Objective To document the dynamics of secondary liver injury in pigs with traumatic hemorrhagic shock(THS) induced by simulated desert dry heat environment and to explore its possible mechanism. Methods Sixty male Landrace piglets were randomly divided into three groups: Dry heat trauma hemorrhagic shock group (DHS group, n=20), dry heat trauma hemorrhagic shock sham operation group (DHC group, n=20), normal temperature trauma hemorrhagic shock group (NTS group,n=20). DHS group and DHC group were exposed to a dry and hot environment [temperature (40.5±0.5) ℃, humidity 10%±2%];while NTS group were exposed to normal temperature environment [temperature (25.0±0.5) ℃, humidity 35%±5%] for 3 h. Then the model of blood pressure controlled hemorrhagic shock was established. Animals were euthanized at 0 min (T₀), 50 min(T₁), 100 min (T₂) or 150 min (T₃) after the successful establishment of the hemorrhagic shock model, blood and live tissue were collected. The pathological changes of liver tissue were observed by HE staining; the levels of TNF-α and IL-1β in liver tissue were detected by ELISA; the expressions of HMGB-1 and ICAM-1 in liver tissue were detected by Western blotting; the contents of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum were determined. Results HE staining results showed that the DHS group had different degrees of injury at each time point, and gradually aggravated with time, and gradually appeared different degrees of hepatic sinusoidal expansion, congestion, hepatic lobule, portal area structure disorder, inflammatory cell infiltration, liver cell degeneration, necrosis and so on. In the NTS group, the injury began to appear at T₂ and gradually worsened. In the DHC group, there was no obvious pathological change at each time point (P>0.05). In the DHS group, ALT and AST showed dynamic changes, and the changing trend was the same, compared with the DHC group, it began to rise at T₀, the difference was statistically significant (P<0.01), and reached the peak at T₁ and T₃, respectively, and the differences were statistically significant compared with DHC group and NTS group at the same time point (P<0.01); however, there was no significant change in DHC group at each time point. TNF-α and IL-1β began to increase at T₀ in the DHS group, and the differences were statistically significant compared with the DHC group and NTS group at the same time point (P<0.01). Both the DHS group and NTS group showed a continuous growth trend in a time-dependent manner with a significantly faster growth rate in the DHS group than that of the NTS group (P<0.01). There were no statistical significances on ALT or AST levels in the DHC group (P>0.05). As time went on, the expression of ICAM-1 and HMGB-1 in the DHS group was higher than that in the previous time point (P<0.05 or P<0.01). Conclusion In desert dry and hot environment, the secondary liver injury of THS occurs early and progresses seriously. This can activate more Kupffer cells in the liver to promote the release of TNF-α and IL-1β leading to elevated expression of HMGB-1 and ICAM-1 resulting in further liver injury.

Objective To investigate the expression level and clinical significance of serum miR-21 and Peli1 mRNA in peripheral blood mononuclear cells (PBMC) of patients with autoimmune premature ovarian insufficiency (aPOI). Methods A total of 26 patients untreated and initially diagnosed as autoimmune POI (aPOI group) and 30 healthy young females (control group), visited during April 2018 to October 2019 in Zhujiang Hospital of Southern Medical University, were included in present study. The general data of each subject were recorded. The expression levels of serum miR-21 and PBMC Peli1 mRNA were detected by qRT-PCR, and the serum sex hormone [estradiol (E₂), follicle stimulating hormone (FSH), luteinizing hormone (LH)], anti-Mullerian hormone (AMH), thyroid hormones and immune-related indicators were evaluated. Uterus and ovary index of all subjects were assessed by ultrasonography. Results The expression levels of serum miR-21 and PBMC Peli1 mRNA were significantly lower in aPOI group than those in control group (0.60±0.14 vs. 1.01±0.07; 0.30±0.14 vs. 1.63±0.54, P<0.05), and Peli1 mRNA was positively related with miR-21 (r=0.719, P<0.05). Compared with control group, aPOI group showed earlier menarche age, shorter menstrual period, fewer gravidity and parity, less contents of E₂ and AMH, smaller uterus and ovaries; while longer menstrual cycle, higher levels of FSH and LH, and the number of positive menopausal symptoms and immune indexes were significantly higher than those in control group (P<0.05). MiR-21 and Peli1 mRNA were positively related to E₂, AMH, the size of uterus and ovarian volume, respectively; and negatively related to FSH, LH, and the number of positive immune indexes. Conclusions The serum miR-21 is positively related to the decreased expression level of PBMC Peli1 in aPOI patients, and both miR-21 and Peli1 might be involved in the pathogenesis of aPOI, therefore show some values for the auxiliary diagnosis of aPOI.

