Objective To investigate the predictive value of central venous oxygen saturation (ScvO₂) in elderly patients with acute kidney injury (AKI) after robot-assisted partial nephrectomy (RAPN). Methods Seventy-eight elderly patients who underwent RAPN in the Department of Urology, the Third Medical Center of Chinese PLA General Hospital from February to September 2022 were selected. AKI was diagnosed according to the International Nephropathy Improving Global Prognosis Criteria, and the patients were divided into AKI group (n=22) and non-AKI group (n=56) according to whether AKI occurred after surgery. Blood gas analysis of venous blood was taken after central venous puncture (T₀), 5 min after renal artery occlusion (T₁), 5 min after renal artery opening (T₂), and after surgery (T₃). Hemoglobin (Hb), arterial blood lactic acid (Lac), arterial oxygen partial pressure (PaO₂), ScvO₂ were recorded respectively. Oxygen uptake rate (O₂ER) were calculated. Multivariate logistic regression analysis was used to analyze the risk factors for postoperative AKI. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of ScvO₂ for AKI in elderly patients after RAPN. Results Compared with non-AKI group, fasting plasma glucose (FPG) level in AKI group significantly increased at T₁-T₂ (P<0.05). Compared with T₀, FPG level in two groups obviously increased at T₁-T₃ (P<0.01). Compared with T₁, the FPG level in T₃ significantly increased in non-AKI group (P<0.01). Compared with non-AKI group, ScvO₂ in AKI group significantly increased at T₁-T₂ (P<0.01), Lac level at T₂ significantly increased (P<0.05). There was no significant difference in O₂ER between the two groups at each time point (P>0.05). Compared with T₀, O₂ER in T₁-T₃ significantly decreased (P<0.01), and ScvO₂ in both groups significantly increased (P<0.01). Compared with T₁, ScvO₂ in non-AKI group significantly increased at T₂-T₃ (P<0.05 or P<0.01). Compared with T₂, ScvO₂ in non-AKI group significantly increased in T₃ (P<0.05). Multiple-factor analysis showed that T₁ ScvO₂ (OR=1.127, 95%CI 1.006-1.263, P=0.039) was an independent risk factor for AKI after RAPN. ROC curve analysis showed that T₁ ScvO₂ had a sensitivity of 77.3%, specificity of 71.4%, truncation value of 81%, and area under the curve (AUC) of 0.761 in predicting AKI after RAPN. Conclusion ScvO₂ has certain predictive value for the occurrence of short-term AKI after RAPN.

Incompressible massive hemorrhage at the junction of trunk and limbs is the major cause of the potential preventable death in modern military conflicts, natural disasters and sudden trauma accidents. Because of the failure of direct compression hemostasis, aortic occlusion can reduce the amount of bleeding and provide a short time for injury recovery and accurate control of bleeding. As an effective assistant hemostasis method, resuscitative endovascular balloon occlusion of the aorta (REBOA) has shown initial potential in military and civilian hospitals and even pre-hospital trauma emergency treatment. With the continuous development of catheter guide technology, it is expected to achieve the emergency hemostasis treatment of war wound and massive hemorrhage. Basic and pre-clinical studies have been carried out in Europe and America, and the technology has been applied to the treatment of some patients with massive bleeding, but rarely reported in China. This paper reviews the history, scope, limitations and improvement of application and military application of REBOA in the treatment of traumatic hemorrhage, so as to promote the recognition of REBOA.

