内毒素、PCT联合NLR对经皮肾镜碎石术后患者尿源性脓毒血症的预测价值

摘要 目的：探讨内毒素、降钙素原（PCT）联合中性粒细胞与淋巴细胞比值（NLR）对经皮肾镜碎石术（PCNL）术后患者发生尿源性脓毒血症的预测价值。方法：选取2020年5月-2023年5月于西安医学院第二附属医院和空军军医大学第一附属医院泌尿外科行PCNL的患者750例作为研究对象。根据尿源性脓毒症发生情况分为尿源性脓毒血症组（n=45）和非脓毒血症组（n=705）。检测PCNL术前血清内毒素、PCT、中性粒细胞与淋巴细胞水平，并计算NLR。对比两组血清内毒素、PCT水平及NLR。采用多因素Logistic回归模型分析PCNL术后患者发生尿源性脓毒血症的影响因素。绘制受试者工作特征（ROC）曲线分析血清内毒素、PCT联合NLR预测PCNL术后患者发生尿源性脓毒血症的临床效能。结果：与非脓毒血症组相比，尿源性脓毒血症组血清内毒素、PCT及NLR更高（P<0.05）。多因素Logistic回归模型分析结果显示，血清内毒素升高、PCT升高、NLR升高、尿白细胞阳性、术前发热及鹿角型结石是PCNL术后患者发生尿源性脓毒血症的独立危险因素（P<0.05）；ROC曲线分析结果显示，血清内毒素、PCT联合NLR检测预测PCNL术后患者发生尿源性脓毒血症的曲线下面积（AUC）为0.913，高于上述各指标单独检测。结论：PCNL术前血清内毒素、PCT和NLR升高可能与术后患者发生尿源性脓毒血症有关。血清内毒素、PCT水平升高、NLR升高、术前发热、尿白细胞阳性、鹿角型结石是PCNL术后患者发生尿源性脓毒血症的危险因素。血清内毒素、PCT联合NLR检测对PCNL术后患者发生尿源性脓毒血症具有较高预测价值。     

Macroscopic anisotropic bone material properties in children with severe osteogenesis imperfecta

Children with severe osteogenesis imperfecta (OI) typically experience numerous fractures and progressive skeletal deformities over their lifetime. Recent studies proposed finite element models to assess fracture risk and guide clinicians in determining appropriate intervention in children with OI, but lack of appropriate material property inputs remains a challenge. This study aimed to characterize macroscopic anisotropic cortical bone material properties and investigate relationships with bone density measures in children with severe OI. Specimens were obtained from tibial or femoral shafts of nine children with severe OI and five controls. The specimens were cut into beams, characterized in bending, and imaged by synchrotron radiation X-ray micro-computed tomography. Longitudinal modulus of elasticity, yield strength, and bending strength were 32–65% lower in the OI group (p < 0.001). Yield strain did not differ between groups (p ≥ 0.197). In both groups, modulus and strength were lower in the transverse direction (p ≤ 0.009), but anisotropy was less pronounced in the OI group. Intracortical vascular porosity was almost six times higher in the OI group (p < 0.001), but no differences were observed in osteocyte lacunar porosity between the groups (p = 0.086). Volumetric bone mineral density was lower in the OI group (p < 0.001), but volumetric tissue mineral density was not (p = 0.770). Longitudinal OI bone modulus and strength were correlated with volumetric bone mineral density (p ≤ 0.024) but not volumetric tissue mineral density (p ≥ 0.099). Results indicate that cortical bone in children with severe OI yields at the same strain as normal bone, and that their decreased bone material strength is associated with reduced volumetric bone mineral density. These results will enable the advancement of fracture risk assessment capability in children with severe OI.     

Clinical and immunological features of convalescent pediatric patients infected with the SARS-CoV-2 Omicron variant in Tianjin,China

COVID-19 has spread surprisingly fast worldwide, and new variants continue to emerge. Recently, the World Health Organization acknowledged a new mutant strain “Omicron”, with children were accounting for a growing share of COVID-19 cases compared with other mutant strains. However, the clinical and immunological characteristics of convalescent pediatric patients after Omicron infection were lacking. In this study, we comparatively analyzed the clinical data from pediatric patients with adult patients or healthy children and the effects of SARSCoV-2 vaccine on the clinical and immune characteristics in convalescent pediatric patients. Our results indicated that convalescent pediatric patients had unique clinical and immune characteristics different from those of adult patients or healthy children, and SARS-CoV-2 vaccination significantly affected on the clinical and immune characteristics and the prevention of nucleic acid re-detectable positive (RP) in convalescent patients. Our study further deepens the understanding of the impact of Omicron on the long-term health of pediatric patients and provides a valuable reference for the prevention and treatment of children infected with Omicron.     

