Investigating ischemia and reperfusion-induced organ damage in severe cardiac arrest:A comprehensive proteomics perspective

Cardiac arrest(CA)is a life-threatening condition with complex pathophysiology and limited treatment options.To gain deeper insights into the pathological state of vital organs,we employed a proteomics analysis in rodents to assess proteome alterations in the brain,heart,kidney,and liver using a rat model of CA.The brain displayed severe protein alterations in essential cellular pathways,including three major energy-generating pathways after CA,which worsened after resuscitation,resulting in the most significant overall protein changes among the organs.Conversely,the liver,experiencing the most substantial protein alterations post-CA,demonstrated significant recovery,presenting the least protein changes post-resuscitation.

The association between orthostatic blood pressure changes and subclinical target organ damage in subjects over 60 years old

Background Although recent studies have indicated that both orthostatic hypotension and orthostatic hypertension independently predict cardiovascular events,the underlying mechanisms are still controversial.The aim of the study was to investigate the relationships between orthostatic changes and organ damage in subjects over 60 years old.Methods This is a prospective observational cohort study.One thousand nine hundred and ninety-seven subjects over 60 years old were enrolled.Participants were grouped according to whether they had a drop>20 mmHg in systolic or>10 mmHg in diastolic BP(orthostatic hypotension),an increase in mean orthostatic systolic blood pressure>20 mm Hg(orthostatic hypertension),or normal changes within 3 min of orthostatism.Multiple regression modeling was used to investigate the relationship between orthostatic hypotension,orthostatic hypertension and subclinical organ damage with adjustment for confounders.Results Orthostatic hypotension and orthostatic hypertension were found in 461(23.1%)and 189(9.5%)participants,respectively.Measurement of carotid intima-media thickness(IMT),brachial-ankle pulse wave velocity(baPWV),clearance of creatinine,and microalbuminuria were associated with orthostatic hypotension;measurement of IMT and baPWV were associated with orthostatic hypertension in a cruse model.After adjustment,IMT[odds ratio(OR),95%confidence interval(CI)per one-SD increment:1.385,1.052-1.823;P=0.02],baPWV(OR=1.627,95%CI:1.041-2.544;P=0.033)and microalbuminuria(OR=1.401,95%CI:1.002-1.958;P=0.049)were still associated with orthostatic hypotension,while orthostatic hypertension was only associated with IMT(OR=1.730,95%CI:1.143-2.618;P=0.009).Conclusions Orthostatic hypotension seems to be independently correlated with increased carotid atherosclerosis,arterial stiffness and renal damage in subjects over 60 years old.Orthostatic hypertension correlates with carotid atherosclerosis only.

Clinical characteristics, target organ damage and associate risk factors ofresistant hypertension determined by ambulatory blood pressure monitoringin patients aged ≥80 years

Objectives To investigate clinical characteristics, target organ damage, and the associated risk factors of the patients aged ≥ 80 yearswith true resistant hypertension （RH）. Methods Patients aged ≥ 80 years with hypertension （n = 1163） were included in this study. Theincluded participants attended a structured clinical examination and an evaluation of RH was carried out. The prevalence, clinical characteristicsand target organ damage of patients with RH were assessed. The associated clinical risk factors were analyzed by using logistic regression.Results The prevalence of RH diagnosis by 24-h ambulatory blood pressure monitoring assessment was 21.15%. End-diastolic left ven-tricular internal dimension, left ventricular mass index as well as prevalence of left ventricular hypertrophy were significantly greater in pa-tients with RH than in control group. The common carotid artery intimal media thickness, carotid walls thickness, common carotid arterydiameter and relative wall thickness were significant greater in RH group than in control. A relatively higher level of creatinine, estimatedglomerular filtration rate, microalbuminuria and retinal changes was found in RIt group than in control. A multivariate analysis showed thatpatients with a history of diabetes, higher body mass index （BMI） and lipid profiles were independent risk factors of RH. Conclusions Theprevalence of RH in patients aged ≥ 80 years was within the range of reported rates of the general population. Subjects with RH diagnosisshowed a higher occurrence of target organ damage than patients with well controlled blood pressure. Patients with diabetes, higher BMI andserum lipid profiles were independent risk factors for RH in patients aged ≥ 80 years.