Objective To report a case of atrial septal defect (ASD) with congenital fibrinogen deficiency (CFD), and review the literature. Methods A case of secondary ASD with CFD treatment in Xuanwu Hospital of Capital Medical University was reported, and the defect was repaired under CPB on beating heart. The management experience of cardiac surgery under CPB in patients with CFD was summarized by means of PubMed database and literature analysis. Results This patient was female,30 years old. She was admitted to the hospital with the complaint that ASD was found for 8 months after physical examination. On admission, echocardiography showed that the atrial septum was interrupted by about 34 mm. Color Doppler flow imaging(CDFI) detection indicated systolic left to right shunt, the pressure difference of tricuspid regurgitation was 66 mmHg, systolic pulmonary artery pressure (SPAP) was 76 mmHg, ejection fraction (EF) was 64%. Coagulation function: Prothrombin time was>120 s, thrombin time >240 s, activated partial thrombin time >180 s, and fibrinogen <0.6 g/L. Preoperative continuous intravenous infusion of fibrinogen 4 g per day was to maintain the plasma fibrinogen >1.5 g. Three days later ASD repair was performed under CPB on beating heart. Infusion of fibrinogen 2 g was performed by venous injection during operation, and another fibrinogen 2 g was given after heparin was neutralized by protamine. Operation time was 3.5 hours, and CPB time was 45min. Fibrinogen 4 g per day was supplemented postoperatively for 5 days. At the 3rd day chest drainage tube was removed. The patient was discharged at the 7th day. There were no hemorrhage and thrombosis complications. After 3 months, outpatient follow-up showed the surgical incision healed well, echocardiography showed no residual shunt in the atrial septum, and EF value was 67%. A total of 8 English literatures were obtained after searching PubMed database and manually screening, including 875 patients with hypofibrinogenemia after CPB cardiac surgery. Among them, 604 were males (69.0%) and 271 were females (31.0%). There were 6 case reports, including 1 infant(5 days old, weight 2.5 kg) and 5 adult cases, and they were all male. Patients with abnormal afibrinogenemia may have both bleeding and thromboembolic symptoms. Patients with fibrinogen deficiency who undergo CPB cardiac surgery need to be supplemented with fibrinogen, cryoprecipitation or fresh frozen plasma during the perioperative period to prevent severe postoperative bleeding complications. Conclusion Patients with fibrinogen deficiency should be given a individualized perioperative management plan according to the quantitative and other coagulation indexes of fibrinogen in plasma for cardiac surgery under CPB.

Objective To investigate the curative effect of low molecular weight heparin (LMWH) on preventing the formation of deep vein thrombosis (DVT) of high-risk pregnant women during pregnancy and puerperium. Methods A total of 1099 high-risk pregnancy patients were collected as LMWH group who received LMWH for preventing the formation of DVT in Zhujiang Hospital of Southern Medical University from January 2019 to July 2020; and 2107 high-risk pregnancy cases without LMWH were selected as control group from January 2016 to December 2018. SPSS 20.0 was employed for statistical analysis, and the number of thrombosis cases, the incidence of prepartal and puerperal hemorrhage, the cesarean section rate and other indicators were compared and analyzed between the two groups. Results After LMWH treatment, no new case of DVT occurred in LMWH group during pregnancy and puerperium, while there were 24 cases of new thrombosis in control group, the difference was statistically significant between the two groups (P=0.000). There were 2 cases of placental abruption before delivery occurred in the LMWH group, and only 1 case in control group. The 2 h postpartum hemorrhage was (182.25±120.62) ml in LMWH group, and (165.00±68.58) ml in control group. The cesarean section rate was 37.5% in LMWH group and 38.9% in control group. No significant differences existed in the incidence of placental abruption, postpartum hemorrhage and cesarean section between the two groups (P>0.05). Conclusion For pregnant women with high risk factors for thrombosis, LMWH can be used according to the score to prevent thrombosis, and it is safe and effective.

