Military traumatic brain injury (TBI) belongs to military psychiatry, which is a new subcategory of psychiatry. Military TBI has become a landmark injury in modern military conflicts, which not only has a high incidence and death rate, but also has many sequelae, bringing heavy burden to patients and society. There have been frequent reports on TBI, but the pathophysiological mechanism of trauma to human brain tissue caused by military action and war has not been extensively studied. In this paper, epidemiological data, pathogenesis, molecular biological diagnosis and research achievements of existing therapeutic techniques related to TBI were reviewed, especially in terms of pathophysiological mechanism, and the pathogenesis, pathophysiological changes, blood-brain barrier injury, neuroinflammation and immune response of military TBI induced concussion and impact brain injury were summarized. It will provide useful reference for further study of military TBI.

Objective To analyze the level of reactive oxygen species (ROS) produced by neutrophils and to explore its clinical significance in patients with chronic hepatitis B virus (HBV) infection. Methods Eighty-eight chronic HBV infected patients who admitted to the Fifth Medical Center of Chinese PLA General Hospital from April 2022 to September 2022 were enrolled in this study. Thirty patients who received nucleoside (acid) analogues (NAs) treatment were classified as the treated group, and fifty-eight did not receive treatment were classified as the untreated group. Simultaneously, twenty healthy individuals were classified as control group. The differences in clinical and virological parameters were compared between the three groups. The spontaneous ROS production by neutrophils after incubation with DHR 123 fluorescent dye were detected by flow cytometry. And the correlation between the spontaneous ROS and HBV DNA viral load, hepatitis B surface antigen (HBsAg), white blood cell (WBC), C-reactive protein (CRP), alanine transaminase (ALT) and aspartate transaminase (AST) were further analyzed. Culture medium, HepG2 cell supernatant and HepG2.2.15 cell supernatant were used to co-culture with neutrophils from healthy controls, respectively, to verify the effect of HBV virus particles and proteins on neutrophil spontaneous ROS in vitro. The secondary ROS production by neutrophils after lipopolysaccharide (LPS) stimulation was compared between the three groups. Results The spontaneous ROS production by neutrophils in the untreated group was higher than control group (P<0.05). The spontaneous ROS production by neutrophils in untreated patients was positively correlated with HBV DNA viral load and HBsAg quantification (r=0.315, P=0.016; r=0.326, P=0.013), but had no significant correlation with WBC, CRP, ALT and AST. HepG2.2.15 cell supernatant could induce the spontaneous ROS production by neutrophils in a dose-dependent manner (P<0.05). After LPS stimulation, the secondary ROS production by neutrophils in the untreated group and the treated group were lower than the control group (P<0.05). Conclusion Reducing the viral load by antiviral treatment contributes to reduction of spontaneous ROS production by neutrophils but not to restore the secondary ROS production by neutrophils after stimulated by LPS.

Diabetic cardiomyopathy (DCM) is a specific cardiomyopathy, independent of hypertension, coronary heart disease, valvular disease, congenital heart disease or other cardiovascular diseases. The pathogenesis of DCM is one of the current research hot spots in recent years. Due to the imbalance of glucose and lipid metabolism, the increase of oxidative stress and the activation of various inflammatory reactions, further mediating the myocardial cell and extracellular damage, resulting in pathological myocardial remodeling, diastolic and systolic dysfunction and eventually evolving into heart failure. At present, the effective methods for early screening and treatment of DCM are still limited. In order to better understand the specific mechanism of the occurrence and development of DCM, the latest research progress on pathophysiological mechanism, clinical manifestation and therapeutic prospect of DCM were reviewed for providing reference for the early clinical prevention and treatment of DCM.

