目的 探讨重症急性胰腺炎(SAP)患者外周血miR-21-3p、miR-22-3p与并发肺损伤(ALI)的相关性.方法 选择2017年7月～2020年2月本院收治的124例SAP患者作为研究对象,按照是否合并ALI分为单纯SAP组(78例)、SAP合并ALI组(46例);另选择同期体检的50例健康志愿者作为对照组.采集患者外周静脉血,采用实时荧光反转录定量聚合酶链式反应检测miR-21-3p、miR-22-3p表达,收集SAP患者临床资料.结果 单纯SAP组、SAP合并ALI组患者外周血miR-21-3p、miR-22-3p显著高于对照组(P＜0.05);SAP合并ALI组高于单纯SAP组(P＜0.05).不同CT分级、伴有胸水与否、急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分患者外周血miR-21-3p、miR-22-3p水平比较差异具统计学意义(P＜0.05);CT分级为E级、合并胸水、APACHEⅡ评分≥15分患者外周血miR-21-3p、miR-22-3p水平高于CT分级为D级、无胸水、APACHEⅡ评分＜15分的患者(P＜0.05).Logistic回归分析显示,CT分级、胸水、外周血miR-21-3p、miR-22-3p表达水平与SAP患者并发ALI相关(P＜0.05).外周血miR-21-3p、miR-22-3p诊断ALI曲线下面积(AUC)为0.770、0.812,当截点值为2.668、1.815时,约登指数最大;两者联合诊断AUC为0.869.结论 SAP患者外周血miR-21-3p、miR-22-3p与ALI并发密切相关,临床可检测其水平明确SAP程度及是否发生ALI,对指导临床治疗具有重要价值.

目的 探讨常规剂量与负荷剂量瑞舒伐他汀对急性心肌梗死患者血管内皮细胞功能变化的影响.方法 选取急性心肌梗死患者160例,随机分为常规剂量瑞舒伐他汀10 mg组、负荷剂量瑞舒伐他汀20 mg组,每组80例.服用瑞舒伐他汀7、30、60 d后采用流式细胞术对外周循环血管内皮细胞进行识别和量化分析;酶联免疫吸附法测定血管内皮细胞表面标志物:沉默信息调节因子相关酶1(SIRT1)、趋化因子受体4(CXCR4)、重组碱性成纤维细胞生长因子(bFGF)、血管内皮生长因子(VEGF)水平.结果 服药7 d时,瑞舒伐他汀10 mg组CD45-/CD133+/CD34+细胞、CD45-/CD34+/KDR+细胞水平明显低于瑞舒伐他汀20 mg组,服药30、60 d时,瑞舒伐他汀10 mg组CD45-/CD133+/CD34+细胞、CD45-/CD34+/KDR+细胞水平明显高于瑞舒伐他汀20 mg组,差异均具有统计学意义(P<0.05).服药7 d时,瑞舒伐他汀10 mg组SIRT1、CXCR4、bFGF、VEGF水平明显低于瑞舒伐他汀20 mg组,差异具有统计学意义(P<0.05);服药30、60 d时,瑞舒伐他汀10 mg组SIRT1、CXCR4、bFGF、VEGF水平明显高于瑞舒伐他汀20 mg组,差异具有统计学意义(P<0.05).结论 在急性心肌梗死急性期,20 mg/d瑞舒伐他汀对机体修复功能的提升作用明显优于10 mg/d;但长期应用10 mg/d瑞舒伐他汀治疗在改善血管内皮功能、促进血管新方面明显优于20 mg/d瑞舒伐他汀.

Objective To explore the influence of edaravone for serum TNF-αand IL-1 and effects of in a-cute intracerebral hemorrhage.Mehtods Ninety cases with acute intracerebral hemorrhage were randomly divided into two groups:45 cases were treated with conventional therapy as control group,45 cases were treated with edaravone 30 mg and 0.9% NS 100 mL iv gtt,bid for 14 days as treatment group.The neurological impairment score (NIHSS)and activi-ty of daily living(ADL)scale were evaluated and compared before and after treatment between two groups.The changes of TNF -αand IL-1 were detected before and after treatment between two groups.Results The NIHSS and ADL of treatment group were higher than those of control group 14 days later(P <0.05).The clinical effect of treatment group was significantly better than control group (P <0.05).Both neurological impairment score and capability of daily living were improved obviously.Serum TNF-αand IL-1 in treatment group were significantly decreased compared with control group after treatment(P <0.05).Conclusion Edaravone can alleviate inflammatory reaction,eliminate free radicals, improve the symptoms of neurological impairment for acute intracerebral hemorrhage.

