Background Survivors of acute respiratory distress syndrome (ARDS) frequently experience cognitive impairment, psychological symptoms, and reduced health-related quality of life after intensive care. Immersive virtual reality (VR) may provide an engaging, multimodal adjunct to conventional rehabilitation, but evidence in the ARDS recovery population remains limited. Methods In this single-center, parallel-group randomized controlled trial, 88 ARDS patients in the rehabilitation phase were randomized 1:1 to a 4-week augmented rehabilitation package incorporating immersive VR in addition to usual care (n = 44) or usual care alone (n = 44). One control participant was lost to follow-up, and 87 participants were included in the available-case analysis. The primary outcome was change in Montreal Cognitive Assessment (MoCA) score from baseline to 4 weeks. Secondary outcomes included the 36-Item Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS) scores. The main between-group analysis used analysis of covariance (ANCOVA), with follow-up score as the dependent variable and baseline score as the covariate. Results Baseline imbalances were observed for age, MoCA, SF-36, and HADS-A scores. After adjustment for corresponding baseline scores, the VR group showed greater improvement in MoCA score than the control group (adjusted between-group effect: 1.42, 95% CI 0.86 to 1.98;p < 0.001). The VR group also showed higher SF-36 scores (adjusted effect: 13.20, 95% CI 11.85 to 14.54; p < 0.001) and lower HADS-A scores (adjusted effect: -2.55, 95% CI -3.23 to -1.88; p < 0.001). In the VR group, 29 of 44 participants (65.9%) reported being very satisfied or satisfied with the intervention. Conclusions An augmented rehabilitation package incorporating immersive VR was associated with short-term improvements in cognition, health-related quality of life, and anxiety symptoms during early ARDS recovery. Because the package also entailed additional structured rehabilitation exposure, staff attention, interaction, repeated activity, feedback, and treatment time, and because the control condition was not time- or attention-matched, the observed differences cannot be attributed specifically to VR. These single-center, short-term, hypothesis-generating findings require confirmation in larger studies with time- and attention-matched controls. Trial registration: Chinese Clinical Trial Registry, ChiCTR2600122078; retrospectively registered on 8 April 2026, after completion of participant recruitment.

Background: While a potential relationship between red cell distribution width (RDW) and cardiac arrest (CA) prognosis has been raised, the question of whether there is robust data to support this connection remains open. To examine the association of red blood cell distribution width with prognosis in patients with cardiac arrest. Methods: This study strictly followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies were identified from searches conducted in the PubMed, Web of Science, the Cochrane Library, and Embase electronic databases up to March 12, 2025. The Newcastle–Ottawa scale was used to assess the quality of the included studies. The combined effect size was determined utilizing standardized mean differences (SMDs), hazard ratios (HRs), and 95% confidence intervals (CIs). Subgroup analyses were also performed to elucidate the sources of heterogeneity. Simultaneously, we also pooled sensitivity (SEN), specificity (SPE), diagnostic odds ratios (ORs), and the area under the summary receiver operating characteristic curve (AUROC). Results: This meta-analysis encompassed eight studies involving CA patients with CA. Our results suggested that patients who died after CA exhibited higher RDW levels than those who survived (SMD = 0.45; 95% CI: 0.30–0.60). There was a 1.63-fold higher risk of death in CA patients with high RDW levels versus those with low levels (95% CI: 1.27–2.08). The SEN, SPE, and AUC for using the RDW to predict mortality were 0.82 (95% CI: 0.74–0.88), 0.49 (95% CI: 0.23–0.74), and 0.80 (95% CI: 0.76–0.83), respectively. Conclusions: RDW is a relatively accurate predictor of prognosis in patients after CA. Thus, using RDW can provide some insights into patient outcomes, enabling healthcare professionals to make informed decisions in advance. The PROSPERO registration: CRD420251023018, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251023018.