Objective To investigate the clinical characteristics of severe coronavirus disease 2019 (COVID-19) and explore the relevant risk factors that affect outcomes of the patients. Methods A retrospective analysis was performed on the data of the patients with severe COVID-19 admitted to the ICU of Huoshenshan Hospital of Wuhan City during the period from February to April, 2019. The patients were classified into survival group and death group. The general data, clinical manifestations, laboratory examinations, and treatments were compared between the 2 groups. Results A total of 122 severe COVID-19 patients were included in the study, 56 died and the fatality rate was 45.9%. The proportion of comorbidities of coronary heart disease in death group was significantly higher than that in the survival group [19.6%(11/56) vs. 7.6%(5/66), P=0.049]. Compared with patients in the survival group, the platelet count in the death group decreased [190.1(132.3, 245.0)×10⁹/L vs. 217.0(176.0,262.3)×10⁹/L, P=0.015] and the levels of C-reactive protein and brain natriuretic peptide in the death group increased [37.4(4.3,125.6) mg/L vs. 8.9(2.7, 51.4) mg/L, P=0.027 and 65.17(18.84, 167.71) pg/ml vs. 16.60(0.01, 67.68) pg/ml, P=0.007]. The prothrombin time and thrombin time in the death group were longer than those in the survival group [14.20(13.22, 15.86) s vs.13.27(12.16, 14.27) s, P<0.01 and 16.32(15.11, 18.02) s vs. 15.75(14.81, 16.62) s, P=0.037]. Dynamic observation data showed that there were significant differences in neutrophil count, lymphocyte count, neutrophil/lymphocyte ratio and levels of both lactate dehydrogenase and α-hydroxybutyrate dehydrogenase (α-HBDH) between the two groups. ROC curve analysis showed that LDH and α-HBDH were of high value in predicting outcome, and the area under the curve was more than 0.7. Conclusions We should pay close attention to the changes of blood routine, LDH, and α-HBDH for older patients with underlying diseases. This will help us to identify the patients with high risk of death in the early stage, and take effective treatment measures as early as possible to improve the prognosis.

Objective To explore the clinical features of patients with end-stage renal disease (ESRD) complicated with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) and undergoing maintenance hemodialysis (MHD). Methods A total of 133 ESRD patients complicated with tuberculosis, treated at the Tuberculosis Department of the 8th Medical Center of Chinese PLA General Hospital and undergoing MHD at the Blood Purification Center, were selected from July 2012 to February 2021, and divided into PTB group (87 cases) and EPTB group (46 cases). The clinical characteristics, treatment and prognosis of the two groups were compared and analyzed. Results Both PTB group and EPTB group were predominantly male patients (80.5% and 58.7%), but the proportion of female patients was higher in EPTB group (41.3%) than that in PTB group (19.5%, P<0.05). No significant differences existed between the two groups in age, primary kidney disease, comorbidities, dialysis duration, and the detection time-point of tuberculosis after dialysis. Among the first symptoms, the proportion of cough+sputum and fever was significantly higher in PTB group than that in EPTB group (59.8% vs. 23.9% and 60.9% vs. 28.3%, respectively, P<0.05), while the proportion of pain at lesion location was significantly lower in PTB group than that in EPTB group (8.0% vs. 41.3%, P<0.05).CT or MRI imaging was the dominated method for definite diagnosis in both PTB group and EPTB group (67.8% and 76.1%), the secondary method was sputum smear or culture (26.4% and 6.5%) and needle biopsy (5.7% and 17.4%), respectively, with a significant difference between the two groups (P<0.05). No significant difference existed in the positive rate of γ-interferon release assay (γ-IRA) between the two groups. In both PTB group and EPTB group, the proportion of lymphocytes, hemoglobin and albumin decreased markedly, while the proportion of erythrocyte sedimentation rate (ESR) and increased C-reactive protein(CRP) were relatively higher, but there was no statistical difference between the two groups. Both groups were treated with anti-tuberculosis drugs, and one case in EPTB group received anti-tuberculosis drugs plus surgery of tuberculosis focus clearance. No significant difference existed in the incidence of adverse reactions between the two groups, and the improvement rate after treatment was similar. Conclusions Significant differences exist between PTB and EPTB patients with ESRD on MHD in gender ratio, first manifested symptom and diagnosis methods. Paying attention to these differences and conducting individualized monitoring, diagnosis and treatment will be helpful to reduce the morbidity and mortality of patients with PTB and EPTB.

