Objective To explore the effects of low body weight and different ages on the 28-day death and other clinical outcomes of intensive care patients. Methods Data were extracted from Medical Information Mart for Intensive Care Ⅲ(MIMIC-Ⅲ) intensive care database, and adult patients admitted to the intensive care unit (ICU) were screened. The body mass index (BMI) is calculated according to the initial weight and height when entering the ICU. According to their age, they were divided into two groups when they entered the ICU: the younger age group <65 years old, and the older age group ≥65 years old. BMI was divided into two groups: low BMI group <18.5 kg/m² and non-low BMI group ≥18.5 kg/m². Univariate analysis, multivariate logistic regression, and interaction analysis analyzed the impact of low body weight and different ages on the 28-day death and other clinical outcomes of intensive care patients. Results A total of 17 134 patients met the inclusion criteria. According to their age, they were divided into 7986 patients in the low-age group and 9148 patients in the high-age group. According to BMI, they were divided into 458 patients with low BMI and 16 676 patients with non-low BMI. Compared with non-low BMI, patients with low BMI were older(66.65±18.02 vs. 64.73±15.98, P=0.012), had a higher proportion of recent weight loss (19.7% vs. 3.7%, P<0.001) and emergency admissions (83.0% vs. 73.0%, P<0.001), had a higher prevalence of chronic obstructive pulmonary disease (COPD), rheumatoid arthritis, cancer, sepsis, and acute renal insufficiency. However, patients with low BMI had a lower prevalence of hypertension and diabetes. On the final clinical outcome, patients with low BMI had a higher prevalence of sepsis and acute renal insufficiency and longer mechanical ventilation time [29.2(12.0, 106.0) h vs. 18.7(5.7, 93.8) h, P<0.001]. In the whole cohort and different age groups,it could be seen that the 28-day mortality rate of patients with low BMI was higher than that of non-low BMI. Univariate analysis showed all the characteristics, including high age, low BIM, weight loss, emergency hospital admission, cardiac insufficiency, COPD,cancer, sequential organ failure assessment (SOFA) score, acute renal insufficiency, sepsis, septic shock, and highest white blood cell,were risk factors for 28-day death. Multivariate analysis showed that cancer and SOFA score were independent risk factors for 28-day death. In the interaction analysis, compared with the low-age group with non-low BMI, after adjusting the variables of P<0.05 in the multivariate regression and clinically significant variables, the low-age group with low BMI (OR=1.77, 95%CI 1.24-3.14, P=0.004),high-age group with non-low BMI (OR=1.84, 95%CI 1.64-2.08, P<0.001) and high-age group with low BMI (OR=2.95, 95%CI 2.09-4.17, P<0.001) were risk factors for death at 28 days. Conclusions Low BMI is a risk factor for short-term death in intensive care patients of different ages. Its poor prognosis may be related to low BMI patients with high cancer prevalence, severe illness, and longer mechanical ventilation time.

The patients after cardiac surgery often suffer from malnutrition due to insufficient energy intake, which increases the incidence of complications and mortality. Thus, energy and protein intake can accelerate patients' recovery. Previously, enteral nutrition has been widely considered to be the major nutritional way, however, an increasing studies suggest a combination of enteral and parenteral way can provide nutrition to patients maximally. Albeit the timing of the inception of parenteral way of nutrition remains controversial, it is confirmed that early start of the enteral way is salubrious to patients, and the duration of nutritional support should be determined according to the specific situation of patients. Additionally, nutritional scoring system plays a crucial role. Various nutritional risk scores can predict the clinical outcome of patients, thus, the most adaptable nutritional score for patients after receiving cardiac surgery needs further study. This article reviews the importance of nutritional support for the patients after cardiac surgery, selection, timing, and duration of post-operative nutritional support, and the advances in nutritional risk assessment etc.

