Objective To explore the mechanism of shengmai injection on relieving ischemia reperfusion injury and antagonizing systemic inflammatory response syndrome by regulating cytokines when it was applied at the early stage of cardiopulmonary resuscitation(CPR).Methods 40 cases suffering from cardiac arrest and had their heart beat recovered through CPR for more than 24 hours were randomly divided into SMI group and control group(20 cases for each).The patients in the two groups were treated with common therapeutics based on the CPR,but the patients in SMI group were intravenously dropped with SMI in the early period of PLS phase,then the changes of serum concentration of TNF-α and IL-81h,2h,6h,12h and24h after CPR in the two groups was compared.Results The concentrations of serum TNF-α and IL-8 stepped up gradually after resuscitation and the levels of TNF-αand IL-8 in SMI group were lower than that of the control group at 1h,2h,6h,12h and 24h after resuscitation(P＜0.05).Conclusion SMI functions to relieve ischemia reperfusion injury by regulating cytokines and antagonizing systemic inflammatory response syndrome.

bone fracture, mild col apse of the articular surface;femoral head deformation, bone fracture, articular surface col apse, hip degeneration. MRI of four categories of avascular necroses appeared as phase Ⅰ:line-like low signal of weight-bearing area of femoral head on T1WI, high signal on T2WI as the main change. Phase Ⅱ:clear boundary crescent-shaped uneven signal on T1WI, T2WI displayed moderately higher, uneven slightly lower signal around, showing a typical two-line sign. Phase Ⅲ:femoral head deformation, subchondral fracture, col apse, crescent formation, zonal low signal on T1WI, medium or high signal on T2WI. Phase Ⅳ, Ⅴ:complete destruction of articular cartilage, joint space narrowing, significant col apse and deformation of the femoral head, non-specific secondary osteoarthritis of the acetabulum, such as sclerosis, cystic degeneration and marginal osteophyte. The X-ray, CT, MRI performances of four types of avascular necroses at the same period were basical y the same.

Objective To study the application of spiral CT three-dimensional reconstruction in diagnosing intra-articular and other bone fractures in the earthquake of Wenchuan.Methods 25 cases with joint and other bone fractures in Wenchuan earthquake underwent multi-slice spiral CT volume scanning,the images were dealed with three-dimensional reconstruction at workstation including multiplanar reconstruction (MPR) and surface shaded display(SSD) to observe the fractures.Results 36 fractures in 25 cases were found by three-dimensional reconstruction(MPR and SSD),which included knee joint bone fracture in 6,one case was avulsion fracture of the point attached to the tibia by posterior cruciate ligament and missed by X-ray;ankle fracture in 3,1 case was Pilon fracture;shoulder fracture in 5,one case with glenoid anterior labrum missed by radiography;elbow fracture in 3;spinal fractures including cervical vertebra in 2,thoracic vertebra in 4 and lumbar vertebra in 5,2 cases were burst fracture accompanied with the articular process fracture; pelvis bone fracture in 8,1 case was sacroiliac fracture accompanied with sacroiliac separation.There were open bone fractures in 4 cases,fractures with dislocation in 6 cases,soft tissue swelling in different degree around the fractures in 25 cases.Conclusion Spiral CT three-dimensional reconstruction of bone can directly and really show the fractures that will provide in-formations for the clinical diagnosis and treatment .

BACKGROUND: Ischiofemoral impingement (IFI) syndrome has attracted more and more attention, but there is little report on IFI because of its low incidence. Moreover, its imaging characters have not yet been fully understood.OBJECTIVE: To discuss the MRI diagnostic criteria for IFI, thus understanding the imaging characters of IFI revealed on MRI.METHODS: Sixteen cases (21 hips) of suspected IFI were selected as experimental group, and 25 healthy volunteers as control group. The bilateral ischiofemoral space (IFS, the shortest distance between the ischial tuberosity and lesser trochanter of femur) and quadratus femoris space (QFS, distance between the lesser trochanter of femur and hamstring tendon insertion) were measured on MRI axial image. The signal and morphology of the quadratus femoris were observed. The differences in QFS and IFS were compared between two groups.RESULTS AND CONCLUSION: (1) Among 16 patients, there were 13 females, and 3 males, and 5 female cases of bilateral IFI. (2) In the experimental group, the IFS ((13.65±3.87) mm versus (22.17±5.75) mm) and QFS ((7.15±3.50) mm versus (12.89±3.13) mm) showed significant differences between affected and opposite sides (P < 0.01). (3) In the control group, the IFS ((23.59±6.14) mm versus (23.08±5.82) mm) and QFS ((12.41±3.75) mm versus (13.22±3.84) mm) did not differ significantly between left and right sides (P > 0.05). (4) Compared with the control group, there were significant differences in IFS and QFS of the affected side in the experimental group, and no significant differences in IFS and QFS of the opposite side. (5) In the experimental group, quadratus femoris appeared with deformation, edema and atrophy. (6) To conclude, the incidence of IFI in females is significantly higher than that in males, and bilateral hips are usually affected. MRI diagnostic criteria for IFI are IFS ≤ 11.46 mm, QFS ≤ 5.53 mm of the affected side, and quadratus femoris present edema and deformation, which are more sensitive on axial fat-suppressed MRI imaging.

