Background Acute fatty liver of pregnancy (AFLP) is a rare, life-threatening obstetric emergency. Early prediction of its severe postpartum complications remains a significant clinical challenge, optimal risk stratification tools have not been established. Methods This retrospective cohort study included 106 patients with AFLP admitted to a tertiary care hospital between 2011 and 2020. Severity scores (MELD, APACHE II, SOFA) were calculated using data from 24 h before delivery or within 24 h of ICU admission. Predictive performance for six major complications—acute kidney injury (AKI), disseminated intravascular coagulation (DIC), sepsis, multiple organ dysfunction syndrome (MODS), postpartum hemorrhage (PPH), and acute liver failure (ALF) was assessed using logistic regression, with discrimination evaluated by area under the receiver operating characteristic curve (AUC-ROC) and clinical utility by decision curve analysis (DCA). Results Among 106 patients, the most common complication was AKI (71/106, 67.0%), followed by DIC (30/106, 28.3%), MODS (30/106, 28.3%), PPH (29/106, 27.4%), sepsis (28/106, 26.4%), and ALF (24/106, 22.6%). The combined MELD-SOFA score was the best predictor for DIC (AUC 0.764, 95% CI 0.662–0.856), MODS (AUC 0.757, 95% CI 0.655–0.855), and ALF (AUC 0.797, 95% CI 0.692–0.886), and also demonstrated strong predictive value for AKI (AUC 0.882,95% CI 0.803–0.943). The combined MELD-APACHE II score demonstrated excellent discrimination for AKI (AUC 0.899, 95% CI 0.815–0.967). APACHE II alone best predicted sepsis (AUC 0.748, 95% CI 0.643–0.848). All models performed poorly for PPH (AUC < 0.7). DCA confirmed greater net clinical benefit for the combined models within relevant threshold probabilities. Conclusions A complication-specific approach to score selection optimizes risk stratification in AFLP. While the combined MELD-SOFA score demonstrates broad applicability by showing high effectiveness for predicting DIC, MODS, ALF and AKI, optimal prediction for specific complications requires tailored combinations. the MELD-APACHE II score is superior for AKI, and APACHE II alone for sepsis. These findings support the targeted use of combined scoring models to guide early intervention and improve maternal outcomes.

Objective To evaluate whether the immunomodulatory drug thymosin α1 reduces mortality in adults with sepsis. Design Multicentre, double blinded, placebo controlled phase 3 trial. Setting 22 centres in China, September 2016 to December 2020. Participants 1106 adults aged 18-85 years with a diagnosis of sepsis according to sepsis-3 criteria and randomly assigned in a 1:1 ratio to receive thymosin α1 (n=552) or placebo (n=554). A stratified block method was used for randomisation, and participants were stratified by age (<60 and ≥60 years) and centre. Interventions Subcutaneous injection of thymosin α1 or placebo every 12 hours for seven days unless discontinued owing to discharge from the intensive care unit, death, or withdrawal of consent. Main outcome measure The primary outcome was 28 day all cause mortality after randomisation. All analyses were based on a modified intention-to-treat set, including participants who received at least one dose of study drug. Results Of 1106 adults with sepsis enrolled in the study, 1089 were included in the modified intention-to-treat analyses (thymosin α1 group n=542, placebo group n=547). 28 day all cause mortality occurred in 127 participants (23.4%) in the thymosin α1 group and 132 (24.1%) in the placebo group (hazard ratio 0.99, 95% confidence interval 0.77 to 1.27; P=0.93 with log-rank test). No secondary or safety outcome differed statistically significantly between the two groups. The prespecified subgroup analysis showed a potential differential effect of thymosin α1 on the primary outcome based on age (<60 years: hazard ratio 1.67, 1.04 to 2.67; ≥60 years: 0.81, 0.61 to 1.09; P for interaction=0.01) and diabetes (diabetes: 0.58, 0.35 to 0.99; no diabetes: 1.16, 0.87 to 1.53; P for interaction=0.04). Conclusions This trial found no clear evidence to suggest that thymosin α1 decreases 28 day all cause mortality in adults with sepsis. Trial registration ClinicalTrials.gov NCT02867267 .

