To evaluate the effect of noninvasive high-frequency oscillation ventilation (nHFOV) in premature infants with respiratory distress syndrome (RDS).

A total of 200 premature infants with RDS from March 2017 to March 2020 were randomly divided into a research group and a control group, with 100 cases in each group. The research group was treated with nHFOV and the control group was treated with nasal continuous positive airway pressure. The effective rate, failure rate of initial treatment, incidence of bronchopulmonary dysplasia (BPD), incidence of adverse events, blood gas analysis related indicators, amplitude integrated electroencephalogram (aEEG) score and high mobility group protein B1 (HMGB1) level were compared between the two groups.

The effective rate was much better in the research group than in the control group [93.00% (93/100) vs. 63.0% (63/100), χ² = 68.923, P <0.001]. The failure rate of initial treatment [6.00% (6/100) vs. 15.00% (15/100), χ² = 4.310, P = 0.038] and the incidence of BPD [1.00% (1/100) vs. 9.00% (9/100), χ² = 6.737, P = 0.009] in the research group were much lower than those in the control group. There was no significant difference in the incidence of adverse events such as pneumothorax/air leakage, gastrointestinal perforation, necrotizing enterocolitis, retinopathy of prematurity, intracranial hemorrhage, nasal injury and death between the two groups (χ² = 2.083, 2.909, 0.977, 1.332, 1.047, 0.521, 2.750; all P > 0.05). The levels of partial pressure of oxygen [(89 ± 28) mmHg vs. (80 ± 29) mmHg, t = 2.151, P = 0.033], partial pressure of carbon dioxide [(37 ± 7) mmHg vs. (41 ± 10) mmHg, t = 3.386, P<0.001] and oxygen saturation [(97.4 ± 2.1)% vs. (90.6 ± 6.4)%, t = 10.049, P<0.001] significantly improved, the aEEG score remarkedly increased [(8.5 ± 1.5) vs. (5.2 ± 1.9), t = 13.319, P<0.001], and the serum HMGB1 level obviously decreased [(578 ± 71) ng/L vs. (628 ± 72) ng/L, t = 5.071, P<0.001] in the research group after treatment, as compared with the control group.

The nHFOV can effectively improve brain function, blood gas indicators and respiratory support related indexes, reduce serum HMGB1 levels and enhance overall clinical efficacy in premature infants with RDS.

探讨骨桥蛋白（OPN）中和抗体处理对脓毒症小鼠生存情况的影响及其加剧急性肺损伤的机制。

将80只雄性小鼠分成假手术组（Sham组）、脓毒症组[盲肠结扎穿孔术（CLP）组]、阴性对照组[CLP+免疫球蛋白G（IgG）组]及OPN中和抗体组（CLP+ OPN Ab组），每组各20只。采用CLP制备脓毒症小鼠模型，Sham组除不结扎和穿刺盲肠外，其余手术步骤相同。建模成功即刻，CLP+ IgG组及CLP+ OPN Ab组小鼠分别经颈内静脉注射IgG和OPN单抗，Sham组和CLP组注射等量磷酸盐缓冲液。每组10只用于观察小鼠活动状态及术后7 d存活情况；另外10只分别于术后24 h采集眼眶血及收集肺组织用于OPN及髓过氧化物酶（MPO）检测。比较4组小鼠血清、肺组织OPN信使RNA（mRNA）水平和肺组织中OPN蛋白水平，外周血丙氨酸转氨酶（ALT）、天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、白细胞介素6（IL-6）、趋化因子配体2（CXCL-2）和MPO活性。