An immunohistochemical study of the diagnostic value of TREM-1 as marker for fatal sepsis cases

Triggering receptor expressed on myeloid cells-1 (TREM-1) is produced and up-regulated by exposure of myeloid cells to lipopolysaccharides or other components of either bacterial or fungal origin, which causes it to be strongly expressed on phagocytes that accumulate in inflamed areas. Because TREM-1 participates in septic shock and in amplifying the inflammatory response to bacterial and fungal infections, we believe it could be an immunohistochemical marker for postmortem diagnosis of sepsis. We tested the anti-TREM-1 antibody in 28 cases of death by septic shock and divided them into two groups. The diagnosis was made according to the criteria of the Surviving Sepsis Campaign. In all cases, blood cultures were positive. The first group was comprised subjects that presented high ante-mortem serum procalcitonin and the soluble form of TREM-1 (s-TREM-1) values. The second group comprised subjects in which s-TREM-1 was not measured ante-mortem. We used samples of brain, heart, lung, liver and kidney for each case to test the anti-TREM-1 antibody. A semiquantitative evaluation of the immunohistochemical findings was made. In lung samples, we found immunostaining in the cells of the monocyte line in 24 of 28 cases, which suggests that TREM-1 is produced principally by cells of the monocyte line. In liver tissue, we found low TREM-staining in the hepatocyte cytoplasm, duct epithelium, the portal-biliary space and blood vessel. In kidney tissue samples, we found the TREM-1 antibody immunostaining in glomeruli and renal tubules. We also found TREM-1 staining in the lumen of blood vessels. Immunohistochemical staining using the anti-TREM-1 antibody can be useful for postmortem diagnosis of sepsis.     

血清NT-proBNP水平在小儿心源性与非心源性呼吸困难诊断鉴别的价值

目的：探究血清B 型利钠肽前体（NT-proBNP）水平在小儿心源性与非心源性呼吸困难诊断鉴别的价值。方法：本研究于 2013 年2月~2015年2 月期间,选择我院收治的急性呼吸困难患儿72 例为研究对象,根据临床诊断将其分为心源性呼吸困难组 （39例）和非心源呼吸困难组（33 例）。采用电化学发光免疫分析法（ECLIA）测量两组患儿血清NT-proBNP 水平,并采用受试者工 作特征曲线（ROC）曲线评估血清NT-proBNP 水平在小儿心源性与非心源性呼吸困难诊断鉴别中的价值。结果：心源性呼吸困难 组患儿血清NT-proBNP水平为(253.23± 39.38)ng/L,明显高于非心源性呼吸困难组患儿血清NT-proBNP水平（76.39± 17.39） ng/L（t=23.882,P<0.05）。小儿血清NT-proBNP 水平诊断心源性呼吸困难和非心源性呼吸困难的曲线下面积为0.914,曲线下面积 的95%的置信区间为（0.861,0.967）,当血清NT-proBNP水平为118.34ng/L 时,约登指数取最大值为0.923,敏感度为97.43% （37/39）、特异度为94.87%（32/33）。结论：NT-proBNP 作为一个特异性指标可用于小儿心源性呼吸困难与非心源性呼吸困难的鉴 别诊断。     

小儿复发性肠套叠的微创治疗研究

目的：探讨小儿复发性肠套叠（套叠3 次及以上）的微创治疗。方法：回顾性分析2007 年12 月~2013 年1 月期间收治的21 例复发性肠套叠（套叠3 次及以上）患儿的临床资料。结果：21 例患儿均予以腹腔镜探查,3 例患儿仅发现回肠末端肠系膜淋巴结 增生,18 例探及原发病灶：其中Meckel憩室10 例,结肠息肉3 例,肠重复畸形2 例,非霍奇金淋巴瘤1 例,异位胰腺1 例,小肠腺 瘤1 例。20 例术后随访至今均未再次复发,1 例失访。结论：年龄＞2 岁,有多次复发肠套叠病史（套叠3 次及以上）,尤其是短期内 复发频繁的患儿,大多存在肠道器质性病变,应积极手术治疗,且以腹腔镜治疗为佳。     

The impact of vitamin D3 supplementation on muscle function among HIV-infected children and young adults: a randomized controlled trial

Objectives:

We tested the hypothesis that daily vitD₃ supplementation increases neuromuscular motor skills, jump power, jump energy, muscular force, and muscular strength.