Objective To evaluate the efficacy of patient-controlled infraclavicular brachial plexus block for analgesia after elbow arthrolysis.Methods Eighty patients with elbow stiffness of both sexes, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective elbow arthrolysis, were equally and randomly assigned to receive either the infraclavicular (Ⅰ group) or axillary (A group) brachial plexus block.All catheters were placed using ultrasound visualization preoperatively.When patients complained of pain in the recovery room after regaining consciousness, 0.2％ ropivacaine was injected via the catheter, 15 min later patient-controlled infraclavicular brachial plexus block was performed with 0.2％ ropivacaine (400 ml), and an electronic pump was set up with a 5 ml bolus dose, a 30 min lockout interval and background infusion at a rate of 5 ml/h.The patients underwent rehabilitation exercise everyday for 3 consecutive days starting from 24 h after operation.The catheter insertion time, successful block, and occurrence of moderate or severe pain (numeric rating scale [NRS] score ＞ 4) and greater inserting resistance (inserting resistance score＞ 1) during insertion, and the occurrence of paresthesia and vascular damage during insertion were recorded.NRS score was recorded at 24, 48 and 72 h after operation during rehabilitation exercise.The elbow articular range of motion was recorded at 72 h after operation, and the improvement in articular range of motion was calculated.The satisfaction with the improvement in articular range of motion (improvement ≥ 80％) and occurrence of complete improvement in articular range of motion (improvement=100％) were recorded.Catheter-related adverse reactions (such as oozing from the insertion site, obstruction, prolapse) and local anesthetics-related adverse reactions (nausea and vomiting, central nervous system toxicity) were recorded.Results The success rate of blockade was 100％ during insertion in both groups.Compared with group A, the catheter insertion time was significantly shortened, the incidence of moderate or severe pain and greater inserting resistance during insertion was decreased, the incidence of paresthesia and vascular damage during insertion was decreased, NRS score at 24 h after operation durig rehabilitation exercise was decreased, the incidence of complete improvement was increased (P＜0.05), and no significant change was found in the improvement in articular range of motion and satisfaction with the improvement in group I (P＞0.05).Conclusion Patient-controlled infraclavicular brachial plexus block can be safely and effectively used for analgesia after elbow arthrolysis, and it provides better efficacy than patient-controlled axillary brachial plexus block.

Objective:To identify proteins associated with nasopharyngeal carcinoma (NPC) metastasis,and provide scientific basis for the prevention and cure of NPC.Methods:A two-dimensional gel electrophoresis and mass spectrometry were performed to screen for differential proteins between highly metastatic 5-8F and non-metastatic 6-10B NPC cell lines.Western blot was used to confirm the differential proteins.We used siRNA to inhibit the expression of differential protein nm23-H1 to determine the association of nm23-H1 with NPC in vitro invasive ability.Immunohistochemistry and statistics were used to evaluate the correlation of nm23-H1 expression with clinicopathological features and clinical outcomes in paraffin-embedded archival tissues including 93 cases of primary NPC and 20 cases of cervical lymphonode metastatic NPC (LMNPC).Results:A total of 15 differential proteins in the 2 cell lines were identified by a proteomic approach,and 3 differential proteins were selectively confirmed.Downregulation of nm23-H1 by siRNA significantly increased the in vitro invasive ability of 6-10B.Significant nm23-H1 downregulation was observed in LMNPC compared with primary NPC.nm23-H1 downregulation in primary NPC was positively correlated with lymphonode and distant metastasis,advanced clinical stage and recurrence.Survival curves showed that patients with nm23-H1 downregulation in primary NPC had a poor prognosis.Multivariate analysis confirmed that nm23-H1 expression level in primary NPC was an independent prognostic indicator.Conclusion:nm23-H1 behaves as a metastasis suppressor in NPC,and nm23-H1 downregulation is a biomarker for poor NPC prognosis.