Study of elastic-plastic damage model of cement consolidated soil with high organic content

On the basis of elastic-plastic damage model of cement consolidated soil,the authors took organic contents into reasonable damage variable evolution equation in order to seek relation between the organic contents and parameters in the equation,and established the elastic-plastic damage model of cement consolidated soil considering organic contents.The results show that the parameters change correspondingly with difference of the organic contents.The higher the organic contents are,the less the valves of the parameters such as elastic modulus(E),material parameters(K,n) and damage evolution parameter(ε) become,but the larger strain damage threshold value(εd) of the sample is.Meanwhile,the calculation results obtained from established model are compared with the test data in the condition of common indoors test,which is testified with reliability.

Influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis complicated by MODS

Objective:To study the influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis accompanied by MODS.Methods: A total of 78 patients with severe acute pancreatitis complicated by MODS who were treated in our hospital between June 2012 and March 2016 were selected and divided into control group (n=39) and observation group (n=39) according to random number table. Control group were treated with routine treatment, observation group were treated with conventional treatment plus continuous blood purification, and serum inflammatory factors, liver function indexes and renal function indexes were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of inflammatory factors, liver function indexes and renal function indexes were not statistically significant between two groups of patients. After treatment, serum inflammatory factors IL-6, IL-8, MCP-1 and HMGB1 levels of observation group were lower than those of control group, liver function indexes ALT, AST, TBIL and ALP levels of observation group were lower than those of control group, and renal function indexes Scr and BUN levels of observation group were lower than those of control group.Conclusion: Continuous blood purification can reduce the systemic inflammatory response as well as liver and kidney injury in patients with severe acute pancreatitis complicated by MODS.

Correlation between shock index and inflammation, oxidative stress as well as target organ damage in patients with sepsis

Objective:To study the correlation between shock index and inflammation, oxidative stress as well as target organ damage in patients with sepsis.Methods: A total of 70 patients with sepsis treated in our hospital between March 2013 and May 2016 were collected and divided into no shock group (SI<0.5) (n=11), general shock group (0.5 SI 2) (n=42) and severe shock group (SI>2.0) (n=17) according to the shock index (SI). Immediately after admission, serum levels of inflammatory factors, oxidative stress indexes and liver function indexes were detected.Results:Serum interleukin-1β (IL-1β), interleukin-8 (IL-8), tumor necrosis factor (TNF-α), advanced oxidation protein products (AOPPs), total bilirubin (TB),γ-glutamyl transpeptidase (GGT) and alanine aminotransferase (ALT) levels of severe shock group and general shock group were higher than those of no shock group while anti-inflammatory factors interleukin-10 (IL-10), interleukin-13 (IL-13), soluble tumor necrosis factor receptorⅠ(sTNF-RI), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) and catalase (CAT) levels were lower than those of no shock group;serum IL-1β, IL-8, TNF-α, AOPPs, TB, GGT and ALT levels of severe shock group were higher than those of general shock group while IL-10, IL-13, sTNF-RI, CAT, GSH-Px and SOD levels were lower than those of general shock group.Conclusion:The higher the shock index in patients with sepsis, the more severe the inflammation, oxidative stress and target organ damage, and the two are positively correlated.

Effect of continuous blood purification on inflammatory response, immune response and target organ damage in patients with sepsis

Objective: To study the effect of continuous blood purification on inflammatory response, immune response and target organ damage in patients with sepsis. Methods: A total of 78 patients with sepsis who were treated in the hospital between January 2015 and December 2016 were collected and divided into control group and observation group according to the random number table method, 39 cases in each group. Control group received conventional therapy for sepsis, and observation group received continuous blood purification on the basis of conventional therapy. The differences in inflammatory response, immune response and target organ damage were compared between the two groups before and after treatment. Results: Before treatment, difference in serum inflammatory factor contents, peripheral blood Th17/Treg cellular immunity levels and serum myocardial injury marker contents were not statistically significant between the two groups. After treatment, serum IL-2, IL-6, PCT, CRP, NT-prBNP, CK, CK-MB, TnT and TnI contents as well as peripheral bloodTh17 and Treg cell levels and Th17/Treg proportion of both groups of patients were lower than those before treatment, and serum IL-2, IL-6, PCT, CRP, NT-prBNP, CK, CK-MB, TnT and TnI contents as well as peripheral blood Th17 and Treg cell levels and Th17/Treg proportion of observation group were lower than those of control group. Conclusion: Continuous blood purification can effectively reduce systemic inflammatory response, inhibit immune response, and reduce myocardial injury in patients with sepsis.