Objective To investigate the effect of Captopril on plasmic homocysteine(Hcy)and renal function in rats with diabetic nephropathy(DN)and its mechanism. Methods The diabetes mellitus models were established in 30 Sprague Dawley(SD)rats with Streptozotocin(STZ),and were randomly divided into control group,DN group and Captopril group(n = 10 for each group). Captopril group was lavaged with 17. 5 mg /( kg·d)Captopril(1 / d),while the control and DN groups were lavaged with same volume of physiological saline(1 / d). In all groups,contents of plas-ma Hcy and angiotensin Ⅱ(AngⅡ)in nephridial tissue,levels of urea and creatinine,urinary albumin excretion rate (UAER)and kidney weight / body weight were detected,relative expression levels of mRNA in protein kinase C(PKC) and isoforms PKCα in nephridial tissue were detected using real-time polymerase chain reaction(PCR)after 12 weeks of treatment. Results Compared with those in control group,the values of Hcy and AngⅡ contents,levels of urea and creatinine,UAER,kidney weight / body weight,relative expressions of mRNA in PKC and PKCα were significantly in-creased in DN group(P ﹤ 0. 05). Compared with those in DN group,the above values were significantly decreased in Captopril group(P ﹤ 0. 05). Conclusion Captopril may decrease level of Hcy expression and protect renal function of diabetic nephropathy rats,and its mechanism may exert its effect by inhibiting PKCα signal activation.

目的：分析不同危重评分对急性肾功能衰竭（Acute renal failure，ARF）预后判断价值，为A R F患者预后判断提供参考依据。方法：选取我院2013年5月—2015年5月收治的129例A R F患者，均于其确诊后24 h内行急性生理学和慢性健康状况评分（APACHE II）、简化急性生理评分（SAPS II）及序贯器官衰竭估计评分（SOFA），并按照其预后情况分为存活组与病死组，比较2组患者各项评分差异，并以受试者工作特征曲线（ROC）分析不同危重评分判断患者预后价值。观察APACHE II评分与病死率、死亡风险的关系。结果：129例患者病死86例，病死率66.7%。存活组APACHE II、SAPS II评分显著低于病死组，差异有统计学意义（P＜0.05），2组患者SOFA评分比较，差异无统计学意义（P＞0.05）。APACHE II评分的ROC曲线下面积显著高于SAPS II评分、SOFA评分，差异有统计学意义（P＜0.05），SAPS II评分与SOFA评分的ROC曲线下面积比较，差异无统计学意义（P＞0.05）。随着患者APACHE II评分的增加，其病死率、R值均呈上升趋势。结论：APACHE II对ARF患者预后的判断价值最高，建议作为临床预测患者预后的首选评分手段。

Objective To observe the effect of Xuebijing on expression of intercellular adhesion molecule-1 (ICAM-1)in the lung tissue of rats with acute lung injury induced by lipopolysaccharide.Methods Forty-five Wistar rats were randomly divided into 3 groups by random number table method:(1)control group(n =15),(2)LPS group (n =15),(3)Xuebijing group(XBJ group)(n =15).Injection of LPS(5 mg/kg)into femoral vein to reproduce ALI model in LPS group and XBJ group.Male Wistar rats of XBJ group were given XBJ 4 mL/kg 30 min before the intrave-nous injection of LPS,whereas control group and LPS group were given equivalent volume normal saline.Five rats in each group were killed at 6 h,12 h and 24 h,which were divided into subgroup I,Ⅱ,Ⅲ.The pathomorphism changes of lung tissue were observed by light microscope,and expression of ICAM-1 in pulmonary was examined by immunohisto-chemistry.Results Expression of ICAM-1 were gradually increased with experimental time prolonged and reached the peak at 24h in LPS group after establishing model.ICAM-1 were significantly lower in XBJ group than LPS group at each time points (P <0.05).Compared to LPS group,the pathological change was significantly reduce in XBJ group under microscope.Conclusion Xuebijing can inhibit the expressions of ICAM-1 and reduce acute lung injury induced by li-popolysaccharide in the lung tissue of rats.

