Hepatic encephalopathy (HE) is a common clinical end-stage liver disease complicated with a complex neuropsychiatric syndrome, the occurrence of HE often suggests a poor outcome in patients with liver disease. The pathological mechanism involved in HE is complex, and the exact mechanism remains unclear. In recent years, with the continuous in-depth studies on the intestinal flora of patients with cirrhosis, the correlation between intestinal flora changes and HE occurrence has become the focus of attention. At present, the treatment of HE by regulating intestinal flora imbalance has achieved certain efficacy.Therefore, the relationship between intestinal flora and HE, as well as the treatment measures for HE are reviewed, aiming to provide new ideas for further exploring the pathogenesis of HE and new theoretical basis for clinical treatment of HE.

Intestinal flora is increasingly considered to be associated with multiple diseases, such as insulin resistance, bile acid metabolism and inflammatory reaction. Research on the relationship of intestinal flora to the occurrence and development of hypertension and chronic kidney disease has made remarkable progress in recent years. The occurrence and development of hypertension and chronic kidney disease disrupt the original gut microbiota composition, further contribute to the advancement of hypertension and chronic kidney disease. So far, further discussion is needed on the causality and exact mechanism of intestinal flora to hypertension and chronic kidney disease. The composition of intestinal microorganisms in hypertension and chronic kidney disease has been reviewed in present paper, and focused on the role of symbiotic microorganisms in affecting the host immunity and the progress of the primary disease, and summarized the relationship of intestinal flora mediated immune response to hypertension and chronic kidney disease, mainly interlinked each other through short-chain fatty acids, angiotensin Ⅱ and trimethylamine oxide to provide the basis for finding potential treatment methods for hypertension and chronic kidney disease.

Stress is a non-specific response of the body when suffering from internal or external factors. It is involved in the development and progression of many physical and mental diseases such as irritable bowel syndrome, functional gastrointestinal diseases, anxiety and depression. It is the main cause of non-combat attrition. Gut microbiota can regulate the body's metabolism,immune and nervous system development and functions through the gut microbiota-gut-brain axis and affect the health and behavior. The interaction between its composition and function and stress-related diseases is gradually being revealed. The intervention and regulation of gut microbiota may become a new solution to prevent and treat stress-related diseases and participate in influencing the reaction of military personnel to military stress. This review focuses on the research progress of stress-related mechanisms, gut microbiota characteristics and related intervention research, the study status of military stress-related and gut microbiota and the prospects of its application.

Objective To explore the effect and potential mechanism of Guiqi Yiyuan ointment on rats injured by bystander effects of ¹²C⁶⁺ radiation. Methods A total of 70 Wistar male rats were randomized into the following groups (n=10):blank control group, radiation 24 h group, Guiqi Yiyuan ointment + radiation 24 h group, Guiqi Yiyuan ointment 24 h group,radiation 7 d group, Guiqi Yiyuan ointment + radiation 7 d group, and Guiqi Yiyuan ointment 7 d group. Fourteen days before irradiation, rats in the groups with Guiqi Yiyuan ointment treatment received the same volume and concentration of Guiqi Yiyuan ointment. Other rats received the same amount of normal saline. After 14 days, the right lungs of each radiation group and the Guiqi Yiyuan ointment + radiation group were irradiated with a single 4 Gy ¹²C⁶⁺ beam (exposing only the right lung). The blank control group and each Guiqi Yiyuan ointment group were not irradiated. Rats in each group were sacrificed at different time points such as 24 h and 7 d, and lung tissues were collected. The histology of the left and right lungs of each group was examined by HE staining.The mRNA and protein expression levels of TGF-β₁ and p-Smad3 in the left and right lung tissues were quantified by Q-PCR and Western blotting, respectively. Results HE staining results showed the normal structure of the right lung alveoli of blank control group and each Guiqi Yiyuan ointment group. In radiation 24 h group, the alveolar septum of both lungs increased with inflammatory cells infiltrated. In Guiqi Yiyuan ointment + radiation 24 h group, both lungs showed some broken alveolar septum and some infiltrated inflammatory cells. In radiation 7 d group, the alveolar septal fissure was obvious, the alveolar cavity expanded irregularly,the inflammatory cells infiltrated, and the degree of infiltration in the left lung was lighter than that in the right lung. In Guiqi Yiyuan ointment + radiation 7 d group, there was no fibrous hyperplasia, no congestion in the alveolar cavity, and the degree of left lung injury was lighter than that of the right lung. Q-PCR and Western blotting results showed that compared with blank control group,the expression levels of TGF-β₁ mRNA and protein in the left and right lung tissues of rats in radiation 24 h group and radiation 7 d group increased (P<0.05), the expression level of p-Smad3 protein increased (P<0.05), the expression level of Smad6 mRNA in the right lung decreased (P<0.05), and the expression level of Smad6 mRNA in the left lung increased (P<0.05), the expression of Smad6 protein decreased in the left and right lung tissues (P<0.05), and the expressions of TGF-β₁ mRNA and protein in radiation 7 d group were higher than those in radiation 24 h group (P<0.05), and there was a time effect. The expressions of TGF-β₁ mRNA and protein and p-Smad3 protein in the left and right lungs of rats in Guiqi Yiyuan ointment + radiation group decreased, while the expression of Smad6 mRNA and protein increased (P<0.05). Conclusion Guiqi Yiyuan ointment has a protective effect on rats with bystander effects of radiation. The mechanism may be related to the downregulation of TGF-β₁ and p-Smad3, but increased Smad6 in the left and right lung tissues.

