注射用尼扎替丁治疗消化性溃疡出血205例

目的:研究注射用尼扎替丁治疗消化性溃疡出血的疗效及安全性.方法:采用多中心、随机、双盲、阳性药物平行对照研究.将2008-09/2009-12收集的205例经胃镜证实的消化性溃疡出血患者随机分为两组,试验组102例给予尼扎替丁0.1g,每日3次,对照组103例给予法莫替丁20mg,每日2次,连续5d.结果:共有201例患者可供疗效评价.试验组的临床显效率为85.0%,总有效率为99.0%,对照组的临床显效率为82.2%,总有效率为98.0%,两组间差异无统计学意义(P>0.05).两组不良反应主要为白细胞减少、转氨酶轻度升高和贫血(P>0.05).结论:注射用尼扎替丁是治疗消化性溃疡合并上消化系出血有效且安全的药物.     

坚持三个确保 全面服务部队谋打赢

本文结合医院为部队服务实际,总结医院充分发挥军医大学附属医院人才技术优势,坚持以市场练兵确保战场打赢,坚持以平时造血确保战时输血,坚持以国际竞争中领先确保与强敌过招中取胜,全心全意为部队服务的做法和经验。     

Association of serum soluble human leukocyte antigen-G levels with chronic hepatitis B virus infection

Human leukocyte antigen-G is involved in immunotolerogenic, inflammatory and carcinogenic process. This study investigated serum soluble HLA-G (sHLA-G) levels in patients with chronic hepatitis B virus (HBV) infection according to the infection phases and clinical diagnoses. The study included 223 patients with chronic HBV infection [phases: 38 immune-tolerant (IT), 83 immune clearance (IC), 30 non/low-replicative (LR) and 72 HBeAg negative hepatitis (ENH); diagnoses: 38 asymptomatic HBV carriers (ASC), 98 chronic hepatitis (CH), 46 cirrhosis (LC) and 41 hepatocellular carcinoma (HCC)], 62 HBV infection resolvers and 66 healthy controls. The sHLA-G levels in patients were elevated compared with resolvers and healthy controls (P < 0.001). According to phases, sHLA-G levels were higher in IC and ENH than in IT (P = 0.017 and P = 0.001, respectively). Serum sHLA-G levels were also higher in ENH than in LR (P = 0.008). According to diagnoses, sHLA-G levels in HCC were significantly increased compared with LC, CH and ASC (P = 0.010, P < 0.001 and P < 0.001, respectively). Serum sHLA-G levels were higher in CH than in ASC (P = 0.039). The sHLA-G levels in IC, ENH and CH were correlated with alanine aminotransferase levels (P = 0.011, P = 0.010 and P < 0.001, respectively). It is concluded that sHLA-G is involved in the pathogenesis of chronic HBV infection and correlates with infection phases and clinical diseases, suggesting the value in evaluating disease activity and defining clinical diagnosis.     

Dexmedetomidine may reduce the risk of acute kidney injury development in critically ill patients during colistin therapy

IntroductionColistin is considered as a last resort therapy for multidrug-resistant gram-negative organisms. It is widely used despite the significant risk of nephrotoxicity. Experimental studies showed the nephroprotective effect of dexmedetomidine, a sedative agent, against colistin toxicity. This study was performed to show the possible nephroprotective effect of dexmedetomidine among critically ill patients who received colistin.MethodsAdult (>17 years) patients who were admitted to our surgical and medical intensive care unit (ICU) from March 2018 through March 2021, and who received colistin were included. Patients who receive Colistin therapy or intensive care unit follow-up of <72 h (discharge or death) and Acute kidney injury (AKI) or need hemodialysis prior to colistin therapy at the same hospitalization were excluded. AKI risk factors were examined by grouping patients with and without AKI. Patients, receiving colistin concomitantly with dexmedetomidine were also evaluated.ResultsOf the 139 patients included, 27 (17.8%) patients received dexmedetomidine. Sixty-five patients (47%) had AKI, at a median 5 (4-7) days after the initiation of colistin. Older age, lower baseline estimated glomerular filtration rate, and vasopressor use were associated with a higher risk of AKI, while dexmedetomidine use was associated with a lower risk. In the multivariate regression model, dexmedetomidine use was independently associated with a lower risk of AKI development (OR 0.20 95% CI 0.07–0.59, p = 0.003).ConclusionIn respect to these findings, dexmedetomidine may provide protection against AKI during colistin therapy in critically ill patients.     

