Objective To explore the predictive value of heparin-binding protein(HBP)combined with soluble growth-stimulated gene 2 protein(sST2)for the prognosis of elderly patients with acute heart failure(AHF).Methods A total of 338 elderly AHF patients who were treated in the Affiliated Hospital of Xuzhou Medical University and Kuitun Hospital of Ili Kazakh Autonomous Prefecture from April 2021 to March 2022 were selected as the research subjects.The patients were followed up for 1 year.According to whether the ma-jor adverse cardiovascular and cerebrovascular events(MACE)occurred during the follow-up period,they were divided into the MACE group and the non-MACE group,respectively.The baseline characteristics of the patients were recorded,laboratory indicators were detected,transthoracic color Doppler ultrasound examina-tion was completed,the risk factors affecting the prognosis of elderly patients with AHF,as well as the predic-tive value of HBP and sST2 for the prognosis of elderly patients with AHF were analyzed.Results Among the 338 elderly AHF patients,101 patients experienced MACE,and 237 patients did not.The levels of serum creatinine,NT-proBNP,troponin T,white blood cell count(WBC),left ventricular end-diastolic diameter(LVEDD),HBP,and sST2 in the MACE group were higher than those in the non-MACE group,while the left ventricular ejection fraction(LVEF)was lower than that in the non-MACE group,and the differences were statistically significant(P＜0.05).LVEF was a protective factor for the occurrence of MACE(HR＜1,P＜0.05)and age,diabetes mellitus,creatinine,NT-proBNP,troponin T,LVEF,WBC,HBP,and sST2(HR≥1,P＜0.05)were the influencing factors for the occurrence of MACE.The optimized model(Model 5)has the highest predictive efficiency for the prognosis of elderly patients with AHF,with an area under the curve(AUC)of 0.976(95％CI:0.962-0.990).Conclusion Both HBP and sST2 are independent risk factors for the occurrence of MACE in elderly AHF patients.The predictive model established by combining HBP and sST2 has a high predictive value.

Objective:To screen out the potential key genes of sepsis-associated acute kidney injury (AKI), and provide theoretical and experimental evidence for the treatment of sepsis-associated AKI.Methods:① Bioinformatics analysis: two gene expression datasets (GSE30718 and GSE53773) were downloaded for bioinformatics analysis from the Gene Expression Omnibus (GEO). These two datasets recorded mRNA microarray data from kidney biopsies before and after kidney transplantation, and a subset of patients developed AKI after kidney transplantation. Differential analysis was conducted, and the genes with the same differential expression and a higher area under the receiver operator characteristic curve (AUC) in both databases were used as the target gene for subsequent cell experiments. ② Cell validation experiment: human proximal renal tubular cells HK2 were cultured in vitro, and lipopolysaccharide (LPS) was used for establishing LPS-HK2 cell model (LPS 10 mg/L for 6 hours, LPS model group), and the blank control group was set. Then, small interfering RNA (siRNA) technology was used to knock down the target gene obtained by bioinformatics analysis in LPS-HK2 cells (gene knockdown group), and a gene negative control group was set. The real-time fluorescent quantitative reverse transcription-polymerase chain reaction (RT-qPCR) technique was used to detect the expression of the target gene in HK2 cells. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of inflammatory factors in the cell supernatants. Western blotting was used to detect the expressions of key apoptosis proteins. Results:① Results of bioinformatics analysis: 325 genes in the two datasets showed the same expression trend, of which 144 were significantly down-regulated and 181 were significantly up-regulated, while the expression difference of secretory leukocyte protease inhibitor (SLPI) in the two datasets was both statistically significant. Further receiver operator characteristic curve (ROC curve) analysis confirmed that the SLPI expression in GSE30718 and GSE53773 datasets had a high diagnostic efficiency for AKI, with AUC of 0.83 and 0.92, respectively. Therefore, SLPI was selected as the target gene for subsequent cell validation experiment. ② Cell validation experiment: the RT-qPCR analysis showed that the expression of SLPI in LPS-HK2 cells of the LPS model group was significantly higher than that of the blank control group (2 -ΔΔCT: 1.80±0.14 vs. 1.00±0.11, P < 0.01), and the change trend was the same with the results of bioinformatics analysis. Furthermore, knockdown SLPI gene analysis showed that the levels of inflammatory factors in LPS-HK2 cells supernatants in the gene knockdown group were significantly higher than those in the negative control group [Interleukin-6 (IL-6, ng/L): 509.58±27.08 vs. 253.87±75.83, IL-1β (ng/L): 490.99±49.52 vs. 239.67±26.97, tumor necrosis factor-α (TNF-α, ng/L): 755.22±48.66 vs. 502.06±10.92, all P < 0.01]. The above results indicated that SLPI could inhibit the inflammatory response of HK2 cells induced by LPS. The expressions of key apoptosis proteins Bax and caspase-3 in LPS-HK2 cells in the gene knockdown group were significantly higher than those in the negative control group [Bax protein (Bax/GAPDH): 1.38±0.12 vs. 1.00±0.10, caspase-3 protein (caspase-3/GAPDH): 1.44±0.15 vs. 1.00±0.11, both P < 0.05], and Bcl-2 expression was significantly decreased (Bcl-2/GAPDH: 0.83±0.08 vs. 1.00±0.05, P < 0.05), the above results indicated that SLPI could inhibit the apoptosis of cells in the inflammatory response. Conclusion:SLPI can inhibit the inflammatory response and apoptosis of HK2 cells induced by LPS, which may be involved in the protective mechanism of renal tubular cells in the response to sepsis, and is a potential target for the treatment of sepsis-associated AKI.