术后第7天，Sham组小鼠10只均存活；CLP组及CLP+ IgG组分别有2只存活，而CLP+ OPN Ab组仍有4只小鼠存活。4组小鼠7 d存活情况比较，差异有统计学意义（χ² = 17.374，P = 0.001）。且与Sham组相比，CLP组、CLP+ IgG组和CLP+ OPN Ab组小鼠存活情况均显著降低（P均< 0.05）；而CLP组、CLP+ IgG组和CLP+ OPN Ab组小鼠存活情况比较，差异均无统计学意义（P均> 0.05）。CLP术后24 h，4组小鼠血清、肺组织OPN mRNA水平和肺组织中OPN蛋白水平，外周血中ALT、AST、LDH、IL-6、CXCL-2、MPO活性比较，差异均有统计学意义（F = 84.227、51.929、41.563、19.558、55.416、75.968、32.824、176.945、119.046，P均< 0.05）。进一步两两比较发现，CLP组、CLP+ IgG组和CLP+ OPN Ab组小鼠血清、肺组织OPN mRNA水平和肺组织中OPN蛋白水平，外周血中ALT、AST、LDH、IL-6、CXCL-2、MPO活性均较Sham组显著增高，且CLP组和CLP+ IgG组更高（P均< 0.05）。

OPN单抗中和OPN可调控脓毒症小鼠肺内中性粒细胞浸润，减轻急性损伤，提示OPN可作为脓毒症急性肺损伤的治疗靶点。

To evaluate the effect of changes in alveolar microenvironment on lung fibroblast (LF) in patients with acute respiratory distress syndrome (ARDS).

Fifty-eight ARDS patients admitted to the intensive care unit (ICU) of Shaoxing People's Hospital from January 2014 to December 2016 were recruited. The patients were divided into the mild group (n=26), moderate group (n=15) and severe group (n=17) according to patients' oxygenation index and Berlin definition criteria. Another 10 patients with mechanical ventilation but no pulmonary diseases were enrolled as the control group. All patients were received bronchoalveolar lavage and the bronchial alveolar lavage fluid (BALF) was collected. The levels of interleukin-1β (IL-1β), keratinocyte growth factor (KGF) and hepatocyte growth factor (HGF) in the BALF were measured by enzyme linked immunosorbant assay (ELISA), and the protein content and cell counts in the BALF were also recorded. Lung fibroblasts (MRC-5) were cultured in vitro and co-cultured with BALF in each group. Cell migration assays were performed by the Transwell system. The expressions of CollagenⅠ and platelet-derived growth factor-receptor α (PDGF-Rα) were determined by Western-blotting.

Compared with the control group, the levels of IL-1β [12 (8, 21), 776 (449, 943), 802 (691, 1 004), 886 (548,1 130) ng/L], KGF [2.0 (1.0, 2.2), 19.0 (15.8, 24.5), 41.4 (36.2, 57.3), 64.7 (49.2, 82.1) ng/L], HGF [90 (75, 106), 514 (373, 785), 867 (674, 1 248), 940 (660, 1 344) ng/L], the protein content [(0.09 ± 0.03), (0.29 ± 0.10), (0.45 ± 0.09), (0.68 ± 0.16) g/L] and cell counts [(2.4 ± 0.6), (16.5 ± 2.1), (17.8 ± 2.0), (18.2 ± 2.0) × 10⁹/mL] in mild, moderate and severe groups increased significantly (Z=26.182, 55.871, 36.354; F=72.860, 177.291; all P<0.05). The KGF level and protein content in mild and moderate groups were much lower, and the HGF and cell counts in the mild group were much lower as compared with severe group (all P<0.05). However, there were no significant differences in the IL-1β level among each ARDS subgroups (all P>0.05). Compared with the control group, the cell migration assays in each ARDS subgroups were much higher (F=12.291, P=0.003), and they were highest in severe group (all P<0.05). The expressions of CollagenⅠand PDGF-Rα showed significant differneces among four groups (F=358.943, P=0.001; F=4.574, P=0.002). The expression of CollagenⅠ in each ARDS subgroups was much higher than that in the control group, and it was much higher in moderate and severe groups than in mild group (all P<0.05). The expression of PDGF-Rα increased obviously in moderate and severe groups, but it was almost absent in control and mild groups (all P<0.05).

With the aggravation of ARDS, the levels of KGF and HGF in BALF increased obviously, and the BALF in ARDS patients could induce LF migration and differentition through elevated CollagenⅠ and PDGF-Rα expressions.

To investigate the incidence and related risk factors of septic cardiomyopathy (SCM).