Multi-Organ Pathogenesis and Therapeutic Strategies for Cystic Fibrosis

Cystic Fibrosis (CF) is the most common lethal autosomal inherited disorder that affects all races and ethnicities in the United States. However, it is mostly predominant in the Caucasian populace accounting for about 80% of all CF cases. CF most severe complication can be referred to as pulmonary bronchiectasis and infections of the airways, nonetheless, the devastating effects of the disease have far-reaching consequences beyond lung damage. CF is a heterogeneous disease that is caused by mutations in Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene. The impairment or absence of this gene can affect multiple organs and systems and is characterized not only by chronic lung blockage, infections, and inflammation but also by exocrine gland dysfunction, intestinal obstruction, liver pathology, elevated sweat chloride concentration, and in males, infertility due to the congenital bilateral absence of the vas deferens. To this end, we briefly explore the pathological effects of CF and how CF mediates the destruction of several critical organs in the body and some of the gene therapeutical approaches such as gene editing and viral-based strategies available for the treatment of this multi-organ disease.

End-organ protection in hypertension by the novel and selective Rho-kinase inhibitor, SAR407899

AIM: To compare the therapeutic efficacy of SAR407899 with the current standard treatment for hypertension [an angiotensin converting enzyme(ACE)-inhibitor and a calcium channel blocker] and compare the frequency and severity of the hypertension-related end-organ damage. METHODS: Long-term pharmacological characterization of SAR407899 has been performed in two animal models of hypertension, of which one is sensitive to ACE-inhibition and the other is insensitive [deoxycorticosterone acetate(DOCA)]. SAR407899 efficiently lowered high blood pressure and significantly reduced late-stage end organ damage as indicated by improved heart, kidney and endothelial function and reduced heart and kidney fibrosis in both models of chronic hypertension. RESULTS: Long term treatment with SAR407899 has been well tolerated and dose-dependently reduced elevated blood pressure in both models with no signs of tachyphylaxia. Blood pressure lowering effects and protective effects on hypertension related end organ damage of SAR407899 were superior to ramipril and amlodipine in the DOCA rat. Typical end-organ damage was significantly reduced in the SAR407899-treated animals. Chronic administration of SAR407899 significantly reduced albuminuria in both models. The beneficial effect of SAR407899 was associated with a reduction in leukocyte/macrophage tissue infiltration. The overall protective effect of SAR407899 was superior or comparable to that of ACE-inhibition or calciumchannel blockade. Chronic application of SAR407899 protects against hypertension and hypertension-induced end organ damage, regardless of the pathophysiological mechanism of hypertension. CONCLUSION: Rho-kinases-inhibition by the SAR407899 represents a new therapeutic option for the treatment of hypertension and its complications.

