Objective To observe the changes of motor function and brain tissue transcriptomic profiles in mice with traumatic brain inury (TBI) by seawater immersion, and to explore its potential mechanism. Methods A total of 51 male C57/BL adult mice were randomly divided into sham surgery group, TBI group and TBI+seawater group (17 mice in each group). Behavior tests (rotating bar and balance beam tests) were performed at 1 d, 3 d and 7 d after injury to detect the changes of endurance and motor coordination ability in mice. Blood-brain barrier permeability (Evans blue staining) and brain tissue pathological changes (HE staining) were detected at 12 h and 24 h after injury. The expression levels of apoptosis-related proteins BCL-2 and Bax in brain tissues were detected with Western blotting 24 h after injury, and carry out brain tissue transcriptomics detection and analyze the related differentially expressed genes and signal pathways. Results Behavior tests showed that compared with the sham surgery group and TBI group, mice in TBI+seawater group had a significantly shortened time on the rotating bar (P<0.001) and spend a significantly prolonged time to pass through the balance beam (P<0.001) on 1 d, 3 d, and 7 d after injury. Evans blue staining showed that the EB permeation area of TBI+seawater group was significantly larger than that of the TBI group (P<0.05), and the EB permeation area at 24 h after injury was significantly smaller than that at 12 h after injury in both groups (P<0.05). HE staining results showed that the pathological damage in TBI+seawater group was worsened compared with TBI group. Western blotting results showed that 24 h after injury, the expression of Bax in TBI+seawater group was significantly increased (P<0.05) while the expression of Bcl-2 was significantly decreased (P<0.05) in injured brain tissue compared with TBI group. Transcriptomic analysis showed that there were 625 differentially expressed genes in the injured brain tissue of TBI+seawater group compared with TBI group (P<0.05), and the expression levels of p53-related genes and natural killer cell-related genes were significantly increased (P<0.05). Pathway enrichment analysis showed that natural killer cell immune regulation, lymphocyte immune regulation, and cytokine-cytokine receptor binding pathways were significantly enriched (P<0.05). Conclusions Seawater immersion can promote apoptosis of damaged neural cells in TBI mice, leading to impaired motor coordination and endurance in mice. Endogenous apoptosis mediated by p53 and immune regulation mediated by natural killer cells may be associated with this phenomenon.

Breast reconstruction is an important cosmetic repair after total mastectomy. Nipple-areola complex-sparing mastectomy (NSM) avoids such problems as nipples loss, poor nipple reconstruction, and complicated surgical procedures during breast reconstruction after total mastectomy, resulting in higher patient satisfaction. Prosthetic breast reconstruction is the most widely used breast reconstruction method with no donor injury, little trauma, low complication rate and re-operation rate. NSM combined with prosthetic breast reconstruction is safe, aesthetically pleasing, highly satisfied after surgery, and can significantly improve the patient's social mental health and quality of life. This article reviews NSM, implant breast reconstruction and the effects of adjuvant therapy on NSM combined with prosthetic breast reconstruction.

Objective To analyze the relationship between small intestinal bacterial overgrowth (SIBO) and gastroesophageal reflux disease (GERD). Method A total of 5832 patients who visited the Department of Gastroenterology, the Sixth Medical Center of Chinese PLA General Hospital from August 2019 to August 2021 were selected. The patients were divided into GERD group (n=1752) and non-GERD group (n=4080) according to gastroesophageal reflux disease. The two groups were compared for general features and SIBO prevalence. Subgroup analysis was performed in GERD group. The gastroesophageal reflux disease questionnaire (GerdQ) scores between the SIBO-positive group (n=1051) and the SIBO-negative group (n=701) were compared. The prevalence of SIBO was compared between the group with proton pump inhibitor (PPI) (n=1280) and the group without PPI (n=472). The prevalence of SIBO was compared between patients in non-erosive esophagitis (n=1051), erosive esophagitis (n=643) and Barrett's esophagus (n=58). Risk factors for GERD were analyzed by multivariate logistic regression. Results Age, body mass index, GerdQ score, smoking and prevalence of SIBO in GERD group were higher than those in non-GERD group (P<0.05). Multivariate analysis found that SIBO, obesity, drinking and smoking were risk factors for GERD. Subgroup analysis showed that the GerdQ score in SIBO-positive group (9.54±1.59) was higher than that in SIBO-negative group (8.40±1.54, P<0.05). The prevalence of SIBO in patients taking PPI (64.9%) was higher than that in patients without PPI (46.6%, P<0.05); The prevalence of SIBO in patients with erosive esophagitis (68.7%) and Barrett's esophagus (69.0%) was higher than that in patients with non-erosive esophagitis (54.1%, P<0.05). Conclusions SIBO is risk factor for GERD. Reflux symptoms are more severe when GERD patients have SIBO.