Objective To explore the clinical application value of transvaginal ultrasound combined with the micro-vascular flow (MV-Flow) imaging in analyzing the ultrasound characteristics of endometrium during ovulation in women of childbearing age. Methods A total of 74 women of childbearing age who underwent transvaginal gynecological ultrasound examination in the First Medical Center of Chinese PLA General Hospital from May 2022 to July 2022 were selected. Among them, aged 22-48 (34.4±5.0) years, including 35 women ≥35 years old in the elderly group and 39 women <35 years old in the younger group. All patients with clinically diagnosed of infertility were divided into infertility group (27 cases) and healthy control group (47 cases). On the day of ovulation, the endometrial thickness, peristalsis score, volume of endometrium, pulsatility index (PI) and resistance index (RI) of uterine spiral artery, PI and RI of bilateral uterine arteries, three-dimensional energy doppler flow parameters [blood flow index (FI), vascularization index (VI), vascular blood flow index (VFI)] and endometrial microvascular bleeding vascularization index (VI_MV) were measured by the transvaginal ultrasound. The above ultrasonic indexes were compared and analyzed between the two groups. Results There was no significant difference in the history of infertility between the younger group and the older group (P>0.05). The RI of uterine spiral artery in the younger group was lower than that in the older group, while the three-dimensional energy doppler flow parameters (VI, FI, VFI) and the VI_MV of endometrium in the younger group were significantly higher than those in the older group. There was no significant difference in age stratification between infertility group and healthy control group (P>0.05). The endometrial thickness, endometrial peristalsis score, endometrial volume, endometrial three-dimensional energy doppler flow parameters (VI, FI, VFI) and the VI_MV in inferbility group were significantly lower than those in healthy control group (P<0.05). Conclusion Transvaginal ultrasound indicators can evaluate the endometrium characteristics of women of childbearing age during ovulation to some extent, especially, VI_MV can quantitatively analyze the microblood perfusion of endometrium.

Objective To evaluate the hemostatic efficacy and safety of a new type of pushable compressed cellulose hemostatic device in emergency treatment of deep tissue massive hemorrhage. Methods The internal compressed cellulose hemostatic granules were placed in excess normal saline to test their saline absorption and volume expansion properties. Femoral artery blood was taken from 3 big-eared white rabbits for measuring the in vitro clotting time of the compressed cellulose hemostatic granules, and equal quality CELOX-A® hemostatic powder was set as the positive control group, and the blank plasma as negative control group. Ten rats were divided into the compressed cellulose hemostatic granule dressing group, CELOX-A® hemostatic powder group and negative control group, and plasma was taken to test the coagulation activity by using a thromboelastometer. The swine models of massive hemorrhage were established by complete transection of the femoral artery and vein, and divided into the model group of medical defatted gauze block, the pushable compressed cellulose hemostatic device group, and the positive control group of CELOX-A®. The three groups used parallel operation for hemostasis. The number of pushable compressed cellulose hemostatic device used in the hemostasis process, the number of presses, the hemostasis time, the total blood loss during the hemostasis process were recorded, the routine blood tests before and after hemostasis, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured and HE staining was used to observe the pathological changes of the tissue vessels. After DMEM medium was used to extract the pushable compressed cellulose hemostatic device, and the extract was added to L929 cells with vigorous growth to test the cytotoxicity. At the same time, the complete DMEM medium with phenol was set as the positive control group and the complete DMEM medium as the negative control group. After pushable compressed cellulose hemostatic device was extracted with normal saline, the normal saline extract was injected into the mice to test its acute toxicity, and equal volume of the normal saline into the mice in the same way as the negative control group. The normal saline was set as the negative control group and the deionized water was set as the positive control group, the hemolysis test was used to detect the hemolysis rate of pushable compressed cellulose hemostatic device. Results The compressed cellulose hemostatic granules inside the device rapidly absorbed and expanded in normal saline buffer, the maximum absorption ratio was more than 7.3 times, and the swelling rate reached about (9.0±0.3) times after 3 s in normal saline buffer. The in vitro clotting time of the compressed cellulose hemostatic granules was (451.7±26.6) s, significantly shorter than that of the negative control group (703.7±32.1) s (P<0.01), and was also shorter than that of the CELOX-A® hemostatic powder about (521.7±18.1) s (P<0.05). The result of thromboelastography showed that compared with negative control group, both the compressed cellulose hemostatic granules and CELOX-A® hemostatic powder significantly shortened the clot formation time (P<0.01), and the compressed cellulose hemostatic granules had shorter coagulation time than CELOX-A® hemostatic powder (P<0.05). The evaluation results of hemostatic efficacy study on the model of massive groin hemorrhage by complete transaction of the femoral artery and vein in the swine showed the pushable compressed cellulose hemostatic device group used (1.2±0.4) devices to achieve hemostasis, while CELOX-A® group needed (2.2±0.4) devices (P<0.05), and the total hemostatic time needed for the pushable compressed cellulose hemostatic device and CELOX-A® was (185.5±2.4) s and (268.5±83.4) s, respectively, and the difference between them was statistically significant (P<0.05). The APTT, PT and pathological changes of tissue and blood vessels were not obvious after the experiment in the pushable compressed cellulose hemostatic device group. The results of in vitro cytotoxicity test, acute toxicity test and hemolysis test were all within the standard range. Conclusions Pushable compressed cellulose hemostatic device has favourable hemostatic efficacy and biological safety. The compressed cellulose hemostatic granule can rapidly block the injured vessel and effectively fill the wound cavity based on its strong absorption and swelling property. To summarize, the pushable compressed cellulose hemostatic device is a promising candidate to be used for controlling junctional hemorrhage and evacuation of the wounded, especially for the hemorrhage caused by gunshot or penetrating injuries in battlefield, thus saving valuable time for the further evacuation and treatment.