γ-butyrolactone is a colorless transparent liquid used in the production of drugs such as cyclopropylamine and pyrrolidone, and is also used as an industrial solvent, diluent, curing agent, etc., and is listed as the third category of precursor chemicals control. There is less clinical exposure to γ-butyrolactone and insufficient studies on its withdrawal response. This article reports a case of severe life-threatening rhabdomyolysis in a patient with γ-butyrolactone withdrawal. After active treatment, the patient eventually recovered. The clinical characteristics and treatment methods of γ-butyrolactone withdrawal reaction were summarized, suggesting that severe withdrawal reaction may occur in γ-butyrolactone.

γ-butyrolactone is a colorless transparent liquid used in the production of drugs such as cyclopropylamine and pyrrolidone, and is also used as an industrial solvent, diluent, curing agent, etc., and is listed as the third category of precursor chemicals control. There is less clinical exposure to γ-butyrolactone and insufficient studies on its withdrawal response. This article reports a case of severe life-threatening rhabdomyolysis in a patient with γ-butyrolactone withdrawal. After active treatment, the patient eventually recovered. The clinical characteristics and treatment methods of γ-butyrolactone withdrawal reaction were summarized, suggesting that severe withdrawal reaction may occur in γ-butyrolactone.

Objective To study the surgical indications and effectiveness of short segment pedicle screw fixation plus pecutaneous vertebroplasty (PVP) for single thoracolumbar fracture combined with Kümmell disease.Methods Between June 2012 and June 2014,a prospective case series analysis was made on the clinical data of 15 selected cases of single thoracolumbar fracture patients who were combined with Kümmell disease.There were three males and 12 females,with an average age of 62.5 years (range,48-80 years).The iujured vertebrae were located at T11 in 3 cases,at T12in 4,at L1 in 5 and at L2 in 3.All the patients were treated by short segment fixation plus PVP.Operative time,surgery-related complications and adjacent vertebral fracture during follow-up were recorded.The effectiveness of the treatment was appraised by visual analogue scale (VAS),Oswestry Disability Index (ODI),Cobb angle of operative segment,which were recorded preoperatively,one week post-operatively and at final follow-up.One-way ANOVA (Analysis of Variance) was employed for statistical analysis.Results The operative time was 0.8-2 hours (mean,1.35 hour).There was no observation of incision infection,nerve injury,cement leakage or other related operative complications.A total of 15 patients were followed up for 16-36 months (mean,22.4 months),which showed solid fusion and bone bridges in all patients,with no fracture of adjacent vertebra observed.VAS was improved from preoperative (5.93 ± 0.62) points to (1.80±0.64) points one week postoperatively and (2.60 ± 0.53) points at final follow-up.ODI was improved from preoperative 61.53 ± 4.30 to 19.93 ±3.26 one week postoperatively and 23.07 ± 4.06 at final follow-up.Cobb angle of operative segment was improved from preoperative (17.40 ± 6.73) ° to (9.53 ± 3.12) o one week postoperatively and (11.00 ± 3.20) ° at final follow-up.There was significant difference of all the indexes namely,VAS,ODI and Cobb angle,between preoperative and one week postoperative status as well as between preoperative and final follow-up (P ＜ 0.05 or 0.01).However,there was no significant difference between ODI and Cobb angle in one week postoperatively and at last follow-up (P ＞ 0.05).Conclusion For single thoracolumbar fracture with Kümmell disease,short segment fixation plus PVP can shorten the surgery time,reduce the rate of complications,relieve pain,recover the function and avoid loss of kyphosis correction,as is worthy of clinical recommendation.

