Objective To investigate the predictive value of continuous non-invasive arterial pressure monitor (CNAP)combined with passive leg raising (PLR) test for volume responsiveness assessment in patients with septic shock. Methods Prospective and observational study was performed in the patients with septic shock admitted to the Fourth Department of Intensive Care Unit (ICU) of Fujian Provincial Hospital from July 2019 to July 2020. Subclavian venous catheter was indwelled in each patient, then the hemodynamic parameters including heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP),cardiac output (CO) and pulse pressure variability (PPV) were measured non-invasively by CNAP before and after PLR and volume expansion (VE) test. The changes of CO during PLR test (ΔCO_PLR) and VE test (ΔCO_VE) were calculated respectively. Patients were classified as responder group or non-responder group according to the ΔCO_VE increased ≥15% or not after VE test. Moreover,Pearson's test was used for the correlation analysis. The roles of ΔCO_PLR and PPV before VE test in predicting volume responsiveness were evaluated by receiver operating characteristic (ROC) curve. Results A total of 40 VE tests in these 36 patients were evaluated and resulting in 18 responder group and 22 non-responder group. There was no significant difference between two groups in the hemodynamics parameters before PLR and VE test (P>0.05). Both in responder group and non-responder group, there was no significant change in HR and MAP after PLR and VE test (P>0.05). After PLR, CVP did not change significantly in the two groups(P>0.05). CVP after VE test increased significantly in the two groups (P<0.05), but there was no significant difference between the two groups (P>0.05). CO was obviously increased after PLR and VE test in the two groups (P<0.05). In responder group, CO after PLR and VE test were significantly higher than those in non-responder group [(6.01±1.28) L/min vs. (5.16±1.22) L/min,(6.31±1.33) L/min vs. (5.15±1.39) L/min, P<0.05]. Besides, the ΔCO_PLR and ΔCO_VE in responder group were significantly higher than those in non-responder group (21.21%±8.54% vs. 10.76%±4.94%, 26.32%±8.64% vs. 9.44%±3.45%, P<0.05).Correlation analysis showed that the ΔCO_PLR was positively related to ΔCO_VE (r=0.820, P<0.05), while the PPV before VE test was unrelated to ΔCO_VE (r=0.194, P>0.05). Furthermore, the area under the ROC curve (AUC) of ΔCO_PLR and PPV predicting volume responsiveness were 0.855 (95%CI 0.707-0.946, P<0.05) and 0.525 (95%CI 0.362-0.685, P>0.05) respectively. The sensitivity and specificity of ΔCO_PLR ≥13.95% to predict volume responsiveness in patients with septic shock were 83.3% and 81.8%, respectively. Conclusion ΔCO_PLR measured by CNAP can predict the volume responsiveness in patients with septic shock and it is reliable to guide further fluid resuscitation.

Objective To analyze the chromosome karyotype and Y chromosome microdeletion of male infertility. Methods Retrospective analysis of the clinical test data of 550 infertile patients who were treated at the Reproductive Center of the Sixth Medical Center of Chinese PLA General Hospital from September 2018 to December 2020. Among them, there were 187 patients of azoospermia and 363 patients of oligozoospermia (90 patients of very severe oligospermia, 101 patients of severe oligospermia, 172 patients of mild to moderate oligozoospermia). Two hundred and forty-six normal males were included as controls.Everyone underwent peripheral blood chromosome karyotype and Y chromosome microdeletion examinations. Among them, 156 patients of azoospermia, 70 patients of very severe oligospermia, 75 patients of severe oligospermia and 75 patients of normal men were tested for sex hormones [luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), testosterone (T)].The sex hormone levels of different sperm concentrations and Y chromosome microdeletion population were compared. Results Among 550 infertile patients and 246 normal men, there were 62 patients of karyotype abnormalities or chromosomal normal polymorphisms, among which: 28 patients of chromosomal abnormalities; 34 patients of chromosomal normal polymorphisms. A total of 38 patients of Y chromosome microdeletion were detected in 550 infertile patients, 17 patients of azoospermia, 18 patients of very severe oligospermia, 2 patients of severe oligospermia and, 1 patient of mild to moderate oligospermia, AZFc region deletion is the most common type. In patients with azoospermia, very severe oligospermia and severe oligospermia, the level of FSH in those with Y chromosome microdeletion is higher than that of those without Y chromosome microdeletion (P=0.032). Conclusions Chromosomal abnormalities can occur in male infertile patients. The incidence of Y chromosome microdeletion is relatively high in male infertile patients. Genetic examination can help to determine whether they have genetic diseases, so as to choose appropriate treatment methods and assisted reproduction methods.