目的 探讨华法林剂量相关基因CYP2C9 1075A/C多态性在江西汉族人群中的流行病分布情况.方法 收集上海交大医学院附属第九人民医院急诊科门诊及病房中常规口服华法林药物的江西汉族患者680例,口拭子无创刮取口腔脱落细胞,采用PCR-限制性片段长度多态性(PCR-RFLP)法检测CYP2C9 1075A/C,统计分析CYP2C9 1075A/C在汉族人群中的分布情况.结果 在680例被检病例中,CYP2C9基因有AA和AC两种基因型被发现,分布频率分别为89.71％和10.29％,等位基因A的频率为94.85％,等位基因C的频率为5.15％.讨论 CYP2C9 1075A/C多态性在中国人群中存在比较广泛,临床使用华法林药物前,应常规对病人进行CYP2C9 1075A/C检测,合理调整华法林使用剂量.

Xuebijing (XBJ) injection, a traditional Chinese medicine, has been reported as a promising approach in the treatment of sepsis in China. However, its actual molecular mechanisms in sepsis-induced lung injury are yet unknown. Therefore, this study aimed to investigate the beneficial effects of XBJ on inflammation and the underlying mechanisms in a model of caecal ligation and puncture-(CLP-) induced lung injury. The mice were divided into CLP group, CLP+XBJ group (XBJ, 4 mL/kg per 12 hours), and sham group. The molecular and histological examinations were performed on the lung, serum, and bronchoalveolar lavage (BAL) fluid samples of mice at the points of 6, 24, and 48 hours after CLP. The results show that XBJ reduces morphological destruction and neutrophil infiltration in the alveolar space and lung wet/dry weight ratio, which improves mortality of CLP-induced lung injury. Meanwhile, XBJ treatment downregulates high mobility group box protein 1 (HMGB1) and the receptor for advanced glycation end products (RAGE) expression, as well as neutrophil counts, production of IL-1β, IL-6, and TNF-α in the BAL fluids. In conclusion, these results indicate that XBJ may reduce the mortality through inhibiting proinflammatory cytokines secretion mediated by HMGB1/RAGE axis.

目的 观察老年人急性脑梗死应用单唾液酸四己糖神经节苷脂治疗的临床疗效及安全性.方法 老年人急性脑梗死病人共65例,随机分为两组,对照组33例应用一般常规治疗,治疗组32例在常规治疗基础上加用单唾液酸四己糖神经节苷脂40 mg加入生理盐水250 mL中静脉输注,每天1次,连续应用14 d为1个疗程.观察比较治疗前后两组临床总有效率和神经功能缺损评分程度变化.结果 治疗组临床总有效率为84.4%,显著高于对照组的63.6%,两组比较有统计学意义(P<0.05).两组治疗后神经功能缺损评分均较治疗前明显改善(P<0.01),治疗组比对照组改善更明显(P<0.05).治疗过程中无明显不良反应发生.结论 对于老年急性脑梗死单唾液酸四己糖神经节苷脂是一种有效安全的治疗药物.

目的：观察神经节苷脂(GM1)治疗急性脑出血的临床疗效。方法将86例急性脑出血患者随机分为两组。对照组43例,给予常规治疗；治疗组在常规治疗基础上加用神经节苷脂80 mg加入生理盐水250 mL静脉输注,1次/日,疗程共14 d。两组基础用药相同。比较两组治疗前后美国国立卫生研究院卒中量表(NIHSS)及日常生活活动量表(ADL)评分,并进行疗效评定。结果治疗组治疗后14dNIHSS评分及ADL评分与对照组相比,差异有统计学意义(P<0.05)。对照组总有效率、显效率分别为74.4%、32.5%；治疗组总有效率、显效率分别为90.7%、60.4%。治疗组临床疗效明显优于对照组(P<0.05)。结论神经节苷脂能更好地改善急性脑出血患者神经功能的缺损程度,改善患者预后。