Studies suggest that the colonization of multidrug-resistant organism in the gut of healthcare workers is similar to that of healthy individuals. However, due to exposure to medical environments, is the abundance of antibiotic resistance genes (ARG) in the gut of ICU healthcare workers higher than that of healthy individuals? Prospective, multicentre, cross-sectional study. Eight medical centers in China, recruiting from January 2024 to February 2024. 303 Healthy people (201 ICU healthcare workers and 103 healthy controls) were screened and 290 Healthy people (191 ICU healthcare workers and 99 healthy controls) were included in analysis. Fecal samples were collected and subjected to metagenomic sequencing. We compared the total ARG abundance, ARG diversity, and gut microbiome composition between the two groups. After adjusting for age, sex, and body mass index, ICU healthcare workers exhibited a significantly higher total ARG abundance compared to healthy controls (fold change = 1.22, 95

Background Trauma remains a significant global health burden, with complex pathophysiological processes necessitating accurate and timely markers for risk assessment. Objective This study investigated the prognostic value of combining the venoarterial carbon dioxide to arteriovenous oxygen content ratio (Pv-aCO(2)/Ca-vO(2)) with lactate measurements in patients with severe trauma. Methods This single-center prospective observational study involved 60 adults with an Injury Severity Score of >= 16 from October 2023 to November 2024. Blood gas parameters and clinical data were collected within 3 h of intensive care unit admission. The primary outcome was 28-day mortality. Results Twenty-nine patients died during the study period. Nonsurvivors had significantly higher Pv-aCO(2)/Ca-vO(2) (median, 2.78 vs. 2.13; p = 0.003) and lactate levels (median, 5.20 vs. 2.70 mmol/L; p = 0.001) than survivors. Multivariate Cox regression analysis identified Pv-aCO(2)/Ca-vO(2) as an independent predictor of mortality (hazard ratio: 1.297; 95% confidence interval: 1.021-1.647; and p = 0.033). The combined indicator demonstrated superior prognostic performance (area under the curve [AUC] = 0.768) over individual parameters (Pv-aCO(2)/Ca-vO(2): AUC = 0.713 and lactate: AUC = 0.729). A moderate positive correlation was observed between Pv-aCO(2)/Ca-vO(2) and lactate (r = 0.456 and p = 0.0002). Conclusions The combination of Pv-aCO(2)/Ca-vO(2) and the lactate level provides enhanced prognostic value in patients with severe trauma. This approach may improve risk stratification and guide clinical decision-making in trauma care.

Objective:To investigate the prognostic value of serum calcium levels in patients with trauma-induced coagulopathy (TIC).Methods:A retrospective analysis was conducted on the clinical data of 142 patients with TIC who were admitted to the ICU of the First Hospital of Jiaxing between January 2015 and January 2023. According to the prognosis of 28 days after ICU admission, patients were divided into a survival group (80 cases) and a death group (62 cases). The basic data, laboratory examination indexes within 24 h after admission to the ICU and assessment of blood consumption scores of the two groups were compared. Multivariate logistic regression was used to analyze the prognostic risk factors of TIC patients, and a receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of serum calcium in the risk of death in TIC patients. A restricted cubic spline (RCS) was used to evaluate the linear relationship between the first serum calcium level after admission to the ICU and the risk of death in TIC patients.Results:Compared with the survival group, the proportions of low fibrinogen [65.0% (52/80) vs. 88.7% (55/62), χ2 = 3.240, P < 0.001], hyperlactacidemia [65.0% (52/80) vs. 88.7% (55/62), χ2 = 3.240, P < 0.001] and hypocalcaemia [73.8% (59/80) vs. 96.8% (60/62), χ2 = 3.223, P < 0.001] and the serum chlorine level [113 (110, 116) mmol/L vs. 115 (111, 118) mmol/L, Z = 2.350, P = 0.019] were much higher, and the platelet count [118 (84, 148) × 109/L vs. 94 (50, 116) × 109/L, Z = 3.447, P < 0.001] and albumin level [(28 ± 6) g/L vs. (23 ± 8) g/L, t = 3.732, P < 0.001] were much lower in the death group. The multivariate logistic regression analysis indicated that hypocalcaemia [odds ratio (OR) = 5.019, 95% confidence interval (CI) (1.279, 19.690), P = 0.021] and hyperlactacidemia [OR = 3.970, 95%CI (1.353, 11.075), P = 0.012] were risk factors for death in patients with TIC. The ROC curve analysis revealed that the area under the curve for serum calcium was 0.734 [95%CI (0.652, 0.816), P < 0.001], and the best cut-off value was 1.950 mmol/L. The RCS showed that there was a linear relationship between serum calcium and prognosis of TIC patients (P = 0.023), and the risk of death decreased with the increase of serum calcium concentration in the range of 1.603 to 2.130 mmol/L after admission.Conclusion:Hypocalcaemia is an independent risk factor for death in TIC patients; especially when serum calcium is lower than 1.950 mmol/L, it has important value in predicting the risk of death.

