目的对长沙市某三甲医院神经外科重症监护室(intensive care unit,ICU)患者呼吸机相关肺炎(ventilator associated pneumonia,VAP)影响因素进行调查,并探究其应对措施,为降低VAP发生提供科学依据。方法选取2019年2月—2022年2月湖南中...目的对长沙市某三甲医院神经外科重症监护室(intensive care unit,ICU)患者呼吸机相关肺炎(ventilator associated pneumonia,VAP)影响因素进行调查,并探究其应对措施,为降低VAP发生提供科学依据。方法选取2019年2月—2022年2月湖南中医药大学第一附属医院神经外科ICU符合纳排标准全部患者400例临床资料,按照VAP发生与否分为发生组与未发生组。自行设计调查问卷,采集调查对象基线资料,采用单因素χ^(2)检验和多因素logistic回归分析VAP发生影响因素,并构建列线图风险预测模型。结果400例神经外科ICU患者,其中112例发生VAP,占28.00%,多因素logistic回归分析显示,气管切开、机械通气时间、误吸、血清白蛋白、抗生素使用种类及时间均为神经外科ICU患者发生VAP的独立影响因素(P<0.05);基于多因素logistic回归分析筛选出的独立影响因素结果,使用R语言软件开发神经外科ICU患者发生VAP的列线图风险预测模型,绘制受试者工作特征曲线,发现曲线下面积为0.882(95%CI:0.827~0.929),提示该风险预测模型区分度良好,校正曲线显示列线图模型预测神经外科ICU患者VAP发生与实际观察的相关性较好。结论神经外科ICU患者VAP影响因素涉及气管切开、机械通气时间、误吸、血清白蛋白水平、抗生素使用种类及时间,在未来机械通气治疗过程中,临床工作者应在此基础上制定具体应对措施,减少VAP发生。展开更多
Mesenchymal stem cell(MSC)-based therapies have emerged as promising methods for regenerative medicine;however,how to precisely enhance their tissue repair effects is still a major question in the field.Circulating ex...Mesenchymal stem cell(MSC)-based therapies have emerged as promising methods for regenerative medicine;however,how to precisely enhance their tissue repair effects is still a major question in the field.Circulating extracellular vesicles(EVs)from diseased states carry diverse pathological information and affect the functions of recipient cells.Based on this unique property,we report that disease-derived circulating EV(disease-EV)preconditioning is a potent strategy for precisely enhancing the tissue repair potency of MSCs in diverse disease models.Briefly,plasma EVs from lung or kidney tissue injuries were shown to contain distinctly enriched molecules and were shown to induce tissue injury-specific gene expression responses in cultured MSCs.Disease-EV preconditioning improved the performance(including proliferation,migration,and growth factor production)of MSCs through metabolic reprogramming(such as via enhanced oxidative phosphorylation and lipid metabolism)without inducing an adverse immune response.Consequently,compared with normal MSCs,disease-EV-preconditioned MSCs exhibited superior tissue repair effects(including anti-inflammatory and antiapoptotic effects)in diverse types of tissue injury(such as acute lung or kidney injury).Disease-derived EVs may serve as a type of“off-the-shelf”product due to multiple advantages,such as flexibility,stability,long-term storage,and ease of shipment and use.This study highlights the idea that disease-EV preconditioning is a robust strategy for precisely enhancing the regenerative capacity of MSC-based therapies.展开更多
文摘目的对长沙市某三甲医院神经外科重症监护室(intensive care unit,ICU)患者呼吸机相关肺炎(ventilator associated pneumonia,VAP)影响因素进行调查,并探究其应对措施,为降低VAP发生提供科学依据。方法选取2019年2月—2022年2月湖南中医药大学第一附属医院神经外科ICU符合纳排标准全部患者400例临床资料,按照VAP发生与否分为发生组与未发生组。自行设计调查问卷,采集调查对象基线资料,采用单因素χ^(2)检验和多因素logistic回归分析VAP发生影响因素,并构建列线图风险预测模型。结果400例神经外科ICU患者,其中112例发生VAP,占28.00%,多因素logistic回归分析显示,气管切开、机械通气时间、误吸、血清白蛋白、抗生素使用种类及时间均为神经外科ICU患者发生VAP的独立影响因素(P<0.05);基于多因素logistic回归分析筛选出的独立影响因素结果,使用R语言软件开发神经外科ICU患者发生VAP的列线图风险预测模型,绘制受试者工作特征曲线,发现曲线下面积为0.882(95%CI:0.827~0.929),提示该风险预测模型区分度良好,校正曲线显示列线图模型预测神经外科ICU患者VAP发生与实际观察的相关性较好。结论神经外科ICU患者VAP影响因素涉及气管切开、机械通气时间、误吸、血清白蛋白水平、抗生素使用种类及时间,在未来机械通气治疗过程中,临床工作者应在此基础上制定具体应对措施,减少VAP发生。
基金supported by the National Natural Science Foundation of China(32071453,32271438,31871001 to Jingping Liu)the 1.3.5 Project for Disciplines of Excellence(ZYYC23001 to Jingping Liu,China),West China Hospital of Sichuan University.
文摘Mesenchymal stem cell(MSC)-based therapies have emerged as promising methods for regenerative medicine;however,how to precisely enhance their tissue repair effects is still a major question in the field.Circulating extracellular vesicles(EVs)from diseased states carry diverse pathological information and affect the functions of recipient cells.Based on this unique property,we report that disease-derived circulating EV(disease-EV)preconditioning is a potent strategy for precisely enhancing the tissue repair potency of MSCs in diverse disease models.Briefly,plasma EVs from lung or kidney tissue injuries were shown to contain distinctly enriched molecules and were shown to induce tissue injury-specific gene expression responses in cultured MSCs.Disease-EV preconditioning improved the performance(including proliferation,migration,and growth factor production)of MSCs through metabolic reprogramming(such as via enhanced oxidative phosphorylation and lipid metabolism)without inducing an adverse immune response.Consequently,compared with normal MSCs,disease-EV-preconditioned MSCs exhibited superior tissue repair effects(including anti-inflammatory and antiapoptotic effects)in diverse types of tissue injury(such as acute lung or kidney injury).Disease-derived EVs may serve as a type of“off-the-shelf”product due to multiple advantages,such as flexibility,stability,long-term storage,and ease of shipment and use.This study highlights the idea that disease-EV preconditioning is a robust strategy for precisely enhancing the regenerative capacity of MSC-based therapies.