Objective To investigate the effects of different target hypothermia on the cardiovascular function and prognosis of rats after cardiopulmonary resuscitation. Methods A total of 44 male SD rats were induced with electrical stimulation to ventricular fibrillation (VF) for 8 minutes, then cardiopulmonary resuscitation (CPR) was performed for 8 minutes followed by electric defibrillation (DF). Totally 28 SD rats survived VF, and randomized into either 37 ℃ normothermia group, 35 ℃hypothermia group, 33 ℃ hypothermia group or 28 ℃ hypothermia group (7 each) after restoration of autonomic circulation(ROAC). Hypothermia was immediately induced with surface cooling to the target temperature. The target temperature was maintained for 4 hours before rewarming to (37±0.2) ℃. Survived animals were observed for up to 72 hours. Mean aortic pressure(MAP), ejection fraction (EF), heart rate (HR), blood lactate level (Lac), microcirculation of buccal flow (MBF), duration of survival, survival rate and neurological deficit score (NDS) were measured during hypothermia and post-rewarming. Results During CPR, there were no difference in coronary perfusion pressure (CPP), times of DF, duration of VF-ROAC (P>0.05). During hypothermia treatment, the slowest HR was observed in the 28 ℃ hypothermia group, and the highest HR was observed in the 37 ℃ normothermia group; The levels of MAP and EF were higher in hypothermia groups than in normothermia group, among which the EF level (%) was obviously higher in 33 ℃ hypothermia group and 28 ℃ hypothermia group than in 35 ℃ hypothermia group [(63.8±6.1, 67.8±8.4)% vs. (54.0±5.2)%, P<0.05]; the Lac level was markedly lower in 33 ℃ hypothermia group and 35 ℃ hypothermia group than in 37 ℃ normothermia group and 28 ℃ hypothermia group (P<0.05); the MBF levels were lower in hypothermia groups than in normothermia group, while no statistical significant difference existed in MBF level among the 3 hypothermia groups (P>0.05). After rewarming, the EF level was markedly higher in 35 ℃ hypothermia group than in the 33 other groups [(52.9±3.3)% vs. (46.9±6.2, 38.5±7.5, 35.8±7.3)%, P<0.05]; MBF was obviously recovered in 33 ℃ and 35 ℃hypothermia groups compared with that in 28 ℃ hypothermia group [(2.8±0.4, 2.4±0.5) vs. (1.6±0.6), P<0.05], but no difference existed between 33 ℃ and 35 ℃ hypothermia group. The duration of survival, survival rate and NDS score were much better in 33 ℃ and 35 ℃ hypothermia groups than in 28 ℃ hypothermia groups and 37 ℃ normothermia group, but no difference between 33 ℃ and 35 ℃ hypothermia groups (P<0.05). Conclusions Hypothermia therapy with 33 ℃ and 35 ℃ target temperature may protect the blood circulation function of rats after CPR, reduce nerve function injury and improve prognosis. Hypothermia therapy with 35 ℃ target temperature might be a new choice for treatment of patients with clinical cardiac arrest after recovery.