Background:The number of patients presenting to emergency departments because of pneumonia is gradually increasing. Acute respiratory distress syndrome (ARDS), a serious complication of pneumonia, is associated with high mortality rates, making its early identification crucial. We therefore conducted a retrospective analysis of patients admitted to our emergency department with pneumonia, aiming to screen for clinical factors associated with the development of ARDS. Methods:This was a retrospective study of patients admitted to the emergency department of a hospital in Beijing because of pneumonia from 1 January 2015 to 30 July 2021. Baseline characteristics, comorbidities, complications, etiological information, and imaging findings were collected. Least absolute shrinkage and selection operator (LASSO) regression was used to screen for factors associated with the development of ARDS, and logistic regression was used to fit a nomogram model. Results:The study cohort comprised 1,544 patients, 769 (49.8%) of whom developed ARDS, including 667 (43.2%) men of average age 64.4±18.5 years. These patients were allocated to a training group of 1,080 patients and a test group of 464 patients. Independent risk factors for ARDS were found to be as follows: hemoglobin concentration [odds ratio (OR) 1.01; 95% confidence interval (CI): 1.00, 1.01; P=0.002], vasopressor administered (OR 2.16; 95% CI: 1.57, 2.99; P<0.001), extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae (OR 4.37; 95% CI: 1.46, 13.13; P=0.008), Acinetobacter baumannii (OR 3.85; 95% CI: 2.58, 5.74; P<0.001), cytomegalovirus (OR 2.10; 95% CI: 1.33, 3.33; P=0.002), Epstein-Barr virus (OR 2.02; 95% CI: 1.21, 3.35; P=0.007), smoking (OR 1.39; 95% CI: 1.03, 1.89; P=0.03), pneumonia severity index (PSI) grading (OR 2.71; 95% CI: 1.74, 4.21; P<0.001), and evidence of air leakage (OR 5.42; 95% CI: 1.12, 26.23; P=0.04). Age (OR 0.98; 95% CI: 0.97, 0.99; P<0.001), immunosuppressants administered (OR 0.40; 95% CI: 0.17, 0.91; P=0.03), and solid tumors (OR 0.45; 95% CI: 0.27, 0.76; P=0.002) were recognized as protective factors. The area under the receiver operating characteristic (ROC) curve was 0.786 in the training cohort and 0.784 in the test group. Conclusions:Hemoglobin concentration, vasopressor use, ESBL-positive K. pneumoniae, A. baumannii, cytomegalovirus, Epstein-Barr virus, solid tumors, immunosuppressant use, smoking, PSI score, and evidence of air leakage manifestations are independent risk factors for ARDS. Age, immunosuppressants administered and solid tumors are protective factors. Early air leakage is strongly associated with ARDS.

BACKGROUND:Sepsis is a severe systemic inflammatory response syndrome that leads to acute lung injury (ALI), which subsequently progresses to lung fibrosis. This study aims to investigate the role of zinc finger and BTB domain containing 16 (ZBTB16), a transcription factor, in septic lung injury. METHODS:The expression of Zbtb16 in the injured lung was evaluated using single-cell sequencing. The signaling pathways that can be regulated by Zbtb16 were predicted using gene set enrichment analysis (GSEA). Then, the functions of ZBTB16 and its potential molecular mechanism in fibrogenesis were explored in lipopolysaccharide (LPS)-induced ALI mice in vivo and LPS-induced MRC-5 cells and primary fibroblasts in vitro. RESULTS:Single-cell analysis showed that Zbtb16 was overexpressed in the fibroblasts of the injured lung. GSEA found that Zbtb16 might activate inflammatory response and glycolysis during lung injury. Silencing of Zbtb16 relieved lung injury, decreased lung wet/dry weight and myeloperoxidase (MPO) activity, reduced the levels of lactate dehydrogenase (LDH), total protein, and neutrophil in the BALF, and inhibited fibrogenesis in septic ALI mice. In LPS-induced fibroblasts, silencing of ZBTB16 suppressed the expression of inflammatory and fibrotic markers by inhibition of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 2 (PFKFB2)-mediated glycolysis. CONCLUSION:ZBTB16 promotes the transcription of glycolytic enzyme PFKFB2 to participate in fibrogenesis in septic lung injury. Our study may offer a potentially promising target for the treatment of fibrogenesis in septic lung injury.