Objective To investigate the effects of astragaloside Ⅳ (AS-Ⅳ) on axon growth inhibitory factor A (Nogo-A) and its downstream pathway protein RHO-associated coiled spiral kinase 2 (ROCK2) in experimental autoimmune encephalomyelitis (EAE) mice, and to explore the mechanism by which it promotes axon repair and regeneration. Methods EAE model was induced in C57BL/6 female mice by subcutaneous injection of myelin oligodendrocyte glycoprotein 35-55 (MOG35-55). Mice were randomly divided into EAE group and AS-Ⅳ group (n=8 per group). EAE group received intraperitoneal injection of PBS on the 3rd day post-immunization, while AS-Ⅳ group was administered AS-Ⅳ at a dosage of 30mg/(kg.d) once daily, 0.2 ml per injection, for 25 consecutive days. On the 28th day post-immunization, the expression levels of growth-associated protein 43 (GAP-43), neuronal core antigen (NeuN), microtubule associated protein 2 (MAP-2), glial fibroacidic protein (GFAP), and Iba1 in the spinal cord were detected using immunofluorescence assay. Real-time fluorescence quantitative PCR (qRT-PCR) was conducted to detect mRNA expression levels of GAP-43, Nogo-A, and Nogo receptor (NgR) genes. Western blotting was utilized to determine the expression levels of GAP-43, Nogo-A, ROCK2, phosphorylated myosin phosphatase (p-MYPT1), B-lymphoblastoma-2 (Bcl-2), and Bcl-2 associated X protein (Bax). Results Compared with EAE group, AS-Ⅳ treatment significantly reduced the positive cell expression rates of Iba1 microglia and GFAP astrocyte in spinal cord (P<0.01 and P<0.001,respectively), while it also increased the positive expression rates of NeuN and MAP-2 (P<0.001 and P<0.05, respectively). The treatment also upregulated the expression level of anti-apoptotic factor Bcl-2 (P<0.001) and downregulated the expression level of pro-apoptotic factor Bax (P<0.05), leading to an increase in Bcl-2/Bax ratio (P<0.05). Furthermore, AS-Ⅳ enhanced the expression of GAP-43 protein (P<0.05) and decreased the mRNA expression levels of neuroregeneration inhibitor Nogo receptor (NgR) and ROCK2 gene (P<0.001, P<0.05, respectively); as well as decreased the expression levels of Nogo-A, ROCK2 and p-MYPT1 proteins (P<0.05, P<0.001). Conclusion AS-IV may inhibit the activation of microglia and astrocytes and neuronal apoptosis in EAE mice by inhibiting Nogo-A and downstream pathway ROCK2, thereby promoting the expression of GAP-43, NeuN and MAP-2, alleviating neuronal damage, and facilitating axon repair and regeneration.

Uric acid, the end product of purine metabolism in human body, can lead to uric acid metabolism abnormality when its production and excretion are out of balance. This abnormality has emerged as one of the important risk factors for metabolic diseases, including diabetes, obesity, hypertension and metabolic syndrome. Recent studies have found that abnormal uric acid metabolism increases the risk of occurrence and development of type 2 diabetes mellitus (T2DM) and its complications, suggesting that uric acid metabolism could be a novel approach for intervening in T2DM. This review summarizes the research progress on how uric acid metabolism abnormality influences the occurrence, development and pathogenesis of T2DM, the beneficial effects of uric acid-lowering therapy, and the selection of hypoglycemic drugs on T2DM, which provide evidence for the early prevention and treatment of T2DM and its complications.

Hemophagocytic syndrome (HPS), also known as hemophagocytic lymphohistiocytosis (HLH), is a rare and highly malignant hematologic disease with a poor prognosis. It can be divided into two categories: primary HLH and secondary HLH. HLH is characterized by a large number of abnormal immune cells that continuously activate and regulate out of control, leading to systemic inflammatory factor storm and multiple organ failure. Clinical manifestations mainly include persistent malignant hyperthermia, pancytopenia, hepatosplenomegaly, and hemophagocytosis in tissues and organs. The pathogenesis of adult HLH is complex, with rapid onset and rapid disease progression, and the fatality rate remains high. The main causes of death in HLH patients are multiple organ failure, abnormal coagulation and septic shock. Due to the specificity of HLH and the lack of effective understanding of the severity and prognosis in clinical practice, some HLH patients are misdiagnosed or overlooked, missing the best opportunity for diagnosis and treatment. Therefore, this review systematically explores and discusses the latest diagnostic and treatment progress of adult HLH, aiming to provide reference for clinical diagnosis, treatment and prognosis assessment of HLH.