Objective To explore the predictive value of preoperative inflammatory immune and nutritional indicators[neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), platelet to serum albumin ratio (PAR) and prognostic nutritional index (PNI)] for the prognosis of patients with thymoma. Methods The clinical data of 109 patients with thymoma,admitted in the Department of Thoracic Surgery, the Second Hospital of Lanzhou University from February 2014 to December 2019, were retrospectively analyzed. The relationships of preoperative NLR, PLR, PAR and PNI to patients' overall survival (OS)were analyzed by receiver operating characteristic (ROC) curves, the best cut-off value was calculated and then used for patients grouping. The Kaplan-Meier survival analysis was used to draw the OS and progression-free survival (PFS) curve of thymoma patients and calculate the cumulative survival rate. The influence factors affecting the prognosis of thymoma patients were analyzed with univariate and multivariate Cox proportional hazards regression model. Results Among 109 thymoma patients, there were 57 males (52.3%, 57/109) and 52 females (47.7%, 52/109), the age ranged in 19-84 (51.3±9.9) years, and no perioperative death occurred. The area under the curve (AUC) with NLR, PLR, PAR and PNI to predict the OS of thymoma patients were 0.484 (P=0.832), 0.600 (P=0.181), 0.708 (P=0.005) and 0.693 (P=0.010), respectively. The best cut-off values of PNI and PNI were 5.05 and 51.48, respectively. Compared to the patients with low PAR, the histological types of tumors in patients with high PAR were likely to incline to be type B and type C (72.7% vs. 50.8%, P=0.030), and not easy to be completely resected (27.3% vs. 9.2%,P=0.013). Compared to patients with high PNI, the tumors in patients with low PNI were more likely to invade blood vessels (34.7%vs. 13.3%, P=0.008), and histological types were likely to incline to be type B and type C (69.4% vs. 51.7%, P=0.004), and possessed higher Masaoka stage (47.0% vs. 28.3%, P=0.021). The cumulative OS and cumulative PFS at 12, 36 and 60 months were higher in low PAR group than in high PAR group (P=0.013, P=0.002), and the cumulative OS and cumulative PFS at 12, 36 and 60 months were lower in low PNI group than in high PNI group (P=0.010, P=0.014). Cox univariate analysis showed that vascular invasion,WHO classification, Masaoka stage, complete resection, PAR and PNI were obviously correlated with OS and PFS in patients with thymoma (P>0.05). Multivariate analysis showed that Masaoka stage, complete resection, adjuvant therapy and PNI were the independent prognostic factors of OS in patients with thymoma, and complete resection was the independent prognostic factor of PFS in patients with thymoma (P<0.05). Conclusion Preoperative PAR and PNI are significantly related to the prognosis of patients with thymoma, and may potentially become the new indicators to guide the treatment and evaluating diagnosis of patients with thymoma.

When the patient suffers from sepsis, pulmonary capillary endothelium is damaged and vascular permeability increases. A large amount of protein-rich exudate destroys the barrier of pulmonary epithelial cells and accumulates in alveoli, which reduces effective ventilation and results in refractory hypoxemia, this is known as acute lung injury. Acute lung injury caused by sepsis is a common disease in intensive care unit, which has high hospital costs and high mortality. Meanwhile, it is also the focus of research on critical diseases. In this paper, the related literature were reviewed from four aspects, such as the mechanism of vascular endothelial injury, the mechanism of alveolar epithelial injury, the reduction of vascular endothelial injury and the protection of alveolar epithelium and the promotion of repair.