Background & aims: While obesity has been reported as a protective factor in septic patients, little is known about the potential modifying effects of age and sex. The objective of this study is to investigate age and sex-specific associations between obesity and the prognosis of septic patients. Methods: A retrospective analysis was conducted on a cohort of 15,464 septic patients, categorized by body mass index (BMI) into four groups: underweight (<18.5 kg/m(2), n = 483), normal (18.5-24.9 kg/m(2), n = 4344), overweight (25-29.9 kg/m(2), n = 4949) and obese (>= 30 kg/m(2), n = 5688). Multivariable logistic regression and inverse probability weighting were employed to robustly confirm the protective effect of a higher BMI on 28-day mortality, with normal weight serving as the reference category. Subgroup analyses based on age (young: 18-39, middle-aged: 40-64 and elderly: >= 65) and sex were performed. Results: The findings demonstrate that high BMI independently confers a protective effect against 28-day mortality in septic patients. However, the relationship between BMI and 28-day mortality exhibits a nonlinear trend, with a BMI of 34.5 kg/m(2) displaying the lowest odds ratio. Notably, the survival benefits associated with a high BMI were not observed in the young group. Moreover, being underweight emerges as an independent risk factor for middle-aged and elderly female patients, while in males it is only a risk factor in the elderly group. Interestingly, being overweight and obese were identified as independent protective factors in middle-aged and elderly male patients, but not in females. Conclusions: The effect of BMI on mortality in septic patients varies according to age and sex. Elderly individuals with sepsis may derive more prognostic benefits from obesity. (c) 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

3-Hydroxybutyrate, also called β-hydroxybutyrate, is a significant constituent of ketone bodies. Previous observational and experimental studies have suggested that ketogenic diet, especially 3-hydroxybutyrate, may have a protective effect against cardiovascular disease. However, the relationship between ketone bodies, especially 3-hydroxybutyrate, and aortic dissection remains uncertain. Publicly accessible data from genome-wide association study (GWAS) was utilized to obtain information on ketone bodies, including 3-hydroxybutyrate, acetoacetate and acetone as exposure respectively, while GWAS data on aortic dissection was used as outcome. Subsequently, two-sample Mendelian randomization (MR) analysis was conducted to examine the potential relationship between ketone bodies and aortic dissection. Then, reverse and multivariate Mendelian randomization analyses were performed. Additionally, sensitivity tests were conducted to assess the robustness of MR study. The inverse-variance weighted (IVW) method of Mendelian randomization analysis of gene prediction observed a negative correlation between 3-hydroxybutyrate and risk of aortic dissection (OR 0.147, 95

Objective: The purpose of this article is to introduce a novel imaging device and technique for percutaneous dilatational tracheostomy (PDT) and evaluate its clinical application. Methods: We have modified the bronchoscope to generate a novel imaging device. The handle of the bronchoscope was removed and replaced with added fixation pieces to secure the new device to the endotracheal tube. Nine mechanically ventilated patients admitted to the intensive care department of Shandong Public Health Clinical Center who underwent PDT between July 2023 and January 2024 have been treated with this novel imaging device. The number of medical staff members needed for the operation, number of needle interventions, operation time, arterial blood gas analysis, and intraoperative complications were observed. Results: Three medical staff were involved in the procedure: an operator, an assistant, and a nurse. The first attempted needle intervention was successful in all patients, and no serious complications such as major bleeding, pneumothorax, mediastinal emphysema, accidental extubation, desaturation, hypercarbia, respiratory acidosis, hemodynamic abnormality, or posterior tracheal puncture occurred. The average time was 11.63 ± 1.56 minutes from skin incision to the needle insertion and 4.43 ± 1.99 minutes from needle insertion to tracheal placement. Conclusions: PDT guided by the novel device is safe, preserves human resources, saves operating space, keeps the view stable, and makes the procedure easy. It is worthy of further research and application.