Linezolid, a fully synthetic oxazolidinone antibiotic, is mainly used to treat severe infections caused by Gram-positive drug-resistant bacteria. In recent years, with the rise in drug-resistant bacteria, the clinical utilization rate of linezolid and the incidence of linezolid-related adverse reactions in the hematological system and metabolic system have increased. The main adverse reactions include thrombocytopenia, anemia and lactic acidosis. Studies have shown that the causes of adverse reactions in linezolid-induced hematological system and metabolic system are diverse, and the mechanisms are not fully elucidated. In this review, the pharmacokinetic characteristics, mechanism of adverse reactions, risk factors, as well as preventive measures and individualized drug administration strategies of linezolid in vivo were discussed based on literature reports at home and abroad, aiming to provide references for clinical prevention and treatment of linezolid-related adverse reactions of hematological system and metabolic system.

Objective To explore the influence factors and predictors of treatment response after adrenocorticotropic hormone (ACTH) in infantile epileptic spasms syndrome(IESS). Methods A retrospective analysis was conducted on 80 cases of IESS infants(50 males and 30 females) who were diagnosed and treated with ACTH in Chengdu Women's and Children's Central Hospital from January 2016 to December 2020. Patients were divided into effective group (n=39) and ineffective group (n=41) based on their response of ACTH treatment after 28 days, and their clinical data including the patients' basic information, etiology, treatment programmer, per- and post-treatment Kramer scores of electroencephalogram (EEG) hypsarrhythmia severity and so on, were collected to compare and analyze between the two groups. A modified Poisson regression model was constructed to discover predictors of outcome, and the receiver operating characteristic (ROC) curves were used to assess the prognosis evaluation of the positive predictive value. Results The ages at seizure onset ranged from one month and seven days to one year and nine months. Seizure types included simple epileptic spasms in 66 cases and combined with other types(focal and secondarily generalized seizures) in 14 cases. Thirty-two cases had been given anti-seizure medications (ASMs) before ACTH treatment. The median Kramer scores per-treatment and at 14 days post-treatment were 10.0 (8.3, 12.0) and 6.0 (4.0, 7.0), respectively. After ACTH treatment, 39(48.8%) cases were effective. Compared with the effective group, the ineffective group had significantly higher proportion of abnormal perinatal conditions, unknown aetiology with normal development, ASMs given before ACTH treatment, the dosages of ACTH greater than 2 U/(kg·d), combinations of two or more ASMs, poor control, and still seizure attack after ACTH treatment of 14 days (P<0.05). Additionally, the Kramer scores after ACTH treatment of 14 days in the ineffective group were also significantly higher (P<0.05). The modified Poisson regression model showed that there were significant statistic differences between the two groups on ASMs given before ACTH treatment (RR=0.546, 95%CI 0.357-0.833, P=0.005) and Kramer scores of hypsarrhythmia severity (RR=0.701, 95%CI 0.620-0.792, P<0.001),while there were no significant differences between the two groups in term of ages, gender, perinatal conditions, etiologies, seizure types, Kramer scores before treatment, time lag between onset and treatment, duration of ACTH treatment, kinds of ASMs combination. ROC curve analysis showed that only Kramer scores at 14 days after ACTH treatment could predict the treatment response with sensitivity and specificity of 92.7% and 84.6%, respectively, with Youden index of 0.773. The area under the ROC curve was 0.930 (95%CI 0.873-0.987, P<0.001) and the cut-point of the score was 6, indicating that the higher the Kramer scores at 14 days after ACTH treatment, the worse the treatment response. The treatment response rate would reduce by about 30.0% if the Kramer score increased by one point. Conclusion ASMs given before ACTH treatment may influence the treatment response. Kramer scores greater than 6 at day 14 after ACTH treatment may be used as a predictor of treatment response after ACTH in IESS patients.