Rimmed vacuole myopathy is a group of disease with characteristic myopathological features, which including deposition of abnormal proteins, such as β-amyloid protein (Aβ) and phosphorylated tau proteins etc. In recent years, positron emission tomography (PET) has been widely used in the imaging diagnosis of Alzheimer's disease (AD) due to the development of molecular imaging technology. Recently, some studies have indicated that molecular imaging PET can also show the abnormal deposition proteins in muscles, which is helpful for the early diagnosis and differential diagnosis of rimmed vacuolar myopathy, and provides a new application for PET. The application directions of PET in rimmed vacuolar myopathy were reviewed in this article, in order to provide a reference base for the implementation of clinical work.

Objective To report a case of granulomatous polyangiitis (GPA) with breast involvement, and perform a literature review to better understand this disorder. Methods Retrospectively analyze the data of a case of GPA with breast involvement, to summarize the clinical characteristics of GPA with breast involvement by searching the database (CNKI, Wanfang Data, PubMed) and comprehensively analyze the literature results. Results A case of 53-year-old woman was admitted to the Department of Rheumatology and Immunology of the First Medical Center of Chinese PLA General Hospital because of "inflamed eyelids for 8 months, hearing loss for 6 months, breast induration for 4 months". The symptoms of mammary gland were bilateral-painful breast induration with ulceration. The patient was diagnosed with GPA by positive proteinase 3 (PR3) antibody and biopsy.After treatment with prednisone and cyclophosphamide, the patient experienced a relapse and then was treated with rituximab.By March 2021 (searching CNKI, Wanfang Data and PubMed), a total of 28 English cases of GPA with breast involvement and no Chinese case were found by searching literature. The disorder often occurs in women aged 40 to 60 (60.7%, 17/28), and the typical manifestation was unilateral breast (75.0%, 21/28) involvement. Positive PR3 antibody (69.2%, 9/13) is common. Pathological characteristics of the mammary are infiltration of lymphocyte, vasculitis and granulomatosis lesion. Conclusions The disorder of GPA with breast involvement is rare with non-specific breast symptoms. Detection of anti-neutrophil cytoplasmic antibodies and pathological examination can assist the diagnosis.

Objective To investigate the effect and mechanism of transplanting Leydig-like cells from BMSCs to repair the testicular function of diethylhexyl phthalate (DEHP) infected mice. Methods Six C57 mice were randomly divided into two groups (3 each): control group (corn oil) and DEHP group [900 mg/(kg.d) DEHP mixed with corn oil]. Venous blood was taken from the eyeball 28 days after treatment to determine the serum testosterone level. One testis was stored in paraformaldehyde for HE and TUNEL staining, the other side of testis, after homogenization, was used to determine the changes of apoptotic proteins of caspase-3, caspase-8, caspase-9, Bcl-2 and Bax with Western blotting, the contents of MDA and GSH and the activities of SOD and GSH-Px were determined. Twenty-seven C57 mice were poisoned with DEHP for 28 days, and then randomly divided into Leydig-like cell transplant group, BMSCs transplant group and control group (9 each). BMSCs and Leydig-like cells from BMSCs were transplanted into the testis of mice in corresponding groups. Venous blood was taken from 3 mice of each group at 7th, 14th and 21st day after transplantation for determining the serum testosterone, and bilateral testis were obtained simultaneously to determine the contents of MDA and GSH and the activities of SOD and GSH-Px. The testis of mice was got 7th day after transplantation for HE and TUNEL staining, and the changes of apoptotic proteins of caspase-3, caspase-8, caspase-9, Bcl-2 and Bax were detected simultaneously. Results Compared with control group, the serum testosterone level decreased significantly, testicular spermatogenic cell disorder, tissue cells showed apoptosis, the serum levels of apoptotic protein caspase-3, caspase-8, caspase-9 and Bax increased obviously, while of Bcl-2 decreased markedly in testis of DEHP group, the content of MDA increased, and of GSH decreased, the activities of GSH-Px and SOD were inhibited with statistically significant difference (P<0.05 or P<0.01). Compared with control group, the serum testosterone level in Leydig-like cell transplantation group increased significantly at 7th, 14th and 21st day after testicular cell transplantation. The serum level of testosterone in BMSC transplantation group was higher than in control group at 14th and 21st day after transplantation. The content of MDA in testicular tissue decreased and of GSH increased,and the activities of GSH-Px and SOD recovered at 7th, 14th and 21st day after testicular cell transplantation (P<0.05 or P<0.01).The 7th day after transplantation, the apoptosis of testicular tissue was alleviated obviously in Leydig-like cell transplantation group and BMSC transplantation group than that in control group, the morphology of spermatogenic cells recovered, and the expression levels of apoptotic protein caspase-3, caspase-8, caspase-9 and Bax decreased significantly, while of Bcl-2 protein increased obviously(P<0.05 or P<0.01). Conclusion Transplantation of Leydig-like cells derived from BMSCs may repair the DEHP induced testicular damage by alleviating testicular oxidative stress and inhibiting testicular apoptosis, increase the teatosterone secretion, so as to promote the recovery of damaged testicular function.

