[Investigation on the current situation of the development of intensive care units in Inner Mongolia Autonomous Region in 2022].

OBJECTIVE: To investigate the development present situation of the department of critical care medicine in Inner Mongolia Autonomous Region (hereinafter referred to as Inner Mongolia), in order to promote the standardized and homogeneous development of critical care medicine in Inner Mongolia, and also provide a reference for discipline construction and resource allocation. METHODS: A survey study was conducted in comprehensive intensive care unit (ICU) of tertiary and secondary hospitals in Inner Mongolia by online questionnaire survey and telephone data verification. The questionnaire was based on the Guidelines for the Construction and Management of Intensive Care Units (Trial) (hereinafter referred to as the Guidelines) issued by the National Health Commission in 2009 and the development trend of the discipline. The questionnaire covered six aspects, including hospital basic information, ICU basic information, personnel allocation, medical quality management, technical skill and equipment configuration. The questionnaire was distributed in September 2022, and it was filled out by the discipline leaders or department heads of each hospital. RESULTS: As of October 24, 2022, a total of 101 questionnaires had been distributed, 85 questionnaires had been recovered, and the questionnaire recovery rate had reached 84.16%, of which 71 valid questionnaires had been collected in a total of 71 comprehensive ICU. (1) There were noticeable regional differences in the distribution of comprehensive ICU in Inner Mongolia, with a relatively weak distribution in the east and west, and the overall distribution was uneven. The development of critical care medicine in Inner Mongolia was still lacking. (2) Basic information of hospitals: the population and economy restricted the development of ICU. The average number of comprehensive ICU beds in the western region was only half of that in the central region (beds: 39.0 vs. 86.0), and the average number of ICU beds in the eastern region was in the middle (83.6 beds), which was relatively uneven. (3) Basic information of ICU: among the 71 comprehensive ICU surveyed, there were 44 tertiary hospitals and 27 secondary hospitals. The ratio of ICU beds to total beds in tertiary hospitals was significantly lower than that in secondary hospitals [(1.59±0.81)% vs. (2.11±1.07)%, P < 0.05], which were significantly lower than the requirements of the Guidelines of 2%-8%. The utilization rate of ICU in tertiary and secondary hospitals [(63.63±22.40)% and (44.65±20.66)%, P < 0.01] were both lower than the bed utilization rate required by the Guidelines (75% should be appropriate). (4) Staffing of ICU: there were 376 doctors and 1 117 nurses in tertiary hospitals, while secondary hospitals had 122 doctors and 331 nurses. There were significant differences in the composition ratio of the titles of doctors, the degree of doctors, and the titles of nurses between tertiary and secondary hospitals (all P < 0.05). Most of the doctors in tertiary hospitals had intermediate titles (attending physicians accounted for 41.49%), while most of the doctors in secondary hospitals had junior titles (resident physicians accounted for 43.44%). The education level of doctors in tertiary hospitals was generally higher than that in secondary hospitals (doctors: 2.13% vs. 0, masters: 37.24% vs. 8.20%). The proportion of nurses in tertiary hospitals was significantly lower than that in secondary hospitals (17.01% vs. 24.47%). The ratio of ICU doctors/ICU beds [(0.64±0.27)%, (0.59±0.34)%] and ICU nurses/ICU beds [(1.76±0.56)%, (1.51±0.48)%] in tertiary and secondary hospitals all failed to meet the requirements above 0.8 : 1 and 3 : 1 of the Guidelines. (5) Medical quality management of ICU: compared with secondary hospitals, the proportion of one-to-one drug-resistant bacteria care in tertiary hospitals (65.91% vs. 40.74%), multimodal analgesia and sedation (90.91% vs. 66.67%), and personal digital assistant (PDA) barcode scanning (43.18% vs. 14.81%) were significantly higher (all P < 0.05). (6) Technical skills of ICU: in terms of technical skills, the proportion of bronchoscopy, blood purification, jejunal nutrition tube placement and bedside ultrasound projects carried out in tertiary hospitals were higher than those in secondary hospitals (84.09% vs. 48.15%, 88.64% vs. 48.15%, 61.36% vs. 55.56%, 88.64% vs. 70.37%, all P < 0.05). Among them, the placement of jejunal nutrition tube, bedside ultrasound and extracorporeal membrane oxygenation were mainly completed independently in tertiary hospitals, while those in secondary hospitals tended to be completed in cooperation. (7) Equipment configuration of ICU: in terms of basic equipment, the ratio of the total number of ventilators/ICU beds in tertiary and secondary hospitals [0.77% (0.53%, 1.07%), 0.88% (0.63%, 1.38%)], and the ratio of injection pump/ICU beds [1.70% (1.00%, 2.56%), 1.25% (0.75%, 1.88%)] didn't meet the requirements of the Guidelines. The equipment ratio was insuffcient, which means that the basic needs of development had not been met yet. CONCLUSIONS: The development of comprehensive ICU in Inner Mongolia has tended to mature, but there is still a certain gap in the development scale, personnel ratio and instruments and equipment compared with the Guidelines. Moreover, the comprehensive ICU appears the characteristics of relatively weak eastern and western regions, and the overall distribution is uneven. Therefore, it is necessary to increase efforts to invest in the construction of the department of critical care medicine.

