Botulismo en la UCI: proceso de cuidados

Introduction and case evaluation

Botulism is a rare disease in Europe, caused by the bacterium Clostridium botulinum, notifiable, non-transmissible person-to-person and potentially fatal (between 5 and 10%) if not treated quickly. The favourable opinion of the Clinical Research Ethics Committee was obtained. We present the nursing care plan of a 49-year-old man with a diagnosis of bacterial intoxication caused by Clostridium botulinum, secondary to ingestion of beans in poor condition, who was admitted to the ICU for a total of 35 days.

The Sonic hedgehog signaling pathway involved in the expression of RACK1 in the pulmonary microvascular endothelial cells induced by lipopolysaccharide北大核心CSCD

Objective To explore the effect of expression of protein kinase C receptor l(RACKl) induced by lipopolysaccharide (LPS) on Sonic hedgehog(SHH) signaling pathway in rat puhnonary microvascular endothelial cells (RPMVEC). Methods The healthy male SPF grade SD rat with 100-120 g body weight were gotten from the laboratory animal center of Annui province. Using immunocytochemistry method, the expression of RACK 1 protein in RPMVECs was detected, cultured RPMVECs were randomly divided into different groups as LPS dose-dependent group, SAG(smoothened Agonist, a SHH signaling pathway specific agonist) dose-dependent group, LPS time-dependent group, SAG time-dependent group and LPS+SAG group. In LPS dose-dependent groups, RPMVECs were cultured with 0.1, 1, 10 mg/L LPS for 8 h. In LPS time-dependent groups, RPMVECs were cultured with 10 mg/L LPS for 0, 2, 4, 8, 12, 24 h. In SAG dose-dependent groups, RPMVECs were cultured with 0.1, 1, 10 u, mol/L for 8 h. In SAG time-dependent groups, RPMVECs were cultured with 1 u, mol/L SAG for 0, 2, 4, 8, 12, 24 h. In LPS+SAG group, RPMVECs were cultured with 1 u. mol/L SAG 8 h after 10 mg/L LPS treatment for 1 h. In addition, blank group, LPS group and SAG group were set for control. Western blot were used to detect the level of RACK1 and RT-PCR were used to detect the expression of GLI-1 mRNA after intervention. Results Immunocytochemistry revealed that RACK1 were present in RPMVEC. 1. In LPS dose-dependent groups (0, 0.1, 1, 10 mg/L), the level of RACK 1 elevated as LPS dose increased correspondingly with inter-group difference (P<0.05); the relative expression levels of GLI-1 mRNA were (1.109 ± 0.063), (1.039 ± 0.135), (0.813 ± 0.066), (0.770 ± 0.105), (1 mg/L vs. 10 mg/L, P>0.05; the rest P<0.05). In LPS time-dependent groups, the relative expression level of RACK1 at 2 h (0.370 ± 0.010) was higher than that at 0 h (0.329 ± 0.008), peaked at 12 h (1.296 ± 0.048), and compared with 0 h, there was significant differences (F=l 272.204, P<0.05). The relative expression level of GLI-1 mRNA was decreased at 2 h (0.929 ± 0.007), and compared with 0 h(1.089 ± 0.042), there was significant differences (F=306.609, /><0.05). 2. In SAG dose-dependent groups, there was no significant difference in level of RACK1 between groups(all P>0.05). The relative expression levels of GLI-1 mRNA were (1.109 ± 0.063), (1.169±0.052), (3.468 ±0.128), (3.434±0.054), (0 μ.mol/L vs. 0.1 μ.mol/L and l μmol/L vs. 10 μ.mol/L, P>0.05, the rest P<0.05). Among SAG time-dependent groups, there was no significant difference in levels of RACK1 protein(P>0.05). The relative expression level of GLI-1 mRNA increased at 2 h (3.027 ± 0.065), and compared with 0 h (2.651 ± 0.123), there was significant differences (F= 132.841, P<0.05). 3. In LPS+SAG intervention groups, the expression of RACK1 was lower than that in LPS group (0.831 ± 0.040 vs. 1.189 ± 0.149, P<0.05), and the expression of GLI-1 mRNA was higher than that in LPS group (2.720 ± 0.130 vs. 0.796 ± 0.082, P<0.05). Conclusions The LPS up-regulates the expression of RACK 1 in RPMVECs, and the activated SHH signaling pathway can down-regulate the expression of RACK 1 induced by LPS in RPMVECs. © 2018 Chinese Medical Association. All rights reserved.     

神经科重症患者护理意外发生的相关因素与预防对策

目的：探讨神经科危重症患者发生护理意外的危险因素,观察护理干预疗效。方法纳入神经科危重症患者275例,对这些患者的基本信息进行记录存档,并就意外危险因素进行调查。2013年5月前入院的患者137例作为对照组,接受常规护理,其中男86例,女51例,2013年5月起入院的患者138例作为观察组,在常规护理的基础上就危险因素进行特定护理干预,其中男92例,女46例,观察二组患者意外发生情况,判断护理干预对神经科危重症患者发生意外的效果。结果神经科危重症患者发生护理意外的危险因素有活动能力（OR ＝3．54,P＝0．000＜0．01）、意识状态（OR ＝6．12,P＝0．000＜0．01）、吞咽能力（OR ＝4．82,P＝0．016＜0．05）、颅内压（OR ＝2．36,P＝0．024＜0．05）;观察组较对照组发生护理意外的几率明显降低。结论针对神经科危重症患者发生护理意外的危险因素如活动能力、意识状态、吞咽能力、颅内压开展护理干预具有明显的临床效果和重要的意义。     

miRNA-126-3p 与先天性心脏病肺动脉高压发病机制相关性的临床研究

目的：探讨 miRNA-126-3p 与肺动脉高压（以下简称肺高压）发病机制的相关性。方法选取25例先天性心脏病患者,其中,肺高压患者11例,对照组14例,采用 qRT-PCR 法检测其肺组织 miRNA-126-3p 的表达,并采用 starBase 进行靶基因预测,并从 mRNA 水平和蛋白水平进行验证。结果肺高压患者与对照组在年龄、性别、生化指标检查等方面比较差异无统计学意义（P＞0．05）;肺高压患者 miRNA-126-3p 表达水平与对照组比较差异有统计学意义（P＜0．01）;生物信息学预测发现 miRNA-126-3p 的生物学功能主要与结合蛋白、信号转导、细胞分化、调控细胞形态、调控 MAPK 和胰岛素受体信号通路等有关,其靶基因主要有 VEGFA 、SPRED1、PIK3R2等;肺高压组的 VEGFA 表达在 mRNA 水平和蛋白水平与对照组比较差异有统计学意义（P＜0．01）;miRNA-126-3p 与 VEGFA 呈现正相关（P＜0．01）。结论 miRNA-126-3p 可能通过调控 VEGFA 参与先天性心脏病相关性肺动脉高压发病。