NLRP3炎症小体抑制剂MCC950通过抑制Th1/Th17和促进Tregs改善脓毒症小鼠器官损伤

目的:探讨核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎症小体抑制剂MCC950对脓毒症小鼠T细胞分化及器官损伤的影响。方法:将18只C57BL/6雄性小鼠随机分为假手术组(sham组)、脓毒症模型组(CLP组)和MCC950治疗组(MCC950组),每组6只。其中CLP组和MCC950组通过盲肠结扎穿孔(CLP)的方法制备脓毒症模型。MCC950组腹腔注射溶于0.5 mL 0.9%氯化钠溶液的MCC950(50 mg/kg),sham组和CLP组腹腔注射等体积的0.9%氯化钠溶液。CLP术后24 h收集小鼠血清及器官标本。HE染色法观察脓毒症小鼠肺脏、肾脏组织病理损伤程度,并计算生存率;Western blot法检测脾脏NLRP3蛋白含量;ELISA法检测小鼠血清和肺组织的细胞因子水平(IL-1β、IL-18、IL-1α、IL-6、TNF-α);分离脾脏获得脾脏淋巴细胞,采用流式细胞术检测辅助性T细胞(Th)1、Th17、调节性T细胞(Tregs)比例。结果:与sham组相比,CLP组小鼠肺组织炎性细胞浸润、水肿和肺泡壁增厚,肾小管刷状缘和上皮细胞减少,肾小球萎缩,肾小管成弥漫性扩张,大量炎性细胞浸润,脾脏NLRP3的蛋白表达上调(P<0.05),血清IL-1β、IL-18、IL-1α、IL-6、TNF-α水平均升高(P<0.05),肺组织中IL-1α、IL-6、TNF-α水平均升高(P<0.05),脾脏CD4^(+)IFN-γ^(+)Th1、CD4^(+)IL-17^(+)Th17、CD4^(+)CD25^(+)Foxp3^(+)Tregs比例均升高(P<0.05),小鼠7 d生存率为30%(P<0.05)。与CLP组相比,MCC950组小鼠肺组织炎性细胞浸润减轻,水肿减退,肾小管扩张不明显,炎性细胞浸润亦有所减轻,脾脏NLRP3的蛋白表达下调(P<0.05),血清IL-1β、IL-18、IL-1α、IL-6、TNF-α水平均降低(P<0.05),肺组织中IL-1α、IL-6、TNF-α水平均降低(P<0.05),脾脏CD4^(+)IFN-γ^(+)Th1、CD4^(+)IL-17^(+)Th17比例减少,CD4^(+)CD25^(+)Foxp3^(+)Tregs比例明显增加(P<0.05),小鼠7 d生存率显著提升(P<0.05)。结论:MCC950阻断NLRP3可改善脓毒症小鼠的器官损伤,其作用可能依赖于抑制Th1/Th17反应和促进Tregs反应。

Mechanisms of multiple organ damages in acute necrotizing pancreatitis

Abstract:Objective To determine the role of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS), and evaluate the progress from SIRS to MODS and the therapeutic strategies for acute necrotizing pancreatitis (ANP).Methods Rat ANP models were made by retrograde injection of 3.5% sodium taurocholate 2.5?ml/kg into the pancreatic duct. Serum interleukin-8 (IL-8), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNFα), amylase, endotoxin, and albumin were examined. The morphology and pathology of the pancreas, liver, lung, kidney and heart after ANP were observed. Finally, TNFα mRNA in the liver, lung, kidney and heart after ANP were observed by reverse transcriptase-polymerase chain reactions, and the efficiency of somatostatin and growth hormone were also observed in this experiment.Results ANP led to remarkable elevation of the inflammatory mediators which were positively correlated with the development of ANP and MODS. Somatostatin and growth hormone inhibited inflammatory mediators and TNFα mRNA overexpressions, reduced the risk of MODS, corrected hypoalbuminemia, reversed negative nitrogen balance, and controlled the reduction of cell groups with functions and reasonably intervened SIRS caused by ANP.Conclusion TNFα mRNA plays an important role in ANP progression. The amelioration of ANP by combination treatment with somatostatin and growth hormone leads to the reduction of complications and marked increase in survival.

渤海C油田馆陶组储层堵塞实验评价研究

为了分析明确渤海C油田导管架期间预钻井的12口生产井,在组块安装后投产产量达不到配产目标的原因,针对有机质沉积、原油乳化堵塞、流体配伍性、钻完井液漏失与返排等潜在储层伤害因素,开展了储层堵塞实验评价研究。实验结果表明:1)免破胶无固相钻开液(EZFLOW)漏失量越高渗透率伤害程度越大,同时考虑钻完井液漏失时,天然岩心的渗透率伤害程度为37%,伤害程度中等;2)有机质沉积对储层伤害较为明显,注入0.4 PV原油后渗透率伤害程度达到98%,且随有机质沉积量的增加,储层伤害越大;3)油包水型乳状液(W/O型)驱替对岩心渗透率伤害程度高达75.01%,水包油型乳状液(O/W型)驱替对岩心渗透率伤害程度为25.21%,低含水层受原油乳化堵塞影响较明显。综合分析认为,渤海C油田12口预钻井低产原因为导管架预钻井后待组块安装期间关井静置过程中有机质沉积和原油乳化伤害。同时,渤海C油田12口预钻井目的层馆陶组储层物性因子较小,产液指数较低是导致低产的原因之一。研究结论为后续增产措施以及方案提供了依据。