A total of 228 patients with sepsis or septic shock admitted to ICU of Shaanxi Provincial People's Hospital from January 2019 to April 2021 were retrospectively analyzed in this study. All patients were divided into the SCM group (42 cases) and the non-SCM group (186 cases) according to the occurrence of SCM. The clinical indicators were recorded and compared between the two groups. The multivariate Logistic regression analysis was used to analyze the risk factors associated with the development of SCM. Meanwhile, the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each indicator on SCM occurrence.

The incidence of SCM in patients with sepsis or septic shock was 18.4% (42/228). In the SCM group, the patients were older (t = 5.309, P<0.001), the incidences of coronary atherosclerotic heart disease (CHD), atrial fibrillation, heart failure and chronic kidney failure were higher (χ² = 5.090, P = 0.024; χ² = 6.399, P = 0.011; χ² = 31.848, P< 0.001; χ² = 3.979, P = 0.046), and the levels of white blood cell (WBC), lactate, creatine kinase isoenzymes-MB, high-sensitivity cardiac troponin T (hs-cTnT) and acute physiology and chronic health evaluation (APACHE) Ⅱ score (t = 4.560, P<0.001; Z = 3.855, P<0.001; Z = 2.075, P = 0.038; Z = 5.513, P<0.001; Z = 5.913, P<0.001) were all much higher than those in the non-SCM group. The multivariate Logistic regression analysis showed that the age [odds ratio (OR) = 1.071, 95% confidence interval (CI) (1.006, 1.139), P = 0.030], CHD [OR = 3.185, 95%CI (1.201, 8.447), P = 0.020], heart failure [OR = 3.028, 95%CI (1.041, 8.810), P = 0.042], WBC [OR = 1.095, 95%CI (1.003, 1.196), P = 0.042], lactate [OR = 1.095, 95%CI (1.014, 1.183), P = 0.021], hs-cTnT [OR = 1.629, 95%CI (1.098, 2.418), P = 0.015], APACHEⅡ score [OR = 1.092, 95%CI (1.003, 1.188), P = 0.043] were independent risk factors for the incidence of SCM. The ROC curve analysis showed that the age [area under the curve (AUC) = 0.767, 95%CI (0.694, 0.840), P<0.001], WBC [AUC = 0.757, 95%CI (0.689, 0.824), P<0.001], lactate [AUC = 0.690, 95%CI (0.603, 0.778), P<0.001], hs-cTnT [AUC = 0.772, 95%CI (0.071, 0.843), P<0.001] and APACHEⅡ score [AUC = 0.792, 95%CI (0.727, 0.856), P<0.001] all had certain predictive values for SCM occurrence.

The incidence of SCM of patients with sepsis or septic shock is relatively high. Age, CHD, heart failure, WBC, lactate, hs-cTnT and APACHEⅡ score are independent risk factors of SCM occurrence.

To evaluate the effects of sulforaphane on inflammatory reaction and Toll like receptor 4 (TLR4)/ nuclear factor-kappa B (NF-κB) signaling pathway in rats with sepsis-induced acute lung injury (ALI).

Thirty male Sprague Dawley rats were randomly divided into the sham operation group, model group and treatment group, with 10 rats in each group. Rats in the model group and treatment group were prepared by cecal ligation and puncture (CLP). Rats in the treatment group were intraperitoneally injected with 50 mg/kg sulforaphane immediately after operation, while the other two groups were injected with isosmotic NaCl solution. Arterial blood samples were collected from the right common carotid artery 24 hours after operation, and then lung tissues were taken from rats to determine their wet/dry ratio. The expression levels of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β) and NF-κB p65 in the lung tissue homogenate of rats in three groups were detected by enzyme-linked immunosorbent assay (ELISA), and TLR4 mRNA expressions were measured by real-time fluorescence quantitative PCR.