OBJECTIVE:To evaluate the effect of curcumin on renal mitochondrial oxidative stress, nuclear factor-κB/NOD-like receptor protein 3 (NF-κB/NLRP3) inflammatory body signaling pathway and tissue cell injury in rats with acute respiratory distress syndrome (ARDS).METHODS:A total of 24 specific pathogen free (SPF)-grade healthy male Sprague-Dawley (SD) rats were randomly divided into control group, ARDS model group, and low-dose and high-dose curcumin groups, with 6 rats in each group. The ARDS rat model was reproduced by intratracheal administration of lipopolysaccharide (LPS) at 4 mg/kg via aerosol inhalation. The control group was given 2 mL/kg of normal saline. The low-dose and high-dose curcumin groups were administered 100 mg/kg or 200 mg/kg curcumin by gavage 24 hours after model reproduction, once a day. The control group and ARDS model group were given an equivalent amount of normal saline. After 7 days, blood samples were collected from the inferior vena cava, and the levels of neutrophil gelatinase-associated lipocalin (NGAL) in serum were determined by enzyme-linked immunosorbent assay (ELISA). The rats were sacrificed, and kidney tissues were collected. Reactive oxygen species (ROS) levels were determined by ELISA, superoxide dismutase (SOD) activity was detected using the xanthine oxidase method, and malondialdehyde (MDA) levels were determined by colorimetric method. The protein expressions of hypoxia-inducible factor-1α (HIF-1α), caspase-3, NF-κB p65, and Toll-like receptor 4 (TLR4) were detected by Western blotting. The mRNA expressions of HIF-1α, NLRP3, and interleukin-1β (IL-1β) were detected by reverse transcription-polymerase chain reaction (RT-PCR). Renal cell apoptosis was detected by TdT-mediated dUTP nick end labeling (TUNEL). The morphological changes in renal tubular epithelial cells and mitochondria were observed under a transmission electron microscope.RESULTS:Compared with the control group, the ARDS model group exhibited kidney oxidative stress and inflammatory response, significantly elevated serum levels of kidney injury biomarker NGAL, activated NF-κB/NLRP3 inflammasome signaling pathway, increased kidney tissue cell apoptosis rate, and renal tubular epithelial cell damage and mitochondrial integrity destruction under transmission electron microscopy, indicating successful induction of kidney injury. Following curcumin intervention, the injury to renal tubular epithelial cells and mitochondria in the rats was significantly mitigated, along with a noticeable reduction in oxidative stress, inhibition of the NF-κB/NLRP3 inflammasome signaling pathway, and a significant decrease in kidney tissue cell apoptosis rate, demonstrating a certain dose-dependency. Compared with the ARDS model group, the high-dose curcumin group exhibited significantly reduced serum NGAL levels and kidney tissue MDA and ROS levels [NGAL (μg/L): 13.8±1.7 vs. 29.6±2.7, MDA (nmol/g): 115±18 vs. 300±47, ROS (kU/L): 75±19 vs. 260±15, all P < 0.05], significantly down-regulated protein expressions of HIF-1α, caspase-3, NF-κB p65, and TLR4 in the kidney tissue [HIF-1α protein (HIF-1α/β-actin): 0.515±0.064 vs. 0.888±0.055, caspase-3 protein (caspase-3/β-actin): 0.549±0.105 vs. 0.958±0.054, NF-κB p65 protein (NF-κB p65/β-actin): 0.428±0.166 vs. 0.900±0.059, TLR4 protein (TLR4/β-actin): 0.683±0.048 vs. 1.093±0.097, all P < 0.05], and significantly down-regulated mRNA expressions of HIF-1α, NLRP3, and IL-1β [HIF-1α mRNA (2-ΔΔCt): 2.90±0.39 vs. 9.49±1.87, NLRP3 mRNA (2-ΔΔCt): 2.07±0.21 vs. 6.13±1.32, IL-1β mRNA (2-ΔΔCt): 1.43±0.24 vs. 3.95±0.51, all P < 0.05], and significantly decreased kidney tissue cell apoptosis rate [(4.36±0.92)% vs. (27.75±8.31)%, P < 0.05], and significantly increased SOD activity (kU/g: 648±34 vs. 430±47, P < 0.05).CONCLUSIONS:Curcumin can alleviate kidney injury in ARDS rats, and its mechanism may be related to the increasing in SOD activity, reduction of oxidative stress, and inhibition of the activation of the NF-κB/NLRP3 inflammasome signaling pathway.