Objective To explore the effect of the maximum dilatation pressure of percutaneous transluminal angioplasty(PTA) balloon on the patency rate of arteriovenous fistula stenosis within 12 months after PTA, and screen out the independent risk factors that affect restenosis after PTA. Methods A hundred patients, admitted and successfully undergone PTA in the Department of Nephrology, the Third Hospital of Hebei Medical University during January to December 2019, were recruited as the subjects, and of them the basic information, primary medical history, comorbidities, related serological indicators and types of fistula stenosis were collected. The internal fistula patency of patients for 12 months after PTA surgery was traced and collected through outpatient or telephone follow-up. According to the maximum pressure required to expand the stenosis during the operation, the patients were divided into high-pressure group (the maximum balloon pressure required to expand the stenosis ≥20 atm) and low-pressure group (the maximum balloon pressure required to expand the stenosis <20 atm), The basic information, primary medical history, comorbidities, related serological indicators and postoperative patency rate were compared between the two groups, and the risk factors leading to restenosis of internal fistula after PTA were analyzed by COX survival analysis. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the maximum balloon inflation pressure for restenosis within 12 months after PTA. Results A total of 100 patients were enrolled in present study, including 48 males and 52 females with average age of (53.21±15.75) years, the median dialysis age at PTA of 24.0 (12.0, 49.5) months, and the median duration of fistula of 12.6 (5.1, 37.4) months. All patients were completely followed up. The rates of diabetic kidney disease in primary diseases,hypertension and the restenosis rate within 12 months after PTA were higher in high-pressure group than those in low-pressure group with statistically significance (P<0.05). The patency rate within 12 months after PTA was higher in low-pressure group than that in high-pressure group (Log-rank test, χ²=5.399, P=0.020). Cox multivariate survival analysis showed that the maximum expansion pressure required to expand the stenosis and hypomagnesemia were the independent risk factors for restenosis after PTA(P<0.05). ROC curve analysis showed that the area under the curve (AUC) of the maximum balloon inflation pressure during PTA was 0.619 (95%CI 0.496-0.742, P<0.05), which has diagnostic value. The best critical value for the maximum balloon dilatation pressure was 19atm, the sensitivity was 60.5%, and the specificity was 66.1%. Conclusions Patients who require higher expansion pressure during PTA are more likely to have restenosis within 12 months after PTA. The maximum expansion pressure required to expand the stenosis during PTA and hypomagnesemia are the independent risk factors for patency after PTA.

Objective To investigate the interaction between staphylococcal nuclease domain containing protein 1 (SND1)and tissue differentiation-inducing non-coding RNA (TINCR), and the effect of SND1 on TINCR expression level and keloid growth. Methods Keloid tissue samples (n=27) were collected from patients with Ⅱ- or Ⅲ-degree burns who received treatment in Shaanxi Provincial People's Hospital from June 2016 to May 2018. Bioinformatics methods were used to predict RNA methylation sites in TINCR sequences; human primary normal skin fibroblasts (HFs) and keloid fibroblasts (KFs) were cultured and divided into HFs group and KFs group. KFs in logarithmic growth phase were taken, and divided into: (1) control group, empty vector group and methyltransferase-like protein 3 (METTL3) overexpression group, (2) control group and 3-deazaadenosine (DAA) group, and(3) control group, SND1 recombinant proteome group and SND1 proteome+DAA group. The relative expression level of TINCR in HFs and KFs was determined by real-time quantitative PCR (RT-qPCR); methylated RNA immunoprecipitation (MeRIP) followed by RT-qPCR