The expression levels of lung tissue wet/dry ratio [(4.00 ± 0.13), (6.10 ± 0.05), (5.80 ± 0.08)], oxygenation index [(315 ± 11), (177 ± 7), (200 ± 12) mmHg], TNF-α [(6.05 ± 0.29), (45.06 ± 0.52), (27.09 ± 0.85) ng/L], IL-1β [(8.02 ± 0.21), (38.23 ± 0.81), (32.73 ± 1.12) ng/L] and NF-κB p65 [(0.375 ± 0.013), (1.230 ± 0.045), (0.988 ± 0.043) ng/L] were statistically significantly different in three groups (F = 480.891, 255.309, 4 245.262, 1 918.168, 564.842; all P < 0.001). Further comparison showed that the wet/dry ratio, TNF-α, IL-1β and NF-κB p65expressions of lung tissue in the model group and treatment group were all significantly higher than those in the sham operation group (all P < 0.05); in the same time, the wet/dry ratio, TNF-α, IL-1β and NF-κB p65 expressions in the treatment group were all significantly lower than those in the model group (all P < 0.05). The oxygenation index of rats in the model group and treatment group was significantly lower than that in the sham operation group (both P < 0.05), while the oxygenation index in the treatment group was significantly higher than that in the model group (P < 0.05). The results of real-time quantitative PCR showed that there was significant difference in the expression of TLR4 mRNA among these three groups (F = 224.538, P < 0.001). Compared with the sham operation group, the expression of TLR4 mRNA of lung tissue in the model group and treatment group were significantly higher (both P < 0.05), while the expression of TLR4 mRNA in the treatment group was significantly lower than that in the model group (P < 0.05).

Sulforaphane can reduce lung tissue inflammatoryreaction and pulmonary edema and improve anoxic state in rats with acute lung injury caused by sepsis. It has a protective effect on lung tissue, and its mechanism may be related to the intervention of TLR4/NF-κB signaling pathway.

To systematically evaluate the clinical efficacy of continuous veno-venous hemofiltration (CVVH) combined with hemoperfusion (HP) in treating hyperlipidemic acute pancreatitis (HLAP).

The randomized controlled trials (RCTs) about CVVH combined with HP for treating patients with HLAP published up to December 2018 were searched from the Cochrane Library, PubMed, VIP, Wanfang and CNKI databases. Two reviewers independently screened articles, extracted data and evaluated quality according to the inclusion and exclusion criteria. Then meta-analysis was performed using the Review Manager 5.1 software.

Totally 10 RCTs with 687 patients were included, containing 343 patients in the experimental group (treated with CVVH and HP) and 344 patients in the control group (treated with CVVH). The meta-analysis suggested that the levels of serum triglyceride [mean difference (MD) = -7.37, 95% confidence interval (CI) (-10.54, -4.20), Z = 4.55, P < 0.000 01], in-hospital mortality [relative risk = 0.43, 95%CI (0.26, 0.71), Z = 3.32, P = 0.000 9], acute physiology and chronic health evaluation Ⅱ score [MD = -1.93, 95%CI (-2.63, -1.23), Z = 5.40, P < 0.000 01], serum tumor necrosis factor-alpha [MD = -67.21, 95%CI (-98.88, -35.54), Z = 4.16, P < 0.000 1] and serum interleukin-6 [MD = -50.60, 95%CI (-62.91, -38.28), Z = 8.05, P < 0.000 1] after treatment were significantly lower in the experimental group than in the control group.

On the basis of conventional treatment, CVVH combined with HP is better than CVVH alone in treating HLAP.

探讨磁共振弥散张量纤维束成像（DTT）图中皮质脊髓束残存率与高血压性基底节区脑出血（HBGH）清除术后运动功能恢复的相关性。

选取2018年7月至2019年9月收治的23例单侧HBGH患者，均行经侧裂-岛叶皮质入路基底节区血肿清除术。于术后2周行弥散张量成像检查，在工作站中以两侧大脑脚为感兴趣区域完成皮质脊髓束三维重塑得出DTT图，测量并计算出HBGH清除术后皮质脊髓束残存率。采用线性回归分析评价皮质脊髓束残存率与Fugl-Meyer评分的相关性。

