Intervertebral disc degeneration (IDD) is a common orthopedic disease characterized by reduction of nucleus pulposus cells and degradation of extracellular matrix. Its specific pathogenesis is not clear. The current treatment can only improve the clinical symptoms of patients, but can not delay or reverse the process of degeneration. Therefore, to find an effective method to repair IDD has become the main goal of current research. In recent years, exosomes have gradually become a research hotspot in the field of regenerative medicine. Exosomes carrying a large number of nucleic acids, proteins, lipids, cytokines and other bioactive molecules participate in the information transmission between different cells and play an important role in regulating the biological functions of receptor cells. Studies have confirmed that exosomes can inhibit the apoptosis and inflammatory reaction of nucleus pulposus cells, promote the proliferation and regeneration of nucleus pulposus cells, and have the potential to cure IDD. In this paper, the characteristics and functions of exosomes from different cell sources and its effect and mechanism in IDD repair were summarized, in order to provide reference for the subsequent studies.

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.

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.

Inguinal hernia is a common surgical disease, which is more and more common in the elderly and children. With the aging of the population and the opening of the second child, there are more and more patients with inguinal hernia surgery,and the difficulty and risk of anesthesia management are increasing. With the application of ultrasound visualization technology in anesthesia field, regional block anesthesia technology is guaranteed and developed. Regional block anesthesia is increasingly used in inguinal hernia surgery, especially in the elderly and children for anesthesia and analgesia. At present, regional anesthesia methods have emerged in endlessly. This article reviews the methods including paravertebral nerve block (PVNB), lumbar plexus nerve block(LPNB), quadratus lumborum block (QLB), ilioinguinal/iliohypogastric nerve block (IINB) and transversus abdominis plane block(TAPB) of regional block anesthesia for inguinal hernia surgery, and to explore the best.

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 investigate the effect and potential mechanism of Boschniakia rossica polysaccharides (BRPS) on the invasion and migration of human liver cancer cells. Methods Different concentrations of BRPS (12.5, 25, 50, 100 and 200 μg/L)were screened on liver cancer HepG2 cells to identify the appropriate concentration. Based on culture conditions, the HepG2 cells were named control group (no treatment), hypoxia-inducible factor-1α (HIF-1α) group (transfected with LV-HIF-1α), HIF-1α-NC group (transfected with LV-HIF-1α-NC), BRPS group (add 50 μg/L BRPS), and BRPS+HIF-1α group (transfected with LV-HIF-1α,and add 50 μg/L BRPS). Hoechst33258 staining was used to evaluate cell apoptosis; flow cytometry was used to detect cell apoptosis rate; the scratch test was used to detect cells migration ability; Transwell test was used to detect cell invasion ability; Western blotting was used to detect HIF-1α and epithelial-mesenchymal transition (EMT) related factors E-cadherin and vimentin protein expressions in cells. Results The ideal BRPS concentration was identified as 50 μg/L. The results of Hoechst33258 staining showed that the blue fluorescence of hepatocarcinoma cells was weak in control group and HIF-1α-NC group, the blue fluorescence of HIF-1α group was dimer than control group; the blue fluorescence of BRPS group was brighter than control group; the blue fluorescence of BRPS+HIF-1α group was lower than that in BRPS group. In the control group, the apoptosis rate was 3.89%±1.25%; the cell healing rate was 63.35%±3.35%; the number of transwell cells was 122.60±3.29. Compared with control group, HIF-1α group showed a lower apoptosis rate (1.67%±0.86%, P<0.05), higher cell healing rate (87.48%±3.92%, P<0.05), and higher number of transwell cells(208.60±6.17, P<0.05). On the contrary, BRPS group showed a higher apoptotic rate (26.58%±1.63%, P<0.05), lower cell healing rate (14.82%±3.81%, P<0.05), and decreased number of transwell cells (68.80±4.25, P<0.05). Interestingly, in BRPS+HIF-1α group,the apoptosis rate was 12.14%±1.05%, higher than HIF-1α group but lower than BRPS group; the cell healing rate and the number of transmembrane cells were 32.59%±3.76% and (123.40±4.94) cells, respectively, both of which were lower than HIF-1α group but higher than that in BRPS group (P<0.05). Compared with control group, in HIF-1α group, the expression levels of HIF-1α and vimentin increased while E-cadherin decreased; however, in BRPS group, the expression levels of HIF-1α and vimentin decreased while E-cadherin increased (P<0.05). As expected, the expression levels of HIF-1α and vimentin in BRPS+HIF-1α group were lower than those in HIF-1α group but higher than those in BRPS group; the expression levels of E-cadherin was higher than that in HIF-1α group but lower than that in BRPS group (P<0.05). Conclusion BRPS can promote HepG2 cell apoptosis, inhibit cell migration and invasion. Its mechanism may be that it can suppress EMT by regulating HIF-1α.

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.

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.

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.

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.