A case of infection-induced thrombotic thrombocytopenic purpura.

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) are a group of microvascular thrombohemorrhagic syndromes with low incidence and high mortality, which are characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, neuropsychiatric disorders, and renal involvement. In addition, TTP has a high rate of misdiagnosis and underdiagnosis due to the lack of specific clinical manifestations. CASE REPORT: A male patient aged 47 years was admitted to our hospital with complaints of dizziness and nausea for 2 days and soy-colored urine for 1 day. The patient had caught a cold and suffered from fever, dizziness, and nausea 2 days before admission. These symptoms were relieved by self-administration of berberine 1 day before admission. Later, the patient found that the urine was scanty and soy-colored. Physical examination on admission showed that the patient developed apathy, with occasional babbling, yellowing skin and sclera, and scattered bleeding spots on the anterior chest area. Based on auxiliary tests combined with clinical manifestations, the patient was diagnosed with TTP and administered plasma exchange, hemofiltration, hormone, and anti-platelet therapies. The patient recovered and was discharged after 3 weeks. The patient regularly took aspirin and was followed up one year later with no recurrence. CONCLUSION: TTP is an acute severe disease with complex etiology, abrupt onset, and dangerous conditions. In this patient with TTP, an important cause of the disease may have been an acute gastrointestinal infection. The plasma examination in another hospital revealed positive results for ADAMTS13 inhibitors, providing strong evidence for the diagnosis of this case. Multiple plasma exchanges and glucocorticoids yielded favorable treatment results and were critical measures of successful treatment of TTP.

Identification of lncRNA-miRNA-mRNA networks in circulating exosomes as potential biomarkers for systemic sclerosis.

Objective: This study aimed to analyze potential biomarkers for systemic sclerosis (SSc) by constructing lncRNA-miRNA-mRNA networks in circulating exosomes (cirexos). Materials and methods: Differentially expressed mRNAs (DEmRNAs) and lncRNAs (DElncRNAs) in SSc cirexos were screened using high-throughput sequencing and detected with real-time quantitative PCR (RT-qPCR). Differentially expressed genes (DEGs) were analyzed using the DisGeNET, GeneCards, GSEA4.2.3, Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases. Receiver operating characteristic (ROC) curves, correlation analyses, and a double-luciferase reporter gene detection assay were used to analyze competing endogenous RNA (ceRNA) networks and clinical data. Results: In this study, 286 DEmRNAs and 192 DElncRNAs were screened, of which 18 DEGs were the same as the SSc-related genes. The main SSc-related pathways included extracellular matrix (ECM) receptor interaction, local adhesion, platelet activation, and IgA production by the intestinal immune network. A hub gene, COL1A1, was obtained by a protein-protein interaction (PPI) network. Four ceRNA networks were predicted through Cytoscape. The relative expression levels of COL1A1, ENST0000313807, and NON-HSAT194388.1 were significantly higher in SSc, while the relative expression levels of hsa-miR-29a-3p, hsa-miR-29b-3p, and hsa-miR-29c-3p were significantly lower in SSc (P < 0.05). The ROC curve showed that the ENST00000313807-hsa-miR-29a-3p-COL1A1 network as a combined biomarker of SSc is more valuable than independent diagnosis, and that it is correlated with high-resolution CT (HRCT), Scl-70, C-reactive protein (CRP), Ro-52, IL-10, IgM, lymphocyte percentage, neutrophil percentage, albumin divided by globulin, urea, and RDW-SD (P < 0.05). Double-luciferase reporter gene detection showed that ENST00000313807 interacts with hsa-miR-29a-3p, which interacts with COL1A1. Conclusion: The ENST00000313807-hsa-miR-29a-3p-COL1A1 network in plasma cirexos represents a potential combined biomarker for the clinical diagnosis and treatment of SSc.

