People wearing positive pressure biological protective suits might face some potential safety risks when work -ing in a high-risk biological contamination environment .These risks could be effectively prevented by simulation experi-ments.This paper elaborates on the progress in risk studys on positive pressure biological protective suits in terms of dynam -ic detection methods and risk assessment , and points out the problems to be solved and the direction of future development .

Objective To establish a reliable unstable pelvic fracture model with sacral plexus stretch injury in goats and to detect electrophysiological signals when pelvis is shifted in different orientations and distance.Methods Twenty-four goats were divided into three groups of 8 animals each:pelvic longitudinal displacement was induced in group A,pelvic lateral displacement in group B,and pelvic dorsal displacement in group C.Animal left L6 and S1 nerve root and initial segment of sciatic nerve were exposed to connect stimulating and receiving electrodes respectively.Left pelvis was shifted at the speed of 0.25 mm/s to produce the model of unstable pelvic fracture with sacral plexus stretch injury.Electrophysiological signals of L6 and S1 were recorded when the placement of pelvis was 0,0.5 and 1.0 cm respectively.Results With pelvic displacement,the threshold potential,maximum stimulus potential and incubation period were gradually increased,but the peak-to-peak value became smaller gradually.When the pelvis displaced 0.5 cm at different orientations,group A showed improved threshold potential and incubation period (P ＜0.05),decreased peak-to-peak value (P ＜0.05),and no significant change in maximum stimulus potential(P ＞0.05);group B only showed lowered peak-to-peak value with no significant variations in other electrophysiological signals (P ＜ 0.05);group C had no significant variations in all electrophysiological signals (P ＞ 0.05).When the pelvis displaced 1.0 cm at different orientations,groups A and B showed improved threshold potential,maximum stimulus potential and incubation period (P ＜ 0.05) and lowered peak to peak value (P ＜ 0.05);group C showed higher incubation period with no significant variations in other electrophysiological signals(P ＜0.05).Between groups,the amplitude of variation in electrophysiological signals was the most in group A and the least in group C.Conclusion After unstable pelvis fracture in goats,sacral plexus stretch injury is the most serious in longitudinal displacement of the pelvis.

We aimed to analyze the clinical data of 10 patients (6 male and 4 female) with Fabry disease (FD). The mean age of the patients was (28.80±9.27) years. Seven patients had classical FD and three had delayed onset FD. Among the 10 patients, six had skin involvement and cutaneous angiokeratoma; five had hypohidrosis or anhidrosis; nine had intermittent neuralgia; and three had supraorbital ridge protrusion, forehead bulge, and lip thickening. Five patients had proteinuria, including one with chronic kidney disease stage 3 and one with chronic kidney disease stage 5. Cardiac involvement occurred in three patients, two had myocardial hypertrophy and one had valvular insufficiency. The activity of galactosidase decreased in seven patients (2.80-1.55 μmol·L -1·h -1). Plasma deacetyl-GL-3 was elevated in all 10 patients(3.12-120.00 ng/ml). Three patients underwent renal biopsy, wherein two cases of focal segmental glomerulosclerosis and one of mesangial proliferative glomerulonephritis was found. A large number of myeloid and zebra bodies were found in the podocytes in three patients, including a small number of myeloid and zebra bodies in the renal tubular epithelial cells in one patient with occasional zebra bodies in the renal interstitium. Nine patients had GLA gene mutations. One patient was c.102T>A, a de novo mutation. Four patients were treated with agalsidase α injection (0.2 mg/kg, intravenous infusion every 2 weeks), and their prognosis was good. FD has various clinical manifestations and multi-system involvement, which requires multidisciplinary cooperation. Detection of galactosidase activity, plasma globotriaosylsphingosine, and GLA gene mutation can help for accurate diagnosis.