口服敌草快和百草枯中毒患者靶器官损害情况分析

目的 分析敌草快和百草枯中毒患者的靶器官损害特点,为进一步提高临床救治水平提供科学依据。方法 回顾性收集88例单纯经口服敌草快中毒患者(敌草快组)和80例百草枯中毒患者(百草枯组)的临床资料,包括年龄、性别、中毒剂量、中毒到入院时间、中毒催吐导泻情况、中毒到洗胃时间、临床表现、中毒到第一次血液灌流时间、血液灌流次数、住院天数、肝肾功能[丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、肌酐(Cr)]、凝血功能[凝血酶原时间(PT)]、白细胞计数(WBC)、肺损伤指标[氧合指数(PO2/FiO2)]、心肌损伤指标[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)]、血乳酸(Lac)、pH值及最终预后等指标。比较敌草快组和百草枯组患者的临床资料差异及不同中毒剂量死亡率与存活率及总体存活率;比较敌草快组和百草枯组死亡患者靶器官功能受损情况;比较死亡患者与存活患者敌草快和和百草枯的中毒剂量。结果 敌草快组年龄最大73岁,最小15岁;百草枯组年龄最大59岁,最小14岁;敌草快组男性34例(38.64%),女性54例(61.36%);百草枯组男37例(46.25%),女43例(53.75%);两组中毒后均以咽喉部疼痛、恶心、呕吐、上腹疼痛为主要临床表现,少部分中毒剂量少的患者可没有任何症状;百草枯组中毒剂量>50 ml的患者出现胸闷气促症状,敌草快组中毒剂量>50 ml的患者出现意识烦躁、嗜睡、谵妄甚至抽搐、昏迷等症状。两组性别、平均年龄、平均中毒剂量、平均中毒到入院时间、中毒催吐导泻率、平均中毒到洗胃时间、平均中毒到第一次血液灌流时间、平均血液灌流次数比较无明显差异(P>0.05);敌草快组的平均住院天数(4.86±1.81)d明显短于百草枯组的(7.85±1.13)d(P<0.05)。中毒剂量21~50 ml和51~100 ml时,敌草快组存活率均高于百草枯组(P<0.05);敌草快组总体存活率78.41%明显高于百草枯组的37.50%(P<0.05)。入院后第3天,敌草快组死亡患者ALT(109.26±63.88)U/L、TBIL(40.29±10.39)μmol/L、PT(12.24±1.56)s、Lac(1.54±1.09)mmol/L及WBC(13.24±3.43)×109/L均低于百草枯组死亡患者的(327.12±127.86)U/L、(68.38±48.55)μmol/L、(17.39±2.73)s、(4.53±1.54)mmol/L、(23.32±4.56)×109/L,Cr(308.44±156.87)μmol/L、PO2/FiO2(207.32±76.10)mm Hg(1 mm Hg=0.133 kPa)、CK(456.56±101.39)U/L、CK-MB(63.29±21.39)U/L、cTnI(11.56±1.31)ng/ml均高于百草枯组死亡患者的(201.93±87.01)μmol/L、(153.25±64.25)mm Hg、(50.29±21.39)U/L、(47.21±12.22)U/L、(4.29±4.21)ng/ml(P<0.05)。死亡患者敌草快和百草枯中毒剂量均明显高于存活患者(P<0.05);死亡患者敌草快中毒剂量大于百草枯(P<0.05);存活患者敌草快和百草枯中毒剂量无明显差异(P>0.05)。结论 敌草快和百草枯中毒患者的年龄以40岁以下中青年女性多见,所有口服中毒患者均出现咽痛、恶心、呕吐等消化道症状;敌草快口服中毒剂量大者会出现意识改变,包括烦躁、嗜睡、抽搐、昏迷等,而百草枯中毒剂量大者会出现胸闷气促等症状;服用同等剂量除草剂,敌草快存活率高于百草枯;敌草快以肾、心肌及神经系统损伤最为显著,且与患者预后密切相关;百草枯中毒以肺、肝和肾脏损伤为主;敌草快中毒患者总体死亡率低于百草枯中毒死亡率。

