Objective To analyze the pathogenic factors, clinical features and treatment measures of critically ill pregnant women so as to provide experience for improving the success rate of treatment. Methods The clinical data of 167 cases of critically ill pregnant women who admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from January 2013 to December 2017 were collected, and the disease distribution of patients, the causes of postpartum hemorrhage, the treatment situation and the results. Patients were divided into obstetrical complications group, pregnancy complicated with basic diseases group and other complicated diseases group according to disease types, and the treatment status of each group was analyzed. Results Among 167 critically ill pregnant women, 118 cases (70.6%) were in the obstetric complications group, 26 cases (15.6%) were in the pregnancy complicated with basic diseases group, and 23 cases (13.8%) were in the other complicated diseases group. Nine cases died in 167 critically ill pregnant women, with a mortality rate of 5.4%. Postpartum hemorrhage was the major obstetric complication (35.3%), and the coagulation function of 59 patients with postpartum hemorrhage was significantly improved 48 hours after active hemostasis and reasonable blood transfusion [compared to entering the ICU, prothrombin time (PT, s): 14.49±4.66 vs. 23.39±8.11, activated partial thromboplastin time (APTT, s): 52.94±36.36 vs. 87.35±74.69, fibrinogen (Fib, g/L): 2.91±1.03 vs. 1.03±0.65, platelet count (PLT, ×109/L): 94.85±30.09 vs. 43.15±24.07, all P < 0.01]. Compared with pregnancy complicated basic diseases group and other complicated diseases group, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores was reduced significantly in obstetrical complications group (10.41±4.85 vs. 16.46±13.87, 16.90±8.82, both P < 0.05), the length of ICU stay was significantly reduced (hours: 57.83±34.67 vs. 79.64±36.01, 278.30±83.72, both P < 0.05). Compared with other complicated diseases group, the mechanical ventilation time [hours :14 (6, 38) vs. 43 (12, 396)] and mortality (0.8% vs. 13.0%) were significantly decreased in obstetrical complications group (both P < 0.05). Conclusions Observe the changes of the condition closely, necessary hemodynamic treatment, respiratory support, and organ function support with critically ill pregnant women can improve the rescue success rate and prognosis.

Objective To investigate the value of "one-stop" scanning of coronary and head and neck CTA in patients with normal body mass index (18 kg/m2 ≤ BMI ≤ 25 kg/m2) using low tube voltage (80 kVp).Methods In a retrospective analysis 80 patients with normal body mass index who had completed "one-stop" scanning of coronary and head and neck CTA were divided into A and B groups according to different scanning method,and 40 consecutive cases were selected in each group.Scanning parameters of group A and group B were tube voltage 80 kV,coronary CTA tube current 550 mA,head and neck CTA tube current 500 mA,and tube voltage 100 kV,coronary CTA tube current 450 mA,head and neck CTA tube current 400 mA separately.Subjective evaluation and objective evaluation were performed on the image quality of the two groups.CT values of coronary artery and head and neck CTA trunk branch vessel,contrast-to-noise ratio (CNR),image noise (SD) and effective dose between the two groups were compared.Results The image quality of both groups met the diagnostic requirements,and there was no statistically significant difference in subjective scores between two groups (P＞0.05).The CT values of coronary arteries,the main branches of the head and neck (the common carotid artery,the internal carotid artery) and SD of head and neck CTA were significantly different between two groups (t=4.737,6.552,3.359,2.165,2.685,4.617,P＜0.05).There was no statistically significant difference in SD of coronary CTA,CT values and CNR between head and neck vessels (middle cerebral artery) in group A and group B (P＞0.05).The effective dose of coronary CTA in group A (1.16±0.20) mSy was reduced by 51.1％ than that in group B (2.37±0.77) mSv.The effective dose of head and neck CTA in group A (0.37±0.03) mSv was reduced by 47.9％ than that in group B (0.71 ± 0.17) mSv.Conclusions The image quality with subjective evaluation met the diagnostic requirements when using a low-tube voltage for "one-stop"scanning of coronary and head and neck CTA.The CNR values were basically consistent with the conventional scanning method,and the patient effective dose was reduced by about 50％.