Sepsis is a serious disease with high incidence and mortality. The pathogenesis, clinical manifestations, and multiple organ dysfunction of sepsis are complex and diverse, and this high heterogeneity leads to many challenges in the treatment of sepsis. The ideal treatment of sepsis should be based on its subphenotypes and targeted to the specific one. This review summarizes the research progress on phenotyping of adult sepsis from the relevant definitions, research methods, existing subtypes (such as based on molecular mechanism, pathophysiological mechanism, clinical manifestations, etc.), and the possible new subtypes in the future. We expect to flash a light on the discovery of new subtypes and the basic clinical research for the treatment of septic subtypes through this paper.

Objective To investigate hepatitis B virus (HBV) reactivation in patients with diffuse large B-cell lymphoma (DLBCL) who were hepatitis B surface antigen negative/antibody to hepatitis B core antigen positive (HBsAg negative/anti-HBc positive) and received rituximab combined with CHOP (R-CHOP) chemotherapy regimen. Methods In this retrospective study, clinical data of 187 HBsAg negative/anti-HBc positive patients with DLBCL were collated and analyzed respectively from Hematology Department of Peking University Third Hospital from 2010 to 2018. All the patients received R-CHOP chemotherapy and did not receive prophylactic antiviral therapy. According to whether HBV was reactivated or not, these patients were divided into non-HBV reactivation group (174 cases) and HBV reactivation group (13 cases). Results The age of the patients in HBV reactivation group was significantly higher than that in non-HBV reactivation group [71(66, 80) years vs. 65(54, 75) years, P<0.05]. HBV DNA changed from undetectable baseline to detectable level in 13 patients (13/13, 100.0%). The time when HBsAg or HBeAg became positive in 2 patients was earlier than the time when HBV DNA could be detected. In 13 patients with HBV reactivation, 2 patients developed hepatitis related to HBV reactivation, and there was no fulminant hepatitis related to HBV reactivation. Serum HBsAg became positive in 7 of the 13 patients (7/13, 53.8%) with HBV reactivation, whereas serum HBeAg became positive in 3 patients (3/13, 23.1%). After HBV reactivation, HBV DNA reached an undetectable level again in 10 patients during follow-up, of which 7 patients received antiviral treatment. HBsAg became negative again in 2 HBsAg positive patients during follow-up. Conclusion DLBCL patients who were HBsAg negative/anti-HBc positive and treated with R-CHOP chemotherapy had a moderate risk of HBV reactivation. Close monitoring of HBV DNA levels and HBV serological markers should be performed in lymphoma patients who received R-CHOP chemotherapy.

Objective To explore the influence of external fixator combined with antibiotic-impregnated calcium sulfate on postoperative infection and bone healing in patients with open tibia and fibula fractures. Methods A total of 83 patients with open tibia and fibula fractures admitted to the First Affiliated Hospital of Hainan Medical College from June 2017 to June 2020 were selected, and according to the throwing method randomly divided into observation group (n=41) and control group (n=42). Patients in the control group were treated with external fixator, and those in the observation group were treated with external fixator combined with antibiotic-impregnated calcium sulfate. The bone healing (including complete weight bearing time, swelling elimination time, external fixator removal time, bone healing time), knee function (HSS score), ankle function (AOFAS score), quality of life, and incidence of complications were compared between the two groups. Results There was no statistically significant difference in the general data between the two groups (P>0.05). The complete weight bearing time, swelling elimination time, external fixator removal time, and bone healing time in observation group were shorter than in control group (P<0.05). There was no statistically significant difference in HSS score, AOFAS score and SF-36 score between the two groups before treatment (P>0.05). After treatment, the HSS scores and AOFAS scores of the two groups increased, and the observation group had higher scores than the control group (P<0.05). The SF-36 scores of the two groups increased, and the scores for energy, general health and physiological function in observation group were higher than in control group (P<0.05). There was no statistically significant difference in the incidence of malunion, nonunion and decreased muscle strength between the two groups (P>0.05), but the incidence of wound infection was lower in observation group than in control group (P<0.05). Conclusion External fixator combined with antibiotic-impregnated calcium sulfate is effective in treatment of patients with open tibia and fibula fractures, which can significantly reduce the postoperative infection rate and accelerate bone healing.

