Objective To investigate the risk factors for concomitant pulmonary thromboembolism (PTE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to construct a line graph prediction model accordingly and validate it. Methods 426 patients with AECOPD who attended the Affiliated hospital of North Sichuan Medical College from January 2019 to December 2021 were selected for retrospective analysis. The patients were divided into 256 cases in model group and 170 cases in validation group in a ratio of 6∶4. Indicators that may affect AECOPD patients with concurrent PTE were collected, and patients in model group were divided into PTE subgroup and non-PTE subgroup according to the presence or absence of concurrent PTE, and the above-mentioned indicators in the 2 subgroups were compared, and the independent influencing factors of AECOPD patients with concurrent PTE were screened by multifactorial logistic regression analysis, which was used to construct a column line graph prediction model. The prediction model was internally validated by Bootstrap method, and then externally validated by using the validation group data. Results A total of 39 (15.2%) of 256 AECOPD patients in model group were complicated by PTE. Multifactorial logistic regression analysis showed that Barthel index score, bed rest time, deep vein thrombosis of lower extremity, right heart insufficiency, PaO₂, fibrinogen, and C-reactive protein were independent influencing factors for complicated PTE in AECOPD patients (P<0.05). According to the results of multi-factor regression analysis, the column line graph prediction model was constructed using R4.1.3 software, and the internal validation area under ROC curve (AUC) of the model was 0.863, 95%CI was 0.798-0.927, sensitivity was 82.94%, and specificity was 74.36%; the internal validation results of the column line graph model by Bootstrap method showed that the mean absolute error was 0.02, and the prediction model was basically fitted with the ideal model; the external validation results showed that the AUC of the column line graph model constructed by the validation group was 0.892 with 95%CI of 0.803-0.942. Conclusions The major risk factors for concomitant PTE in patients with AECOPD include Barthel index score, bed rest time, deep vein thrombosis of lower extremity, right heart insufficiency, PaO₂, fibrinogen, and C-reactive protein, and the column line graph prediction model constructed from this has a high sensitivity and specificity.

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.

Objective To investigate the prevalence and risk factors of hypertension in young men first exposed to high altitude for half a year at 4500 m. Methods A total of 228 young men who firstly traveled from a plain area to an altitude of 4500 meters in northern Tibet and stayed there for six months were recruited in present study. They were divided into hypertension group (HTN, n=66) and non-hypertension group (NTN, n=162) based on their blood pressure status. A self-administered questionnaire, the Pittsburgh Sleep Quality Index (PSQI), physical examinations and laboratory tests were used to investigate the risk factors and clinical complications of hypertension. The general data and clinical complications of the two groups were compared, and multivariate logistic regression was used to analyze the risk factors of high-altitude hypertension and predisposition of clinical complications. Results Among the 228 individuals, 66 developed hypertension (incidence of 28.9%), including 52 cases of stage Ⅰ hypertension and 14 cases of stage Ⅱ hypertension. Fifty-eight individuals had isolated diastolic hypertension, and 8 individuals had combined systolic and diastolic hypertension. The proportions of obesity and overweight, central obesity, smoking over 10 cigarettes per day, family history of hypertension, dyslipidemia, and hyperuricemia were significantly higher in HTN group than those in NTN group (P<0.05). The PSQI score was also higher significantly in HTN group than that in NTN group (P<0.001). Multivariate logistic regression analysis showed that hyperuricemia (P=0.02), central obesity (P=0.04), family history of hypertension (P=0.03) and sleeping quality (P<0.001) were the independent risk factors for high-altitude hypertension. The proportion of clinical complications in the past month in HTN group was significantly higher than that in NTN group (P=0.001), and the proportion of three or more kinds of clinical complications was also higher in HTN group than that in NTN group (P=0.01). After adjusting for demographic differences, the risk of dizziness and headache in HTN group was higher than that in NTN group (P<0.05). Conclusions Young men firstly exposed to an altitude of 4500 meters still have a high incidence of hypertension after six months, mostly stage Ⅰ hypertension with diastolic pressure elevation; Hyperuricemia, central obesity, family history of hypertension, and poor sleep quality are the independent risk factors for high-altitude hypertension. High-altitude hypertension can cause various clinical complications, and the higher risk of accompanying dizziness and headache.

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.