Background In observational and experimental studies, diabetes has been reported as a protective factor for aortic dissection. 3-Hydroxybutyrate, a key constituent of ketone bodies, has been found to favor improvements in cardiovascular disease. However, whether the protective effect of diabetes on aortic dissection is mediated by 3-hydroxybutyrate is unclear. We aimed to investigate the causal effects of diabetes on the risk of aortic dissection and the mediating role of 3-hydroxybutyrate in them through two-step Mendelian randomization.Materials and methods We performed a two-step Mendelian randomization to investigate the causal connections between diabetes, 3-hydroxybutyrate, and aortic dissection and calculate the mediating effect of 3-hydroxybutyrate. Publicly accessible data for Type 1 diabetes, Type 2 diabetes, dissection of aorta and 3-hydroxybutyrate were obtained from genome-wide association studies. The association between Type 1 diabetes and dissection of aorta, the association between Type 2 diabetes and dissection of aorta, and mediation effect of 3-hydroxybutyrate were carried out separately.Results The IVW method showed that Type 1 diabetes was negatively associated with the risk of aortic dissection (OR 0.912, 95% CI 0.836-0.995), The weighted median, simple mode and weighted mode method showed consistent results. The mediated proportion of 3-hydroxybutyrate on the relationship between Type 1 diabetes and dissection of aorta was 24.80% (95% CI 5.12-44.47%). The IVW method showed that Type 2 diabetes was negatively associated with the risk of aortic dissection (OR 0.763, 95% CI 0.607-0.960), The weighted median, simple mode and weighted mode method showed consistent results. 3-Hydroxybutyrate does not have causal mediation effect on the relationship between Type 2 diabetes and dissection of aorta.Conclusion Mendelian randomization study revealed diabetes as a protective factor for dissection of aorta. The protective effect of type 1 diabetes on aortic dissection was partially mediated by 3-hydroxybutyrate, but type 2 diabetes was not 3-hydroxybutyrate mediated.

OBJECTIVE:Despite the recent advances in diagnosis and treatment, sepsis continues to lead to high morbidity and mortality. Early diagnosis and prompt treatment are essential to save lives. However, most biomarkers can only help to diagnose sepsis, but cannot predict the development of septic shock in high-risk patients. The present study determined whether the combined measurement of procalcitonin (PCT), thromboelastography (TEG) and platelet (PLT) count can predict the development of septic shock.METHODS:A retrospective study was conducted on 175 septic patients who were admitted to the intensive care unit between January 2017 and February 2021. These patients were divided into two groups: 73 patients who developed septic shock were assigned to the septic shock group, while the remaining 102 patients were assigned to the sepsis group. Then, the demographic, clinical and laboratory data were recorded, and the predictive values of PCT, TEG and PLT count for the development of septic shock were analyzed.RESULTS:Compared to the sepsis group, the septic shock group had statistically lower PLT count and TEG measurements in the R value, K value, α angle, maximum amplitude, and coagulation index, but had longer prothrombin time (DT), longer activated partial thromboplastin time (APTT), and higher PCT levels. Furthermore, the Sequential Organ Failure Assessment (SOFA) score was higher in the septic shock group. The multivariate logistic regression analysis revealed that PCT, TEG and PLT count were associated with the development of septic shock. The area under the curve analysis revealed that the combined measurement of PCT, TEG and PLT count can be used to predict the development of septic shock with higher accuracy, when compared to individual measurements.CONCLUSION:The combined measurement of PCT, TEG and PLT count is a novel approach to predict the development of septic shock in high-risk patients.