目的 观察氨茶碱治疗脓毒症相关性膈肌功能障碍的疗效.方法 选取脓毒症患者55例,随机分为对照组及观察组,对照组给予基础治疗,观察组在对照组基础上给予氨茶碱治疗.在入组时(T1)、氨茶碱使用后24 h(T2)、使用后72 h(T3)三个时间点分别测量膈肌增厚率(DTF),记录两组患者治疗结局及药物不良反应.结果 观察组中T2及T3时DTF[(16.4±1.83)％,(23.0±1.77)％]高于对照组[(15.4±1.52)％,(14.7±1.62)％](P<0.05).对照组患者T2、T3时DTF[(15.4±1.52)％,(14.7±1.62)％]低于T1时DTF[(16.9±1.42)％](P<0.05).观察组中T3时DTF[(23.0±1.77)％]高于T1、T2时DTF[(16.2±1.76)％,(16.4±1.83)％](P<0.05).观察组患者总机械通气时间、ICU住院时间[(4.8±2.5)d,(6.3±2.42)d]明显短于对照组[(6.9±2.7)d,(8.7±2.46)d](P<0.05),两组住院死亡率差异无统计学意义(P>0.05).两组患者用药期间不良反应发生率差异无统计学意义(P>0.05).结论 氨茶碱对脓毒症相关性膈肌功能障碍有治疗效果.

目的 探讨膈肌增厚分数(diaphragmtic thickening fraction,DTF)联合呼吸浅快指数(rapid shallow breathing index,RSBI)指导脓毒症机械通气患者撤机时机的应用价值.方法 采用前瞻性研究方法,选取2020年1月至2022年4月嘉兴市第一医院(嘉兴学院附属医院)重症医学科收治的103例脓毒症机械通气患者,所有患者均符合撤机标准,根据撤机结果将其分为撤机成功组(n=67)和撤机失败组(n=36).两组患者均进行自主呼吸试验(spontaneous breathing trial,SBT)30min后,记录呼吸频率及潮气量,计算RSBI,通过超声测量吸气末和呼气末膈肌厚度,计算DTF,绘制受试者操作特征(receiver operating characteristic,ROC)曲线评估DTF、RSBI及联合指标对撤机时机的预测价值.结果 撤机成功组患者的DTF显著高于撤机失败组[(24.98±4.70)％vs(19.66±5.31)％],差异有统计学意义(P<0.001);撤机成功组患者的RSBI显著低于撤机失败组[(52.67±13.65)次/(min·L)vs(70.82±20.78)次/(min·L)],差异有统计学意义(P<0.001),DTF、RSBI及联合指标对成功撤机有预测效能,以DTF>21.20％且RSBI≤55.56次/(min·L)作为联合指标的预测效能最大.结论 DTF及RSBI能有效预测脓毒症机械通气患者的成功撤机时机,与单一DTF及RSBI相比,联合指标可显著提高成功撤机的预测效能.

