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OBJECTIVE@#To explore the risk factors of acute respiratory distress syndrome (ARDS) in patients with sepsis and to construct a risk nomogram model.@*METHODS@#The clinical data of 234 sepsis patients admitted to the intensive care unit (ICU) of Tianjin Hospital from January 2019 to May 2022 were retrospectively analyzed. The patients were divided into non-ARDS group (156 cases) and ARDS group (78 cases) according to the presence or absence of ARDS. The gender, age, hypertension, diabetes, coronary heart disease, smoking history, history of alcoholism, temperature, respiratory rate (RR), mean arterial pressure (MAP), pulmonary infection, white blood cell count (WBC), hemoglobin (Hb), platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer, oxygenation index (PaO2/FiO2), lactic acid (Lac), procalcitonin (PCT), brain natriuretic peptide (BNP), albumin (ALB), blood urea nitrogen (BUN), serum creatinine (SCr), acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA) were compared between the two groups. Univariate and multivariate Logistic regression were used to analyze the risk factors of sepsis related ARDS. Based on the screened independent risk factors, a nomogram prediction model was constructed, and Bootstrap method was used for internal verification. The receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated to verify the prediction and accuracy of the model.@*RESULTS@#There were no significant differences in gender, age, hypertension, diabetes, coronary heart disease, smoking history, alcoholism history, temperature, WBC, Hb, PLT, PT, APTT, FIB, PCT, BNP and SCr between the two groups. There were significant differences in RR, MAP, pulmonary infection, D-dimer, PaO2/FiO2, Lac, ALB, BUN, APACHE II score and SOFA score (all P < 0.05). Multivariate Logistic regression analysis showed that increased RR, low MAP, pulmonary infection, high Lac and high APACHE II score were independent risk factors for sepsis related ARDS [RR: odds ratio (OR) = 1.167, 95% confidence interval (95%CI) was 1.019-1.336; MAP: OR = 0.962, 95%CI was 0.932-0.994; pulmonary infection: OR = 0.428, 95%CI was 0.189-0.966; Lac: OR = 1.684, 95%CI was 1.036-2.735; APACHE II score: OR = 1.577, 95%CI was 1.202-2.067; all P < 0.05]. Based on the above independent risk factors, a risk nomograph model was established to predict sepsis related ARDS (accuracy was 81.62%, sensitivity was 66.67%, specificity was 89.10%). The predicted values were basically consistent with the measured values, and the AUC was 0.866 (95%CI was 0.819-0.914).@*CONCLUSIONS@#Increased RR, low MAP, pulmonary infection, high Lac and high APACHE II score are independent risk factors for sepsis related ARDS. Establishment of a risk nomograph model based on these factors may guide to predict the risk of ARDS in sepsis patients.
Assuntos
Humanos , Estudos Retrospectivos , Alcoolismo , Prognóstico , Síndrome do Desconforto Respiratório do Recém-Nascido , Pneumonia , Sepse , Unidades de Terapia Intensiva , Pró-Calcitonina , Fibrinogênio , Curva ROCRESUMO
The high elastic modulus of scaffolds or implants will result in stress shielding effect, which may lead to bone resorption and scaffold or implant loosening in the late stage. Porous scaffolds and implants can adjust their porosity and elastic modulus according to the mechanical environment, thereby reducing stress shielding; meanwhile, porous structures are beneficial to bone tissue growth, which is conducive to osseointegration. Three kinds of basic structure for porous scaffolds and implants by 3D printing were summarized, namely, uniform porous structure, bone-like trabecular structure and functionally graded structure. The design methods of these structures were introduced respectively, including computer-aided design (CAD)-based, implicit surface-based, image-based and topology optimization-based design method, so as to provide references for solving the stress shielding problem, as well as designing porous scaffolds and implants.