Background and objective Cisplatin-resistance in Lung cancer cells is widespread in the clinical treat-ment, seriously affecting the effects of the treatment of lung cancer. hTerefore, the research of mechanisms of cisplain-resistance has significant meaning for developing new chemotherapeutic drug and solving the cisplain-resistance in clinic treatment. IKBKB is one of the most important catalytic subunits of IKK complexes. It plays an important regulatory role in activation of NF-κB. hTe aim of this study is to investigate the differential expression of IKBKB gene in human lung adenocarcinoma cells line A549 and the cisplatin-resistant variant A549/DDP and the mechanisms of cisplain-resistance induced by IKBKB gene. Methods MTT assay was employed to determine the sensitivity of A549 and A549/DDP cells line to cisplatin and the effect of IKBKB gene on A549 cell lines’ sensitivity to cisplatin. hTe mRNA level of IKBKB was determined by real-time PCR. Dual luciferase reporter gene experiment was employed to determine the activity of the NF-κB. Apoptosis rate of lung adenocarci-noma cells was determined by lfow cytometry. Results Apoptosis rate and IC50 were signiifcantly different in A549 and A549/DDP cells, the expression of mRNA level of IKBKB gene in A549/DDP was signiifcantly higher than that in A549. Compared with control group, IKBKB gene was able to reduce the cisplain sensitivity of A549 cells. Atfer A549 was transfected with pcD-NA3.1/IKBKB plasmid, mRNA level of IKBKB was signiifcantly increased, the sensitivity of cisplain was decreased, the IC50 was increased 2.85 fold, the apoptosis rate was decreased 59%, the activity of NF-κB has been greatly increased. Conclusion IKBKB inhibits cisplatin-induced apoptosis via the activation of NF-κB pathway. It will be helpful in the development of new anticancer drug and solving the challenge of cisplatin-resistance.

Objective:To evaluate the diagnostic value of exercise stress echocardiography combined with left ventricular two-dimensional speckle tracking layer-specific strain technique in evaluating subclinical myocardial damage and reserve function in patients with hypertension.Methods:A total of 51 healthy subjects(control group) and 55 hypertensive patients (hypertension group) were enrolled in the treadmill exercise stress test in Sichuan Provincial People′s Hospital from October 2018 to January 2020. According to the European Guidelines for the Prevention and Treatment of Hypertension, the inclusion criteria for patients with hypertension were: blood pressure≥140/90 mmHg or who explicitly took antihypertensive drugs, and related cardiovascular diseases were excluded. The conventional parameters of resting and peak exercise, including left ventricular mass index, left ventricular end-diastolic volume index and left ventricular ejection fraction et al, were analyzed by speckle tracking software in two groups. According to the standard images in the resting and peak exercise, the endocardium /mid-myocardium /epicardium of left ventricular (three-, two-, four-chamber and global) longitudinal strain and circumferential strain (papillary muscle level) were compared respectively in two groups. The characteristics of strain differences and the systolic function reserve between the resting and peak exercise were evaluated.Results:There were significant differences in conventional ultrasound parameters between resting and peak exercise period in hypertension group, except E/A and e/a ratio (all P<0.05), and E/e value increased significantly(12.1±0.38) during peak exercise, indicating impaired diastolic reserve function. The longitudinal and circumferential layer-specific strain values from endocardial to epicardial were gradually decreased in both two groups. Compared with the control group, the resting longitudinal and circumferential endocardial strain values in hypertensive group were decreased, and the differences were more obvious at peak status, for instance global longitudinal endocardium strain at rest[control group (24.4±1.5)%, hypertension group (20.4±2.3)%], peak status[control group (30.8±2.8)%, hypertension group (22.8±2.9)%]( P<0.05). There were no significant differences of the partial layer-specific strain values between the peak exercise and resting status in hypertension group, while peak layer-specific strain of the control group were all significantly increased, suggesting that the left ventricular systolic reserve function of hypertension patients was lower than that of the control group. Conclusions:Left ventricular layer-specific strain can effectively evaluate the myocardial function in patients with hypertension, especially the endocardial strain can be used as an indicator parameter, and the peak exercise stress state is more sensitive. The systolic and diastolic reserve function of the left ventricle in patients with hypertension at the peak period are reduced to different degrees. Exercise stress echocardiography combined with left ventricular layer-specific strain technique can be used as a new method for detection of myocardial function impairment in patients with hypertension.

In the context of the global pandemic of COVID-19, with the epidemic epicenter located in the Wuhan City, China, patients with severe mental illness have also been deeply affected by the epidemic. In this paper, two patients with schizophrenia who recovered from COVID-19 were reported. Because of the long-term positive results of the SARS-CoV-2 serum antibody IgM test, they had to undergo medical isolation and social restrictions for a long time. After the situation was effectively identified by the medical staff and they were eliminated as a potential virus carrier and released from the medical isolation center. Since psychiatrists often lack systematic knowledge of infectious diseases, the authors hope that this paper can provide a reference to avoid unnecessary wastage of medical resources and prevent placing serious mental burden on such patients in the future.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.