Coma ; chemically induced ; Humans ; Nitriles ; adverse effects ; Pyrethrins ; adverse effects

ObjectiveTo analyze the related data of patients with severe pesticide poisoning in Tongling area, put forward the countermeasures,and provide available basis to improve the level of prevention and treatment of the disease.Methods Forty patients with severe pesticide poisoning admitted to the Department of Critical Care Medicine of Tongling People's Hospital Affiliated to Wannan Medical College from August 2014 to November 2015 were analyzed retrospectively, the clinical data including distributions of sex, ages, kinds of poisoning drugs, causes of poisoning, time from intoxication to admission into a hospital, rescue therapy, prognosis etc.Results In the 40 patients, there were 12 males and 28 females, the ratio between male to female was 1∶2.33, and the number of women was significantly higher than that of men. Their ages ranged from 40 - 60 years, accounting for 37.5% (15/40). The toxic agent the most commonly seen was organic phosphorus pesticide (15 cases, accounting for 37.5%), and cases with mixed poisoning by taking two or more than two kinds of toxic material accounted for 25.0% (10/40). In addition, the cause of poisoning was mainly due to family quarrels (33 cases, accounting for 82.5%). In regard of time between taking toxic material to admission into a hospital, only did 3 cases admit into the hospital within 1 hour (7.5%), and the majority was within 3 hours (15 cases, accounting for 37.5%). The comprehensive treatments were as follows: clear means to clear the toxin,solution (to use antidote to detoxify), maintainance (to maintain the basic vital signs) and exclusion (to exclude other complications early); the curative effect of comprehensive treatments was satisfied, and 3 cases died, accounding for 7.5%.Conclusions The majority of patients with severe pesticide poisoning in Tongling city are adult females, the main cause of taking toxic material is due to family quarrels, and the toxic agent the most commonly seen is organic phosphorus pesticide. Directing to the above high risk factors, the prevention and treatment are carried out, anticipating the incidence, mortality and medical cost can be reduced significantly.

BACKGROUND: Studies have shown that sodium hyaluronate inhibits cartilage damage in osteoarthritis and accelerates regeneration of cartilage cels, to stabilize and repair the articular cartilage.
OBJECTIVE:To investigate the therapeutic effect of sodium-rich plasma combined with platelet-rich plasma (PRP) on rabbit knee osteoarthritis.
METHODS:Forty New Zealand white rabbits were randomly divided into five groups, control group, combined group, sodium hyaluronate group, PRP group and model group, and then an osteoarthritis model of the right knee was made in each rabbit. After modeling, sodium hyaluronate+PRP, sodium hyaluronate, autologous PRP and normal saline were givenviathe knee joint cavity in the latter four groups, respectively, once a week for 5 weeks. The control group received no treatment, as normal controls. At 1 week after treatment, ELISA assay was used to detect serum interleukin-1, interleukin-6, tumor necrosis factor-α levels, and changes of the articular cartilage were observed under a light microscope.
RESULTS AND CONCLUSION:Compared with the control group, the levels of interleukin-1, interleukin-6 and tumor necrosis factor-α were al increased in the other four groups (P < 0.01). Compared with the model group, the levels of interleukin-1, interleukin-6 and tumor necrosis factor-α were lowered significantly in the combined, sodium hyaluronate and PRP groups (P< 0.01 orP< 0.05), and the most significant decline was in the combined group. Articular cartilage damage was severest in the model group and mildest in the combined group. Experimental findings indicate that intra-articular injection of sodium hyaluronate+PRP can reduce inflammation and protect the articular cartilage in knee osteoarthritis, which is better than a single drug injection.

Objective To evaluate the clinical outcome of mono-segment transpedicular fixation of type B thoracolumbar fracture.Methods A retrospective analysis was conducted on 40 cases suffering from type B thoracolumbar fracture treated with mono-segment transpedicular fixation from May 2003 to October 2012.According to the AO classification,13 cases were identified with type B1.1,11 type B1.2,11 type B2.2,2 type B3.1,2 type B3.2,and 1 type B3.3.Radiological results were evaluated by measuring compression rate of the fractured vertebra and Cobb' s angle of the vertebra adjacent to the fractured segment.Clinical results were assessed using Frankel classification for spinal cord injury and visual analogue scale (VAS) for pain.Results Mean operation time was 71 minutes and mean intrao perative blood loss was 105 ml.Mean period of follow-up was 47.5 months (range,24-82 months).Mean Cobb' s angle of the vertebra adjacent to the fractured segment and compression rate of the fractured vertebra revealed great correction at one week post-operation compared with preoperative ones (6.2° vs 20.1° and 10.1％ vs 38.9％ respectively,P ＜0.05) and there was no significant correction loss at the last follow-up (6.9° and 10.8％ respectively,P ＞ 0.05).Mean VAS was 8.6 points before operation,but mean VAS was 2.4 points at final follow-up (P ＜ 0.05).Neurological performance improved in 37 cases (93％).No cases experienced neurological deterioration.Conclusions Mono-segment transpedicular fixation has small incision,short operation time,few bleeding and decreased motor function loss.The procedure is indicated for most type B thoracolumbar fracture and clinical results are satisfactory.