Methods:

This was a secondary analysis of a randomized controlled trial of 12-months of oral 7,000 IU/day vitD₃ supplementation or placebo among 56 persons living with HIV aged 9-25 years. Neuromuscular motor skills were quantified using the Bruininks-Oseretsky Test of Motor Proficiency. Power was quantified using peak jump power, and energy was quantified using peak jump height. Muscular force was quantified using isometric ankle plantar- and dorsiflexion, isokinetic knee flexion and extension. Muscular strength was quantified using isometric handgrip strength.

Results:

After 12-months, serum 25-hydroxyvitamin D [25(OH)D] was higher with supplementation versus placebo (β=12.1 ng/mL; P<0.001). In intention-to-treat analyses, supplementation improved neuromuscular motor skills versus placebo (β=1.14; P=0.041). We observed no effect of supplementation on jump power, jump energy, muscular force, or muscular strength outcomes versus placebo.

Conclusions:

Among HIV-infected children and young adults supplementation with daily high-dose vitD₃ increased concentration of serum 25(OH)D and improved neuromuscular motor skills versus placebo.     

股动脉及股静脉血气在烧伤脓毒症患者早期诊断价值

目的:探索股动脉及股静脉血气对烧伤脓毒症患者早期诊断价值。方法:选择自2009年7月至2014年12月我院收治的特重烧伤患者80例,根据是否患有脓毒症,将35例脓毒症患者作为观察组,45例非脓毒症患者作为对照组。在所有患者左侧股动脉、股静脉置管,并抽血,进行血气分析。结果:动脉血气分析中观察组患者股动脉血中HCO3-水平明显低于对照组,且差异具有统计学意义(P0.05);静脉血气分析中观察组患者股静脉血中Pv CO2显著高于对照组,Pv O2、Sv O2、HCO3-水平明显低于对照组,且差异均具有统计学意义(P0.05)。观察组患者的△PO2、△PCO2、△SO2、△HCO3-、△p H水平均显著高于对照组,且差异均具有统计学差异(P0.05)。结论:股动脉和股静脉血气分析可反映出机体组织的血流灌注情况及氧的供需状态,对烧伤脓毒症患者早期诊断具有重要价值。     

Expression of type I interferon by splenic macrophages suppresses adaptive immunity during sepsis

Early during Gram-negative sepsis, excessive release of pro-inflammatory cytokines can cause septic shock that is often followed by a state of immune paralysis characterized by the failure to mount adaptive immunity towards secondary microbial infections. Especially, the early mechanisms responsible for such immune hypo-responsiveness are unclear. Here, we show that TLR4 is the key immune sensing receptor to initiate paralysis of T-cell immunity after bacterial sepsis. Downstream of TLR4, signalling through TRIF but not MyD88 impaired the development of specific T-cell immunity against secondary infections. We identified type I interferon (IFN) released from splenic macrophages as the critical factor causing T-cell immune paralysis. Early during sepsis, type I IFN acted selectively on dendritic cells (DCs) by impairing antigen presentation and secretion of pro-inflammatory cytokines. Our results reveal a novel immune regulatory role for type I IFN in the initiation of septic immune paralysis, which is distinct from its well-known immune stimulatory effects. Moreover, we identify potential molecular targets for therapeutic intervention to overcome impairment of T-cell immunity after sepsis.     

内皮细胞微粒与脓毒症研究进展

内皮细胞微粒是活化或凋亡的内皮细胞表面释放的直径1μm的小囊泡。它是反映内皮功能的标志物。研究表明在脓毒症的发生发展过程中,内皮细胞微粒在炎症反应、凝血反应、血管内皮功能等多方面能发挥有利和有害双方面的作用。脓毒症的研究进展和内皮细胞微粒密切相关。该文将就内皮细胞微粒与脓毒症研究进展做一简要综述。