Objective To investigate the effect of shikonin on atrial fibrillation of rats with myocardial fibrosis mediated by extracellular signal-regulated protein kinase1/2(ERK1/2)/nuclear transcription factor-kappaB (NF-κB). Methods Thirty SD rats were randomly divided into normal control group, model group, shikonin group (10 each). Rats in shikonin group were intragastrically given shikonin 4 mg/kg, in normal control and model groups were given the same amount of normal saline, 1 time/d for consecutive 7 days; Rats in model and shikonin groups were tail intravenous injected with 1 ml/kg ACh-CaCl₂ mixed liquor to establish atrial fibrillation model, 1 time/d for consecutive 7 days, and in normal control group were injected with the same amount of normal saline, taken materials after 7 days. Electrocardiogram was used to record the induced time and duration of atrial fibrillation, and the cardiac function was detected by echocardiography. The pathological condition of myocardial tissue was observed by HE staining. Masson staining was performed to detect the percentage of collagen area in myocardial tissue. The protein expressions of Collagen Ⅰ (ColⅠ), ERK1/2, p-ERK1/2, NF-κB p65 and p-NF-κB p65 were detected by Western blotting. Results The cardiomyocytes were arranged in compact and orderly manner in normal control group, while in model group were disordered, hypertrophic and widened. Shikonin improved the morphology and structure of cardiomyocytes. Compared with normal control group, left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) decreased, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), percentage of collagen area, the expressions of ColⅠ, p-ERK1/2, p-NF-κB p65 protein increased (P<0.05) in model group and shikonin group; Compared with model group, the induced time of atrial fibrillation was longer, duration time was shorter in shikonin group, LVEF and LVFS increased, LVESD and LVEED, percentage of collagen area, and the expressions of ColⅠ, p-ERK1/2, p-NF-κB p65 protein were decreased in shikonin group (P<0.05). Conclusion Shikonin may mitigate the myocardial fibrosis, inhibit the occurrence of atrial fibrillation, and improve myocardial function by inhibiting ERK1/2-NF-κB signaling pathway.

Objective To explore the risk factors of linezolid associated thrombocytopenia and establish a risk prediction model. Methods A total of 796 patients with infection treated by linezolid from January 2010 to December 2020 in 7 intensive care units (ICU) of the First Medical Center of PLA General Hospital were selected. The basic clinical data of the patients were extracted by case retrieval system, and the patients were divided into thrombocytopenia group (n=228) and non-thrombocytopenia group (n=568) according to the occurrence of thrombocytopenia. The general data of the two groups were compared, and the risk factors of linezolid-associated thrombocytopenia were analyzed by multivariate logistic regression, and a risk prediction model was established. Then, the receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of the model. Results Multivariate analysis showed age ≥80 years, duration of linezolid >7 d, WBC count ≥16×10⁹/L, platelet count <200×10⁹/L,and creatinine clearance (Ccr) <50 ml/min were independent risk factors for linezolid associated thrombocytopenia. The area under the curve (AUC) of the risk prediction model was 0.782(95%CI 0.747-0.816, P<0.001), The cut-off value was 6 points, the sensitivity was 82.1%, the specificity was 59.1%, the positive predictive value was 44.7%, and the negative predictive value was 89.1%. Conclusion The risk prediction model based on age, duration of linezolid use, WBC count, platelet count and, Ccr can effectively predict the occurrence of linezolid associated thrombocytopenia.