Immune disorders caused by sepsis have recently drawn much attention. We sought to dynamically monitor the expression of small extracellular vesicle (sEV) miRNAs in peripheral blood during sepsis to explore these miRNAs as potential biomarkers for monitoring immune function in sepsis patients. This study included patients with sepsis. Blood samples were obtained from 10 patients on the first through 10th days, the 12th day and the 14th day since sepsis onset, resulting in 120 collected samples. Serum sEVs were extracted from peripheral venous blood, and levels of MIR497HG, miR-195, miR-497, and PD-L1 in serum sEVs were detected by qPCR, and clinical information was recorded. Our study revealed that the levels of MIR497HG, miR-195, miR-497 and PD-L1 in serum sEVs showed periodic changes; the time from peak to trough was approximately 4-5 days. The levels of sEV MIR497HG and miR-195 had a positive linear relationship with SOFA score (r values were -0.181 and -0.189; p values were 0.048 and 0.039, respectively). The recorded quantities of sEV MIR497HG, miR-195 and PD-L1 showed a substantial correlation with ARDS. ROC curve analysis revealed that sEV MIR497HG, miR-195 and miR-497 could predict the 28-day mortality of sepsis patients with an AUC of 0.66, 0.68 and 0.72, respectively. Levels of sEVs MIR497HG, miR-195, miR-497 and PD-L1 showed periodic changes with the immune status of sepsis, which provides a new exploration direction for immune function biomarkers and immunotherapy timing in sepsis patients.

Ultrasound elastography is a new technique that can objectively evaluate the elasticity of body tissues. It has been widely used in the assessment of elasticity of the liver, kidney, breast, thyroid, and prostate. In recent years, the continuous development of pulmonary ultrasound technology has made it be widely used in the diagnosis and evaluation of critical care illness patients due to its advantages of non-invasiveness, cheapness, non-radiation, and repeatability. Lung ultrasound elastography has shown high sensitivity and specificity in the diagnosis of some lung diseases (such as tumors, lung interstitial diseases, and pulmonary edema). In particular, the ultrasonic surface wave elastography technology developed by Zhang et al from Mayo Clinic has expanded a new field for the diagnosis of lung diseases. This review summarizes the application of lung ultrasound elastography in lung diseases and discusses its application prospects.

Background:Sepsis is a life-threatening condition with high mortality. A few studies have emerged utilizing single-cell RNA sequencing (scRNA-seq) to analyze gene expression at the single-cell resolution in sepsis, but a comprehensive high-resolution analysis of blood antigen-presenting cells has not been conducted.Methods:All published human scRNA-seq data were downloaded from the single cell portal database. After manually curating the dataset, we extracted all antigen-presenting cells, including dendritic cells (DCs) and monocytes, for identification of cell subpopulations and their gene profiling and intercellular interactions between septic patients and healthy controls. Finally, we further validated the findings by performing deconvolution analysis on bulk RNA sequencing (RNA-seq) data and flow cytometry.Results:Within the traditional DC populations, we discovered novel anergic DC subtypes characterized by low major histocompatibility complex class II expression. Notably, these anergic DC subtypes showed a significant increase in septic patients. Additionally, we found that a previously reported immunosuppressive monocyte subtype, Mono1, exhibited a similar gene expression profile to these anergic DCs. The consistency of our findings was confirmed through validation using bulk RNA-seq and flow cytometry, ensuring accurate identification of cell subtypes and gene expression patterns.Conclusions:This study represents the first comprehensive single-cell analysis of antigen-presenting cells in human sepsis, revealing novel disease-associated anergic DC subtypes. These findings provide new insights into the cellular mechanisms of immune dysregulation in bacterial sepsis.

呼吸道感染性疾病是临床最常见的流行性疾病之一,据统计,80％以上的急性上呼吸道感染是由病毒感染引起.近年来,新型冠状病毒感染大流行、流感病毒感染高发使呼吸道核糖核酸(RNA)病毒感染成为社会关注的焦点.小分子抗病毒药为目前备受关注的抗呼吸道病毒感染的治疗方案.为进一步促进抗呼吸道RNA病毒的小分子药物的合理应用,有效提高呼吸道RNA病毒药物治疗水平,山东省药学会循证药学专委会与山东省新冠病毒感染重症救治专家组联合,结合国内外最新研究成果,制订了《抗呼吸道RNA病毒的小分子药物应用专家意见》.