[Value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury].

OBJECTIVE: To investigate the value of combined detection of biomarkers in early diagnosis and prognosis of patients with septic myocardial injury. METHODS: The clinical data of 103 patients with sepsis admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology from October 2018 to January 2021 were enrolled. According to the cardiac troponin I (cTnI) at admission of ICU, they were divided into septic myocardial injury group (cTnI ≥ 0.15 µg/L) and non-septic myocardial injury group (cTnI < 0.15 µg/L). The serum levels of heart-type fatty acid-binding protein (H-FABP), procalcitonin (PCT), C-reactive protein (CRP), MB isoenzyme of creatine kinase (CK-MB), cTnI and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 6 hours after ICU admission and the worst value of acute physiology and chronic health evaluation II (APACHE II) score within 24 hours after ICU admission in 103 patients was recorded as well as the 28-day prognosis of patient with septic myocardial injury. Spearman correlation analysis was used to analyze the correlation of each index; receiver operating characteristic curve (ROC curve) was drawn, and the area under ROC curve (AUC) was calculated to analyze the early diagnosis and prognostic value of each index and APACHE II score alone or combined detection in patients with septic myocardial injury. RESULTS: (1) Among 103 patients with sepsis, 58 patients were complicated with myocardial injury and 45 patients were not complicated with myocardial injury. The serum levels of PCT, CRP, NT-proBNP, CK-MB, cTnI, H-FABP and APACHE II score in patients with septic myocardial injury were significantly higher than those in patients without septic myocardial injury [PCT (µg/L): 3.46±1.35 vs. 1.89±0.43, CRP (mg/L): 81.1±26.8 vs. 65.3±19.1, NT-proBNP (U/L): 8 261.4±2 346.9 vs. 6 120.2±1 809.6, CK-MB (U/L): 15.89±6.25 vs. 12.14±4.24, cTnI (µg/L): 1.50 (0.91, 2.21) vs. 0.18 (0.16, 0.19), H-FABP (µg/L): 26.45±8.24 vs. 12.82±5.73, APACHE II score: 24.0 (18.0, 29.0) vs. 16.0 (14.0, 18.0), all P < 0.01]. Spearman correlation analysis showed that PCT, CRP and APACHE II scores were positively correlated with NT-proBNP, CK-MB, cTnI and H-FABP. ROC curve analysis showed that H-FABP in the diagnosis of septic myocardial injury (AUC = 0.916) was superior to NT-proBNP (AUC = 0.756) and CK-MB (AUC = 0.675); the AUC of NT-proBNP and CK-MB combined with H-FABP was 0.921, the sensitivity was 82.1%, and the specificity was 88.2%. (2) Twenty-three patients survived in 28 days, and 35 died. The levels of serum PCT, CRP, NT-proBNP, CK-MB, cTnI, H-FABP and APACHE II score in death group were significantly higher than those in survival group [PCT (µg/L): 3.86±1.27 vs. 2.84±1.24, CRP (mg/L): 92.3 (65.0, 101.7) vs. 74.3 (65.7, 79.8), NT-proBNP (ng/L): 9 106.4±2 013.9 vs. 6 975.5±2 266.7, CK-MB (U/L): 17.90±6.49 vs. 12.82±4.46, cTnI (µg/L): 2.11±0.86 vs. 1.12±0.44, H-FABP (µg/L): 30.08±7.90 vs. 20.93±5.14, APACHE II score: 25.0 (20.0, 30.0) vs. 19.0 (17.0, 24.0), all P < 0.01]. ROC curve analysis showed that H-FABP in evaluating 28-day death of patients with septic myocardial injury (AUC = 0.839) was superior to PCT (AUC = 0.707), CRP (AUC = 0.716), NT-proBNP (AUC = 0.761), CK-MB (AUC = 0.733), cTnI (AUC = 0.824) and APACHE II score (AUC = 0.724); the AUC of NT-proBNP and cTnI combined with H-FABP was 0.888, the sensitivity was 91.4%, and the specificity was 82.6%. CONCLUSIONS: H-FABP plays an important role in the early diagnosis and prognosis of septic myocardial injury. Early combined detection of NT-proBNP, CK-MB and H-FABP can significantly improve the diagnostic ability of septic myocardial injury, and NT-proBNP and cTnI combined with H-FABP can significantly improve the ability to predict the adverse prognosis of sepsis myocardial injury.