In December 2019, an outbreak of novel coronavirus pneumonia spread over Wuhan, Hubei Province, China, which then developed into a significant global health public event, giving rise to substantial economic losses. We downloaded throat swab expression profiling data of COVID-19 positive and negative patients from the Gene Expression Omnibus (GEO) database to mine novel diagnostic biomarkers. XGBoost was used to construct the model and select feature genes. Subsequently, we constructed COVID-19 classifiers such as MARS, KNN, SVM, MIL, and RF using machine learning methods. We selected the KNN classifier with the optimal MCC value from these classifiers using the IFS method to identify 24 feature genes. Finally, we used principal component analysis to classify the samples and found that the 24 feature genes could effectively be used to classify COVID-19-positive and negative patients. Additionally, we analyzed the possible biological functions and signaling pathways in which the 24 feature genes were involved by GO and KEGG enrichment analyses. The results demonstrated that these feature genes were primarily enriched in biological functions such as viral transcription and viral gene expression and pathways such as Coronavirus disease-COVID-19. In summary, the 24 feature genes we identified were highly effective in classifying COVID-19 positive and negative patients, which could serve as novel markers for COVID-19.

Objective:To investigate the effect of curcumin on renal fibrosis in lipopolysaccharide (LPS) induced acute respiratory distress syndrome (ARDS) in adult SD rats.Methods:Twenty-four male SD rats were randomly (random number) divided into four groups: control group, ARDS group, low dose group, and high dose group ( n=6 per group). In the control group, the rats were given atomization intratracheal of standard saline 2 mL/kg; in the ARDS group, low-dose group, and high-dose group, the rats were given atomization intratracheal of 4 mg/kg LPS; in the low-dose group, the rats were given curcumin 100 mg/d by the oral administration, and in the high-dose group, the rats were given curcumin or 200 mg/d respectively. After seven days, the rats were sacrificed. The superoxide dismutase (SOD) activity and the content of malondialdehyde (MDA) and glutathione (GSH) in renal tissue were detected by colorimetric assay. Nuclear factor kappa-B p65 (NF-κB p65) and transforming growth factor-β1 (TGF-β1) were detected by Western blot. The expression of interleukin-6 (IL-6) mRNA, proline hydroxylase 3 (PHD3) mRNA, vascular endothelial growth factor (VEGF) mRNA and erythropoietin receptor (EPOR) mRNA were detected by quantitative real-time PCR (qRT-PCR). HE staining and Masson staining were used to assess pathological damage. One-way analysis of variance was used for comparison among multiple groups and SNK method was used for comparison between two groups. Results:Compared with the control group, the SOD activity and GSH content in the ARDS group, low-dose group, and high-dose group were significantly decreased (all P<0.05); the protein expression levels of MDA, NF-κB p65, and TGF-β1 were increased significantly, and IL-6 mRNA, PHD3 mRNA, VEGF mRNA, and EPOR mRNA were significantly upregulated (all P<0.05). HE staining showed inflammatory cell infiltration, and fibrogenesis in kidney tissue, and Masson staining showed deposition of collangen-like substance. Compared with the ARDS group, SOD activity and GSH content were increased, while the protein expression of NF-κB p65 and TGF-β1, IL-6 mRNA, PHD3 mRNA, VEGF mRNA, and EPOR mRNA were decreased significantly in the low-dose group and high-dose group (all P<0.05). Curcumin therapy reduced inflammatory cellular infiltration, and the deposition of collagen-like substance in kidney tissue. Compared with the low-dose group, SOD activity and GSH content were increased in the high-dose group (all P<0.05), and the protein expression of NF-κB p65 and TGF-β1, IL-6 mRNA, PHD3 mRNA, VEGF mRNA, and EPOR mRNA were decreased significantly in the high-dose group (all P<0.05). The high-dose group exhibited a significant reduction in edema, and a decrease of the deposition of collagen-like substance in kidney tissue. Conclusions:Curcumin can inhibit the development of renal fibrosis induced by acute respiratory distress syndrome in rats, and its mechanism may be related to inhibiting the expression of inflammatory factors and enhancing hypoxia tolerance.