Objective To explore the effect of tribbles homologue 3 (TRB3) on spinal astrocytes injury induced by the oxygen-glucose deprivation/reoxygenation (OGD/R) in rats. Methods The spinal astrocytes of newborn SD rats were isolated and cultured. Cells were divided into control group (without treatment) and OGD/R group (cells were exposed to OGD/R). The mRNA and protein expression levels of TRB3 were detected by Real-time PCR and Western blotting. Cells were divided into control group, Scramble group (infected with scramble virus) and shTRB3 group (infected with TRB3 shRNA lentivirus), and the mRNA and protein expression levels of TRB3 were detected by Real-time PCR and Western blotting to confirmed knockdown efficiency.Cells were divided into control group, OGD/R group, Scramble group, shTRB3 group, OGD/R+Scramble group (cells were infected with scramble virus, and then treated with OGD/R) and OGD/R+shTRB3 group (cells were infected with TRB3 shRNA lentivirus,and then treated with OGD/R). The cell apoptosis, cell viability and lactic dehydrogenase (LDH) leakage rate were detected by flow cytometry, CCK-8 assay, and LDH detection kit, respectively. Malondialdehyde (MDA) content was detected by the TBA method and the activity of superoxide dismutase (SOD) was tested by the xanthine oxidase method. The concentrations of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were determined by ELISA. The protein expression of nuclear factor kappa-B (NF-κB)p65 was measured by Western blotting. Cells in OGD/R and OGD/R+shTRB3 were also treated with NF-κB p65 agonist betulinic acid (BA, 20 μmol/L), and cell apoptosis was detected by flow cytometry. Results Real-time PCR and Western blotting results showed that the mRNA (2.15±0.12 vs. 1.00±0.05) and protein (2.10±0.16 vs. 1.00±0.08) expression levels of TRB3 in spinal astrocytes were upregulated after OGD/R (P<0.05). Compared with control group, TRB3 shRNA lentivirus infection significantly decreased mRNA (0.30±0.07 vs. 1.00±0.10) and protein (0.30±0.04 vs. 1.00±0.06) expression levels of TRB3 (P<0.05).Compared with control group, OGD/R group and OGD/R+Scramble group showed significantly decreased cell viability, SOD activity and nuclear NF-κB p65 level, and increased LDH, MDA, TNF-α, IL-1β levels and cell apoptosis rate (P<0.05), indicated that TRB3 shRNA lentivirus infection is successful. Compared with OGD/R group and OGD/R+Scramble group, TRB3 silencing significantly inhibited OGD/R induced decreased cell viability, SOD activity and nuclear NF-κB p65 level (P<0.05). And the increase of LDH, MDA, TNF-α, IL-1β and apoptosis induced by OGD/R was significantly inhibited by TRB3 silencing (P<0.05).Compared with OGD/R group, NF-κB p65 activator BA treatment could significantly increase cell apoptosis rate (36.15%±0.87%vs. 24.70%±1.05%, P<0.05), and it also could reverse the effect of TRB3 silencing on OGD/R induced cell apoptosis rate(22.00%±1.04% vs. 13.91%±1.20%, P<0.05). Conclusion TRB3 silencing inhibits OGD/R-induced rat spinal astrocyte injury,which may be mediated by blocking the NF-κB pathway.