Objective To evaluate the perioperative anxiety state and analyze the influencing factors of burned patients. Methods A total of 110 burned patients undergoing selective surgery under general anesthesia were included in the Fourth Medical Center of Chinese PLA General Hospital from February to August 2022. All patients were evaluated with self-rating anxiety scale (SAS), visual analogue scale-anxiety (VAS-a), visual analogue scale-pain (VAS-p), mini-mental state examination (MMSE), and Ramsay sedation score 1-day before and after operation. The patients' parameters were recorded including mean arterial pressure (MAP) and heart rate (HR) at admission (T₀), before anesthesia induction (T₁), 2 min after intubation (T₂), 15 min after surgery (T₃), during surgery (T₄), at surgery end (T₅), and immediately after leaving the operating room (T₆). The occurrence and the influencing factors of perioperative anxiety in burn patients were analyzed using the univariate and multivariate logistic regression. Results The incidence of preoperative and postoperative anxiety in burn patients was 29.1% and 22.3% respectively. Univariate logistic analysis showed that gender (P=0.002), burn time (P=0.046), burn area (P=0.005), burn site (P=0.035), and degree of preoperative pain (P=0.001) were related with preoperative anxiety status in burn patients; while burn time (P=0.030), burn area (P=0.001), burn site (P=0.016), degree of preoperative pain (P=0.021), and preoperative anxiety status (P<0.001) were related with postoperative anxiety state in burn patients. Multivariate logistic regression analysis showed that gender and degree of preoperative pain were the independent influencing factors of preoperative anxiety status in burn patients (P=0.002, 0.022), and preoperative anxiety status was the independent influencing factor of postoperative anxiety status in burn patients (P<0.001). Compared with the preoperative non-anxious patients (n=73), preoperative anxious patients (n=30) showed no significant difference in MAP at each time point (P>0.05), but HR was accelerated (P<0.05), and the dosage of sufentanil, remifentanil and propofol increased significantly during the operation (P<0.05). Conclusions The anxiety state of burn patients was significantly higher before operation than that after operation, and their consumption of anesthetic drugs during operation was higher, and there was no significant correlation with the type and number of operation. Gender, degree of preoperative pain and anxiety state were the independent influencing factors of perioperative anxiety state in burn patients. Early intervention against relevant factors will help patients recover quickly.

Objective To report the clinical and imaging characteristics of a case with the clinical manifestation of multiple lung and liver nodules, diagnosed as IgG₄-related hepatic inflammatory pseudotumor (HIPT) complicated by hepatic tissue-infection, and review the literature in order to facilitate clinical diagnosis and differential identification of IgG₄-related HIPT. Methods A retrospective analysis was conducted on the medical records of a patient with IgG₄-related disease (IgG₄-RD) characterized by multiple lung and liver nodules. A literature review was performed by searching Chinese and English databases to summarize the clinical and imaging characteristics of IgG₄-related HIPT and hepatic tissue infection. Results The case involved a 64-year-old female admitted to the Rheumatology and Immunology Department of the First Medical Center of Chinese PLA General Hospital due to "poor appetite and fatigue for over a year, and dry cough for four months". She presented with multiple nodules in the lungs and liver, without involvement of the eyelids, salivary glands, submandibular glands, or pancreas. Laboratory test results revealed elevated serum IgG₄ levels at 14.1 g/L and C-reactive protein (CRP) at 82.1 mg/L. Pulmonary CT scans indicated multiple solid nodules in both lungs with clear boundaries. Abdominal contrast-enhanced MRI revealed a nodule in liver segment S7 with a pseudocapsule around it, clear boundaries, and uniform enhancement; another nodule in liver segment S5 with blurred boundaries and ring enhancement. The final diagnosis of the liver nodules was confirmed by pathological and metagenomic sequencing to be an IgG₄-related HIPT in segment S7 and hepatic tissue infection in segment S5. After a full course of anti-infection and treatment with methylprednisolone and leflunomide, follow-up imaging showed near-complete resolution of the lung and liver nodules. Literatures were searched in China National Knowledge Infrastructure (CNKI), Wanfang, and PubMed databases (up to September 2023), and no case of IgG₄-RD complicated with both liver involvement and infection was found. A total of 26 cases of IgG₄-RD involving the liver have been reported so far, predominantly in males (92.3%), with an average age of 51 years. Most patients presented with abnormal liver function as the initial symptom, with normal blood inflammatory markers. Imaging typically shows a single nodule in 88.5% of cases, with clear boundaries and uniform enhancement, as well as ring enhancement. Concurrent involvement of the pancreas and biliary tract is common. Pathology is the gold standard for confirming the disease. Conclusions This case reports coexistence of IgG₄-related HIPT and infection within multiple hepatic nodules. In the diagnosis and treatment of patients with IgG₄-RD presenting with multiple hepatic nodules, if the imaging characteristics of the nodules are inconsistent, it is necessary to consider the possibility of the underlying disease coexisting with other conditions, which can be easily misdiagnosed. Actively obtaining pathological tissue is crucial for aiding in the definitive diagnosis.

