Objective To observe and analyze clinical significance of detection of serum sol-uble intracellular adhesion molecule-1 (sICAM-1),inflammatory mediators levels for the patients with chronic obstructive pulmonary disease (COPD).Methods 60 patients with acute exacerbated COPD were selected as the AECOPD group and divided into complicated with respiratory failure group and the without complicated respiratory failure group according to whether the patients had been complicated with respiratory failure before the treatment;60 patients with AECOPD whose clinical symptoms were relieved after the routine treatment during the same period were selected as the COPD stable phase group;60 patients with healthy examination results during the same period were selected as the control group.The serum levels of sICAM-1,interleukin-10 (IL-10),inter-leukin-18 (IL-18)of the subjects in the three groups were detected and analyzed.Results The serum sICAM-1 and IL-18 levels of the patients in the AECOPD group were significantly higher than those of the COPD stable phase group (P <0.05)and the serum sICAM-1 and IL-18 levels of the patients in the COPD stable phase group were significantly higher than those of the control group (P <0.05);The serum IL-10 level of the patients in the AECOPD group was significantly lower than that of the COPD stable phase group (P <0.05)and the serum IL-10 level of the patients in the COPD stable phase group was significantly lower than that of the control group (P < 0 .0 5 );The serum sICAM-1 and IL-1 8 levels of the patients in the complicated with respiratory failure group were significantly higher than those of the without complicated respirato-ry failure group (P <0.05)and the serum IL-10 level of the patients in the complicated with res-piratory failure group was significantly lower thanthat of the without complicated respiratory fail-ure group (P <0.05);In the AECOPD group,the serum IL-10 level was negative related with the serum sICAM-1 level of (r =-0.53,P <0.05),while the serum IL-18 level was positively related with the serum sICAM-1 level (r =0.68,P <0.05).Conclusion The increased serum sICAM-1 and IL-18 levels and the decreased serum IL-10 level may be associated with the occur-rence of AECOPD and the complicated respiratory failure.The increasing of the serum sICAM-1 level can reflect the state of the inflammatory reaction of patients.

Objective To observe and analyze clinical significance of detection of serum sol-uble intracellular adhesion molecule-1 (sICAM-1),inflammatory mediators levels for the patients with chronic obstructive pulmonary disease (COPD).Methods 60 patients with acute exacerbated COPD were selected as the AECOPD group and divided into complicated with respiratory failure group and the without complicated respiratory failure group according to whether the patients had been complicated with respiratory failure before the treatment;60 patients with AECOPD whose clinical symptoms were relieved after the routine treatment during the same period were selected as the COPD stable phase group;60 patients with healthy examination results during the same period were selected as the control group.The serum levels of sICAM-1,interleukin-10 (IL-10),inter-leukin-18 (IL-18)of the subjects in the three groups were detected and analyzed.Results The serum sICAM-1 and IL-18 levels of the patients in the AECOPD group were significantly higher than those of the COPD stable phase group (P <0.05)and the serum sICAM-1 and IL-18 levels of the patients in the COPD stable phase group were significantly higher than those of the control group (P <0.05);The serum IL-10 level of the patients in the AECOPD group was significantly lower than that of the COPD stable phase group (P <0.05)and the serum IL-10 level of the patients in the COPD stable phase group was significantly lower than that of the control group (P < 0 .0 5 );The serum sICAM-1 and IL-1 8 levels of the patients in the complicated with respiratory failure group were significantly higher than those of the without complicated respirato-ry failure group (P <0.05)and the serum IL-10 level of the patients in the complicated with res-piratory failure group was significantly lower thanthat of the without complicated respiratory fail-ure group (P <0.05);In the AECOPD group,the serum IL-10 level was negative related with the serum sICAM-1 level of (r =-0.53,P <0.05),while the serum IL-18 level was positively related with the serum sICAM-1 level (r =0.68,P <0.05).Conclusion The increased serum sICAM-1 and IL-18 levels and the decreased serum IL-10 level may be associated with the occur-rence of AECOPD and the complicated respiratory failure.The increasing of the serum sICAM-1 level can reflect the state of the inflammatory reaction of patients.

Objective To study the clinical features of patients with scrub typhus and provide scientific basis for clinical diagnosis and treatment. Methods Clinical data of patients with scrub typhus in the First Affiliated Hospital of Kunming Medical University from January 2016 to December 2016 were collected. Epidemiological data, clinical manifestations, laboratory findings, image examination results, treatment and outcome were retrospectively analyzed. Results The clinical manifestations included 59 cases (100.0％) with fever, 44 cases (74.6％) with headache, 39 cases (66.1％) with chills, 34 cases (57.6％) with muscle and joint pain, 29 cases (49.2％) with prostration, 49 cases (83.1％) with eschar or ulcer, 42 cases (71.2％) with lymphadenectasis, 23 cases (39.0％) with hepatosplenomegaly. Laboratory test results: 51 cases (86.4％) had normal or elevated white blood cell count, 50 cases of eosinophil reduced (84.7％), 27 cases of blood platelet (PLT) reduced (45.8％), 33 cases of albumin reduced (55.9％), 50 cases of alanine aminotransferase (ALT) increased (84.7％), 48 cases of aspartate aminotransferase (AST) increased (81.4％), and 56.1％ (23/41) of the patients with triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3) and free thyroxine (FT4) levels significantly lowered, with predominantly free FT3 reduction (82.6％,19/23); C reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and ferritin were increased in 93.9％(46/49), 35.4％ (17/48), 64.9％ (24/37), and 83.8％ (31/37) of the patients, and 95.6％(43/45) was accompanied with chest radiographic abnormalities. Tetracycline, doxycycline and azithromycin treatment were all effective. Conclusions The clinical manifestations of patients with scrub typhus, involving multisystem, are diverse and thyroid hormones decrease is observed. Early diagnosis and treatment is the key to improve the prognosis of patients with scrub typhus.