Objective To investigate the clinical experience and associated factors of extracorporeal membrane oxygenation(ECMO)for adult patients with severe acute respiratory distress syndrome(ARDS).Methods The clinical data of 22 adult patients with severe ARDS,which met the criteria for ECMO,were retrospectively collected and analyzed.The ECMO team all receiving VV-ECMO treatment (Veno-venous extracorporeal membrane oxygenation),data collection including the patients,general data,blood gas analysis,hemodynamics,mechanical ventilation parameter before and after the ECMO treatment and the auxiliary complications,etc.The control group were 14 cases of patients with severe ARDS which receiving conventional treatment;We collected the same data as the research team.Results In the research,8 patients treated with VV-ECMO,There were 5 males and 3 females,with an average age of (46.3 ± 14.1)years.Compared with the factors at the same time point in the control group,those of the ECMO group,except MAP (t =-0.872,P =0.357),Respiratory rate (t =-1.670,P =0.357),Heart rate (t =-1.973,P =0.042),PH (t =-1.432,P =0.033),PaCO2 (t =-2.564,P =0.024),PO2 (t =-4.955,P ＜ 0.001),PO2/FiO2 (t =-3.654,P ＜ 0.01),PEEP (t =-1.382,P =0.031),Pplateau (t =-2.785,P ＜ 0.01),Blood lactate (t =-2.564,P =0.024) were significantly improved after ECMO running 24 hours (all P ＜ 0.05).And also the factors such as the length of ICU stay (t =-2.452,P =0.027),the times of mechanical ventilation (t =-1.478,P =0.038),number of organ failure(t =-1.963,P =0.047),the hospital mortality rates(t =-1.970,P =0.045) and treatment costs(t =-1.667,P =0.035) between the ECMO group and the control group were significantly different (P ＜0.05).In the end,we divided the ECMO group into survival group and death group,and compare the time of Mechanical Ventilation before ECMO(P =0.031) the total time of Mechanical Ventilation(P =0.038),the time of ECMO adjutant (P =0.047),the length of ICU stay (P =0.043) and the cost of treatment (P =0.037) between the two groups;and there were also statistically significant difference (P ＜ 0.05).Conclusion ECMO can significantly improve the patients,oxygenation and respiratory physiology indexes which can not sustain under the conventional mechanical ventilation therapy and win the time for rest and repair of lung.Indexes such as age,time of mechanical ventilation before ECMO therapy,the primary cause of ARDS are the important factors influencing the efficacy of ECMO treatment in the patients with severe ARDS.

Neutrophil elastase(NE),a major protease in the primary granules of neutrophils,is involved in microbicidal activity.NE is an important factor promoting inflammation,has bactericidal effects,and shortens the inflammatory process.NE also regulates tumor growth by promoting metastasis and tumor microenvironment remodeling.However,NE plays a role in killing tumors under certain conditions and promotes other diseases such as pulmonary ventilation dysfunction.Additionally,it plays a complex role in various physiological processes and mediates several diseases.Sivelestat,a specific NE inhibitor,has strong potential for clinical application,particularly in the treatment of coronavirus disease 2019(COVID-19).This review discusses the pathophysiological processes associated with NE and the potential clinical applications of sivelestat.