Objective:To investigate the value of plasma monocyte chemoattractant protein-1 (MCP-1), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and high mobility group box 1 (HMGB1) levels in evaluating the condition and prognosis of patients with acute lung injury (ALI).Methods:A total of 120 patients with ALI admitted to the Third People's Hospital of Haikou City from January 2016 to December 2019 were divided into a survival group (n=78) and a death group (n=42) according to their survival status. The age, gender, body mass index, underlying disease, heart rate, respiratory rate, positive end-expiratory pressure, acute physiology and chronic health evaluation (APACHE) Ⅱ score, plasma MCP-1, sTREM-1 and HMGB1 were recorded for all patients. Multivariate Logistic regression was used to analyze independent risk factors affecting the prognosis of patients with ALI. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of plasma MCP-1, sTREM-1 and HMGB1 levels on their prognosis, and the area under the curve (AUC) was compared by the Z test. Pearson correlation was used to investigate the correlation between the plasma MCP-1, sTREM-1, HMGB1 and APACHE Ⅱ score in patients with ALI.Results:The levels of end-expiratory positive pressure [(14.2 ± 3.7) cmH2O vs. (9.4 ± 2.9) cmH2O], APACHE Ⅱ score [(27 ± 6) vs. (14 ± 4)], plasma MCP-1 [(41 ± 7) ng/L vs. (28 ± 5) ng/L], sTREM-1 [(73 ±11) ng/L vs. (49 ± 6) ng/L] and HMGB1 [(43 ± 12) μg/L vs. (18 ± 5) μg/L] in the death group were significantly higher than those in the survival group (t=7.226, 9.813, 10.252, 13.805, 12.724; all P < 0.001). Multivariate Logistic regression analysis showed that the APACHE Ⅱ score [odds ratio (OR)=2.973, 95% confidence interval (CI) (2.120, 6.215), P=0.013], MCP-1 [OR=2.216, 95%CI (1.552, 4.517), P < 0.001], sTREM-1 [OR=2.550, 95%CI (1.713, 5.106), P < 0.001] and HMGB1 [OR=1.894, 95%CI (1.172, 3.195), P < 0.001] were independent risk factors for the prognosis of patients with ALI. ROC curve analysis showed that the APACHE Ⅱ score [AUC=0.770, 95%CI (0.712, 0.834), P=0.012], MCP-1 [AUC=0.812, 95%CI (0.756, 0.873), P < 0.001], sTREM-1 [AUC=0.840, 95%CI (0.781, 0.902), P < 0.001], HMGB1 [AUC=0.793, 95%CI (0.734, 0.851), P=0.005] and the four combinations [AUC=0.926, 95%CI (0.870, 0.988), P < 0.001] all had predictive value for their prognosis, and the AUC of the four combinations was significantly higher than the single APACHE Ⅱ score (Z=5.938, P < 0.001), MCP-1 (Z=5.310, P=0.006), sTREM-1 (Z=4.783, P=0.013) and HMGB1 (Z=5.672, P < 0.001). Pearson correlation analysis showed that the plasma MCP-1, sTREM-1 and HMGB1 levels were positively correlated with APACHE Ⅱ scores in patients with ALI (r=0.783, 0.824, 0.750; all P < 0.001).Conclusion:The MCP-1, sTREM-1 and HMGB1 levels are correlated with the severity and prognosis of patients with ALI, and their combinations with the APACHE Ⅱ score have good value in predicting the prognosis.

目的 研究胸部超声对慢性阻塞性肺疾病(COPD)机械通气患者撤机结果的预测价值.方法 采用前瞻性研究方法,选取50例需要行气管插管机械通气的COPD患者,对符合撤机筛查条件患者采用持续正压通气(CPAP)模式给予自主呼吸试验(SBT).根据撤机结果分为撤机成功组与撤机失败组,比较两组患者临床资料、SBT前的氧合指数、PaCO2、pH,以及SBT前、SBT后60 min的NT-proBNP水平和肺部超声评分(LUS)及膈肌移动度(DD)的差异,并采用受试者工作特征(ROC)曲线评价LUS和DD对撤机结果的预测价值.结果 50例患者中撤机成功组31例,撤机失败组19例.两组患者在SBT前氧合指数、PaCO2、pH比较,差异均无统计学意义(t分别=0.86、-1.26、0.62,P均>0.05).两组患者SBT前NT-proBNP水平、LUS及DD比较,差异均无统计学意义(t分别=-1.03、-1.98、0.68,P均>0.05);SBT后,撤机成功组患者的NT-proBNP水平、LUS明显低于撤机失败组,DD高于撤机失败组,差异均有统计学意义(t分别=-12.97、-6.61、4.57,P均<0.05).LUS和DD的ROC曲线下面积(AUC)分别为0.86及0.84,截断值为SBT后LUS≤10.50分,SBT后DD>11.20 mm,二者能预测COPD患者成功撤机的灵敏度分别为78.90％及77.40％,特异度为87.10％及84.20％.结论 胸部超声对COPD机械通气患者撤机结果有预测价值,SBT后LUS≤10.5分,DD>11.2 mm,撤机成功率明显升高.