Objective To investigate the influences and mechanism of X chromosome inactivation specific transcript (XIST) on the proliferation and extracellular matrix synthesis of nucleus pulposus cells in rats with intervertebral disc degeneration (IDD). Methods SD rat intervertebral disc nucleus pulposus cells were isolated and cultured in vitro, and then randomly divided cells into control group, model group, XIST knockdown group, empty plasmid group, and XIST knockdown+miR-132-3p knockdown group. Except for control group, the cells in other groups were induced by interleukin (IL)-1β to establish IDD models. After nucleus pulposus cells were grouped and treated, the expressions of XIST and miR-132-3p in the nucleus pulposus cells of rats were detected by qRT-PCR; the proliferation of intervertebral disc nucleus pulposus cells was detected by MTS method and EdU staining; ELISA was used to measure the levels of inflammatory factors IL-6 and IL-18 in the intervertebral disc nucleus pulposus cells; Immunoblotting was used to detect the expression of extracellular matrix labeled proteins Collagen Ⅱ and Aggrecan in rat nucleus pulposus cells. The targeted regulation of miR-132-3p by XIST in rat nucleus pulposus cells was detected by dual-luciferase reporter gene assay. IDD rat models were established by intramuscular injection of IL-1β and divided into sham operation group, model group, XIST knockdown group, no-load plasmid group, XIST knockdown+miR-132-3p knockdown group, with 12 rats in each group. After treatment in each group, the expressions of XIST and miR-132-3p in intervertebral disc tissues were detected by qRT-PCR; TUNEL staining was used to detect apoptosis of nucleus pulposus cells in intervertebral disc tissue of rats; the morphology of intervertebral disc cartilage was observed by saffron O staining; serum levels of inflammatory factors IL-6 and IL-18 were determined by ELISA; the expressions of Collagen Ⅱ and Aggrecan in intervertebral disc tissues were detected by Western blotting. Results Compared with control group (cells)/sham operation group (rats), XIST expression in intervertebral disc tissue and nucleus pulposus cells, apoptosis rate of intervertebral disc nucleus pulposus cells, levels of inflammatory factors IL-6 and IL-18 in intervertebral disc nucleus pulposus cells culture medium and serum were increased in model group (P<0.05), the activity and proliferation rate of nucleus pulposus cells and the expressions of miR-132-3p, Collagen Ⅱ and Aggrecan protein in nucleus pulposus cells and intervertebral disc tissues decreased (P<0.05); compared with model group, the apoptosis rate of nucleus pulposus cells, the levels of inflammatory factors IL-6 and IL-18 in intervertebral disc nucleus pulposus cells culture medium and serum, and the expression of XIST in nucleus pulposus cells and intervertebral disc tissues of rats in XIST knockdown group decreased (P<0.05), the activity and proliferation rate of nucleus pulposus cells and the expressions of miR-132-3p, Collagen Ⅱ and Aggrecan protein in nucleus pulposus cells and intervertebral disc tissues increased (P<0.05). Down-regulation of miR-132-3p attenuates the ameliorative effect of knockdown XIST on IL-1β-induced intervertebral disc injury and cartilage matrix loss. XIST was able to target and down-regulate the expression of miR-132-3p in rat nucleus pulposus cells. Conclusion Knockdown of XIST can inhibit inflammation by up-regulating miR-132-3p, thereby inhibiting the apoptosis of IDD nucleus pulposus cells and promoting their proliferation and extracellular matrix synthesis.