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The high elastic modulus of scaffolds or implants will result in stress shielding effect, which may lead to bone resorption and scaffold or implant loosening in the late stage. Porous scaffolds and implants can adjust their porosity and elastic modulus according to the mechanical environment, thereby reducing stress shielding; meanwhile, porous structures are beneficial to bone tissue growth, which is conducive to osseointegration. Three kinds of basic structure for porous scaffolds and implants by 3D printing were summarized, namely, uniform porous structure, bone-like trabecular structure and functionally graded structure. The design methods of these structures were introduced respectively, including computer-aided design (CAD)-based, implicit surface-based, image-based and topology optimization-based design method, so as to provide references for solving the stress shielding problem, as well as designing porous scaffolds and implants.
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Aim To investigate the effect of PLK1 on epithelial-mesenchymal transition (EMT)of human e-sophageal squamous cell carcinoma (ESCC)cells TE-1 5 and its relevant molecular mechanisms.Methods PLK1 overexpressed ESCC cells and control vector were used as the experimental cells.The expression of EMT-related protein markers E-cadherin and vimentin were measured by Western blot.vimentin mRNA was measured by Real-time PCR.Total cellular protein and nuclear protein were respectively extracted,and then they were used to detect the expression of β-catenin by Western blot.β-catenin siRNA and non-specific siR-NA were transiently transfected into the cell clones overexpressed PLK1 ,and then vimentin was detected by Western blot.β-catenin protein degradation com-plex was detected by immunoprecipitation and Western blot.Results The mesenchymal marker vimentin was distinctively upregulated and the epithelial marker E-cadherin was distinctively downregulated in the cell clones overexpressed PLK1 ,compared with those in the vector clones.This indicated that EMT occurred in ESCC cells.vimentin mRNA was also markedly in-creased.In the cell clones overexpressed PLK1 ,β-catenin were both elevated from the total cells and the nucleus.The expression of vimentin was reduced whenβ-catenin was knocked down.APC and GSK-3βwere both reduced from Axin immunoprecipitate in the cell clones overexpressed PLK1 .Conclusion PLK1 up-regulates vimentin and promotes EMT in ESCC cells probably by inhibiting the formation of protein degrada-tion complex and stabilizing β-catenin.
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Objective To evaluate the outcome and safety of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) in the management of esophageal mucosal lesion.Methods The clinical data of 70 patients with esophageal mucosal lesion were analyzed.Twenty-five patients were treated by ESD (ESD group) and 45 patients were treated by EMR (EMR group).The enbloc resection rate,tissue healing resection rate,operation time,complication and recurrence rate were compared between two groups.Results The enbloc resection rate,tissue healing resection rate in ESD group were significantly higher than those in EMR group [60.0％(15/25) vs.48.9％(22/45),48.0％(12/25) vs.40.0％ (18/45)] (P ＜0.05).The local recurrence rate in ESD group was lower than that in EMR group [4.0％ (1/25) vs.20.0％ (9/45)] (P ＜ 0.05).The severe complication such as delayed hemorrhage,perforation,stenosis between two groups had no significant difference (P ＞ 0.05).The operation time in ESD group was (64.3 ±27.1) min,and significantly longer than that in EMR group [(27.6 ± 14.1) min] (P ＜0.05).Conclusions Compare with EMR,ESD has better enbloc resection rate,tissue healing resection rate,and lower recurrence rate.It is more safe and effective in the therapy of esophageal mucosal disease.
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Objective To explore the efficacy and safety of mosapride combined withpancreatic kallikrein in the treatment of diabetic neurogenic bladder(DNB).Methods According to the digital table,120 patients with DNB were randomly divided into the control group and the observation group,each group 60 cases,All patients received basic treatment,including reducing blood glucose,reducing blood pressure,nutrition nerve and regulating blood lipids,and the observation group was accepted the treatment of original enzyme plus mosapride pancreatic kinin on basis of the above treatment.The treatment time of the two groups was both 3 weeks,The effect,blood sugar,blood hpids,urodynamic,quality of life,and the incidence of adverse reactions were observed.Results The total effective rate of the observation group was 93.33％,which was significantly higher than that of the control group (65.00％) (χ2 =14.602,P ＜ 0.01) ；the adverse reaction rate of the observation group was 8,33％,which was significantly lower than that of the control group(20.00％)(χ2 =11.368,P ＜ 0.01),Conclusion Mosapride combined with pancreatic kallikrein in thetreatment of DNB has better effect,and could significantly improve the clinical symptoms and quality of life of patients.So it should be promoted and applied.