Objective:To explore the efficacy and safety of sofosbuvir-based direct-acting antiviral treatment in children and adolescent patients with chronic hepatitis C (CHC).Methods:A total of 52 children and adolescent patients who admitted to The Third People′s Hospital of Kunming City and The People′s Hospital of Fuyuan County aged from three to 17 years old with CHC from January 2018 to August 2022 were enrolled, and their basic information was collected. Patients were treated with sofosbuvir/velpatasvir (SOF/VEL) or ledipasvir/sofosbuvir (LDV/SOF) with or without ribavirin for 12 weeks. The biochemical and virological indexes were followed up before and after treatment and 12 weeks after withdrawal. The primary endpoint was the sustained virological response (SVR) at week 12 of follow-up after treatment, and the occurrence of adverse events (AE) during treatment. Statistical analysis was used by nonparametric test.Results:A total of 52 patients with CHC including 38 children and 14 adolescents were enrolled. Thirty-one were male and 21 were female. The age was 9(7, 12) years old. Among 52 patients, seven patients were type 1b, 11 were type 2a, three were type 2, five were type 3a, 18 were type 3b, one was type 6a, three were type 6k, four were type 6n and one was type 6v. Twelve (23.1%) patients were vertical transmission, 21(40.4%) patients had horizontal transmission among family members, two (3.8%) patients were blood fluid transmission, and 17(32.7%) were unknown transmission route. Compared with the baseline levels, Total bilirubin, alanine aminotransferase and aspartate aminotransferase were all significantly decreased after 12 weeks of treatment and 12 weeks after withdrawal, and the differences were statistically significant ( F=12.71, 30.23 and 42.52, respectively, all P<0.05). Up to September 30, 2022, 100.0%(52/52) of patients achieved SVR at the end of treatment. For patients who completed follow-up for 12 weeks after treatment, 95.8%(46/48) achieved SVR. Common AEs during treatment were fatigue (11.5%(6/52)), headache (5.8%(3/52)), dizziness (1.9%(1/52)), abdominal pain (3.8%(2/52)), diarrhea (1.9%(1/52)), rash (1.9%(1/52)) and skin pruritus (1.9%(1/52)). No patients discontinued treatment because of AE. Conclusions:Sofosbuvir-based direct-acting antiviral treatment is efficient and well-tolerated in children and adolescent patients with CHC. No patients discontinued treatment due to AE.

Objective This study is to explore the clinical efficacy and common adverse reactions of PEG-IFN α-2b combined with TMF and TDF in the treatment of hepatitis B liver fibrosis,and provide more clinical reference for the treatment of chronic hepatitis B.Methods From January 2022 to December 2023,we selected 130 patients with chronic hepatitis B liver fibrosis who were admitted to Kunming Third People's Hospital.Divided into TMF combined group and TDF combined group,the virus reduction level,virus response rate,liver fibrosis four items,instantaneous elastography(FibroScan)and other indicators were compared between the two groups of patients after 48 weeks of treatment.The changes in liver fibrosis grading and adverse reactions before and after treatment were also compared.Results After 48 weeks of treatment,the TMF combined group showed a significant increase in HBV DNA seroconversion rate and HBeAg seroconversion rate compared to the TDF combined group,with statistical significance(P<0.05).However,there was no statistically significant difference in HBsAg seroconversion rate between the two groups of patients(P>0.05).After 48 weeks of treatment,the TMF combined group showed more significant efficacy in reducing the levels of HA,PC Ⅲ,Ⅳ-C,and LN,with a significant difference(P<0.05);After 48 weeks of treatment,both groups of patients showed improvement in the degree of liver tissue fibrosis.Compared with the TDF combined group,the TMF combined group had a more significant effect on tissue improvement.After 48 weeks of treatment,the incidence of dyslipidemia,hypothyroidism,and diarrhea was higher in the TMF combined group than in the TDF combined group(P<0.05);After 48 weeks of treatment,there was no statistically significant difference in the incidence of gingival bleeding,anemia,and thrombocytopenia between the two groups of patients(P>0.05);The incidence of elevated uric acid and joint pain in the TDF combined group was higher than that in the TMF combined group after 48 weeks of treatment(P<0.05).Conclusion TMF combined with PEG-IFN α-2b has better clinical efficacy in treating chronic hepatitis B,strong antiviral ability,greater inhibition of liver fibrosis,good drug safety,better prognosis,and can provide more effective medication basis for clinical cure of hepatitis B.

Objective By analyzing the means of donor maintenance from the perspective of intensive care medicine,the difference of clinical indicators before and after donor treatment is obtained,summarizing the treatment experience and effect of clinical maintenance of donor donors,and providing more clinical evidence for the maintenance and treatment of organ donation donors.Methods A retrospective analysis was performed on 76 organ donors collected from the Department of Intensive Care Medicine,Army Medical Center,Chinese People's Liberation Army from January 2014 to December 2021,collected donor maintenance treatment,including mechanical ventilation,continuous renal replacement therapy(CRRT)treatment,enteral nutrition and parenteral nutrition,enteral and parenteral nutrition,plasma exchange,at the same time,the paired t test was used to compare the organ function before and after treatment.Results The lung,liver and kidney of 76 donors were evaluated before and after treatment to determine the number of eligible donors.The difference between the number of eligible donors of kidney and liver before and after treatment was statistically significant(P<0.05).There was no significant difference in lung evaluation(P>0.05).Conclusion Timely and effective organ support therapy for organ transplantation donors is beneficial to the recovery of organ function and improve the utilization rate of organ.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.