Objective To explore the clinical characteristics and antimicrobial resistance of low respiratory tract infection with Streptococcus pneumonia (S. pneumonia) to provide the basis for clinical treatment. Methods The clinical characteristics of patients diagnosed with S. pneumoniae lower respiratory tract infection admitted to the 980st Hospital of the PLA Joint Logistics Support Force from January 2014 to December 2018 were analyzed. The strains were identified by MA120 system and optochin test,antimicrobial susceptibility testing was carried out by using or E-test method, and the statistical analysis was performed by means of WHONET 5.6 and SPSS 20.0. Results Among the 934 patients with S. pneumoniae infection, the mean age was (1.2±1.2) years,71.07% occurred in autumn and winter, 74.86% had elevated WBC count and 85.16% had high serum C-reactive protein (CRP) level in the children and the mean age was (61.6±19.6) years, 94 patients (45.63%) were ≥65 years old, 149 (72.33%) had underlying diseases, 58.25% occurred in autumn and winter, 77.67% had elevated WBC count and 83.98% had high serum CRP level in the adult patients. The isolated 934 S. pneumoniae strains were 100% sensitive to vancomycin, linezolid and meropenem. The strains from both children and adult had kept highly susceptible to penicillin, and the resistance rate to penicillin was lower than 1%; the resistance rates to amoxicillin/clavulanate, cefotaxime sodium, ceftriaxone sodium, cefepime and levofloxacin were lower than 6%; the resistance rates to erythromycin, azithromycin, tetracycline, clindamycin were more than 80%, and its resistance rates to clindamycin and cefuroxim showed increasing tread in both adults and children. Mean 5-year resistance rate of S. pneumoniae strains isolated from children to cefuroxim was significantly higher than that of strains from adults (P<0.05). Conclusions S. pneumoniae has high resistance rate to macrolides antibiotics, and is not suitable for clinical treatment; S. pneumoniae keeps better sensitivities to penicillin, which can be used to treat S. pneumoniae infection. The resistance rates of S. pneumoniae strains isolated from adults and children to cefuroxim are all high, and show increasing tread, and therefore it is necessary to reasonably choose antibiotics to control bacterial resistance.

Objective To investigate the possible relation of miR-30a rs2222722 and its potential target gene SNAI1 rs1543442 mononucleotide polymorphisms to diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). Methods A total of 520 patients with T2DM, admitted in the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University from October 2018 to September 2019, were included in present study. Of them 240 cases concurred with DKD were set as case group, the other 280 cases non-concurred with DKD as control group. Allele specific TaqMan probe hybridization method was employed to detect the single nucleotide polymorphisms of miR-30a rs2222722 (C>T) and SNAI1 rs1543442 (G>A), and calculate the genotype and allele frequencies of each group. Logistic regression analysis was performed to analyze the independent risk factor of DKD, and the effects of various variables on DKD. Results Among patients with T2DM,the CC genotype carriers of miR-30a rs2222722 were more prone to DKD than the TT and CT genotype carriers (OR=2.73, 95%CI 1.61-4.61, P<0.001). Moreover, the CC genotype was the risk factor of the decreased glomerular filtration rate (OR=2.13, 95%CI 1.37-3.32, P=0.001) and the increased urinary microalbumin/creatinine ratio (ACR) (OR=1.59, 95%CI 1.08-2.34, P=0.019). What's more, the GG genotype carriers of SNAI1 rs1543442 was more prone to DKD than the AA and AG genotype carriers (OR=1.70,95%CI 0.73-1.58, P=0.036). Multivariate logistic regression analysis showed that the miR-30a CC and SNAI1 GG genotype were independent risk factors to the development of DKD. Conclusions The CC genotype of miR-30a rs2222722 and GG genotype of SNAI1 rs1543442 might be the risk factors for the occurrence of diabetic kidney disease. And miR-30a rs2222722 CC genotype is closely related to the decrease of glomerular filtration rate and the increase ACR.