线性回归分析结果显示，单侧基底节区出血清除术后患者DTT中测得的术后皮质脊髓束残存率与6个月后Fugl-Meyer评分存在线性关系，且用皮质脊髓束残存率预测Fugl-Meyer评分的实际效果较佳（R²=0.864，P < 0.001）。

DTT图中术后皮质脊髓束残存率能有效评估HBGH清除术后患者预后运动功能恢复情况。

分析经急诊医学科（ED）诊断脓毒症住院患者特点，为脓毒症早期防治提供依据。

采用回顾性队列研究分析2017年1月1日至2020年12月31日天津医科大学总医院收治的2 110例脓毒症住院患者，根据是否经ED诊断住院，将其分为经ED诊断脓毒症住院组（1 274例）和非ED诊断脓毒症住院组（836例）。分析两组患者的流行病学特点以及影响死亡的危险因素。

2017至2020年每月脓毒症住院患者占总住院数波动在3.6‰~19.0‰，主要集中于1至3月份，尤其是2月份达到最高。脓毒症住院患者多集中于年龄≥ 70岁、男性、首次住院、住院中位时间15（9，25）d、住院中位费用4.7（2.5，10.1）万元、城职医保，病死率为25.5%（538/2 110）。经ED诊断脓毒症住院患者随住院次数增加，病死率逐渐升高；死亡患者多集中于住院时间≤ 7 d和≥ 61 d、年龄≥ 70岁以及住院费用≥ 3~< 6万元；年龄、住院次数和住院时间是经ED诊断脓毒症住院患者死亡的危险因素，且患者年龄≥ 70岁死亡风险高于18~39岁者，住院次数≥ 3次的死亡风险高于<3次患者，住院时间为14 d内的死亡风险高于其他时间段（P均< 0.05）。经ED诊断脓毒症住院、低龄、女性是脓毒症住院患者生存的保护因素，住院次数≥ 3次是危险因素（P均< 0.05）。

经ED诊断脓毒症住院是患者生存的保护因素，临床医生应从社会学特征、住院次数、住院时间和医疗消费角度提高对脓毒症早期救治的认识。

To investigate the cardioprotective effect of esmolol on septic shock patients.

Forty-four patients with septic shock in Tongde Hospital of Zhejiang Province were randomly divided into the control group (n = 22) and treatment group (n = 22). The treatment group received intravenous infusion of esmolol on the basis of routine treatment, while the control group was continuously pumped with isoosmotic NaCl solution. The general data, heart rate, central venous pressure (CVP), mean arterial pressure (MAP), stroke volume index (SVI), cardiac index, global end diastolic volume index (GEDVI), left ventricular ejection fraction (LVEF), mitral orifice diastolic peak flow velocity ratio (E/A), cardiac troponin I (cTnI), brain natriuretic peptide, blood lactate and central venous blood oxygen saturation (ScvO₂) of the two groups were recorded at 0, 24, 48, 72 and 96 h after enrollment, and the mortality rate in 28 days was compared.

There were significant differences in the heart rate, cardiac index, GEDVI, E/A, cTnI and brain natriuretic peptide between the two groups (F = 58.045, 11.102, 7.132, 7.136, 2.970, 3.006; all P < 0.05). Further comparison showed that the heart rate and cardiac index in the treatment group at 24, 48, 72 and 96 h were significantly lower than those in the control group at the same time point and in the treatment group at 0 h (all P < 0.05). The levels of GEDVI and E/A in the treatment group at 48, 72 and 96 h were significantly higher than those in the control group at the same time point and in the treatment group at 0 h (all P < 0.05). The expressions of cTnI and brain natriuretic peptide in the treatment group were significantly lower than those in the control group at 48, 72 and 96 h (all P < 0.05). The expressions of cTnI and brain natriuretic peptide at 72 and 96 h were significantly lower than those at 0 h in the treatment group (all P < 0.05). There was no significant difference in the mortality rate between the two groups in 28 days (7/22 vs. 5/22, χ² = 0.458, P = 0.498).

Esmolol can alleviate myocardial injury and improve myocardial diastolic function in septic shock patients; it has no effect on circulation, tissue perfusion and oxygen metabolism, and has no significant change in prognosis.