Objective To study the risk factors for extraesophageal symptoms in the patients with reflux esophagitis. Method One hundred and thirty-nine reflux esophagitis cases diagnosed by endoscophy and pH monitoring of the esophagus and hospitalized in Characteristic Medical Center of Strategic Support Army from March 2018 to November 2019. These cases were divided into positive or negative groups according to reflux symptom index (RSI) > or <13. Differences in gender, age, body mass index (BMI), smoking, drinking, emotional factors (anxiety and depression evaluation), reflux esophagitis microscopic classification,24-hour esophageal pH monitoring related index (Demeester index) were taking into account in logistical regression to identify the potential cause of reflux esophagitis. Results The positive group had higher age [(58.8±15.4) years], higher BMI (63%),higher anxiety (36%) and higher DeMeester (54%) than negative group [(52.8±11.7) years, 39%, 14%, 27% respectively], and the differences were statistically significant (P<0.05). There were no significant differences in gender, smoking, drinking, depression rate and endoscopic grade of reflux esophagitis between the two groups (P>0.05). Logistic multiple regression results showed that high BMI and positive DeMeester score were independent risk factors for patients with extrasoesophageal symptoms (OR=1.896, 95%CI 1.363-3.942, P<0.05; OR=6.868, 95%CI 1.648-18.087, P<0.01). Conclusions Higher BMI (overweight) and positive DeMeester score have predictive value for extraesophageal symptoms of the patients with reflux esophagitis, and they would increase the incidence of extraesophageal symptoms.

Objective To compare the clinicopathological features, differential diagnosis and treatment between perirenal angiomyolipoma (AML) and liposarcoma. Methods Eleven cases of AML and thirty-nine cases of liposarcoma around the kidney from Peking University International Hospital from January 2015 to December 2020 were reviewed in terms of clinical manifestations, imaging examination, pathological morphology, immunophenotype and treatment follow-up. Results The tumors in both groups were close to the kidney, and the imaging signs of renal defect were not distinctive enough to diagnose correctly.Perirenal AML was mainly female (P=0.003), the age of onset was younger than liposarcoma (P<0.001). Most of perirenal AML were single (90.9%, 10/11) and primary (100.0%, 11/11), the histomorphology was mostly accompanied by vascular hyaline degeneration(63.6%, 7/11), and Melan-A and HMB45 were positive by immunohistochemistry. While liposarcoma was often multiple (51.3%,20/39) and recurrent (79.5%, 31/39), Ki-67, P16, CDK4, MDM2 were more highly expressed than AML (P<0.05), and MDM2 gene was amplified. There was no significant difference in the maximum diameter and necrosis between the two groups (P>0.05). Conclusions Retroperitoneal perirenal AML and liposarcoma have similar imaging features, and gender, age, tumor number,primary/recurrent character, histomorphology, protein expression and gene amplification detection are helpful to differentiate them.Liposarcoma needs more extensive resection, active treatment and follow-up.

ESKAPE pathogens are the most common conditional pathogenic bacteria in nosocomial infection. Considering that ESKAPE pathogens are not sensitive to conventional antimicrobial treatment, some emerging treatment strategies that could effectively deal with ESKAPE pathogens will bring huge economic and social benefits. Seven emerging strategies to potentiate the effects of current antimicrobial including anti-virulence strategies, prevention of biofilm formation, antimicrobial peptides, plant-derived antimicrobial, nanoparticle drug delivery system, photodynamic therapy, phage therapy and so on will be discussed in present review. All of strategies discussed here aim to provide direction for further development of ideal drugs and solutions to handle antibiotic resistance.