Objective:To investigate the effect of curcumin pretreatment on pulmonary fibrosis and goblet cells in rats with acute respiratory distress syndrome (ARDS) induced by intratracheal aerosol lipopolysaccharide (LPS).Methods:A total of 24 adult male Sprague Dawley rats were randomly divided into 3 groups: the control group (intratracheal aerosol of isotonic NaCl solution), ARDS group (intratracheal aerosol of LPS 4 mg/kg) and curcumin group (intraperitoneal injection of curcumin 50 mg/kg 30 min before aerosol of LPS 4 mg/kg), 8 rats in each group. The ratio of wet to dry weight (W/D) in lung tissue and the contents of tumor necrosis factor-alpha (TNF-α) and type Ⅲ procollagen (PCⅢ) in bronchoalveolar lavage fluid were calculated after 5 d of modeling in each group. The protein expression levels of Toll-like receptor 4 (TLR4) and nuclear factor-kappa Bp65 (NF-κBp65) in lung tissue were detected by Western-blotting. The distribution of collagen fibers was observed by Masson staining and the goblet cells and mucus were observed by alcian blue-periodic acid schiff (AB-PAS) staining.Results:The W/D, TNF-α, PCⅢ, TLR4 protein and NF-κBp65 protein among the three group all showed significant differences (F = 136.155, 139.639, 95.353, 94.034, 67.540; all P<0.001). Compared with the control group, the W/D [(3.99 ± 0.16), (5.53 ± 0.15), (4.81 ± 0.24)], TNF-α [(61 ± 5), (219 ± 25), (157 ± 21) ng/L], PCⅢ [(0.67 ± 0.22), (61.66 ± 11.95), (35.62 ± 9.64) μg/L], TLR4 protein and NF-κBp65 protein increased obviously in the ARDS and curcumin groups, and they increased most in the ARDS group (all P < 0.05). Masson staining showed extensive collagen deposition in the ARDS group and mild diffuse collagen deposition in the curcumin group. AB-PAS staining showed goblet cell metaplasia in the ARDS group and mild goblet cell metaplasia in the curcumin group.Conclusion:Curcumin can reverse goblet cell metaplasia and pulmonary fibrosis in LPS-induced ARDS rats, which may be related to improving lung inflammatory responses by inhibiting the TLR4/NF-κB pathway.

Objective To investigate the value of ultrasound in the dynamic assessment of lung injury after acute paraquat poisoning. Methods A prospective observational study was performed on patients with paraquat poisoning from admission to day 28 or discharge. Ultrasound assessment of the lungs was performtyed every 48 hours. The correlation of the lung ultrasound score (LUS) with other indicators was analyzed. Results Twenty-six patients were enrolled, with an average age of 46 ± 16 years. The average toxic dose was 95 ± 51 mL. The intensive care unit (ICU) stay averaged 9 ± 8 days, and the 28-day mortality was 88.5%. There was a significant negative correlation between LUS and oxygenation index (rho = −0.896) and a significant positive correlation between LUS and carbon dioxide concentration (rho = 0.567). Lung ultrasound and computed tomography imaging correlated closely. Conclusion Lung ultrasound can reflect changes in lung status in patients with paraquat poisoning and can be used to evaluate lung injury in these patients. Trial registration: ChiCTR, ChiCTR-DDD-16010211. Registered 21 December 2016, http://www.chictr.org.cn/listbycreater.aspx .