Abstract Objectives Temperature management is an important aspect of the treatment of critically ill patients. While body temperature is regularly recorded in ICUs, there is variation in measurement location and instrumentation. Additionally, there is currently no standardized temperature at which intervention becomes necessary, nor are there standards for which cooling method should be used. Methods A 20-question survey was used to gather information on temperature management strategies from ICUs across China. Data such as method and frequency of temperature measurement, management goals, cooling measures, and management recommendations were collected. Results A total of 425 questionnaires from unique ICUs were included in the study, with responses collected from all provinces and autonomous regions in China. Mercury thermometers were the most widely used measurement tool (82.39%), and the axilla was the most common measurement site (96.47%). There was considerable variability in the frequency of temperature measurement, the temperature at which intervention should begin, intervention duration, and temperature management goals. While there was no clearly preferred drug-based cooling method, the most widely used equipment-based cooling method was the ice blanket machine (93.18%). The most frequent recommendations for promoting temperature management were continuous monitoring and targeted management. Conclusion Our investigation revealed a high level of variability in the methods of temperature measurement and management among ICUs in China. Since fever is a common clinical symptom in critically ill patients and can lead to prolonged ICU stays, we propose that standardized guidelines are urgently needed for the management of body temperature in these patients.

ABSTRACTIntroduction: Temperature management is an important aspect of the treatment of critically ill patients, but there are differences in the measurement and management of temperature in different Intensive Care Units (ICUs). The objective of this study was to understand the current situation of temperature measurement and management in ICUs in China, and to provide a basis for standardized temperature management in ICUs.Methods: A 20-question survey was used to gather information on temperature management strategies from ICUs across China. Data such as method and frequency of temperature measurement, management goals, cooling measures, and temperature management recommendations were collected.Results: A total of 425 questionnaires from unique ICUs were included in the study, with responses collected from all provinces and autonomous regions in China. Mercury thermometers were the most widely used measurement tool (82.39%) and the axilla was the most common measurement site (96.47%). There was considerable variability in the frequency of temperature measurement, the temperature at which intervention should begin, intervention duration, and temperature management goals. While there was no clearly preferred drug-based cooling method, the most widely used equipment-based cooling method was the ice blanket machine (93.18%). The most frequent recommendations for promoting temperature management were continuous monitoring and targeted management.Conclusion: Our investigation revealed a high level of variability in the methods of temperature measurement and management among ICUs in China. Since fever is a common clinical symptom in critically ill patients and can lead to prolonged ICU stays, we propose that standardized guidelines are urgently needed for the management of body temperature (BT) in these patients.

Objectives: Recently, the Gastrointestinal Dysfunction Score (GIDS) was developed for use with critically ill patients. This study evaluated the association of GIDS with disease severity and clinical outcomes to assess the technical feasibility of using GIDS to reflect the severity and short-term prognosis of critically ill patients. Methods: Association between Gastrointestinal Dysfunction Score (GIDS) and disease severity and prognosis in critically ill patients: A prospective, observational study. This was a prospective observational study involving adult patients in two Intensive Care Units (ICUs). During the first seven days of ICU admission, GIDS, acute gastrointestinal injury (AGI), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA) scores were assessed daily.Results: A total of 276 patients from two centers were enrolled in this study. Patients were divided into GIDS 0-1 (121, 43.8%) and GIDS 2-4 (155, 56.2%). The ICU length of stay and 28-day mortality in the GIDS 2-4 group were significantly higher than the GIDS 0-1 group (P = 0.032, P = 0.001, respectively). The APACHE II and SOFA scores in the GIDS 2-4 group were also significantly higher (P < 0.001). The ROC curves of GIDS, AGI, APACHE II, and SOFA scores on the first day of ICU admission for the prediction of 28day mortality showed that the AUC of GIDS was 0.702 (95%CI 0.628, 0.775; P < 0.001). The AUC for GIDS thorn SOFA was 0.719 (95%CI 0.648, 0.790; P < 0.001), compared with SOFA alone (AUC = 0.703), showing improved predictive power for 28-day mortality.Conclusions: GIDS represents a step toward a reliable clinical tool for GI dysfunction to assess disease severity and short-term prognosis in critically ill patients. In addition, combining GIDS with SOFA score may better predict mortality risk compared to SOFA score alone.(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

