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Sepsis is the main cause of death in intensive care unit (ICU). Sepsis and septic shock seriously affect the prognosis of patients and increase the mortality and re-morbidity of patients. Early and timely intervention can reduce the mortality and recurrence rate of patients with sepsis. The occurrence of sepsis may be related to the phosphorylation of connexin 43 (Cx43), which needs to be realized through various signal pathways. The related sites of connexin 43 are phosphorylated through different signal pathways to achieve the precise regulation of sepsis, these sites may be related targets for the treatment of sepsis and provide a direction for accurate treatment of sepsis. This paper mainly analyzes the role of Cx43-related signal pathways such as protein kinase A (PKA), protein kinase C (PKC), mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) in the pathogenesis of sepsis.
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Sepsis is a systemic inflammatory disease caused by infection that affects the lungs and can develop into acute lung injury or acute respiratory distress syndrome.Acute lung injury caused by sepsis is one of the common critical diseases in intensive care unit, which is often manifested as intractable hypoxemia, diffuse double pneumonia infiltration, pulmonary edema, etc.Its pathogenesis is complex, and there is no specific treatment method at present.MicroRNAs are non-coding gene regulators involved in the regulation of various physiological and pathological processes of the body, including sepsis acute lung injury.This paper briefly summarized the pathophysiological mechanism of acute lung injury in sepsis, summarized the regulatory mechanism of miRNAs on alveolar macrophages, epithelial cells and endothelial cells during the pathogenesis of ALI, and finally comprehensively expounded the current situation and future direction of miRNAs in the treatment of acute lung injury in sepsis.
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Objective To investigate the effect of mechanical ventilation in prone position combined with lung recruitment on severe acute respiratory distress syndrome (ARDS).Methods From February 2015 to February 2017,82 patients with ARDS admitted to ICU of the Second Hospital of Shanxi Medical University were divided into two groups according to random number table,with 41 cases in each group.The study group was treated with mechanical ventilation in prone position combined with lung recruitment therapy,and the control group was treated with mechanical ventilation in supine position combined with lung recruitment therapy.The differences of heart rate (HR),central venous pressure (CVP),mean arterial pressure (MAP),partial pressure of oxygen (PaO2),oxygenation index (PaO2/FiO2),plateau pressure (Pplat),and static pulmonary compliance (Cst) were compared between the two groups before treatment (T0),and 1h (T1),2h (T2),6h (T3) after treatment.Results The PaO2 and PaO2/FiO2 levels of the two groups increased significantly after lung recruitment.In the study group at different time after treatment,PaO2 [(69.17 ±7.51) mmHg,(74.64 ±6.78) mmHg,(82.52 ± 10.37) mmHg],PaO2/FiO2 [(116.91 ±15.57) mmHg,(123.06 ± 16.34) mmHg,(135.23 ± 18.41) mmHg] were higher than those in the control group [PaO2:(64.23 ± 7.72) mmHg,(68.51 ± 8.05) mmHg,(73.43 ± 9.12) mmHg;PaO2/FiO2:(106.50 ± 12.97) mmHg,(115.42 ± 13.19) mmHg,(123.42 ± 14.95) mmHg],the differences were statistically significant (t =3.225,3.254,4.245,3.954,3.886,4.135,all P ＜ 0.05).HR and CVP increased at T2-T3,T3 decreased,MAP decreased at T2-T3,and T3 increased in both two groups.HR at T1-T3 in the study group were (123.17 ± 13.41) times/min,(114.64 ± 10.08) times/min,(102.52 ± 6.57) times/min,which were lower than those in the control group [(129.23 ±12.75) times/min,(117.51 ± 10.35) times/min,(108.43 ± 9.77) times/min],the differences between the two groups were statistically significant (t =3.884,4.215,4.667,all P ＜ 0.05).Conclusion Prone position mechanical ventilation combined with lung recruitment can effectively improve the oxygenation status of severe ARDS,and has less effect on hemodynamics,and the effect is better than supine position mechanical ventilation combined with lung recruitment.