目的:探索肺部超声评分动态变化在评估危重病患者肺炎病情及预后判断中的价值。方法:选2015年7月至2015年12月嘉兴市第一医院重症医学科肺炎患者44例，记录其肺部超声评分（LUS）、临床肺部感染评分（CPIS ）、超敏C反应蛋白（CRP）、前降钙素（PCT）、白细胞（WBC ）、体温（T）、氧合指数（PaO 2/FiO 2）、二氧化碳分压（PaCO 2 ）。比较LUS与CPIS、CRP、PCT、WBC、T及PaO 2/FiO 2的相关性。根据临床结果分为死亡组和存活组，比较两组间LUS以及入ICU第3天两组LUS的变化。采用临床诊断性能评价指标（ROC曲线）评价LUS预测危重病患者肺炎死亡的诊断价值。 结果:LUS与CPIS、CRP呈正相关（ P<0.001），与PaO 2/FiO 2呈负相关，与PCT、WBC、T无相关性（ P>0.05 ）。入ICU第3天死亡组LUS高于存活组。LUS预测肺部感染死亡的敏感度为72.0%，特异性为52.6%，ROC曲线下面积（AUC）为0.565。入ICU第3天LUS为12.5分作为预测死亡发生的最佳临床诊断临界点。 结论:LUS可辅助用于危重病患者肺炎病情的动态评估及预后判断。

Objective To evaluate the clinical efficacy of Taohua decoction in treating antibiotic-associated diarrhea (AAD). Methods Sixty-two patients diagnosed with AAD admitted to the department of intenive care unit (ICU) of Jiaxing Hospital of Traditional Chinese Medicine (TCM), Jiaxing First Hospital, Jiaxing Second Hospital and Haining Hospital of TCM from April 2015 to November 2016 were enrolled, and they were divided into an experimental group (32 cases) and a control group (30 cases) according to the random number table method. The two groups were given routine treatment of western medicine, the patients in experimental group were additionally given Taohua decoction (ingreients: red halloysite 30 g, zingiberis 15 g, japonica rice 30 g), while in the control group, the patients only received the routine treatment of western medicine. The therapeutic course in the two groups was 14 days. The TCM syndrome score, the duration of diarrhea, the time of abdominal pain relief and the time using antibiotics, besides acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, albumin level, endoscopic and pathological changes were observed before and after treatment in the two groups. Results After treatment, the scores of TCM syndrome and APACHE Ⅱin the two groups were all lower than those before treatment, the level of albumin was higher than that before treatment, and the changes of above indexes in the experimental group were more significant than those in the control group [the scores of TCM syndrome: 9.32±8.86 vs. 13.50±6.52, APACHE Ⅱ score: 11.08±4.37 vs. 14.06±5.42, albumin (g/L): 33.89±5.02 vs. 30.85±6.44, all P < 0.05]; in experimental group, the time of diarrhea duration (days:12.28±2.28 vs. 15.36±8.68), time of abdominal pain relief (days: 10.09±6.41 vs. 14.27±7.52), time of using antibiotics (days: 11.77±4.72 vs. 15.08±6.98) were significantly shorter than those of the control group (all P < 0.05). The examinations of endoscopy and light microscopy showed that after treatment the numbers of patients with mild intestinal mucosal changes in the experimental group were increased compared with those in the control group (endoscope:18 cases vs. 8 cases, light microscopy: 19 cases vs. 9 cases), but the numbers of patients with moderate (endoscope:14 cases vs. 20 cases, light microscopy: 13 cases vs. 19 cases) and severe (endoscope: 0 vs. 2 cases, light microscopy:0 vs.2 cases) changes were less than those in the control group. Conclusions Taohua decoction can improve the clinical efficacy of mild AAD patients.

我们在临床中运用桃花汤治疗抗生素相关性腹泻(AAD),取得较好疗效,现报道如下. 1 一般资料 选取2015年4月至2016年11月在嘉兴市中医医院院、嘉兴市第一医院、嘉兴市第二医院、海宁市中医院4家医院诊断为AAD患者62例,其中男35例,女27例,年龄44 ～ 80岁,腹泻前抗生素使用时间为3～ 10d.