郭光业教授从“五脏损伤”论治长新冠综合征经验

长新冠综合征是指新冠病毒感染急性期后仍长期存在,表现为疲乏、咳嗽、心慌、腹胀等的一系列症状,严重影响患者的工作能力及生活质量。据统计,目前全球有超过6500万人受其困扰,而且未来可能面临更多此类患者。这种情况已经引起了国外医学界的广泛关注,但其病理机制复杂不清,尚无有效的治疗方案。郭光业教授从“五脏损伤”角度论治长新冠综合征,并组成经验方加减治疗,临床应用疗效肯定。

心电向量图诊断高血压早期心脏靶器官损害的临床应用及影响因素

目的探讨心电向量图(vectorcardiogram,VCG)对高血压心脏电活动异常的诊断价值,并分析早期心脏靶器官损害的影响因素。方法选取昆明市中医医院心血管病科2022年1月至2023年2月的高血压病住院患者80例,经超声心动图(ultrasound cardiogram,UCG)排外心脏结构异常。比较心电图(electrocardiogram,ECG)与VCG对异常心室除极与复极指标的检出情况。按心电向量检查结果将80例病例分为正常组(n=40)与异常组(n=40),比较2组早期心脏损害的相关影响因素指标,将差异有统计学意义的因素做二元Logistic回归分析,筛选出早期心脏损害的独立影响因素。结果VCG检出异常心室复极指标较ECG有优势(P<0.05),二者对异常除极指标的检出差异无统计学意义(P>0.05)。正常组与异常组比较,在年龄、规律服药、家族史、糖尿病、24 h平均收缩压(24 h average systolic blood pressure,24 h SBP)、白昼平均收缩压(daytime average systolic blood pressure,DSBP)、夜间平均收缩压(night average systolic blood pressure,NSBP)、血压负荷值、清晨血压、脉压差等指标上,差异有统计学意义(P<0.05)。二元Logistic回归分析显示,年龄[OR(95%CI)=0.891,0.998]、夜间平均收缩压[OR(95%CI)=1.018,2.10]、家族史[OR(95%CI)=0.029,0.499]、糖尿病[OR(95%CI)=0.042,0.916]是高血压早期心脏损害的独立影响因素。结论VCG为高血压早期心脏靶器官损害的有效检测手段。

基于危险因素构建列线图评估高血压伴不明原因低钾血症患者靶器官损害风险

目的基于危险因素构建列线图,评估高血压伴不明原因低钾血症患者靶器官损害风险。方法回顾性分析2022年3月-2024年3月于呼和浩特市第一医院住院治疗的158例高血压伴不明原因低钾血症患者临床资料,依据是否并发靶器官损害分为发生组、未发生组。单因素、多因素logistic回归分析法明确影响高血压伴不明原因低钾血症患者靶器官损害的危险因素,据此构建高血压伴不明原因低钾血症患者靶器官损害风险列线图模型,Hosmer-Lemeshow检验、受试者工作特征曲线(ROC)验证预测模型的效能。结果高血压伴不明原因低钾血症患者的靶器官损害以急性左心衰竭、不稳定性心绞痛为主。发生组年龄≥60岁比例及同型半胱氨酸(Hcy)、白介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)水平均高于未发生组[59.38%比31.75%、(27.52±5.68)μmol/L比(19.50±3.52)μmol/L、(48.50±3.78)ng/L比(38.95±3.27)ng/L、(30.33±4.92)ng/L比(20.02±1.55)ng/L、(59.82±10.15)ng/L比(48.55±7.52)ng/L,P<0.05];IL-10水平低于未发生组[(665.25±52.60)ng/L比(825.25±74.46)ng/L,P<0.05]。多因素logistic回归分析结果显示,年龄≥60岁(OR=1.829,P<0.05)、Hcy(OR=1.874,P<0.05)、IL-6(OR=1.990,P<0.05)、IL-8(OR=1.866,P<0.05)、TNF-α(OR=1.794,P<0.05)、IL-10(OR=1.874,P<0.05)是影响高血压伴不明原因低钾血症患者靶器官损害的危险因素。基于年龄、Hcy、IL-6、IL-8、TNF-α、IL-10构建高血压伴不明原因低钾血症患者靶器官损害风险列线图模型,结果显示,实测值与预测值结果基本一致,C-index指数为0.889(95%CI 0.728~0.942)。结论年龄、Hcy、IL-6、IL-8、TNF-α、IL-10是影响高血压伴不明原因低钾血症患者靶器官损害的危险因素,据此构建的列线图模型预测效能良好。