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Objective@#To investigate the effect of mechanical ventilation in prone position combined with lung recruitment on severe acute respiratory distress syndrome (ARDS).@*Methods@#From February 2015 to February 2017, 82 patients with ARDS admitted to ICU of the Second Hospital of Shanxi Medical University were divided into two groups according to random number table, with 41 cases in each group.The study group was treated with mechanical ventilation in prone position combined with lung recruitment therapy, and the control group was treated with mechanical ventilation in supine position combined with lung recruitment therapy.The differences of heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP), partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), plateau pressure (Pplat), and static pulmonary compliance (Cst) were compared between the two groups before treatment (T0), and 1h (T1), 2h (T2), 6h (T3) after treatment.@*Results@#The PaO2 and PaO2/FiO2 levels of the two groups increased significantly after lung recruitment.In the study group at different time after treatment, PaO2[(69.17±7.51)mmHg, (74.64±6.78)mmHg, (82.52±10.37)mmHg], PaO2/FiO2 [(116.91±15.57)mmHg, (123.06±16.34)mmHg, (135.23±18.41)mmHg]were higher than those in the control group[PaO2: (64.23±7.72)mmHg, (68.51±8.05)mmHg, (73.43±9.12)mmHg; PaO2/FiO2: (106.50±12.97)mmHg, (115.42±13.19)mmHg, (123.42±14.95)mmHg], the differences were statistically significant (t=3.225, 3.254, 4.245, 3.954, 3.886, 4.135, all P<0.05). HR and CVP increased at T2-T3, T3 decreased, MAP decreased at T2-T3, and T3 increased in both two groups.HR at T1-T3 in the study group were (123.17±13.41)times/min, (114.64±10.08)times/min, (102.52±6.57)times/min, which were lower than those in the control group[(129.23±12.75)times/min, (117.51±10.35)times/min, (108.43±9.77)times/min], the differences between the two groups were statistically significant (t=3.884, 4.215, 4.667, all P<0.05).@*Conclusion@#Prone position mechanical ventilation combined with lung recruitment can effectively improve the oxygenation status of severe ARDS, and has less effect on hemodynamics, and the effect is better than supine position mechanical ventilation combined with lung recruitment.
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Objective To analyze the literature of snakebite and tetanus infection at home and abroad, and understand the situation of tetanus in snakebite patients.Methods The retrieval of China CNKI database, Wanfang database, VIP database and MEDLINE, Web of Science Embase and Science Direct database was performed with “snake bite” and “tetanus” as the key words, and the retrieval time from January 1953 to October 2017.Results A total of 98 articles was retrieved, which clearly records the snakebite patient data with tetanus has collected 8 literatures, Chinese 6 literatures, English 2 articles;a total of 16 patients, including 11 cases of Chinese, 4 in Nigeria, 1 in Thailand;the bite sites were limbs;9 patients with blood circulation the snake wound, 7 cases of mixed snakebite;snake bite patients with tetanus before;1 patients were injected with Tetanus Antitoxin, 13 patients were treated with Chinese herbal medicine on the wound, 2 patients were untreated.Prognosis analysis showed that in 16 cases, 12 cases were cured, 4 cases died, and the death of the patients had the history of herbal.Conclusions The prevention of tetanus infection should be strengthened in patients with extremities trauma, external application of herbs, blood based drugs, or mixed venomous snake bites.
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Objective To investigate the curative effect of imipenem cilastatin sodium in the treatment of patients with severe infection complicated with multiple organ dysfunction ,and its effect on blood lactic acid.Methods From January 2012 to January 2017,a total of 124 patients with severe organ failure and multiple organ dysfunction in the Second Hospital of Shanxi Medical University were selected ,and they were randomly divided into study group and control group according to the digital meter method ,with 62 cases in each group.The study group received a broad -spectrum antibiotic imipenem cilastatin sodium treatment , the control group received levofloxacin treatment.The curative effect,bacterial clearance rate,infection control time and the change of BLA level in the two groups were recorded and compared.Results The total effective rate was 82.26%in the study group and 79.03%in the control group,there was no statistically significant difference between the two groups (χ2＝1.187,P＞0.05).The bacterial clearance rate in the study group was 80.00%,which was significantly higher than 52.94%in the control group(χ2＝5.176,P＜0.05).The infection control time in the study group was earlier than that in the control group [(3.17 ± 1.14)d vs.(5.21 ±1.18) d),t ＝11.579,P ＜0.05].Before treatment,there was no statistically significant difference in BLA level between the two groups (t＝1.879,P＞0.05).After treatment,the BLA level in the study group was significantly higher than that in the control group (t＝12.179,P＜0.05),the level of BLA in the study group gradually decreased after one week of withdrawal ,which had no statistically significant difference compared with the control group(t＝1.483,P＞0.05).There was no statistically significant difference in BLA level between the two groups after one week of discontinuation (t＝1.237,P＞0.05).Conclusion Imipenem and cilastatin sodium has good curative effect and bacterial clearance rate in the treatment of patients with severe infection complicated with multiple organ dysfunction.It can control the infection more promptly and has a significant effect on the prognosis of patients.It is worthy of widely clinical promotion and application.