Objective:Through retrospective analysis of the admission and treatment of patients in the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University over the past 5 years, it provides a basis for the construction of the subspecialty of intensive care medicine.Methods:Collect clinical data of patients admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from January 1, 2016 to December 31, 2020, including gender, age, first consultation department, intensive care unit (ICU) hospitalization time, ventilator use time, main diagnosis, acute physiology and chronic health evaluationⅡ(APACHEⅡ) when transferred into and out of ICU, treatment results, whether to give mechanical ventilation, whether to use a non-invasive ventilator to assist breathing, whether to die in 24 hours, rescue times and success rate, etc. Changes in the above indicators during the 5 years were analyzed.Results:In the past 5 years, our hospital has treated 2 668 patients in the comprehensive ICU with severe neurological, severe circulation, and severe trauma as the main treatment area, including 1 648 males and 1 020 females; aged 6 months to 94 years old, the average age (53.49±19.03) years old. Neurosurgery (907 cases) was the most frequently diagnosed department, the top 3 diseases were cerebral hemorrhage (539 cases), septic shock (214 cases), and hypovolemic shock (200 cases); ICU hospitalization time was 126 (52, 253) hours, ventilator time was 65 (17, 145) hours, APACHE Ⅱ scores were 23.29±8.12 and 12.99±6.37 when transferred into and out of ICU. The proportion of receiving mechanical ventilation was 92.94% (2 147/2 310), and 314 cases used non-invasive ventilators. 84 cases died within 24 hours (mortality was 3.15%). A total of 2 585 rescues were performed, and the rescue success rate was 92.84% (2 400/2 585). From 2016 to 2020, the 5-year cure rates were 65.92%, 65.83%, 61.53%, 65.64%, 69.06%, respectively, and the 5-year mortality were 13.13%, 14.29%, 18.89%, 16.69%, 13.38%, respectively.Conclusions:With the continuous expansion of critical care medicine, the establishment of classified subspecialties can focus on the admission of patients, so that treatment can be professionalized and standardized, improve the cure rate, and reduce mortality. At the same time, medical staff can focus on management and learning related expertise to master the disease, it is also more in-depth, which is helpful for doctors to improve themselves, and is conducive to the proficiency of related sub-specialties, and lays a good foundation for the development of the department.

AIM:To explore the roles and associations of hepatocyte nuclear factor 4 alpha(HNF4A)and mu-protocadherin(MUCDHL)in the kidney of diabetic mice.METHODS:(1)A cohort of six 12-week-old db/m mice and six db/db mice were selected and maintained on a standard diet until 16 weeks.The protein levels of fibronectin(FN),collagen type III(Col-III),E-cadherin,α-smooth muscle actin(α-SMA),HNF4A,Snail and MUCDHL in renal tissues were scrutinized using Western blot.Immunohistochemical staining was conducted to observe the distribution and expres-sion of FN,HNF4A and MUCDHL.(2)Mouse renal tubular epithelial cells(mRTEC)were cultured in vitro and catego-rized into groups:normal glucose(NG)group,high glucose(HG)group,overexpression control groups(NG+vector and HG+vector),overexpression groups(NG+OE-MUCDHL,HG+OE-MUCDHL,NG+OE-HNF4A and HG+OE-HNF4A),knockdown control groups(NG+control and HG+control),and knockdown groups(NG+si-MUCDHL,HG+si-MUCDHL,NG+si-HNF4A and HG+si-HNF4A).The relevant protein levels were also detected by Western blot.RESULTS:(1)In db/db group,elevated body weight,blood glucose and urine albumin-to-creatinine ratio(UACR)indicated significant re-nal injury.Compared with db/m group,the mice in db/db group exhibited increased expression of FN,Col-III,α-SMA and Snail,and decreased expression of E-cadherin,HNF4A and MUCDHL.MUCDHL was predominantly expressed in the apical membrane of renal tubular epithelial cells,FN in the tubular mesenchyme,and HNF4A in the plasma and nu-cleus of renal tubular cells.(2)In HG group,there was an up-regulation in the expression of fibrosis-related proteins and a down-regulation in the expression of E-cadherin,HNF4A and MUCDHL compared with NG group.Overexpression of MUCDHL led to a decrease in the expression of FN,Col-III,α-SMA and Snail proteins,an increase in the expression of E-cadherin and MUCDHL proteins,and unaltered expression of HNF4A.Knockdown of MUCDHL resulted in a reversal of the aforementioned effects,with HNF4A expression remaining unaltered.Overexpression of HNF4A led to an increased ex-pression of MUCDHL,and the expression changes of the remaining indicators were consistent with the overexpression of MUCDHL.Knockdown of HNF4A reversed the aforementioned effects.MUCDHL may represent a downstream target gene of HNF4A.CONCLUSION:The diminished expression of HNF4A and MUCDHL in the renal tubules of diabetic mice implies their involvement in the progression of renal fibrosis in diabetic kidney disease(DKD).HNF4A may potentially impede the progression of renal fibrosis in DKD by up-regulating the expression of MUCDHL.