Objective To explore the potential protective effect of Xuebijing on lipopolysaccharide-induced acute lung injury( ALI) in rats. Methods 45 Wistar rats were randomly divided into 3 groups as following:( 1) control group( n = 15),( 2) LPS group( n = 15),( 3) Xuebijing treatment group( XBJ group)( n = 15). LPS( 5mg /kg)was infused by femoral vein to establish ALI model in LPS group and XBJ group. The rats were received XBJ at a dose of 4ml /kg( XBJ group) and the equivalent volume normal saline( control /LPS group) 30 min before the intravenous injection of a bolus of LPS. Five rats in each group were sacrificed on the 6th、12th and 24 th day after the model,which were divided into subgroup I,Ⅱ,and Ⅲ. The pathomorphism changes of lung tissue were observed using light microscope,and the dynamic arterial blood gas analysis,were conducted. The lung wet to dry weight ratio( W /D) and the semi-quantitative lung pathologic scores was also calculated. The expression of TNF-α were determined by enzymelinked immunosorbent assay( ELISA). Results In comparison with the LPS group,the arterial partial pressure of oxygen( PaO2) was significantly increased( P 0. 05),and the ratio of lung tissue wet /dry( W /D),the scores were significantly decreased( P 0. 05) in XBJ group on 6 th,12 th,24 th day after LPS injection. The levels of serum TNF-a were significantly decreased( P 0. 05). Conclsion The treatment with Xuebijing could alleviate the inflammatory reaction and protect against the septic lung injury induced by LPS,which maybe involved in the down-regulation of TNF-α.

目的观察醒脑静注射液治疗老年人急性脑梗死的临床疗效及安全性。方法将老年人急性脑梗死患者130例随机分为2组,对照组66例给予一般常规治疗,治疗组64例在常规治疗基础上予醒脑静注射液30 mL加入5%葡萄糖注射液250 mL静脉滴注,每天1次,连续应用14 d。观察2组临床疗效及治疗前后神经功能缺损评分变化。结果治疗组总有效率和神经功能缺损评分改善程度都明显优于对照组(P均<0.05),治疗过程中无明显不良反应发生。结论对于老年急性脑梗死,醒脑静注射液是一种有效安全的治疗药物。

Objective To study high mobility group box 1(HMGB1)expression in lipopolysaccharide-induced acute lung injury in rats and investigate the effect of Xuebijing and its possible mechanism.Methods 45 Wistar rats were randomly divided into 3 groups as following:(1)control group(n=15),(2)LPS group(n=15),(3)Xuebijing treatment(XBJ)group(n=15).LPS(5mg/kg)was infused by femoral vein to reproduce ALI model in LPS group and XBJ group.Male Wistar rats were given either saline in LPS group or XBJ in XBJ group 4ml/kg 30 min before the intravenous injection of a bolus of LPS,whereas control group were given equivalent volume normal saline.Five rats in each group were killed at 6h,12 h and 24 h,which were divided into subgroup I,Ⅱ,Ⅲ,and lung tissue was collected.The pathomorphism changes of lung tissue were observed using light microscope.and the expression of HMGB1 protein in pulmonary was examined by immunohistochemistry in all the rats.Results The expression of HMGB1 protein in pulmonary showed a gradual increase and reached the peak at 24h in LPS group.Lower level of HMGB1 protein was found in XBJ group than that in LPS group at all time points(P0.05).The pathological change was more obvious in LPS group than that in XBJ group.Conclusion HMGB1 expression is increased in acute lung injury in the rats induced by LPS.Xuebijing could attenuate the degree of acute lung injury in rats induced by LPS,which may be related to its inhibition of the HMGB1 protein expression in lung tissue.

目的观察醒脑静注射液治疗急性重型脑梗死的疗效及安全性。方法将136例急性重型脑梗死病例随机分为两组,对照组66例采用常规治疗,治疗组70例在常规治疗基础上给予醒脑静注射液30 mL加入5%葡萄糖注射液250 mL静脉输注,每日1次,连续用14 d为1个疗程。比较治疗前后两组神经功能缺损程度评分变化。结果治疗后治疗组总有效率及神经功能缺损评分改善情况均明显优于对照组(P<0.05),治疗期间无明显不良反应发生。结论醒脑静注射液是一种安全有效的治疗急性重型脑梗死的药物。