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Objective To conduct a meta-analysis of the curative effect and safety of the drug-coated balloon (DCB) and uncoated balloon (UCB) in treating femoropopliteal artery ischemic disease in order to provide more credible conclusion to guide clinical practice.Methods By retrieving relevant documents contained in Medline,EMbase,Cochrane library,EBSCO,Springer Link,Scopus,Web and other data pools,the research articles of clinical trials that met the inclusion and exclusion criteria were collected.According to the risk assessment standard of Cochrane collaboration network,the academic qualities of included articles were evaluated,the relevant data were extracted,then,the meta-analysis was conducted with RevMan5.3 software.Results A total of 8 papers were collected,which were originated from 6 clinical trials (from 2008 to 2015) and included 1188 patients in total.DCB group had 722 patients,and UCB group had 466 patients.Meta analysis showed that the target lesion revascularization (TLR) rates at 6,12 and 24 months after angioplasty in DCB group were significantly lower than those in UCB group.The late lumen loss (LLL) amount and re-stenosis rate at 6 month after angioplasty in DCB group were lower than those in UCB group.No statistically significant differences in amputation rate and mortality at 6,12 and 24 months after angioplasty existed between the two groups.Conclusion In treating femoropopliteal artery ischemic disease,the use of DCB is superior to the use of UCB in aspects of TLR rate,LLL amount and re-stenosis rate,besides,no significant difference in safety exists between DCB and UCB.Therefore,priority should be given to the use of DCB when the patient's economic conditions permit.
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Nine patients with maxillofacial fracture that received intraoperative CT examination in Lanzhou General Hospital of Lanzhou Military Command from January 2017 to March 2017 were retrospectively studied. The procedure of intraoperative CT was introduced. The value of this technique was preliminarily discussed in order to provide a new method for the accurate implementation of maxillofacial fracture surgery.
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Objective To study the effect of protein C mutation on venous thrombosis (VTE) by PROC gene sequencing in patients with VTE. Methods Human PROC gene sequence was designed to amplify the third exon region of the PC-Gla domain , and then the PCR products were sequenced to search for a single nucleotide mutation (SNVs). The SNVs was constructed into eukaryotic expression system and a stable expression of wild-type and mutant PC cells were also constructed. At the same time , the distribution of PC levels in normal and VTE patients were detected with ELISA. Results Three single nucleotide mutations were found in different patients. In HUVEC cells, the synthesis of PC decreased in each mutant strain. The PC level in the normal patients , VTE patients , and the mutant samples were detected , which were significantly lower in the mutant samples than that of the VTE group (P = 0.035 3) and the normal level (P < 0.000 1). Conclusion Three mutation sites PCArg-1Cys , PCVal34Met and PCArg9Cys are important genetic factors lead to a significant decrease in plasma PC levels and the increase of VTE risk.
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BACKGROUND:Bone marrow mesenchymal stem cels have a therapeutic effect on acute lung injury, but the mechanism is unclear. If the mechanism is understood, the majority of patients with acute lung injury can obtain a benefit. OBJECTIVE:To explore the possible mechanism underlying bone marrow mesenchymal stem cels in the treatment of acute lung injury with sepsis in rats. METHODS: (1) Thirty-six adult Wistar rats were randomly divided into three groups, sham operation group (sham group), sepsis group and bone marrow mesenchymal stem cels group (cel treatment group). In the sepsis and cel treatment groups, animal models of sepsis with acute lung injury were established by cecal ligation and puncture, while in the sham group, the cecum was not ligated and punctured. Then, 1 mL normal saline was injected via the femoral vein in the sepsis and sham groups, and 1 mL bone marrow mesenchymal stem cel suspension (1×109/L) was injected into the cel treatment group. After 6 hours, interleukin 10 and macrophage inflammatory protein-2 levels in serum were measured in the three groups. Lung tissues were taken for pathological observation using hematoxylin-eosin staining. (2) Rat alveolar macrophages were obtained by bronchoalveolar lavage, seeded into 24-wel culture plates, and divided into three groups: control group (group A), sepsis model group (group B) and intervention group of bone marrow mesenchymal stem cels (group C). Normal saline, septic plasma, and co-intervention of septic plasma and mesenchymal stem cels were used in the groups A, B, C, respectively. Then, cels in the three groups were cultured in a 5% CO2 incubator at 37℃ for 1 hour. After that, alveolar macrophages were taken to detect whether nuclear factor-κB (P65) protein entered into the nucleus using laser scanning confocal microscopy. RESULTS AND CONCLUSION: (1) The results of animal experiments showed that compared with the sham group, the macrophage inflammatory protein-2 levels in the sepsis group and cel treatment group were significantly increased (P 0.05); inflammatory cel infiltration, interstitial pulmonary edema and pulmonary hemorrhage existed in the sepsis and cel treatment groups, but these symptoms were significantly reduced in the cel treatment group compared with the sepsis group. (2) Results from cel experiments showed that compared with the group A, in group B and group C, the number of nuclear factor-κB (P65) proteins into the nucleus was significantly higher (P < 0.05), but it was lower in the group C than the group B (P < 0.05). These findings indicate that bone marrow mesenchymal stem cels in acute lung injury with sepsis can regulate nuclear factor-κB (P65) protein of alveolar macrophages into the nucleus, reduce expression of macrophage inflammatory protein-2, and thereby play a protective role in the lungvia reducing neutrophil infiltration. Temporarily, this study cannot explain whether bone marrow mesenchymal stem cels have an effect on interleukin 10.