Objective To analyze the clinical features and pathological diagnosis of 3 cases of pineal region papillary tumor(PTPR), and review the related literature. Methods Three cases of PTPR patients were collected in the First Affiliated Hospital of Xinjiang Medical University from January 2012 to March 2021, and studied by HE staining and immunohistochemistry to observe its histological morphology and immunohistochemical phenotype. Combined with reviewing the relevant literature to understand the molecular characteristics of the disease and find potential therapeutic targets. Results The first symptom in the three PTPR patients were headache and intracranial hypertension. Histological examination showed that PTPR tumor cells formed a single-layer or stratified papillary structure surrounding the vascular. The distribution of the tumor cells had polarity, with more abundant cells near the vascular. Immunohistochemistry reveals strong reactivity for AE1/AE3, CAM5.2, cytokeratin 18 (CK18) and pair box 8(PAX8). The staining for vimentin (VIM) showed positive which is especially dense in cells near the vessel. The staining for nervous marker S-100 displayed diffuse positive in two cases while focal positive in the other one, while both glial fibrillary acidic protein(GFAP) and oligodendrocyte transcription-2 (OLIG-2) were negative in all the three cases. PTEN expression deficiency and p-Akt positive expression in the three cases. Literature reviews obtained 9 reports relevant to the molecular mechanism of PTPR, with 7 of them using genomic hybridization to detect chromosomal alterations in 29(29/62) patients, among which chromosome 10 loss and chromosome 8 gain were observed in 96.6%(28/29) cases and 57.1%(16/28) cases, respectively. Conclusions Exhibiting specific papillary structures, PTPR displayed specific immunohistochemical characteristics, which is helpful for diagnosis. PTEN protein deletion and positive expression of p-Akt and PAX8 suggested that PAX8, PTEN and PI3K/Akt/mTOR signal pathways played a potential role in the occurrence and development of PTPR and may become potential therapy targets.

Since the outbreak of the coronavirus disease 2019 (COVID-19), machine learning has been widely used in forecasting the epidemic trend of COVID-19, screening and tracking high-risk people, early diagnosis and monitoring of patients, etc., which has greatly improved the efficiency of information processing during the epidemic period and provided efficient decision support for clinicians. However, due to the different data types and scales and training methods used to develop models, machine learning that perform diagnosis or prognosis tasks also have different limitations. This review introduces the application of machine learning in the diagnosis and prognosis of COVID-19 from the aspects of machine learning combined with imaging data, laboratory results, and the model trained by integrating these two aspects, trying to provide more practical ways for machine learning in training and application.

