Objective To explore the predictive value of red volume distribution width (RDW) for the clinical outcome of sepsis in the elderly. Methods Two hundred and ten elderly patients with sepsis admitted to the General Hospital of Eastern Theater Command of PLA from January 2018 to December 2019 were included. The highest Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ)score and sequential organ failure (SOFA) score were calculated during sepsis. According to clinical outcome, 210 patients were divided into septic shock (n=93) /non-shock (n=117) groups; severe (n=79)/mild organ dysfunction (n=131) groups and death (n=60)/survival groups (n=150). The differences in age, sex, smoking and drinking history, medical history, APACHE Ⅱ score, SOFA score, RDW were compared between the different groups. Spearman's correlation analysis was used to analyze the correlation between RDW and APACHE Ⅱscore, SOFA score, total hospital days and ICU hospital days. Unconditional logistic regression was used to analyze the risk factors for septic shock, severe organ dysfunction and death in elderly patients with sepsis. Receiver operating characteristic (ROC) curves were adopted to analyze the predictive value of RDW, SOFA score, and APACHE Ⅱ score for septic shock and severe organ dysfunction in elderly patients with sepsis. Results The RDW, APACHE Ⅱ score, SOFA score, the incidence of severe organ dysfunction and death in the septic shock group were higher than those of the non-sepsis group; RDW, APACHE Ⅱscore, SOFA score, the incidences of septic shock and mortality in the severe organ dysfunction group were higher than those in the mild organ dysfunction group; RDW, APACHE Ⅱ score, SOFA score, the incidence of septic shock and severe organ dysfunction in the death group were higher than those in the survival group, there was a significant difference between each group (P<0.05); RDW was positively correlated with APACHE Ⅱ score, SOFA score, total hospital days and ICU hospital days (P<0.001); Elevated RDW was an independent risk factor for septic shock and severe organ dysfunction (P<0.05); the risk of septic shock and severe organ dysfunction was significantly increased when RDW>20% (P<0.05); The ROC AUC of SOFA score was 0.958, sensitivity was 0.817, specificity was 0.940, ROC AUC of RDW combined with SOFA score was 0.959, sensitivity was 0.968, specificity was 0.676 in predicting septic shock; The ROC AUC of APACHE Ⅱ score was 0.973, sensitivity was 0.911, specificity was 0.931, the ROC AUC of the RDW combined with APACHE Ⅱ score was 0.978, sensitivity was 0.972, and specificity was 0.668 in predicting severe organ dysfunction. Conclusions RDW is an independent risk factor to predict septic shock and severe organ dysfunction in elderly patients with sepsis; RDW combined with SOFA score and RDW combined with APACHE Ⅱ score have better sensitivity to predict septic shock and severe organ dysfunction than any single factor.

Objective To investigate the risk factors related to carotid atherosclerosis in aircrew. Methods With a retrospective case-control study, aircrew admitted in the Air Force Medical Center from January 2016 to December 2019 and underwent carotid artery ultrasound examination were recruited as the subjects. Those ultrasound diagnosed as carotid atherosclerosis(n=110) were set as case group, and age- and sex-matched aircrew with normal ultrasonography (n=110) were as control group. The differences in risk factors of atherosclerosis and flight factors between the two groups were compared. Logistic regression analysis was performed to explore the risk factors of carotid atherosclerosis in aircrew. Results The total flight time and average annual flight time of the aircrew in case group were significantly longer than those in the control group [4700(3015, 6200) h vs. 4050(3000, 5275) h,P=0.048; 168.82(129.79, 200.81) h vs. 147.73(120.26, 185.11) h, P=0.045]. The prevalence of hypertension and hyperlipidemia were higher in case group than those in control group [28.2%(31/110) vs. 14.5%(16/110), P=0.015; 56.4%(62/110) vs. 32.7%(36/110),P=0.000]. The percentage of aircrew without any risk factors of atherosclerosis was lower in case group than that in control group[12.7%(14/110) vs. 21.8%(24/110)], while the percentage of aircrew with ≥4 risk factors was significantly higher in case group than that in control group [12.7%(14/110) vs. 0%(0/110)]. Significant difference existed in the number of atherosclerotic risk factors between the two groups (P=0.003). Logistic regression analysis showed that hyperlipidemia and average annual flight time were the independent risk factors for carotid atherosclerosis in aircrew (P<0.05). Conclusion Hyperlipidemia and the long average annual flying time have a significant influence on the incidence of carotid atherosclerosis in aircrew.