Objective To evaluate the risk factors of treatment outcomes in MDR-PTB patients with long-term treatment regimen in China. Methods 332 patients with MDR-PTB were recruited from 22 sentinel hospitals and 1 tertiary general hospital in 23 Provinces in China from January 2013 to December 2017. The treatment outcomes were investigated retrospectively, and the influencing factors of treatment outcomes were collected and analyzed. Results For the 332 patients, 196 cases were successful (59.04%), 76 cases failed (22.89%), 33 cases lost follow-up (9.94%), 12 cases died (3.61%), and 15 cases were transferred out (4.52%). The main factors affecting the outcome of treatment included age ≥50 years (OR=0.342, 95%CI 0.169-0.690), course of MDR-PTB ≥1 year (OR=0.297, 95%CI 0.108-0.815), irregular treatment (OR=0.429, 95%CI 0.197-0.934), cavities before treatment (OR=0.073, 95%CI 0.026-0.207) and positive sputum culture month 3 (OR=0.161, 95%CI 0.072-0.358), and cavity closure month 6 (OR=15.723, 95%CI 5.690-43.444) is predictor of success. Conclusions The result of this study indicated that age, course of MDR-PTB, irregular treatment, sputum culture in month 3, cavity before treatment and cavity closure in month 6 were the influencing factors of MDR-PTB outcome. In the initial stage of treatment of MDR-PTB patients, sputum culture results in month 3 and CT images have important predictive value for the treatment results of MDR-PTB patients.

Objective To analyze the drug resistance features of 118 patients with bone and joint tuberculosis. Methods The clinical data of 118 joint tuberculosis patients who were hospitalized in Beijing Chest Hospital from January 2016 to January 2022 were retrospectively analyzed. Drug susceptibility test was performed for the following 16 drugs streptomycin (Sm), isoniazid (INH), rifampicin (RFP), ethambutol (EMB), rifapentine (Rft), levofloxacin (Lfx), amikacin (Am), capreomycin (Cm), prothionamide (Pto), isoniazid aminosalicylate (Pa), moxifloxacin (Mfx), p-aminosalicylic acid (PAS), clarithromycin (Clr), rifabutin (Rfb), kanamycin (Km) and clofazimine (Cfz). Analyze the Mycobacterium tuberculosis culture results, drug sensitivity results, initial or retreatment status of patients with bone and joint tuberculosis, as well as the drug resistance types of patients diagnosed with bone and joint tuberculosis by etiology. Results The total drug resistance rate of 118 bone and joint tuberculosis patients to at least one of the 16 drugs was 28.0%(33/118), of which the drug resistance rate was significantly higher in previously treated patients than in new patients with statistically significant difference [70.0%(21/30) vs. 13.6%(12/88), P<0.001]. The top seven drug resistance rate of bone and joint tuberculosis to the 16 drugs were: Sm, INH, RFP, Rft, Rfb, Pa and Clr, and the top seven drug resistance rates of new patients were: Sm, INH, Clr, Pa, RFP, Rft and PAS, and the top seven drug resistance rates of in previously treated patients were: Sm, RFP, Rft, Rfb, INH, Pa and EMB. The mono-resistance rate of bone and joint tuberculosis, poly-drug resistance rate of spinal tuberculosis, and multidrug-resistance rate were 7.6%(9/118), 8.5%(10/118), and 11.9%(14/118), respectively. There was no significant difference of the mono-resistance rate of bone and joint tuberculosis between new patients and in previously treated patients [6.8%(6/88) vs. 10.0%(3/30), P=0.691], but the poly-drug resistance rate and the multidrug-resistance rate were significantly higher in previously treated patients than in new patients, and the differences were statistically significant [20.0%(6/30) vs. 4.5%(4/88), P=0.017; 40.0%(12/30) vs. 2.3%(2/88), P<0.001]. Conclusions There was serious epidemic of drug resistance in bone and joint tuberculosis. While performing surgical treatment, clinicians should develop effective drug treatment regimens according to the results of drug sensitivity tests.