Objective To study the relationship between preoperative serum a-fetoprotein (AFP) level and early recurrence of patients with hepatocellular carcinoma (HCC) after partial hepatectomy.Methods 267 patients with hepatocellular carcinoma who underwent partial hepatectomy in Xijing Hospital,the Fourth Military Medical University from January 2011 to November 2015 were retrospectively studied.The patients were divided into the AFP-negative group (AFP ≤20 μg/L) and the AFP-positive group (AFP ＞ 20 μg/L) according to the preoperative serum AFP levels.The risk factors of early recurrence of HCC in patients after partial hepatectomy were studied by multivariate regression analysis.The recurrence-free survival rates during 24 months after surgery between the AFP-negative group and the AFP-positive group were compared.Results In 267 patients,97 patients had low or negative AFP levels (AFP≤20 μg/L) and 170 patients had high or positive AFP levels (AFP ＞ 20 μg/L).Patients in the AFP-positive group had significantly more well differentiated HCC on tumor histology when compared with patients in the AFP-negative group (x2 =17.050,P ＜ 0.05).The proportion of patients with liver cirrhosis in the AFP-positive group was significantly higher than that of the AFP-negative group (x2 =4.374,P ＜ 0.05).On the other hand,the numbers of patients with adjacent tissue invasion (x2 =4.374,P ＜ 0.05) and early HCC recurrence (x2 =7.595,P ＜ 0.05) in the AFP-positive group were significantly less than those of the AFP-negative group.Survival analysis showed that the recurrence-free survival rates in the AFP-positive and negative groups were 35.3％,52.6％,respectively.The results on univariate analysis showed that portal vein tumor thrombus,HBsAg positivity,tumor number,tumor diameter,tumor tissue differentiation,preoperative serum AFP level and adjacent tissue invasion were significantly associated with early recurrence of liver cancer (P ＜ 0.05).Cox multivariate regression analysis revealed that serum AFP positivity (HR =1.605,P ＜ 0.05),portal vein tumor thrombosis (HR =3.936,P ＜ 0.05),HBsAg positivity (HR =1.621,P ＜0.05),tumor diameter (HR =1.977,P ＜ 0.05) and tumor number (HR =1.991,P ＜ 0.05) were significantly correlated with early recurrence of liver cancer after partial hepatectomy.Conclusion The preoperative serum AFP level had an important predictive value for early recurrence of primary hepatocellular carcinoma in patients after partial hepatectomy.

Behcet′s disease is a chronic, multisystemic, inflammatory disease characterized by recurrent episodes of mucous membranes, eyes, musculoskeletal, blood vessels, central nervous system, and gastrointestinal tract.The treatment of Behcet′s disease varies according to the degree of organ involvement, gender and age of the patient, and there is no standard treatment. Behcet′s disease can be divided into vascular type, gastrointestinal type and neural type. Vascular type often leads to high mortality and disability rate.Glucocorticoids, azathioprine and cyclophosphamide are still recommended as first-line treatments for vascular Behcet′s disease.However, with the use of tumor necrosis factor inhibitors, they are an acceptable option for the treatment of refractory vascular Bezier′s disease.This article reviews the current treatment of vascular Behcet′s disease.

OBJECTIVETo assess the association of TLR4 gene polymorphisms with large artery atherosclerosis (LAA) stroke and liability to atherosclerosis in an ethnic Han population from northern China.

METHODSThe study has involved 286 LAA stroke patients and 300 healthy controls. The LAA group has been divided 4 subsets according to angiostenosis conditions. Polymerase chain reaction-restriction fragment length polymorphism and pyrosequencing were employed to analyze three single nucleotide polymorphism (SNPs) (rs1927914, rs1927911 and rs2149356) of the TLR4 gene. A Haploview software package was used to analyze the haplotypes.

RESULTSSNPs rs1927911 and rs2149356 were associated with LAA stroke. Genotypic and allelic frequencies of rs1927914 did not differ significantly between the two groups. Genetic variants of the three SNPs did not vary significantly between all subsets. Haplotype analysis was revealed a significant difference between the LAA group and the control group. Compared with the controls, the frequencies of haplotypes H2 and H8 were lower, and that of H3 was greater in the LAA group.

CONCLUSIONAn association between the TLR4 gene polymorphisms and LAA stroke subtype in ethnic Han population in northern China has been found. However, no association of liability to atherosclerosis in different vascular bed has been found with these polymorphisms.

Adult ; Aged ; Asian Continental Ancestry Group ; ethnology ; genetics ; Base Sequence ; Coronary Artery Disease ; ethnology ; genetics ; pathology ; Coronary Vessels ; pathology ; Female ; Genetic Association Studies ; Humans ; Male ; Middle Aged ; Molecular Sequence Data ; Polymorphism, Single Nucleotide ; Stroke ; ethnology ; genetics ; pathology ; Toll-Like Receptor 4 ; genetics

