Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by capillary leakage of plasma fluids throughout the endothelium. The mechanism of SCLS is still unknown. Vascular endothelial growth factor (VEGF), an inducer or barrier disruption, is markedly upregulated in SCLS. This study was to investigate the molecular mechanisms involving SCLS-related inflammation and neuron damage in SCLS remain unclear. Data files of GSE97287 dataset were extracted and processed for identification of differentially expressed genes (DEGs), including upregulated adrenomedullin (ADM) gene, hypoxia-inducible factor-1α (HIF-1α) and VEGFA; and downregulated aldehyde dehydrogenase 1A1 (ALDH1A1) gene and interleukin (IL)-2 receptor β (IL-2RB) gene. Weighted gene coexpression network analysis (WGCNA) was performed for DEGs and four significant modules were identified and were enriched Gene Ontology (GO) biological processes and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways related to immune response, angiogenesis, neuroblast proliferation, HIF-1 signaling pathway, and Parkinson's disease. The activated HIF-1α/VEGFA signaling in SCLS patients might well be responsible for the impaired inflammatory, nervous, and immune systems.

INTRODUCTION AND OBJECTIVES:Acute liver failure (ALF) is a dramatic disorder requiring intensive care. MicroRNAs (miRNAs) have been identified to play important roles in ALF. This study was performed to identify miRNA-mRNA co-expression network after ALF to investigate the molecule mechanism underlying the pathogenesis of ALF.MATERIALS AND METHODS:The microarray dataset GSE62030 and GSE62029 were downloaded from Gene Expression Omnibus database. Overlapping differentially expressed miRNAs (DEmiRNAs) and genes (DEGs) were identified in liver tissues from patients with hepatitis B virus (HBV)-associated ALF in comparison with normal tissues from donors. Gene enrichment analysis was performed. Key pathways associated with the DEGs were identified. The miRNA-mRNA regulatory network was constructed.RESULTS:Total 42 DEmiRNAs and 523 DEGs were identified in liver tissues from patients with HBV-associated ALF. Gene ontology and pathways enrichment analysis showed upregulated DEGs were related to immune responses, inflammation, and infection, and downregulated DEGs were associated with amino acids, secondary metabolites and xenobiotics metabolism. In miRNA-mRNA co-expression network, DEGs were regulated by at least one DEmiRNA and transcription factor. Further analysis showed DEmiRNAs, including has-miR-55-5p, has-miR-193b-5p, has-miR-200b-3p, and has-miR-3175 were associated with amino acid metabolism, drug metabolism and detoxication, and signaling pathways including mitogen-activated protein kinase (MAPK), phosphatidylinositol 3-kinase (PI3K)/AKT, Ras, and Rap1.CONCLUSIONS:These miRNA-mRNA pairs and changed profiles were associated with and might be responsible for the impairment of detoxification and metabolism induced by HBV-associated ALF.

Background: Acute kidney injury (AKI) refers to a sudden loss of renal function. This study was performed to identify the key RNAs acting in the mechanism of sepsis-induced AKI. Methods: Microarray dataset GSE94717 (including six sepsis-induced AKI samples and three control samples) was downloaded from Gene Expression Omnibus database. Differentially expressed miRNAs (DE-miRNAs) were identified. The miRNA targets were predicted and enrichment analysis was performed. Protein-protein interaction (PPI) and competing endogenous RNA (ceRNA) regulatory networks were constructed. Mouse podocytes were treated with lipopolysaccharide (LPS), following by cell viability and PCR analysis. Cellular apoptosis and the ceRNA network were validated. Results: Thirty-one common DE-miRNAs (two up-regulated and 29 down-regulated) by AKI versus control and male AKI versus control were identified. We found the targets of miR-15a-5p, miR-15b-5p, and miR-16-5p were involved in mTOR signaling pathway, and those of miR-29b-3p and miR-16-5p were enriched in PI3K-Akt signaling pathway. RNAs including miR-15b-5p, miR-15a-5p, miR-107, XIST, miR-16-5p, and cullin 3 gene (CUL3) were included in the ceRNA regulatory network. The downregulation of miR-15a-5p and miR-15b-5p and the upregulation of lncRNA XIST and CUL3 gene were validated using qPCR. The miR-15a-5p-XIST-CUL3 regulatory axis was identified and was validated. We confirmed that LPS inhibited the growth of mouse podocytes and seven of the ten miRNAs, but upregulated XIST and CUL3. Transfection analysis showed XIST siRNA enhanced LPS-induced MPC5 cell apoptosis and miR-15a-5p inhibitor reserved it, so did as CUL3 overexpression for miR-15a-5p mimics. Conclusion: The miR-15a-5p-XIST-CUL3 regulatory axis was related to the pathogenesis of sepsis-induced AKI. Highlights Totally, 31 miRNAs were dysregulated between disease and control groups. MiR-15a-5p, miR-15b-5p, and miR-16-5p were involved in mTOR signaling pathway. MiR-16-5p and miR-29b-3p were implicated in PI3K-Akt signaling pathway. The miR-15a-5p-XIST-CUL3 axis was critical for sepsis-induced AKI.