Percutaneous coronary intervention (PCI) is one of the effective treatments for coronary heart disease (CHD), but it may cause stress events since its invasive might lead to various somatization symptoms, and then bring about anxiety, depression and other psychological disorders, thus affecting its curative effect and prognosis. In recent years, due to the extensive development of PCI treatment, such patients are not rare in clinic. It has been proved that anxiety and/or depression and CHD are reciprocal and influenced by multiple factors, but the pathophysiological mechanism is still not clear. With the continuous development of "double-heart medicine" model, clinical workers have paid more attention to the identification and diagnosis of cardiovascular disease complicated with psychological problems. The research progress of clinical diagnosis and treatment of patients with complicated anxiety and/or depression after PCI has been reviewed in present paper, thus provides a reference for the implementation of clinical work.

Cardiac computed tomography angiography (CCTA) has become an important non-invasive method to evaluate coronary artery disease. With the extensive application and increased image analysis features, more demands on operational technique and efficiency are asked. Machine learning (ML) is the subarea of artificial intelligence (AI), which is completely data driven, by computer algorithm to identify and analyze the potential relationship of centralized variables in large data sets for realizing the prediction of external data. In the field of cardiac CT, the application of various ML algorithms would improve the efficiency and quality of CCTA, helping accurate lesion assessment and risk stratification. It also brings new applications in cardiac functional imaging. The applications of ML in cardiac CT have been reviewed in present paper including CT-image analysis, risk stratification, CT-myocardial perfusion and CT-fractional flow reserve.

Diabetic nephropathy (DN) is a common complication of diabetes, and is one of the main causes of end stage renal disease (ESRD). At present, the practical therapeutic method for DN is still lacked due to unclear pathogenesis. However, as a traditional Chinese medicine, astragalus, especially Astragalus membranaceus, is commonly used in the treatment of DN. The main active ingredients of Astragalus membranaceus include astragaloside Ⅳ (AS-Ⅳ) and astragalus polysaccharide (APS), which can effectively reduce proteinuria and protect renal function. The mechanism of AS-Ⅳ and APS in treatment of DN was reviewed in present article including regulation of endoplasmic reticulum stress (ERS), anti-inflammatory, reducing cell apoptosis, inhibiting fibrosis, and regulating metabolism of sugar and lipid, in order to provide reference for the research and clinical application.

Intervertebral disc degeneration (IDD) is a common disease in orthopedics, and its pathogenesis is complicated. The main pathological changes are cell apoptosis and extracellular matrix degradation. Clinical therapies are mainly symptomatic and cannot cure diseases at the etiological level. IDD targeted therapy has become the focus of current research due to its small side effects and broad prospects. The apoptosis of nucleus pulposus cells caused by activation of the Fas signaling pathway is an important cause of IDD. It affects IDD's pathophysiological process through genetic factors and is closely related to the pathogenesis of IDD inflammation, immunity, and abnormal vascular growth. Targeting Fas signaling inhibition may be a new type of therapy to slow down the process of IDD effectively. This paper reviews Fas apoptotic pathway, etiology of IDD, the relationship between Fas pathway and IDD, and targeted inhibition of Fas pathway in the treatment of IDD.