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ObjectiveTo study the role of the myenteric plexus (ENS) nitrergic neurons in type 2 diabetic rats with gastroparesis.MethodsThiry male 8-week-SD rats were randomly divided into control group (CON),type 2 diabetic group (DM),insulin-treated group ( INS ) and insulin-lipoie acid group( LA ),each 15.The rats were sacrificed at 16 weeks after diabetic model established,the stomach relative residual rate of pigmented was measured and the protein content of neuronal nitric oxide synthase (nNOS) was evaluate,the level of malondialdehyde (MDA) and superoxide dismutase (SOD),were measured,the the morphological changes of gastric antrum nitrergic neurons was observed.ResultsCompared with CON group,gastric motility,gastric antrum nitrergic neuron count,T-SOD and CuZn-SOD,and were significantly decreased in DM group ( P ＜0.05).Compared with the CON group,DM group gastric antrum nitrergic neurons nNOS expression decreased,while MDA levels significantly increased ( P ＜ 0.05 ).Compared with DM group,INS group and LA group has significantly rapider gastric motility than that of DM group ( P＜ 0.05 ),the neuron counting markly increased in nitrergic neuron of gastic sinus ( P ＜ 0.05 ),increased expressions of nNOS in gastric sinus,while still lower than control group( P ＜0.05).compared with the INS group,antrum nitrergic neuron counts of LA group significantly increased ( P ＜ 0.05 ).Conclusion The gastrointestinal dyskinesis of type 2 diabetic rats might be associated with lesions of gastric myenteric plexus nitrergic neuron.Insulin intensive therapy and treated with alpha-lipoic acid as an antioxidant can inhibit the abnormally high levels of oxidative stress,protect gastrointestinal nitrergic neurons,delay the progress of diabetic gastrointestinal motility disorders.Insulin combined with a-lipoic acid treatment is superior to single-use insulin.
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Objective To obtain two-dimensional gel electrophoresis maps of the renal tissue proteins of normal and chronic intermittent hypoxia(CIH) rats for identifying the diferentially expressed proteins in the CIH rats.MethodsCIH rat models were established, and the proteins in the renal tissue underwent two-dimensional gel electrophoresis with immobiline pH gradientisoeleclricfocusingasthefirstdimensionandverticalSDS-PAGEasthesecond dimension.Analysis of 2-DE maps was used to determine differential expression of proteins between the two groups by ImageMaster 2D Platinum 5.0, and four protein spots expressed differently were picked up for further identification by MALDI-TOF-MS.Results Matched and compared with those of control group, 112 protein spots were determined with differently expressive levels in CIH group.By MALDI-TOF-MS, three protein spots of them were identified as ATP synthase delta subunit of mitochondrial precursor, catechol O-methyltransferase, apurinic/apyrimidinic endonudease.Conclusions There is obvious difference in expressive proteomes in renal tissue between normal and chronic intermittent hypoxia rats.The functions of those identified proteins are involved in cellular energy metabolism, apoptosis, signal transduction, anti-cell injury and hormone metabolism,so that proteomics can serve as a new approach in the study of obstructive sleep apnea-hypopnea syndrome to discover new therapeutic targets.