Expression and Identification of a Novel Spore Wall Protein in Microsporidian Nosema bombycis.

Microsporidia are a group of obligate intracellular parasites causing significant disease in human beings and economically important animals. Though a few spore wall proteins (SWPs) have now been identified in these intriguing species, the information on SWPs remains too little to elucidate the spore wall formation mechanisms of microsporidia. It has been well described that numerous proteins with tandem repeats tend to be localized on the cell wall of fungi and parasites. Previously, by scanning the proteins with tandem repeats in microsporidian Nosema bombycis, we obtained 83 candidate SWPs based on whether those proteins possess a signal peptide and/or transmembrane domain. Here, we further characterized a candidate protein (EOB13250) with three tandem repeats in the N-terminal region and a transmembrane domain in C-terminus of N. bombycis. Sequence analysis showed that the tandem repeat domain of EOB13250 was species-specific for this parasite. RT-PCR indicated that the expression of the gene encoding this protein started on the fourth day postinfection. After cloned and expressed in Escherichia coli, a polyclone antibody against the recombinant EOB13250 protein was prepared. Western blotting demonstrated this protein exist in N. bombycis. Immunofluorescence analysis (IFA) and immunoelectron microscopy analysis (IEM) further provided evidence that EOB13250 was an endospore wall protein. These results together suggested that EOB13250 was a novel spore wall protein of N. bombycis. This study provides a further enrichment of the number of identified spore wall proteins in microsporidia and advances our understanding of the spore wall formation mechanism in these obligate unicellular parasites.

Effect of vitrification on in vitro development and imprinted gene Grb10 in mouse embryos.

Vitrification of embryos is a routine procedure in IVF (in vitro fertilization) laboratories. In the present study, we aimed to investigate the effect of vitrification on mouse preimplantation embryo development in vitro, and effect on the epigenetic status of imprinted gene Grb10 in mouse embryos. The blastocyst formation rate for vitrified 8-cell embryos was similar to the non-vitrified 8-cell embryos, whereas the blastocyst hatching rate was lower than that of the non-vitrified group. The expression level of Grb10 major-type transcript decreased significantly in vitrified blastocysts compared with non-vitrified and in vivo blastocysts. Moreover, the global DNA methylation level in 8-cell embryos and blastocysts, and the DNA methylation at CpG island 1 (CGI1) of Grb10 in blastocysts were also significantly decreased after vitrification. In vitro culture condition had no adverse effect, except for on the DNA methylation in Grb10 CGI1. These results suggest that vitrification may reduce the in vitro development of mouse 8-cell embryos and affect the expression and DNA methylation of imprinted gene Grb10.

[Administration of bone marrow mesenchymal stem cells attenuates inflammation of rats with sepsis].