基于血清学指标构建H型高血压患者MACE发生风险预测模型

目的探讨H型高血压患者不良心血管事件(MACE)发生的危险因素,并构建H型高血压患者MACE发生风险预测模型。方法选取2019年1月至2022年11月该院收治的375例H型高血压患者作为研究对象,根据是否发生MACE分为MACE组(41例)和非MACE组(334例)。收集两组临床资料,采用多因素Logistic回归分析H型高血压患者发生MACE的危险因素。构建H型高血压患者MACE发生风险的列线图预测模型,以C-index量化模型预测性能,并绘制校准曲线评价列线图预测模型的校准度及鉴别效度,绘制决策曲线分析列线图预测模型的临床净受益。结果MACE组高血压病程、同型半胱氨酸(Hcy)、尿酸(UA)、Toll样受体(TLR4)水平及靶器官损害数目>2个的患者比例、高血压分级为3级的患者比例、入院当日收缩压(SBP)、入院当日舒张压(DBP)、夜间平均SBP、夜间平均DBP均高于非MACE组,高分子量脂联素(HMW-ADP)水平低于非MACE组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,夜间平均SBP、Hcy、TLR4水平升高及HMW-ADP水平降低均是H型高血压患者发生MACE的危险因素(P<0.05)。列线图预测模型预测H型高血压患者MACE发生风险的C-index为0.821(95%CI:0.712~0.896)。决策曲线分析结果显示,当列线图预测模型预测值为0.75~0.80时,可提供附加临床获益。结论基于Hcy、TLR4、HMW-ADP、夜间平均SBP构建H型高血压患者MACE发生风险的列线图预测模型具有良好预测效果,适合在临床工作中推广应用。

个人信息保护民事公益诉讼的适用研究

个人信息的公共属性是个人信息民事公益诉讼的正当性基础,《个人信息保护法》是个人信息民事公益诉讼的法律基础。作为一般性规范,《个人信息保护法》第70条仅对提起个人信息保护民事公益诉讼的起诉条件、起诉主体进行了初步规范。针对适用过程中存在的不足,文章提出在起诉条件上,“众多”不仅要考虑人数的多寡,还要考虑信息本身,要以损害社会公共利益为实质要件;在起诉顺位上,应肯定检察机关在既有实践中的重要作用,将其作为提起个人信息民事公益诉讼的第一顺位;在责任承担上,不应把损害赔偿视为主要法律责任,不宜适用惩罚性赔偿。

基于损伤控制理论的救治管理对肝脏与胆管外伤患者救治效果的影响

目的 探究基于损伤控制理论的救治管理在肝脏与胆管外伤患者救治中的应用效果。方法 回顾性分析2022年8月—2023年3月收治的肝脏与胆管外伤102例的临床资料,根据临床处理方案分为观察组52例和对照组50例,对照组实施常规急诊救治,观察组实施基于损伤控制理论的救治管理。观察2组救治相关指标、并发症及干预前后损伤严重程度、氧化应激指标[髓过氧化物酶(MPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)]变化情况。结果 观察组手术时间、术后肛门首次排气时间及住院时间均短于对照组,术中出血量少于对照组(P<0.01);干预后,观察组损伤严重程度轻于对照组(P<0.05);干预后,观察组血清MPO、MDA水平低于对照组,血清SOD水平高于对照组(P<0.05);观察组多器官功能障碍综合征、失血性休克发生率分别为3.85%(3/52)、1.92%(1/52),低于对照组的18.00%(9/50)、16.00%(8/50),差异有统计学意义(P<0.05)。结论 基于损伤控制理论的救治管理可降低肝脏与胆管外伤患者应激及损伤程度,加速康复进程,改善临床结局。