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BACKGROUND: It is indicated in researches of recent years that both astragalus and angelica act on anti-free radical and protect renal injury due to ischemia / reperfusion.OBJECTIVE: To observe the protection and its mechanism of astragalus and angelica injections on adenosine triphosphate-ase (ATPase) in renal injury due to ischemia/reperfusion.DESIGN: The observing controlled experiment based on experimental animals .SETTING: Physiological teaching & research room and teaching & research room of renal functional protection in a medical college. MATERIALS: The experiment was performed in Physiological Experimental Room of Luzhou Medical College from January 2001 to March 2001. Totally 33 Japanese big-ear white healthy adult rabbits of either sex were employed,provided by Experimental Animal Center of Luzhou Medical College, in the mass of(1.63 + 0. 22) kg. According to random number table, they were divided in sham-operation control(8 rabbits), simple ischemia/reperfusion group (8 rabbits), astragalus injection + ischemia/reperfusion group (astragalus group) (8 rabbits) and angelica injection + ischemia/reperfusion group(angelica group) (9 rabbits).METHODS: One day before operation, on the day of operation and 1 day after operation, successively, intravenous medical injections (astragalus 1.25 g/kg,angelica 12.5 g/kg) were administrated in astragalus and angelica groups everyday respectively, and injection with physiological saline 5 mL/kg was applied in the control and simple ischemia/reperfusion group. In 48 hours reperfusion after 1 hour ischemia in kidney, blood sample was collected from inferior vena cava. The upper tissue of the right kidney was collected and fixed by placed in 30 mL/L glutaraldehyde and the lower tissue was prepared into homogenate. Ultrastructure of renal tissue was examined with electron microscope; serum creatinine level and ATPase activity in renal tissue were assayed.MAIN OUTCOME MEASURES: Ultrastructure of renal tissue, serum creatinine level and ATPase activity in renal tissue.RESULTS: In simple ischemia/reperfusion group, renal tissue was degenerated significantly, and the disorders in astragalus and angelica groups were reduced markedly compared with simple ischemia/reperfusion group. Serum creatinine level in simple ischemia/reperfusion group was higher remarkably than the sham-operation control ( P ＜ 0. 05 ), and that in astragalus and angelica groups was reduced than simple ischemia/reperfusion group (P ＜ 0. 05) . In simple ischemia/reperfusion group, the levels of Mg2+-ATPaes, Na+-K+-ATPase and Ca2+-ATPase were(0. 155 ±0. 020),(0.179±0.018), (0.150±0.022) nkat/g respectively, which was markedly reduced compared with sham-operation control [ (0. 174 + 0. 012),(0. 198 + 0. 012), (0. 181 + 0. 017) nkat/g], ( t = 2. 344, 2. 438, 3. 014,P ＜ 0.05 ). In astragalus and angelica groups, respectively, the activities of Mg2+-ATPaes, Na+-K+-ATPase and Ca2+-ATPase were(0. 172 ± 0. 023),(0. 196 ±0. 077), (0. 175 ±0. 016) and (0. 177 ±0. 015), (0. 200 ±0.011 )and (0. 181 ± 0. 025) nkat/g successively. Except that Mg2+-ATPaes activity in astragalus group was not different significantly from that in simple ischemia/reperfusion group, all the rest were higher than simple ischemia/reperfusion group(t =2. 372 -2. 786, P ＜0.05).CONCLUSION: Both astragalus and angelica inhibit the decrease of ATPase and improve the disturbed local blood-flow adjustment in kidney, which has provided experimental basis of astragalus and angelica on reducing renal injury induced by ischemia/reperfusion through protecting ATPase.
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AIM: To determine the effect of Radix Angelicae Sinensis(RAS) on renal ischemia/reperfusion injury in rabbits and to explore its mechanism. METHODS: Twenty-five rabbits were divided randomly into the sham operated group(Control group), renal ischemia/reperfusion injury group(IR group) and RAS+IR group. At the time point of reperfusion 48 h after renal ischemia 1 h, the renal tissue were observed by electron-microscope and the contents of creatinine(Cr) in serum, tumor necrosis factor-?(TNF-?), interleukin-6(IL-6)and basic fibroblast growth factor(bFGF) in the renal tissue were measured. RESULTS: A remarkably degenerative changes in renal tissue were showed under electronmicroscope in IR group , but the changes in RAS+IR group were slight . The contents of Cr, TNF-? and IL-6 in IR group were higher than those in Control group, these parameters in RAS+IR group were lower than those in IR group, the difference between these groups was significant ( P