Objective To investigate the clinical efficacy and safety of CT-guided percutaneous microwave ablation (MWA)in elderly patients with early-stage lung cancer who were unable to underwent surgery,and to evaluate the risk factors for prognosis.Methods A total of 51 patients with early stage(stages Ⅰ and ⅡA)non-small cell lung cancer (NSCLC)who underwent MWA in Beijing hospital from January 2016 to December 2018 were collected as the MWA group.And 50 patients with similar age and gender receiving lobectomy surgery were collected as the control group.In a retrospective follow-up study,the clinical efficacy and safety of treatment were compared between the study(n=51)and control(n=50)groups.Kaplan-Meier survival analysis was used to assess the overall survival and local recurrence-free survival.COX analysis was used to evaluate the risk factors.Results Of the 101 patients,62 were male(61.4％),aged 60-85 years(average,72.3± 11.6 years).There was no significant difference in baseline characteristics,including age,gender,smoking,medical history,lung function,tumor size,pathological type and histological grading,tumor position and clinical stage between the two groups(P＞0.05).There were no serious complications in the MWA group during perioperative period,and 14 cases (27.5％)had a small amount of pneumothorax after operation,which were absorbed after special treatment.Five cases (9.8％)had a small amount of hemoptysis,7 cases(13.7％)had a small amount of pleural effusion,9 cases(17.6％)had low fever (＜ 38.5 ℃),and 9 cases (17.6 ％) had postoperative mild pain.There were no serious complications in the control group.The follow-up period was up to December 31,2018,and the median follow-up time was 11.7 months(4.5 20.3 months).During the follow-up,local recurrence occurred in 10 patients(9.9％),including 7 patients(13.7％)in the MWA group and 3 patients(6.0％)in the control group.There was no significant difference between the MWA group and the control group in the 1-year overall survival rate(92.2％ or 47 cases vs.96.0％ or 48 cases,P =0.313),tumor-specific survivalrate(100.0％ vs.100.0％,P=1.00),local recurrence free survival rate(86.3％ or 44 cases vs.94.0％ or 47 cases,P =0.156).Multivariate COX regression analysis showed age (HR =1.22,95 ％CI:1.06-1.38,P =0.004),tumor size (HR =1.75,95 ％ CI:1.14-2.36,P =0.005) and clinical stage of tumor(HR =1.53,95 ％ CI:1.17-1.89,P =0.001) were risk factors for the local recurrencefree survival.Conclusions MWA is an effective and safe treatment for elderly patients with early-stage lung cancer who are not suitable for surgery.Age,tumor diameter and clinical stage are risk factors for local recurrence-free survival.

In the differentiation and treatment of recurrent urinary tract infection （rUTI） from the perspective of the seminal orifice， it is proposed that the urinary tract belongs to the category of "seminal orifice"， and the physiological process of urination is closely related to the function of the seminal orifice. From the three dimensions of orifice body， orifice pivot and orifice spirit， the physiological relationship between seminal orifice and the function of five zang-organs （脏） is constructed， that is， lung heat， yin damage and pathogen counter-restriction lead to malnutrition of orifice body； burning heart fire and spirit disorder lead to unfavorable orifice spirit， and kidney deficiency， liver constraint and spleen stagnation lead to unfavorable orifice pivot. In the early stage of rUTI， there is usually unfavo-rable orifice pivot， for which the treatment principle should be treating the root and the branch simultaneously， consi-dering both deficiency and excess， and paying attention to the management of accompanied symptoms. Zishui Qinggan Beverage （滋水清肝饮） and Modified Shenzhuo Decoction （肾着汤加减） are often selected based on syndrome differentiation. In the middle stage， lack of nourishment of the orifice body and unfavorable orifice spirit and pivot coexist， and the treatment should be draining the orifice and unblocking strangury， commonly withmodified Qingxin Lianzi Beverage （清心莲子饮）. In the late stage， loss of nourishment of the orifice body is the main pathogenesis， and it is necessary to further nourish the orifice body to prevent recurrence， and modifed Wuzi Yanzong Pills and Erxian Decoction （五子衍宗丸合二仙汤） is often used. Furthermore， the specific medicinals should be selected targeting at the orifice body， orifice pivot， and orifice spirit， so as to nourish orifice body by dispelling external pathogens and rectify healthy qi， to drain orifice pivot by freeing emotions and minds and unblocking qi movement， and to calm orifice spirit by unblocking heart and kidney and nourishing heart spirit.