目的 比较右美托咪定和瑞芬太尼用于ICU机械通气患者镇痛、镇静的效果.方法 选择500例有创机械通气超过24h的患者,采用随机数字表法分为右美托咪定组及瑞芬太尼组,每组250例.两组分别给予右美托咪定[1μg/kg维持10min的负荷剂量,然后予0.4～1μg/(kg ·h)]和瑞芬太尼0.05μg/(kg·h)持续静脉泵入镇痛、镇静,采用数字评分法(NRS)评估疼痛,Richmond躁动-镇静评分法(RASS)评估镇静,ICU谵妄评分量表(CAM-ICU)评估谵妄情况.两组患者在治疗期间执行每日唤醒策略,分别记录两组用药前及用药1、6、12、24、36、48h的NRS、RASS和生命体征,加用丙泊酚及每日中断药物以唤醒的病例数,谵妄发生率、机械通气时间、住ICU时间,以及不良反应发生情况.结果 两组均可达到满意的镇痛、镇静目标.两组间镇痛、镇静深度总体无明显差异,但用药1h时右美托咪定组NRS明显高于瑞芬太尼组(P＜0.05);右美托咪定组合并用药患者数多于瑞芬太尼组(P＜0.05),机械通气时间、住ICU时间均较瑞芬太尼组明显缩短(均P＜0.05),并且谵妄发生率明显降低(P＜0.05);右美托咪定组出现心动过缓、低血压患者较瑞芬太尼组多(均P＜0.05).结论 右美托咪定用于ICU机械通气患者与瑞芬太尼组治疗效果相当,但能缩短机械通气时间、住ICU时间,减少谵妄发生率,但有更多的心动过缓和低血压.

Objective To discuss the clinical effects of different energy densities of enteral nutrition (EN) preparations on mechanical ventilation (MV) patients with acute severe traumatic brain injury (sTBI). Methods Sixty MV patients with acute sTBI admitted to the Department of Critical Care Medicine of Hangzhou Xiaoshan District First People's Hospital from July 2015 to December 2017 were divided into two groups according to different energy densities of nutritional preparations. Thirty patients of the control group were given nasal feeding with standard energy density EN (energy density 3.35 - 4.19 kJ/mL) and 30 patients of the observation group were given nasal feeding with relatively higher energy density (energy density 5.44 - 6.28 kJ/mL). The indexes of nutritional status between the two groups before and after treatment were compared: including prealbumin (PA), albumin (Alb), globulin (Glo), hemoglobin (Hb), 5-day and 1-week heat calorie compliance rates of reaching target calories, MV time and incidence of complications. Results There were no statistically significant differences in nutritional indicators before treatment between the two groups (all P > 0.05). The compliance rates of reaching target calories of the observation group on the 5 and 7 days after treatment were significantly higher than those in the control group [5 days: 66.67% (20/30) vs. 50.00% (15/30), 1 week: 81.33% (25/30) vs. 70.00% (21/30), both P < 0.05], and the MV time was significantly lower than that in the control group (hours: 92.48±12.04 vs. 128.88±16.29, P < 0.05); the levels of PA, Alb, Hb, Glo were significantly higher in the observation group than those in control group on the 21st day after treatment [PA (g/L): 0.28±0.11 vs. 0.15±0.04, Alb (g/L): 36.52±5.79 vs. 29.63±2.74, Hb (g/L): 92.40±9.50 vs. 81.10±8.60, Glo (g/L): 24.42±1.73 vs. 18.19±3.59, all P < 0.05]. Complications: the total incidence of abdominal distension, diarrhea and constipation of the observation group was 36.6% (11/30), while that of the control group was 66.7% (20/30), the difference between the two groups being statistically significant (P < 0.05). Conclusion High energy density enteral nutrition can improve the nutritional status of the organisms of MV patients with acute sTBI, reduce the time of MV and the incidence of complications, thus it is worthy to be widely applied clinically.