改良式胃管置入法的应用效果

目的探讨改良式胃管置入法在急诊科患者中的应用效果。方法将2012年1-7月需置入胃管的129例急诊科患者按随机数字表法分为改良式胃管置入组(n=68)和常规置管组(n=61),比较两组患者的一次置管成功率、总置管成功率、置管时间及不良反应发生率。结果改良式胃管置入组置管时间明显短于常规置管组(P0.01),一次置管成功率和总置管成功率明显高于常规置管组(P0.05),不良反应发生率低于常规置管组(P0.05)。结论改良式胃管置入法不仅具有置入成功率高、置入时间短的优点,而且改良式胃管结构简单,置管时操作快捷、方便,减轻了患者的痛苦。     

地塞米松调节claudin-4减轻海水淹溺性肺水肿的机制研究

目的探讨地塞米松对海水淹溺性肺水肿的保护作用及其分子机制。方法采用气管内滴注海水的方法复制海水淹溺性肺损伤的大鼠模型,测定肺水肿的指标及肺组织中claudin-4、核转录因子-κB(NF-κB)、p38蛋白水平的表达;培养A549细胞,分别应用NF-κB抑制剂、p38抑制剂、糖皮质激素受体(GR)阻断剂(RU486)研究地塞米松改善海水淹溺性肺水肿的分子机制。结果吸入海水后肺水肿形成,海水可活化NF-κB及p38,同时下调claudin-4,地塞米松可缓解上述改变;应用PDC抑制NF-κB活化,并采用SB203580抑制p38活化可缓解海水诱导的claudin-4下调和单层细胞通透性的增高,应用RU486阻断GR后,地塞米松上调claudin-4的作用则大大降低。结论地塞米松可抑制海水诱导的NF-κB活化,缓解NF-κB活化介导的claudin-4表达下调及肺通透性增高,从而减轻海水淹溺性肺水肿。     

Metabolic-associated fatty liver disease and the risk of cardiovascular disease

BackgroundWith the gradual adoption of new metabolic-associated fatty liver disease (MAFLD) definitions in clinical practice, the relationship between MAFLD and cardiovascular disease (CVD) risk remains unclear. Similarly, clinical differences between MAFLD and nonalcoholic fatty liver disease (NAFLD), and the relationship between MAFLD and CVD risk are unclear.MethodsWe conducted a retrospective study using the 1988–1994 National Health and Nutrition Examination Surveys (NHANES III) database, including 11,673 individuals. Multivariate logistic regression analysis was performed to test relationships between MAFLD and the 10-year CVD risk.ResultsMAFLD was more significant than NAFLD in medium/high 10-year CVD risk (according to Framingham risk score) (1064 (29.92%) vs. 1022 (26.37%), P < 0.005). MAFLD patients were stratified according to NAFLD fibrosis scores (NFS's). In univariate regression analysis, when compared with non-MAFLD patients, unadjusted-OR values for MAFLD with different liver fibrosis stages, which were tiered by NFS (NFS < -1.455,-1.455 ≤ NFS < 0.676, and NFS ≥ 0.676) in the medium 10-year CVD risk (according to Framingham scores) were 1.175 (95% CI 1.030–1.341), 3.961 (3.449–4.549), and 5.477 (4.100–7.315), and the unadjusted or values of different MAFLD groups in the high 10-year CVD risk were 1.407 (95% CI 1.080–1.833), 5.725 (4.500–7.284), and 5.330 (3.132–9.068). Then, after adjusting for age, sex, race, alcohol consumption, and smoking, or adjusting for age, race, alcohol consumption, smoking, type 2 diabetes mellitus (T2DM), and other confounding factors, the incidence of medium and high 10-year CVD risk was statistically significant (P < 0.05).ConclusionsWe showed that patients with MAFLD had a higher 10-year CVD risk when compared with patients with NAFLD. Increased MAFLD hepatic fibrosis scores were associated with a 10-year CVD risk.