目的探讨醒脑静注射液对老年人急性脑出血的疗效及安全性。方法将107例老年急性脑出血患者随机分为两组,对照组54例采用常规治疗,治疗组53例在常规治疗基础上加用醒脑静注射液30 ml加入5%葡萄糖注射液250 ml静滴,1次/d,连续用21 d为一疗程。比较两组临床有效率和治疗前后神经功能缺损程度评分变化。结果治疗后治疗组总有效率及神经功能缺损评分改善情况均明显优于对照组(P均<0.05),两组治疗期间无明显不良反应发生。结论醒脑静注射液是一种有效且安全的治疗老年人急性脑出血的药物。

Objective To assess the clinical effect and safety of human blood albumin in treatment of acute cerebral hemorrhage.Methods 88 patients with acute cerebral hemorrhage were randomly divided into 2 groups. Both group were given routine therapy and 45 cases in the treating group were given additional 10% human blood albumin 100 ml ivgtt once a day for 7 days.14 days served as a treatment course.Neurofunction was compared before and after treatment.Results Both the effective rate (P<0.05) and the neurofunction in the treating group were better than that of the control group (P<0.05).No advert effect happened.Conclusion Human blood albumin is an efiective and safe medicine for treatment of acute cerebral infarction.

Aim:To observe the therapeutic efficacy of Shuxuetong Injection for acute cerebral infarction.Meth- ods:Ninety patients with acute cerebral infarction were randomly divided into two groups.All the patients received symp- tomatic and supportive therapies.Their blood pressure and intracranial pressure were controlled.The patients in control group (n=44) were given Danshentong Injection in 5% glucose solution or 250 mL normal saline (NS) (igtt),once a day for two weeks.The patients in the treatment group (n=46) were given Shuxuetong Injection 8 mL in 5% glucose so- lution or NS 250 mL via intravenous infusion,once a day,for two weeks.Results:The overall response rate and im- provement of neurological deficits had significant difference between treatment group and control group (P<0.05).No adverse reaction was observed during the therapeutic process.Conclusion:The clinical effects of Shuxuetong Injection on acute cerebral infarction is definite and safe.

目的:观察分析白蛋白治疗急性重型脑梗死的临床疗效及安全性。方法:78例急性重型脑梗死患者分为两组,两组均采用常规治疗。治疗组加用10%白蛋白100mL静脉滴注1次/d,连续用7d,14d为一疗程。比较治疗前后两组神经功能缺损程度评分变化。结果:治疗后治疗组总有效率及神经功能缺损评分改善情况均优于对照组,有显著统计学意义(P<0.05),治疗过程中无不良反应发生。结论:白蛋白治疗急性重型脑梗死临床疗效确切、安全。

PURPOSE:To evaluate the results of multidisciplinary management of severe oral and maxillofacial multiple space infections with the aim of improvement of the clinical efficacy.METHODS:10 cases of severe oral and maxillofacial multiple space infections were treated by multidisciplinary approach involving emergency department,and oral and maxillofacial surgery department of our hospital.The approaches included establishment of patent drainage,anti-infection,anti-shock as well as nutrition support.The clinical data,laboratory data,diagnosis and treatment procedures were retrospectively analyzed.RESULTS:Among 10 cases with severe oral and maxillofacial multiple space infections,7 were cured after cooperative treatment while 3 died.The rate of mortality(30.0%)was lower than that of traditional treatment(61.5%).CONCLUSION:For severe oral and maxillofacial multiple space infections,better clinical results and lower mortality can be achieved by cooperative management including systematic and local treatment.

Objective To observe the clinical effect of herba erigerontis injection plus naloxone on treating acute cerebral infarction.Methods All 80 patients with acute cerebral infarction were randomly divided into two groups: the treatment group(40 cases)and the control group(40 cases).The treatment group was treated with herba erigeron- tis injection plus naloxone while the control group was treated with herba erigerontis injection once a day for 14 days. Two groups were given the same routine treatment,such as anti-infection,controlling blood pressure,correcting hydro-electrolytic disorder,lowering intracranial pressure,etc.Results The overall effective rate amounted to 92.5% in the treatment group and 77.5% in the control group.There was a significant difference,Improvement of dys- neuria scores in the treatment group was superior to that in the control group and there was a statistical significance (P<0.01).Conclusion Herba erigerontis injection plus naloxone is an effective and safe drug for treating acute cerebral infarction.It can improve degree of neurofunctional deficits and decrease the disabled rate.