目的:观察中药大承气汤联合奥曲肽治疗重症急性胰腺炎临床疗效.方法:将纳入的76例重症急性胰腺炎患者按随机数字表法分为2组各38例,2组患者入院后均给予常规治疗,治疗组在常规治疗的基础上给予中药大承气汤联合奥曲肽治疗,对照组在常规治疗的基础上加用奥曲肽治疗,比较2组临床治疗效果.结果:临床疗效总有效率治疗组89.47％,对照组68.42％,2组临床疗效比较,差异有统计学意义(P＜0.05);治疗组腹痛消失、腹胀消失、肠鸣音恢复、排气恢复及住院时间均短于对照组,2组间比较,差异均有统计学意义(P＜0.05);且2组血清淀粉酶、脂肪酶、血白细胞及急性生理和慢性健康状况评估-Ⅱ(APACHE-Ⅱ)评分均有改善,治疗前后比较,差异均有统计学意义(P＜0.05);且治疗组改善情况分别与对照组比较,差异均有统计学意义(P＜0.05).结论:中药大承气汤联合奥曲肽治疗重症胰腺炎临床疗效良好,能缓解患者临床症状,缩短住院时间,值得临床应用.

目的:观察中西医结合治疗对重症监护室(ICU)危重病患者胃肠功能的影响.方法:选取70例肠胃燥热型危重病患者作为观察对象,按照不同治疗方法分为参照组和试验组各35例,参照组单纯采用西医疗法进行治疗,试验组采用中西医结合疗法进行治疗,对2组患者的胃肠道并发症发生情况、胃肠道功能改善情况及各症状缓解时间进行观察和比较.结果:胃肠功能改善有效率试验组为91.4％,参照组为68.6％,2组比较,差异有统计学意义(P＜0.05).试验组肠麻痹、胃肠黏膜出血、器官功能障碍综合征(MODS)发生率均低于参照组,差异均有统计学意义(P＜ 0.01,P＜0.05).试验组腹胀缓解时间、呕吐、呃逆消失时间、肠鸣音恢复时间及排气、排便时间均较参照组缩短,差异均有统计学意义(P＜0.01).结论:中西医结合治疗有利于保护ICU危重病患者的胃肠道功能,防止胃肠道并发症,进一步缩短康复时间,改善预后.

目的：观察奥美拉唑联合生长抑素治疗老年重症急性胰腺炎（SAP）患者的效果。方法选择2014年1月至2015年12月浙江萧山医院消化内科收治的老年SAP 急性反应期患者60例为观察对象，按照入院时间先后将患者分为对照组和观察组各30例。对照组给予注射用生长抑素，观察组在对照组用药基础上给予注射用奥美拉唑钠，比较两组疗效、不良反应、住院时间及症状缓解时间，治疗前后血清淀粉酶、尿淀粉酶、腹内压、D-乳酸及二胺氧化酶（DAO）。结果观察组总有效率明显高于对照组，住院时间、腹痛腹胀缓解时间、恶心呕吐好转时间均明显短于对照组，治疗后血淀粉酶、尿淀粉酶、腹内压、D-乳酸及DAO均明显低于对照组，差异有统计学意义；两组不良反应发生率比较差异无统计学意义。结论奥美拉唑联合生长抑素治疗老年SAP患者效果较好，可有效降低患者的淀粉酶含量及腹内压，改善肠道功能，快速改善临床症状，且用药较安全。

目的 分析高血压前期合并糖代谢异常(IGT)老年患者的颈动脉内膜中膜厚度(IMT)改变.方法 按照高血压前期和IGT的诊断标准,将研究对象分为:高血压前期组(仅高血压前期,无IGT)72例；IGT组(仅IGT,无高血压前期)；高血压前期合并IGT组108例；对照组(无高血压前期和IGT) 100例.均测量血压、体重指数(BMI),空腹静脉采血,进行血脂、血糖、肾功能和高敏C反应蛋白(hs-CRP)的测定并进行IMT测量.结果 高血压前期组和高血压前期合并IGT组的收缩压和舒张压显著高于IGT组和对照组(P＜0.05),IGT组和高血压前期合并IGT组的2h PG显著高于高血压前期组和对照组(P＜0.05),高血压前期合并IGT组的hs-CRP和IMT显著高于其余三组(P＜0.05).同时,高血压前期组和IGT组的hs-CRP和IMT均高于对照组(P＜0.05).析因设计的方差分析显示只有hs-CRP和IMT受到血压和血糖交互作用的影响(均P＜0.05).收缩压、舒张压、2 hPG和hs-CRP对IMT有显著影响,回归分析得到方程:IMT=-0.732 +0.328(hs-CRP) +0.052(2 h PG) +0.004(收缩压)+0.004(舒张压).结论 IGT会显著促进老年高血压前期患者的血管损害,老年高血压前期合并IGT患者不但需要控制血压,还需要及时检测自身的血糖变化,并加强早期干预.