was performed to analyze the methylation levels of TINCR; Western blotting was used to detect the relative expression levels of SND1 and METTL3 protein; the half-life of TINCR was determined by actinomycin D treatment combined with RT-qPCR,and the cell proliferation capacity was assessed with CCK-8 and clone assays. A keloid xenograft model was generated with 18 BALB/c nude mice, and then randomly divided into three groups (6 mice in each group): keloid group, keloid+SND1 recombinant protein group, and keloid+SND1 recombinant protein+DAA group. Keloid tissue growth was observed by HE staining; the expression level of SND1 in keloid tissue was detected by immunohistochemistry staining and Western blotting. Results The third exon of TINCR contains seven potential RNA methylation sites. The relative expression level and methylation level of TINCR elevated obviously in KFs than in HFs (5.43±0.35 vs. 1.00±0.11, P<0.01; 19.73%±1.56% vs. 10.25%±1.13%, P<0.01), and the protein levels of SND1 and METTL3 in KFs were significantly increased (P<0.01), methylated TINCR could bind both SND1 and METTL3. Compared with empty vector group, overexpression of METTL3 stimulated the mRNA and protein expression of METTL3 (mRNA: 6.03±0.55 vs. 1.09±0.09, P<0.01; protein: 4.33±0.35 vs. 0.96±0.08, P<0.01) and increased the methylation level of TINCR (32.89%±2.88%vs. 19.04%±1.72%, P<0.01) and relative expression level (4.65±0.32 vs. 1.00±0.10, P<0.01). Compared with control group,DAA treatment reduced the stability [(8.50±1.13) h vs. (12.90±1.41) h, P<0.001] and the methylation level (7.43%±0.55% vs.18.88%±1.76%, P<0.01) of TINCR, and inhibited the viability and clonogenic ability of KFs (P<0.01). Compared with control group, SND1 recombinant protein treatment increased the stability of TINCR [(23.95±1.25) h vs. (13.10±1.33) h, P<0.01],cell viability and clonogenic ability (P<0.01), but showed no significant effect on TINCR methylation levels (20.15%±1.74% vs.19.04%±1.77%, P>0.05); DAA treatment may abolish the effect of SND1 recombinant protein on TINCR stability [(12.00±1.21) h vs. (23.95±1.44) h, P<0.01], cell viability and clonogenic ability (P<0.01). Compared with the keloid group, a large number of fibroblasts and collagen fibers existed in the dermal layer of keloid+SND1 recombinant protein group. Furthermore, the percentage of positive SND1 cell and the relative expression level of protein in keloid tissue increased significantly (63.43%±3.32% vs.21.16%±4.67%, P<0.01; 2.54±0.13 vs. 1.00±0.10, P<0.01); However, DAA treatment made large amount of loose fibrous collagen in keloid tissue, and the percentage of positive SND1 cells and the relative expression level of protein decreased significantly(38.52%±6.88% vs. 63.43%±3.32%, P<0.01; 1.07±0.09 vs. 2.54±0.13, P<0.01). Conclusion TINCR is hypermethylated in KFs. SND1 can recognize and bind the methylation sites of TINCR, accelerate the stability of TINCR and promote the growth of TINCR mediated keloid.

Low back pain has become a public health problem worldwide. Intervertebral disc degeneration (IDD) is the main cause of low back pain, however, the molecular mechanism of IDD has not been fully elucidated. Stromal cell-derived factor-1(SDF-1) and its receptor C-X-C motif chemokine receptor-4 (CXCR4) are highly expressed in degenerative disc tissues and are believed to mediate the occurrence and development of IDD, including disc angiogenesis, inflammatory response, stromal cell metabolism, apoptosis and other pathological processes. In recent years, SDF-1/CXCR4 have also been used in tissue engineering research such as disc regeneration. Therefore, actively exploring the role of SDF-1/CXCR4 in IDD is of great significance for elucidating the molecular mechanism of IDD and studying new strategies for the treatment of IDD. The research progress in recent years has been reviewed in present paper of SDF-1/CXCR4 in IDD and intervertebral disc regeneration, in order to provide a basis for intensive study of the molecular mechanism of IDD and provide new ideas for early targeted treatment of IDD.