探讨阑尾黏液性肿瘤的超声特征性图像.回顾性分析2016年4月至2022年2月16例阑尾黏液性肿瘤患者的临床资料及超声图像.病理结果显示 12例为低级别阑尾黏液性肿瘤,4例为阑尾黏液腺癌;其中7例合并腹膜假黏液瘤.特征性超声图像主要包括:(1)右下腹或腹盆腔囊性或囊实性肿物;(2)呈盲管状/椭圆形或不规则型;(3)短径≥2 cm;(4)囊内透声差,呈"洋葱皮"样或"胶冻样"改变;(5)囊壁见强回声钙化;(6)合并"胶冻样"腹水.阑尾黏液性肿瘤超声声像图具有一定的特征,有助于提高超声医师对该病的诊断准确性.

OBJECTIVE To explore whether barium chloride (BaCl2) preconditioning has the protective effect on lipopolysaccharide (LPS)-induced acute respiratory distress syndrome (ARDS) model in mice and the possible mechanism. METHODS Sixty 8-12 week old healthy C57BL/6 male mice were randomly divided into control group, ARDS model group and BaCl2 pretreatment group, with 20 mice in each group. The BaCl2 pretreatment group was continuously injected with BaCl2 (4 mg/kg through the tail vein) for 3 days before ARDS model establishment. ARDS model was established by intratracheally injecting (3 mg/kg) LPS. The control group was intratracheally given the same volume of 0.9% normal saline. On 24th hour after ARDS model establishment, some mice were sacrificed for obtaining fresh lung tissue. And the right lower lobe of the lung was separated for observing the pathological changes of lung tissue while the left lung tissue was used to measure the wet/dry weight ratio (W/D) of the lung. Some mice were sacrificed for observing pulmonary microvascular permeability at 2nd hours after injecting Evans blue (EB) through tail vein. The left mice were killed for alveolar lavage to measure the levels of tumor necrosis factor-α (TNF-α) via enzyme linked immunosorbent assay (ELISA). RESULTS Comparing with the control group, ARDS model group showed typical ARDS pathological changes, which included the increased W/D ratio (4.951±0.161 vs. 3.449±0.299, P < 0.01) and the content of EB in the lung tissue (μg/g: 0.130±0.027 vs. 0.085±0.011, P < 0.01), the damaged alveolar wall structure, lung congestion and exudates in the alveoli, as well as amounts of inflammatory cells. The pathological score of lung injury (10.33±1.15 vs. 1.67±0.58) and the level of TNF-α in BALF (ng/L: 900.85±247.80 vs. 68.21±5.79) were significantly increased in the ARDS model group (both P < 0.01). Comparing with the ARDS model group, the lung W/D ratio (4.620±0.125 vs. 4.951±0.161) and the EB content in the lung tissue (μg/g: 0.108±0.011 vs. 0.130±0.027) of BaCl2 pretreatment group were significantly reduced (both P < 0.01). And the damaged pulmonary structural BaCl2 pretreatment group were significantly alleviated. In addition, the pulmonary pathological score (5.00±1.00 vs. 10.33±1.15) and the level of TNF-α in BALF (ng/L: 169.16±73.33 vs. 900.85±247.80) were significantly decreased (both P < 0.01). CONCLUSIONS Barium chloride pretreatment can improve the lung histopathological changes of ARDS model mice induced by LPS by reducing the permeability of pulmonary capillaries and local inflammatory reaction.Barium chloride has the protective effect against LPS attack in mice model of ARDS.