目的 回顾性分析不同病因引起的重症急性胰腺炎(SAP)的治疗措施及疗效,以寻求更为合理的SAP治疗方案.方法 总结2003年1月～20010年6月共81例不同病因引起的SAP治疗的临床资料,并评价各项治疗方法的疗效、安全性.结果 81例SAP中,胆源性56例,酒精性5例,高脂血症7例,不明原因13例.Ranson评分平均为4.24项,治愈60例,死亡或自动出院21例.各种治疗措施中,ERCP+EST或LC+ERCP+EST疗效最好,并发症最少;急诊手术治疗组死亡率最高.结论我国SAP的发病原因仍以胆源性居多,本组中胆源性占了69.1%,因此积极治疗胆道系统的原发疾病,是治疗SAP的关键.手术治疗特别是急诊手术,创伤大,并发症多,需严格掌握适应症.内镜治疗及联合外科微创手术,具有创伤小,疗效好,安全性高的优越性,是胆源性SAP保守治疗失败后的首选方法.

Objective To investigate the differentiation of Mesenchymal stem cell (MSCs) into the endothelial cells by the extracts of the vascular endothelial cells. Methods MSCs were separated from the bone marrow by density gradient centrifugation, wall sticking screening and amplifi ed in vitro. The surface antigens of MSCs were evaluated with the flow cytometry. The 4th passaged cells were induced to differentiate into endothelial cells by means of differentiation induction media containing the extracts of the vascular endothelial cells, the extracts of the vascular endothelial cells treated by the boiling water and the basic medium, respectively. The expression of cell specifi c genes, including CD31, CD34, CD144 and eNOS, was detected by RT-PCR, and the morphological changes were observed by inverted microscopy. Results It was revealed by flow cytometry that the isolated and cultivated MSCs expressed CD73 and CD90, and did not express CD34. After induction, the morphology of the differentiated has no distinctive changes. But the expression of the endothelial cell specifi c genes, fourteen days after induction, only was detected in the induced cells with the extracts of the vascular endothelial cells. Conclusion There are some factors in the extracts of the vascular endothelial cells, which can induce the MSCs to differentiate into the endothelial cells. And the fates of stem cells may be regulated by the cellular contents around them.

目的 探讨纤支镜灌洗联合机械通气治疗重症肺部感染的安全性及临床疗效.方法 2004年6月～2009年3月间笔者所在科室共收治重症肺部感染患者6O例,在机械通气下行纤支镜直视下经气管插管灌洗.结果 纤支镜灌洗治疗后患者的pH恢复到正常范围内,PaO2明显提高,PaCO2明显下降,差异均有统计学意义(P＜0.05).57例患者一次拔管成功;1例患者发生气胸,2例患者发生纵隔气肿,2例患者出现多器官功能衰竭,1例患者死亡.结论 早期及时应用气管插管行有创高浓度供氧,控制机械通气迅速纠正缺氧后,联合应用纤支镜直视下经气管插管灌洗治疗重症肺部感染是安全可行的,疗效肯定,值得临床推广应用.

<正>急性左心衰竭常见于冠状动脉粥样硬化性心脏病(简称冠心病)、心肌炎、高血压性心脏病,少见于瓣膜性疾病。近期我院抢救2例"急性呼吸衰竭"、拟诊"吸入性肺炎"患者,后经心脏彩超等进一步确诊为二尖瓣脱垂、急性左心衰竭,体会颇深,现报道如下。

<正>外伤性多发性肋骨骨折可引起严重并发症,如血气胸、肺不张等,而肺不张在胸外科处理极为棘手。本文将2000年至2006年本院因多发肋骨骨折后肺不

着重介绍16例正己烷中毒患者的神经电生理改变,经积极治疗,肌电图全部恢复正常,但部分患者的运动与感觉神经传导速度仍有损害.

Objective To analyze the nerve electrom yo gram changes in patients with chronic N-h exane intoxication.Methods The elec tromyography and nerve conduction velocities were determined in 16patients wit h N-hexane intoxicatio n.Results The condution ve-locity of the sensory nerve and the mo tor nerve decreased at a rate of 29.7%and 59.4%respectivel y,The distal l atencies were prolonged51.6%.Conclusions The chronic N-h exane intoxication mainly correlates with the distal motor nerve,and the damage s of the nerve might be related to the duration of exposure t o N-hexane.