Objective To investigate the diagnostic value of platelet parameters, fibrinogen (Fib) and D-dimer for deep venous thrombosis (DVT). Methods Six hundred and sixty-seven patients with DVT hospitalized in the Peripheral Vascular Disease Department of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from June 2014 to June 2019 were selected as the observation group, and 200 outpatients without DVT were selected as the control group. The general data, platelet parameters [platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), platelet hematocrit (PCT)and platelet-large cell ratio (P-LCR)], FIB and D-dimer of the subjects were collected, and the differences in the above indexes were compared between the two groups. Logistic regression was used to analyze the risk factors of DVT, Pearson correlation was used to analyze the relation between PLT, MPV, PDW, PCT, P-LCR, Fib and D-dimer, and area under ROC curve (AUC) were used to analyze the diagnostic value of the above indexes for DVT. Results Compared with control group, the levels of MPV, PDW and P-LCR of DVT group decreased (P<0.05), the levels of Fib and D-dimer of DVT group increased, and the differences were statistically significant (P<0.05). Fib and D-dimer were not only risk factors of DVT (OR=1.493, 28.154, P<0.05), but also independent risk factors of DVT (OR=1.739, 4.837, P<0.01); P-LCR was the protective factor of DVT (OR=0.914, P<0.05). PLT was negatively correlated with MPV, PDW and P-LCR (r=–0.269, –0.233, –0.120, P<0.01), positively correlated with PCT (r=0.062, P<0.01); MPV was positively correlated with PDW and P-LCR (r=0.945, 0.597, P<0.01); PDW was positively correlated with P-LCR (r=0.582,P<0.01) and negatively correlated with D-dimer (r=–0.551, P<0.01). MPV, PDW, P-LCR and Fib had low diagnostic value for DVT(AUC was 0.588, 0.606, 0.588 and 0.699, P<0.01), and D-dimer had medium diagnostic value (AUC was 0.882, P<0.01); MPV, PDW and P-LCR combined with Fib could improve the sensitivity of Fib diagnosis alone (53.3%-54.7% vs. 49.6%), and combined with D-dimer could improve the specificity of D-dimer diagnosis alone (88.1%-89.0% vs. 81.4%). Conclusion Platelet parameters (MPV,PDW, P-LCR), Fib and D-dimer have certain reference value for clinical diagnosis and disease condition evaluation of DVT.

Objective To analysis the risk factors for the progression of white matter hyperintensities (WMHs) in the non-demented elderly. Methods A total of 263 non-demented elderly who completed baseline and 3-year follow-up T₂ FLAIR scans were screened from the Alzheimer's Disease Neuroimaging Initiative (ADNI)-1 cohort. They were divided into the progressive group(n=66) and non-progressive group (n=197) according to the progression of WMHs. The baseline demographic data, cardiovascular disease history, apolipoprotein E (apoE) genotype, cognitive function and WMHs volumes at baseline and three-year follow-up were compared between the two groups. The risk factors for the progression of WMHs in the non-demented elderly were evaluated by logistic regression analysis. Results The age, the proportion of coronary heart disease, the WMHs volume at baseline and three-year follow-up in WMHs progressive group were higher than those in non-progressive group, and the scores of immediate memory of auditory verbal learning test and trail making test-B were significantly lower than those in non-progressive group, and the differences were statistically significant (P<0.05). Age correlated positively with baseline WMHs volume and WMHs volume at three-year follow-up (r_s=0.273, P<0.001; r_s=0.306, P<0.001). Multivariate logistic regression analysis showed that age ≥80 years and a history of coronary heart disease were independent risk factors for the progression of WMHs (OR=2.257, 95%CI 1.219-4.178, P=0.010;OR=2.556, 95%CI 1.048-6.234, P=0.039). Conclusion Age ≥80 years and a history of coronary heart disease are independent risk factors for the progression of WMHs in the non-demented elderly.

Objective To evaluate the predictive values of erythrocyte and platelet parameters for the severity of sepsis in children. Methods A total of 213 children with sepsis admitted to Pediatric Intensive Care Unit (PICU) of Hebei Children's Hospital from December 2015 to December 2020 were selected as the research subjects. According to the severity, they were divided into the sepsis group (152 cases) and septic shock group (61 cases). The gender, age, infected site and treatment of the enrolled subjects were recorded. The erythrocyte and platelet parameters were collected within 24 hours after the diagnosis of sepsis. The children were scored according to acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure score (SOFA) within 24 hours after admission to PICU. The median of the red cell volume distribution width (RDW) and platelet distribution width (PDW) and interquartile range were calculated for the child patients using the quartile method, and the 213 child patients were stratified on the basis. The gender, age, length of PICU stay, continuous renal replacement therapy (CRRT), mechanical ventilation, and occurrence of septic shock were compared between the child patients with different RDW and PDW stratifications.Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of erythrocyte and platelet parameters for the severity of children with sepsis. Results The scores of RDW [17.03%(16.17%, 18.72%)], PDW [24.25 fl (23.25 fl, 26.60 fl)],APACHE Ⅱ (19.06±3.78) and SOFA (7.35±2.62) in septic shock group were higher than those [15.28%(14.23%, 16.39%),21.28 fl (18.84 fl, 23.40 fl), 15.73±3.89, 5.68±2.40] in sepsis group, with statistical significance (P<0.05). There was statistically significant difference in the duration of assisted ventilation for RDW stratification (P<0.05), and there was statistically significant difference in the duration of hospitalization in PICU for PDW stratification (P<0.05). There was statistical significance in sepsis severity between RDW stratification and PDW stratification (P<0.05). RDW had the highest predictive value for sepsis severity,while PDW had the highest sensitivity for sepsis severity. Conclusion RDW and PDW are important biomarkers for predicting the severity of sepsis in children.