Objective To investigate the therapeutic effects of bone marrow-derived mesenchymal stem cells (BMSCs) in rats with sepsis. Methods Forty-eight Wistar rats were divided into blank group, sham group, model group and treatment group. Sepsis model was made using cecum ligation and puncture (CLP). BMSCs were extracted and cultured to the third generation. The rats in the treatment group received BMSCs through a tail vein and the rats in the model group received an equivalent dose of PBS. The survival rate was recorded in each group 72 hours after operation. Pathological changes of lung tissues were observed by HE staining. The mRNA levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), fork head box protein 3 (Foxp3), CC chemokine ligand 2 (CCL2) were tested by quantitative real-time fluorescence PCR. The serum levels of IL-6, IL-17 and TNF-α proteins were detected by ELISA. Results In both blank group and sham group, the survival rate and histological changes of the lungs showed normal; no bacteria were found growing in rats' blood culture; IL-6, IL-17, TNF-α, CCL2, Foxp3 mRNA and IL-6, IL-17, TNF-α protein levels had no significant differences. In the model group, the survival rate of rats was obviously lower than that of the sham group; the pathological changes of the lungs were significant; any amount of enterobacteria were seen growing in rats' blood culture; IL-6, IL-17, TNF-α, CCL2 mRNA and protein expression levels were apparently higher than those of sham group, while Foxp3 mRNA expression level was obviously lower than that of sham group. In the treatment group, the survival rate was significantly higher than that of the model group; the pathological changes of the lung tissues were evidently eased; IL-6, IL-17, TNF-α, CCL2 mRNA and protein expression levels significantly decreased compared with the model group, while Foxp3 mRNA expression level significantly increased compared with the model group. Conclusion BMSCs injection increases the survival rate in rats with sepsis and reduces the levels of inflammatory cytokines.

[Evaluation of genetic diversity and population structure of Bletilla striata based on SRAP markers].

Bletilla striata has been used as traditional Chinese medicine for several centuries. In recent years, the quality and quantity of wild B. striata plants have declined sharply due to habitat deterioration and human over-exploitation. Therefore, it is of great urgency to evaluate and protect B. striata wild plant resource. In this study, sequence-related amplified polymorphism (SRAP) markers were applied to assess the level and pattern of genetic diversity in twelve populations of B. striata. The results showed a high level of genetic diversity (PPB = 90.48%, H = 0.349 4, I = 0.509 6) and moderate genetic differentiation among populations (G(st) = 0.260 9). Based on the unweighted pair-group method with arithmetic average (UPGMA), twelve populations gathered in three clusters. The cluster 1 included four populations. There are Nanjing, Zhenjiang, Xuancheng and Hangzhou. The seven populations which come from Hubei Province, Hunan Province, Jiangxi Province and Guizhou Province belonged to the cluster 2. The cluster 3 only contained Wenshan population. Moreover, Mantel test revealed significant positive correlation between genetic distances and geographic distances (r = 0.632 9; P < 0.000 1). According to the results, we proposed a series of conservation consideration for B. striata.

[Adipose-derived stem cells promote the polarization from M1 macrophages to M2 macrophages].

OBJECTIVE: To investigate the effects of adipose-derived stem cells (ADSCs) on M1/M2 macrophages and whether ADSCs are able to promote the polarization from M1 macrophages to M2 macrophages. METHODS: M1 macrophages were induced from J774.1 macrophages by 24-hour stimulation of lipopolysaccharide (LPS) and interferon γ (IFN-γ), and M2 macrophages were induced from J774.1 macrophages by interleukin 4 (IL-4) for another 24 hours. Then M1/M2 macrophages were separately cultured in the presence of ADSCs for 24 hours. The M1/M2 macrophages and their corresponding supernatants were collected for further analysis. The expressions of IL-6, tumor necrosis factor α (TNF-α), inducible nitric oxide synthase (iNOS), CC chemokine ligand 2 (CCL2), CD86, arginase 1 (Arg1), mannose receptors/CD206 (MR/CD206), IL-10, found in inflammatory zone 1 (FIZZ1), chitinase 3-like 3 (Ym-1) were detected by real-time PCR and ELISA. RESULTS: ADSCs significantly decreased the levels of IL-6, TNF-α, iNOS, CCL2 and CD86, and increased the levels of Arg1, CD206 and IL-10 in M1 macrophages. In the supernatant of M1 macrophages, the expressions of IL-6 and TNF-α were reduced, while those of CD206 were enhanced. In M2 macrophages, ADSCs resulted in down-regulation of IL-6, TNF-α, iNOS, CD86 and up-regulation of Arg1, CD206, FIZZ-1, Ym-1 and IL-10. In the supernatant of M2 macrophages, the expression levels of IL-6 and TNF-α were down-regulated and those of CD206 were up-regulated. CONCLUSION: ADSCs can inhibit the gene expression of M1 macrophages and promote the gene expression of M2 macrophages, as well as mediate the polarization from M1 macrophages to M2 macrophages.

