albumin level, basic disease rates, other infec-tion sites rates, drainage tube indwelling time, trauma history rates of hip and knee of the two groups were compared, and the relationship between those indexes and infection were analyzed by the logistic regression analysis. Results The age, BMI value, operation time, basic disease rates, other infection sites rates, drainage tube indwelling time, trauma his-tory rates of hip and knee of the observation group were respectively (78.42 ± 5.21) years, (25.16 ± 2.32) kg/m2, (2.56 ± 0.30) h, 58.06%, 35.48%, (31.64±2.76) h and 32.26%, which were all higher than (72.60±4.81) years, (22.87±2.14) kg/m2, (1.98±0.22) h, 32.26%, 12.90%, (24.08±2.53) h and 12.90%of the control group;while the serum albumin level (31.82± 3.85) g/L of the observation group was lower than (37.67 ± 4.25) g/L of the control group;all of the above differences were statistically significant (P<0.05). Logistic regression analysis showed that those indexes all had close relationship with the postoperative infection around the prosthesis (P<0.05). Conclusion The age, BMI value, operation time, se-rum albumin level, basic disease rates, other infection sites rates, drainage tube indwelling time, trauma history rates of hip and knee are all the related factors of infection around the prosthesis of patients with advanced age after hip and knee arthroplasty, so the indexes should be paid enough attention, and timely intervention measures should be taken.

目的 评价磷霉素治疗ICU医院获得性感染危重患者耐碳青酶烯类-肺炎克雷伯菌(CRKP)的安全性和有效性.方法 对诊断为ICU医院获得性CRKP,经临床药师会诊建议采用静脉磷霉素治疗的患者11例,经中心静脉导管滴注磷霉素钠,根据药敏结果联用敏感抗菌药物,以病死率为主要结局指标,以临床疗效、细菌学疗效、不良事件发生率为次要结局指标.结果 11例患者均取得细菌微生物清除或假定清除,临床疗效评价为临床治愈.有2例患者死亡,病死率为18.2％,无患者因CRKP导致感染复发.所有患者均能耐受磷霉素,没有发现肝或肾功能检查异常.结论 磷霉素可能成为成人患者CRKP感染治疗的一种选择,特别是联用其他抗菌药物时可获得更好的临床疗效.

Objective To observe the efficacy and safety of fosfomycin for the treatment of nosocomial infection caused by carbapenem-resistant Klebsiella pneumoniae ( CRKP ) in ICU critically ill patients. Methods 11 ICU patients with acquired CRKP infection and adopting the fosfomycin treatment suggested by the clinical pharmacist consultation were selected and treated by intravenous drip of fos-fomycin via the central venous catheter. The combination use with sensitive antibacterial drugs was conducted according to the drug sus-ceptibility test results. The cases fatality rate was taken as the main outcome indicator and the clinical effects, bacteriological effect and occurrence rate of adverse events were taken was the secondary outcome indicators. Results All the cases obtained the bacterium-germs clearance or presumptive clearance. The clinical curative effects were evaluated as the clinical cure. 2 cases died with the fatality rate of 18. 18%. No cases had relapse caused by CRKP infection. All cases were tolerable for fosfomycin, no hepatic or renal function abnormality was found. Conclusion Fosfomycin may be a new options for the treatment of adult CRKP infection, especially the combi-nation use with other antibacterial drugs.

OBJECTIVE To investigate the effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults. METHODS Between January 2008 and December 2011, 32 patients with lumbar spondylolysis underwent U-shape titanium screw-rod fixation system with bone autografting. All patients were male with an average age of 22 years (range, 19-32 years). The disease duration ranged from 3 to 24 months (mean, 14 months). L3 was involved in spondylolysis in 2 cases, L4 in 10 cases, and L5 in 20 cases. The preoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores were 8.0 +/- 1.1 and 75.3 +/- 11.2, respectively. RESULTS The operation time was 80-120 minutes (mean, 85 minutes), and the blood loss was 150-250 mL (mean, 210 mL). Primary healing of incision was obtained in all patients without complications of infection and nerve symptom. Thirty-two patients were followed up 12-24 months (mean, 14 months). Low back pain was significantly alleviated after operation. The VAS and ODI scores at 3 months after operation were 1.0 +/- 0.5 and 17.6 +/- 3.4, respectively, showing significant differences when compared with preoperative ones (t = 30.523, P = 0.000; t = 45.312, P = 0.000). X-ray films and CT showed bone fusion in the area of isthmus defects, with the bone fusion time of 6-12 months (mean, 9 months). During follow-up, no secondary lumbar spondyloly, adjacent segment degeneration, or loosening or breaking of internal fixator was found. CONCLUSION The U-shape titanium screw-rod fixation system with bone autografting is a reliable treatment for lumbar spondylolysis of young adults because of a high fusion rate, minimal invasive, and maximum retention of lumbar range of motion.

目的 观察中西医结合综合疗法治疗强直性脊柱炎(AS)的临床疗效和安全性.方法 将确诊为AS早、中期的60例患者随机分为2组,治疗组30例采用中西医结合综合方法治疗,对照组30例采用柳氮磺胺吡啶治疗,观察2组的临床疗效及各项主要相关指标.结果 治疗组和对照组总有效率分别为97％和67％,2组比较有显著性差异.2组患者治疗后的主要观察指标均比治疗前有明显改善.治疗组改善情况优于对照组.并且治疗组的不良反应少于对照组.结论 中西医结合综合疗法治疗AS安全有效,尤其适用于AS早、中期.