The special environment of low oxygen in the plateau area will have a significant impact on human physiology and psychology, especially in a short period of time to reach the plateau, which can lead to the impairment of attention, memory, executive function, information processing and other types of cognitive functions, and directly affect health and working ability of people in the plateau. To correctly recognize and avoid the damage has become an urgent problem for researchers and clinicians. This paper summarizes the research status of the impact of acute high altitude hypoxia on human cognitive function in recent years, and summarizes the mechanism of high altitude hypoxia affecting brain physiological function, the damage characteristics of acute hypoxia on different types of cognitive function and hypoxia acclimatization strategies, in order to more clearly explain the relationship between high altitude hypoxia and cognitive changes, and better ensure the health and safety of people entering the plateau and Tibet.

Advances in the treatment of haematological malignancies have improved the long-term prognosis of patients to some extent, but have also highlighted the importance of tumour progression and cardiovascular events caused by anti-tumour therapy. A significant proportion of patients with haematological malignancies receiving existing and emerging oncological treatment regimens such as anthracyclines, proteasome inhibitors, targeted therapies and immunotherapy experience cardiovascular events at some point after disease remission, which seriously affects the survival and quality of life of the patients. This article reviews the mechanisms, clinical manifestations and interventions of cardiotoxicity induced by therapeutic agents for haematological malignancies, with the aim of providing a reference to protect patients with haematological malignancies from cardiovascular complications.

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 the effects and mechanisms of TAR DNA-binding protein 43 (TDP-43) on oxygen-glucose deprivation (OGD)-induced apoptosis in mouse atrial myocytes (HL-1 cells). Methods The in vitro cultured mouse atrial myocytes (HL-1 cells) were divided into: (1) control group and groups with different OGD treatment times (2, 4, 8, 16 h), and cell viability was detected by CCK-8 assay, and TDP-43 protein expression level was detected by Western blotting, which was used to determine the time point of OGD induction for the subsequent study; (2) control and OGD groups, flow cytometry was used to detect apoptosis, JC-1 staining to detect mitochondrial membrane potential, chemiluminescence to detect adenosine triphosphate (ATP) relative content, microplate method to detect malondialdehyde (MDA) content, and WST-1 method to detect superoxide dismutase (SOD) content. Mouse atrial myocytes (HL-1 cells) transfected with lentivirus were divided into: (1) negative control lentiviral intervention group (NC-shRNA), TDP-43 knockdown lentiviral intervention group (TDP-43-shRNA1, TDP-43-shRNA2, TDP-43-shRNA3), and Western blotting was used to detect the TDP-43 protein expression level, and the group with the highest lentiviral knockdown efficiency was selected as the TDP-43-shRNA for subsequent experiments; (2) NC-shRNA group, TDP-43-shRNA group, OGD+NC-shRNA group, OGD+TDP-43-shRNA group, under normoxic and OGD conditions, flow cytometry was used to detect the apoptosis rate, MitoTracker staining to detect mitochondrial morphology, JC-1 staining to detect mitochondrial membrane potential, chemiluminescence to detect the relative content of ATP, flow cytometry to detect the fluorescence intensity of reactive oxygen species (ROS), microplate to detect the content of MDA, and WST-1 to detect the content of SOD. Results CCK-8 method showed that, with the prolongation of OGD time, the viability of mouse atrial myocytes (HL-1 cells) gradually decreased; Western blotting assay showed that the expression level of TDP-43 protein gradually increased, and both of them showed a strong time-dependence. Compared with control group, mouse atrial myocytes (HL-1 cells) viability was the lowest (P<0.05) and TDP-43 protein expression was the highest (P<0.05) at 16 h of OGD, accordingly, OGD 16 h was chosen as the induction time point for subsequent experiments. Compared with control group, the apoptosis rate, the fluorescence intensity ratio of mitochondrial membrane potential and the content of MDA increased, the relative content of ATP and SOD decreased in OGD group, and the differences were all statistically significant (P<0.05). Western blotting detection showed that compared with NC-shRNA group, the TDP-43-shRNA2 group had the most obvious reduction in TDP-43 protein expression level (P<0.05) and the highest knockdown efficiency, so the TDP-43-shRNA2 group was selected for subsequent experiments. The results of flow cytometry showed that under normoxic conditions, there was no significant change in the apoptosis rate in TDP-43-shRNA group compared with NC-shRNA group (P>0.05); and under OGD conditions, the apoptosis rate in OGD+TDP-43-shRNA group reduced when compared with OGD+NC-shRNA group (P<0.05). MitoTracker staining results showed that the mitochondrial morphology of TDP-43-shRNA group was intact without significant changes compared with NC-shRNA group; the mitochondria of OGD+NC-shRNA group increased in number, most of which were fragmented and scattered in distribution; compared with OGD+NC-shRNA group, the mitochondrial morphology of OGD+TDP-43-shRNA group was restored. Under normoxic conditions, there were no significant changes in mitochondrial membrane potential, relative ATP content, ROS fluorescence intensity, MDA content, and SOD content in TDP-43-shRNA group compared with NC-shRNA group (P>0.05); however, under OGD conditions, the ratio of fluorescence intensity of mitochondrial membrane potential of cells the fluorescence intensity of ROS, and the content of MDA decreased, and the relative content of ATP and the content of SOD increased in OGD+TDP-43-shRNA group compared with that of OGD+NC-shRNA group, and all of these differences was statistically significant (P<0.05). Conclusion TDP-43 exacerbates OGD-induced mitochondrial dysfunction by regulating cardiomyocyte apoptosis; therefore, knockdown of TDP-43 expression is expected to be a potential therapeutic strategy for ischemic cardiomyopathy.