Type 2 diabetes mellitus (T2DM) is often associated with anxiety disorders. It has been found that there is a complex pathogenic interaction between T2DM and anxiety disorders, but little is known about the mechanism of their overlap.Both T2DM and anxiety disorders are characterized by changes in the function of the central nervous system, share a common biological mechanism on neurobiochemistry, brain-derived neurotrophic factor (BDNF), immune inflammation, and hypothalamus-pituitary-adrenal (HPA) axis, but it is not clear whether it is the mechanism of overlap. The present article mainly reviews whether there is a correlation between T2DM and anxiety disorders in neurobiochemical-related mechanisms such as γ-aminobutyric acid(GABA), glutamate (Glu), 5-hydroxytryptamine (5-HT), dopamine (DA), BDNF, immune inflammation, and HPA axis, in order to explore the potential neuropathophysiological overlap mechanism of T2DM and anxiety disorders and to provide a reference for the treatment of the comorbidity.

Monogenic diabetes is a type of diabetes characterized by single gene mutation. Due to its heterogeneity and overlap with type 1 and type 2 diabetes, it is difficult to be accurately diagnosed clinically. Correct diagnosis is essential for certain types of monogenic diabetes, however, there is still a lack of simple clinical criteria for selecting patients for genetic testing or even interpreting the results of genetic testing. The classification of monogenic diabetes (including maturity onset diabetes of the young, neonatal diabetes mellitus, mitochondrial diabetes mellitus and syndromic diabetes mellitus) and the clinical diagnosis and corresponding treatment methods of monogenic diabetes based on the new generation sequencing and clinical characteristics have been reviewed in present paper for providing theoretical basis for clinical diagnosis of physicians as well as help to individualize the treatment of patients with monogenic diabetes.

Objective To evaluate the value of GeneXpert MTB/RIF Ultra (Xpert Ultra) in the early and rapid diagnosis of sputum and bronchoalveolar lavage fluid (BALF) samples in patients with smeared negative tuberculosis. Methods A total of 93 patients with sputum smear-negative suspected pulmonary tuberculosis who were admitted to Shandong Public Health Clinical Center from May 2020 to December 2021 were included in this study. Among them, 57 patients were clinically diagnosed as sputum smear-negative pulmonary tuberculosis and 36 patients were non-pulmonary tuberculosis. Sputum and BALF samples were collected from all patients, and Xpert Ultra, GeneXpert MTB/RIF (Xpert), BACTEC MGIT 960 culture (MGIT 960 culture) were performed. To evaluate the sensitivity, specificity and coincidence rate of various detection methods and their combined detection of sputum and bronchoalveolar lavage fluid samples in the diagnosis of smeared negative pulmonary tuberculosis. Results Taking clinical diagnosis as the reference standard, the sensitivity of sputum samples detected by Xpert Ultra for the diagnosis of smeared negative pulmonary tuberculosis was significantly higher than that of Xpert [56.14% (32/57) vs. 36.84% (21/57), P=0.039] and MGIT 960 culture [56.14% (32/57) vs. 33.33% (19/57), P=0.014]. The sensitivity of BALF samples detected by Xpert Ultra for the diagnosis of smeared negative pulmonary tuberculosis was significantly higher than that of Xpert [75.44% (43/57) vs. 56.14% (32/57),P=0.030] and MGIT 960 culture [75.44% (43/57) vs. 38.60% (22/57), P<0.01]. Three different methods of testing sputum samples, the area under the receiver operating characteristic curve (AUC) was the combination of the three elements (0.807)>Xpert Ultra+Xpert (0.798)>Xpert Ultra+MGIT 960 culture (0.789)>Xpert Ultra method (0.781)>Xpert (0.684)>MGIT 960 culture (0.667);Samples of BALF were examined, the AUC was the combination of the three elements (0.895)=Xpert Ultra+Xpert (0.895)>Xpert Ultra+MGIT 960 culture (0.877)=Xpert Ultra method (0.877)>Xpert (0.781)>culture method (0.693). Rifampicin resistance was not detected in the enrolled samples by the three detection methods. Conclusions Xpert Ultra has high clinical application value in the early and rapid diagnosis of smeared negative pulmonary tuberculosis, and the sensitivity of Xpert Ultra in the detection of BALF is higher than that of sputum sample, so the BALF sample is recommended as prior selection.