Objective To investigate the clinical value of changing the diagnostic criteria for non-alcoholic fatty liver disease (NAFLD) to metabolism-associated fatty liver disease (MAFLD) in the risk-stratification and management of cardiovascular disease. Methods A total of 234 patients with fatty liver diagnosed by ultrasound examination were selected from February 2019 to September 2020 in the Gastroenterological Department of the Sixth Medical Center of Chinese PLA General Hospital. All the enrolled patients were collected of the anthropological parameters, history of chronic diseases [hypertension, type 2 diabetes mellitus (T2DM)], liver function, blood lipid, hemoglobin, platelet, blood uric acid, blood urea, bile acid, fasting blood glucose and nonalcoholic fatty liver disease fibrosis score (NFS). According to the different diagnostic criteria of fatty liver, 157 patients who met the diagnostic criteria of NAFLD were classified as NAFLD group and 213 patients who met the diagnostic criteria of MAFLD were classified as MAFLD group. The MAFLD group was regrouped and compared according to the presence or absence of T2DM and alcohol consumption. Results The proportion of male patients, hypertension, T2DM and the levels of alanine aminotransferase(ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and the hemoglobin in the NAFLD group were lower than those in the MAFLD group; and the level of high density lipoprotein cholesterol (HDL-C) in the NAFLD group was higher than that in the MAFLD group, the difference was statistically significant (P<0.05). In the MAFLD group, 75 patients were combined with T2DM and 138 had no T2DM. The proportion of patients with hypertension and the levels of ALT, AST, GGT and alkaline phosphatase (ALP) in patients with T2DM were higher than those without T2DM, and the proportion of patients without liver fibrosis (NFS <–1.455) was lower than those without T2DM, the difference was statistically significant (P<0.05). There were no significant differences in age, gender and BMI between the two groups (P>0.05). In the MAFLD group, 70 patients were drinkers and 143 non-drinkers. The age of the drinking group was lower than that of the non-drinking group, and the proportion of male, hypertension, T2DM and the levels of BMI, ALT, AST, GGT, pre-albumin, TG, TC, LDL-C, hemoglobin, uric acid and fasting blood glucose in the drinking group were higher than those in the non-drinking group, with statistical significance (P<0.05). Conclusion The diagnostic criteria of MAFLD are easier to identify high-risk population of cardiovascular diseases than those of NAFLD, which is helpful for targeted management.

Type 2 diabetes mellitus (T2DM) is often clinically associated with mi- and macrovascular diseases, but is often ignored in the early stage of the disease. Therefore, more auxiliary detection methods are needed clinically for early screening and auxiliary diagnosis of T2DM and high-risk patients. Arteriosclerosis detection--especially pulse wave velocity (PWV), as a non-invasive and effective method for measuring arterial stiffness, has been applied more and more widely in clinic recent years. Existing studies have shown that increased arterial stiffness is an important predictor of the occurrence and development of vascular diseases in T2DM. The value of PWV in the prediction of atherosclerosis is particularly important in order to better predict the occurrence of disease and start health management as soon as possible. Therefore, the relationship between PWV and mi- and macrovasular complications in T2DM is reviewed in present paper to provide early warning for patients with T2DM who have early vascular risk.

Postpartum hemorrhage is the most common cause of maternal death worldwide with an upward trend of incidence recent years. There are many reasons leading to postpartum hemorrhage with very complicated pathogenesis. Recent years, various studies have found that a close relationship existed between the plasma fibrinogen concentration and postpartum hemorrhage and its severity. Prenatal fibrinogen detection is helpful to predict the occurrence of severe postpartum hemorrhage, Detection of postpartum fibrinogen level, and timely correction of transient coagulation dysfunction is an important way to remedy severe postpartum hemorrhage. At the present stage, many domestic hospitals have taken prenatal fibrinogen detection as a routine test item, but it has not yet been taken as an independent risk factor for postpartum hemorrhage. At the same time, the fibrinogen threshold might leading to severe postpartum hemorrhage and whether the lowest fibrinogen level is related to the amount of bleeding are still uncertain. The present review summarized the research progress of the clinical application of plasma fibrinogen measurement in the prediction of severe postpartum hemorrhage and accurate assessment of the amount of bleeding when postpartum hemorrhage occurs, and to explore the clinical value of fibrinogen detection in postpartum hemorrhage. Meanwhile, Suggestions for relative clinical work and future research are presented in order to improve the prognosis of postpartum hemorrhage.

The outbreak of coronavirus disease 2019 has made nucleic acid detection widely known. Fluorescent quantitative polymerase chain reaction (PCR) technique is the most commonly used nucleic acid detection method in this epidemic control. However, its requirements on operators, instruments and sites limited its application in some scenarios with lower resources or outside laboratories. Isothermal amplification technology, especially recombinase polymerase amplification(RPA) technology, has the advantages of mild reaction conditions, high sensitivity, excellent specificity and short reaction time, which let it has a good application prospect in the rapid detection of a variety of pathogenic microorganisms. In this paper, the development and application of RPA technology are reviewed and summarized to provide a reference for the further research and promotion of this technology.