In military training, when the physiological heat stress load is excessive and cannot be corrected in time, heat illness may occur, and in severe cases, exertional heat stroke may occur, which will seriously affect the combat effectiveness. Rapid, effective and uninterrupted cooling is the key measure to relieve excessive heat stress reaction and prevent heat illness/stroke. Based on nearly 10 years of clinical practice experience, the scientific research achievements in heatstroke prevention areas, as well as domestic and foreign latest evidence, Expert Group of Heat Stroke Prevention and Treatment of the Chinese PLA summarized the temperature monitoring, preventive and therapeutic cooling strategies in the whole process of military training, and widely consulted the opinions of emergency and critical care experts in the military, and finally formed the consensus, thus being intended to provide guidance for the implementation of effective temperature management in military training.

Objective To investigate the effects of stem cells from human deciduous teeth (SHED) on temporomandibular joint osteoarthritis (TMJOA) in rats. Methods Sixty 8-week-old male SD rats were randomly divided into control group, sodium iodoacetate (MIA)-induced TMJOA group (MIA group) and SHED treatment TMJOA group (SHED group), 20 rats in each group, and 10 animals were sacrificed in each group 2 and 4 weeks after treatment and were collected. Temporomandibular joint (TMJ) on the left was used for morphological detection, and right TMJ condylar cartilage for molecular biology detection. The degree of cartilage degeneration was evaluated by HE and Saffron O-solid green staining, the expression of type collagen Ⅱ in condylar cartilage was detected by immunohistochemical staining, and the expression changes of cleaved-CASP3, the key molecule of apoptosis, and the pro-inflammatory factor tumor necrosis factor-α (TNF-α), were detected by Western blotting. Results Compared with control group, the arrangement of cells in each layer of condylar cartilage in MIA group was disordered, a large number of cell-free areas were visible, and the fibrous layer was significantly thickened (P<0.001). After SHED treatment, the morphology of SHED group basically returned to normal, and there was no significant difference between SHED group and control group. The histological score of Mankin's osteoarthritis of condylar cartilage in MIA group was significantly higher than that in control group (P<0.001). After treatment, the score decreased significantly in SHED group (P<0.001). The positive area ratio of Saffron-O staining and the percentage of positive area of collagen Ⅱ. Of condylar cartilage in MIA group were significantly lower than those in control group (P<0.001). After treatment, the value increased significantly in SHED group (P<0.01) and there was no significant difference compared with control group. The number of TUNEL-positive cells in the condylar cartilage in MIA group was significantly higher than that in control group (P<0.001). After treatment, this value decreased significantly in SHED group (P<0.001). Western blotting results showed that the protein expression levels of cleaved-CASP3 and TNF-α in the condylar cartilage of MIA group were significantly higher than those in control group (P<0.001). After treatment, this value decreased significantly in SHED group (P<0.001) and there was no significant difference compared with control group. Conclusion Intra-articular injection of SHED can reverse condylar cartilage degeneration induced by MIA.