[The latest research advance in media involved in sepsis].

OBJECTIVE: Sepsis and septic shock are the major causes of death in intensive care units (ICUs) worldwide. A large amount of studies on their pathophysiology have revealed an imbalance in the inflammatory network leading to tissue damage, organ failure, and ultimately, death. Cytokines, proteases, lipid mediators, vasoactive peptides, and cell stress markers play key roles in pathophysiology of sepsis. Although anti-inflammatory mediators can neutralize the promoting role of pro-inflammatory mediators, but persistent immune regulation may cause host susceptibility to concurrent infections. Therefore, it is a great challenge to seek effective clinical therapy against sepsis. To understand the complicated interplay between pro- and anti-inflammatory agents in sepsis, and their interaction in signal transduction and immune regulation in sepsis constitute vital significance to the prevention and control of sepsis. Summarize the latest findings about mediators associated with sepsis and innate and adaptive immune system at home and abroad in recent years, and illustrate the impact of its effects on sepsis, which may lead to resolution of many unexplored queries in the future.

[Applylication of new type combined fragments: nrDNA ITS+ nad 1-intron 2 for identification of Dendrobium species of Fengdous].

In this study, 17 kinds of Dendrobium species of Fengdous including 39 individuals were collected from 4 provinces. Mitochondrial gene sequences co I, nad 5, nad 1-intron 2 and chloroplast gene sequences rbcL, matK amd psbA-trnH were amplified from these materials, as well as nrDNA ITS. Furthermore, suitable sequences for identification of Dendrobium species of Fengdous were screened by K-2-P and P-distance. The results showed that during the mentioned 7 sequences, nrDNA ITS, nad 1-intron 2 and psbA-trnH which had a high degree of variability could be used to identify Dendrobium species of Fengdous. However, single fragment could not be used to distinguish D. moniliforme and D. huoshanense. Moreover, compared to other combined fragments, new type combined fragments nrDNA ITS+nad 1-intron 2 was more effective in identifying the original plants of Dendrobium species and could be used to identify D. huoshanense and D. moniliforme. Besides, according to the UPGMA tree constructed with nrDNA ITS+nad 1-intron 2, 3 inspected Dendrobium plants were identified as D. huoshanense, D. moniliforme and D. officinale, respectively. This study identified Dendrobium species of Fengdous by combined fragments nrDNA ITS+nad 1-intron 2 for the first time, which provided a more effective basis for identification of Dendrobium species. And this study will be helpful for regulating the market of Fengdous.

Different evolutionary processes in shaping the genetic composition of Dendrobium nobile in southwest China.

Knowledge of population genetic structure and intrapopulation genetic variation is important for understanding population dynamics and evolutionary processes. Dendrobium nobile is an endangered traditional Chinese tonic medicine. In order to analyze the population differentiation and genetic diversity in D. nobile and propose proper conservation measurements, we genotyped 102 individual plants from 7 natural populations distributed across southwest China at 9 microsatellite loci. Seven pairs of genomic SSR primers were newly designed, and two pairs were chosen from the EST-SSRs. According to the results, the genetic process of D. nobile on Hainan Island and the Chinese mainland might be affected by different evolutionary processes, the genetic drift caused by founder effect has played an important role in shaping the genetic constitution of the Island population. The population of D. nobile in Hainan Island was highly differentiated and displayed low levels of genetic diversity. For the conservation management plans of D. nobile, we propose that individuals in Hainan Island with rare alleles need to be conserved with top priority, and those individuals with rare alleles and the most common alleles also should be concerned. The seven new microsatellite loci may be informative for further evaluation and conservation of the genetic diversity of D. nobile.