Objective To investigate the prognostic value of C-C motif chemokine ligand 11 (CCL11) and midkine (MK) in serum of patients with differentiated thyroid carcinoma (DTC). Methods One hundred and fifty patients with DTC admitted in Henan Provincial People's Hospital from January 2015 to January 2017 were selected as DTC group, 150 patients with benign thyroid disease in the same period were selected as benign group, and 150 healthy volunteers were selected as control group. The serum CCL11 and MK levels of the three groups were compared. Patients in DTC group were divided into survival subgroup and death subgroup according to their prognosis. The clinical data between survival and death patients were compared. Cox regression analysis was used to analyze the factors affecting the prognosis of DTC patients. The receiver operating characteristic (ROC) curve was established to evaluate the diagnostic value of serum CCL11 and MK levels in the prognosis of DTC. Results Compared with control group, the levels of serum CCL11 and MK increased in DTC group and benign group, and the levels were higher in DTC group than in benign group (P<0.05). On the 3rd day after operation, the levels of serum CCL11 and MK were lower in both DTC group and benign group than those at the time of diagnosis, and still higher in DTC group than in benign group (P<0.05). In DTC group, 135 patients survived and 15 died. The age, tumor diameter, TNM stage, lymph node metastasis, capsular invasion, differentiation degree and serum thyroglobulin (Tg), CCL11, MK levels were significantly different (P<0.05) between the survived and dead patients with DTC. Cox regression analysis showed that TNM stage, lymph node metastasis and serum Tg, CCL11, MK levels were the prognostic factors of DTC (P<0.05). The results of ROC analysis showed that serum CCL11 and MK levels were of high value in diagnosis of DTC prognosis, and the diagnostic efficiency was higher when they were combine used (sensitivity 93.33%, specificity 73.33%, AUC 0.835). Conclusions The serum levels of CCL11 and MK were abnormally elevated in patients with DTC. The combined detection of serum levels of CCL11 and MK might have higher prognostic diagnostic value for DTC.

Objective To screen, identify and validate the immunoreactive epitopes on the glycoprotein-N terminal (Gn) of Hantaan virus (HTNV) for providing a new idea for prevention of hemorrhagic fever with renal syndrome (HFRS). Methods The Gn protein sequences of HTNV strain 76-118 were obtained from UniProt database. IEDB, SMMPMBEC, NetMHCpan 4.1, SYFPEITHI and Rankpep were used to predict epitope affinity. Immunogenicity was analyzed by VaxiJen. Blastp analyzed the conservation; HPEPDOCK and EpiDOCK simulated pMHC docking; TBtools implemented bidirectional cluster analysis; Immunoreactivity of epitope in vivo was evaluated by enzyme-linked immunospot assay. Results The Gn protein sequence of HTNV 76-118 strain (PRO_0000036816) was obtained from UniProt database. Five affinity algorithms were integrated to obtain 61 dominant epitopes in mouse H-2 subtype, 234 dominant epitopes in human major histocompatibility complex (MHC)-Ⅰ subtype, and 212 dominant epitopes in MHC-Ⅱ subtype. VaxiJen screening obtained 23, 110 and 42 dominant epitopes of H-2, MHC-Ⅰ and MHC-Ⅱ subtypes, respectively. Further Blastp screening resulted in 3 MHC-Ⅰ restricted epitopes with high affinity and strong immunogenicity, and 81 MHC-Ⅱ restricted epitopes conserved between species. Bidirectional hierarchical cluster analysis revealed the similarity of HTNV Gn epitopes in H2-d, H2-b of mice and some human leucocyte antigen (HLA). ELISpot verified that 5 epitopes could induce splenic cells to secrete interferon-gamma (IFN-γ). Conclusions The present study predicted and verified the cellular immunoreactive epitopes on HTNV Gn that can induce cellular immune reactivity, revealed the cross activity across-genes, species and genera immunoreactivity of viral antigens in MHC presentation, and provide guidance for the development of novel HFRS epitope vaccines.