The coronary artery functional evaluation indicators have been used recent years to evaluate the physiological function and judge the severity of coronary lesion, and provide the strategy of revascularization for patients with coronary atherosclerotic heart disease (CHD). As an invasive functional index, the efficiency of fractional flow reserve (FFR) has been widely testified by a large number of literature. However, due to its limitation in application, some FFR-based novel functional evaluation indices formed such as instantaneous wave-free reserve (iFR) and quantitative flow ratio (QFR). These indicators have their own characteristics, and provides some guidance and application value in revascularization for CHD patients although they haven't been widely used in clinical practice. The characteristics of coronary artery functional evaluation indicators, the assess capabilities of FFR,iFR and QFR to diagnosis and prognosis as well as strengths and weaknesses, the other novel functional evaluation indices, and the latest application progress of these functional indices in clinical prognosis evaluation have been reviewed in present paper, so as to guide the use of specific evaluation indicators under specific conditions, or combined use of anatomical and functional evaluation indicators to establish revascularization model to reduce false positive and/or false negative rates, so as to improve the accuracy of diagnosis.

Objective To investigate the effect of rehmannia polysaccharide on the renal injury in offspring of pregnant mice with hyperthyroidism, and on regulating the signaling pathway of nuclear factor E₂-related factor (Nrf2)/heme oxygenase(HO-1)/Nod-like receptor protein 3 (NLRP3). Methods Fifty-six female kunming mice pregnant successfully were randomly divided into normal group (n=12), model group (n=12), positive control group (n=10), rehmannia polysaccharide low-dose group(n=11) and rehmannia polysaccharide high-dose group (n=11) to establish pregnancy with hyperthyroidism model. The positive control group was given methimazole 5 mg/kg intragastric administration, and the low and high dose groups were given rehmannia polysaccharide 20 and 40 mg/kg intragastric administration respectively, once a day, until delivery. The body weight of female mice was measured, and the contents of free triiodothyronine (FT₃), free thyroxine (FT₄) and thyroid stimulating hormone (TSH)in the serum were detected by ELISA. Kidney tissue of young mice was observed by HE staining. The contents of urea nitrogen(BUN) and creatinine (Cr) in the serum of the young mice were detected by automatic biochemical analyzer. Superoxide dismutase(SOD) activity, malondialdehyde (MDA) content, interleukin (IL)-1β and IL-18 content were detected by ELISA, and the relative expression levels of Nrf2, HO-1 and NLRP3 proteins were detected by Western blotting. Results HE staining showed that the renal tubules and glomerulus in model group were disorganized, the basement membrane thickened significantly, large number of red blood cells infiltrated, and endothelial cells were edema. Compared with model group, the kidney tissue lesion reduced obviously in positive control group and rehmannia polysaccharide low and high dose group. The body weight of mice was significantly lower in model group than that in normal group, while was significantly higher in positive control group and rehmannia polysaccharide low-dose and high-dose groups than that in model group with statistical significance (P<0.05). ELISA results showed that the contents of FT₃ and FT₄ were significantly higher in model group than that in normal group, while the TSH content was significantly lower in model group than that in normal group (P<0.05). The contents of FT₃ and FT₄ were lower, while TSH content was higher in positive control group and rehmannia polysaccharide low-dose and high-dose groups than those in model group with statistical significance(P<0.05). The contents of BUN and Cr were higher in offspring of model group than those in normal group, while were lower in positive control group and rehmannia polysaccharide low-dose and high-dose groups than those in model group with statistical significance (P<0.05). ELISA results showed that the contents of MDA, IL-1β and IL-18 were higher, while SOD activity was lower in offspring of model group than that in normal group. The contents of MDA, IL-1β and IL-18 were lower, while SOD activity was higher in positive control group, low-dose and high-dose rehmannia polysaccharide groups than those in model group with statistical significance (P<0.05). Western blotting showed that the expression levels of Nrf2 and HO-1 were lower and NLRP3 was higher in model group than those in normal group. The expression levels of Nrf2 and HO-1 were higher, while NLPR3 was lower in positive control group and rehmannia polysaccharide low-dose and high-dose groups than those in model group with statistical significance(P<0.05). Conclusion Rehmannia polysaccharide can improve the thyroid function of pregnant mice with hyperthyroidism and protect their offspring from kidney damage, and Nrf2/HO-1/NLRP3 pathway may play such a role.