Atherosclerotic cardiovascular disease (ASCVD) is a kind of disease including acute coronary syndrome(ACS), history of myocardial infarction (MI), stable or unstable angina pectoris (SAP, UAP), coronary artery or other blood vessel revascularization (PCI), ischemic stroke (IS), transient ischemic attack (TIA), peripheral vascular disease (PAD) and so on. It has a high morbidity rate, high disability rate, and high mortality rate in elderly patients, which puts a heavy burden on patients'families and society. But the early warning markers of ASCVD were still in the exploratory stage. Sarcopenia is a common disease in elderly individuals. A large number of studies showed that sarcopenia may be an independent risk factor for the onset and severity of ASCVD. As a comorbidity, at the same time, it may also be an independent predictor of poor prognosis of ASACVD. In addition, sarcopenia and ASCVD in elderly individuals have some common pathogenesis, such as inflammation, oxidative stress and insulin resistance. The role of sarcopenia in the pathogenesis of ASCVD in the elderly is reviewed in present paper.

Stress fracture is a kind of weight-bearing lower extremity bone injury that usually occurs in athletes, recruits and other specific groups. It is one of the most important reasons that stop them from normal training and may affect athletes'career and military warfare capability. Many intrinsic and extrinsic factors may increase the risk of stress fracture, and preventive measures against these risk factors are the main direction of stress fracture prevention research. At the same time, the importance of more accurate diagnosis and treatment of stress fractures is heightened by the fact that the missed diagnosis or malpractice of stress fractures can have an adverse impact on the career of athletes or military recruits, placing an additional burden on the medical system. In this paper, the treatment and prevention of stress fractures are summarized, and the future prospects are prospected.

Heatstroke is a disease with high morbidity and mortality that causes a patient's core body temperature to be higher than 40.5℃ and combined with organ dysfunction when human body exposed to high temperature, high humidity and slow air circulation environment or after strenuous exercise. Early diagnosis and early cooling can significantly improve patient prognosis, increase patient survival rate and reduce complications. The cooling measures include extravascular cooling which mainly refers to physical cooling of body surface and intravascular cooling is mainly for patients who are not suitable for physical cooling or whose diagnosis and treatment are delayed due to lack of resources, especially for patients with heatstroke, which has a better cooling effect and can improve the prognosis of patients. Currently, the commonly used intravascular cooling measures in clinical practice mainly include intravascular infusion cooling, intravascular temperature management devices cooling and continuous blood purification.This article reviews the classification, mechanism, clinical application, advantages and disadvantages of intravascular cooling.

Objective To investigate the effect of oleanolic acid (OA) in the maturation of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) through switching pyruvate kinase type M isoforms. Methods HiPSC-CMs were derived from human induced pluripotent stem cells (hiPSCs), through sequential activation and inhibition of the Wnt signaling pathway. On day 19 hiPSC-CMs were divided into control group (RPMI 1640+B27), DMSO group (RPMI 1640+B27+2 μl DMSO), and 10 μmol/L OA group (RPMI 1640+B27+2 μl 5 mmol/L OA) and treated for 7 days, and the medium was changed every 2 days. Immunofluorescence or RT-qPCR were used to detect the expression of stem factor in hiPSCs and cardiac specific markers in hiPSC-CMs. Western blotting was used to detect the expression of PK and mitofusin 2 (MFN2). Mito-Tracker staining showed the morphology of mitochondria, and transmission electron microscope (TEM) showed the ultrastructure of mitochondria. EDU staining was used to detect cell proliferation, and flow cytometry was used to detect cell cycle. Results Immunofluorescence showed that hiPSCs expressed Nanog and Sox2, and hiPSC-CMs expressed myocardial specific markers cTnT, Cx43 and α-actinin.RT-qPCR showed that, compared with hiPSCs, significant differences (P<0.05 or P<0.01) existed in hiPSC-CMs expressed troponin I3 (TNNI3), myosin heavy chain 6 (MYH6), and myosin heavy chain 7 (MYH7). Immunofluorescence showed that, compared with control group and DMSO group, the cell area increased, sarcomere length increased, and the cell circularity decreased in hiPSC-CMs cultured with OA, and the differences were statistically significant (P<0.05); Western blotting showed that, compared with control group and DMSO group, the ratio of PKM1/PKM2 and the expression of MFN2 increased obviously, and the differences were statistically significant (P<0.05 or P<0.01), the fusion lengthening of mitochondria was observed under electron microscope, and Mito-Tracker staining showed that mitochondria formed more mature structure; EDU staining showed a decreased cell proliferation in hiPSC-CMs cultured with OA group compared with control group and DMSO group, all differences were statistically significant(P<0.05). The flow cytometry results indicated that the number of coenocytes increased in hiPSC-CMs cultured with OA group compared with control group and DMSO group. Conclusion OA can promote the maturation of cell structure, mitochondrial structure and morphology, and also can promote cell multinucleation. OA can promote hiPSC-CMs' maturation by switching pyruvate kinase type M isoforms.