Objective To investigate the neutrophil elastase (NE) in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).Methods Thirty-six patients of ALI/ARDS and 16 healthy volunteers(control group)were involved in the study.The patients of ALI/ARDS were divided into three groups:group A (the oxygenation index was 201-300 mm Hg,1 mm Hg=0.133 kPa),group B (150-200 mm Hg),and group C (<150 mm Hg).The NE in serum and bronchoalveolar Lavage fluid (BALF) were measured.Results The NE in the serum and BALF in group A [(1.76±0.63)nmol/L and (1.67±0.59)nmol/L],group B [(3.26±0.51)nmol/L and (3.64±0.56)nmol/L] and group C [(4.56 ±0.68)nmol/L and (4.62±0.39)nmol/L] were much higher than that in control group [(0.67±0.54)nmol/L and (0.62±0.48)nmol/L].The NE in the serum and BALF of dead patients were higher than that in patients who were alive.Moreover,the NE in the patients of ALI/ARDS was inversely related to the oxygenation index (r=-0.901,P＜0.01). Conclusion The NE in patients of ALI/ARDS is higher than that in healthy people,and it is significantly related to the severity and the prognosis of ALI/ARDS.

Objective To sum up clinical experiences of intractable temporal lobe epilepsy by microsurgery. Methods A retrospective review was conducted in 50 cases with epilepsy,and temporal lobe was resected by microsurgery from June 1996 to Oct. 2003. Results Follow-up patients from six months to five years.The follow up showed healing outcome in 25 cases,good results in 13 cases,unsatisfactory outcome in 9 cases,no improvement in 3 cases.Slight paresis 6 cases,divagation 8 cases,psychosis 5 cases and no death case. Conclusions Application of microsurgery can obvously improve the clinical result of patients with temporal lobe epilepsy and decrease the complication after operation.

Objective:To investigate the effect of liaison nurse-led relocation program on the relocation stress in family members of neurosurgery patients after ICU transfer.Methods:A total of 90 neurosurgery patients and family members were randomly divided into study group (45 cases) and control group (45 cases) . Participants in the control group received routine nursing, while the study group carried out liaison nurse-led relocation program. Family relocation stress scale and family caregiver task inventory-Chinses version was used to assessed relocation stress, care ability of the families before and after intervention.Results:After intervention, the scores of separation anxiety, environmental changes, nursing model changes, the safety of transfer, self-efficacy of care ability and total relocation stress scores were 15.20±2.42, 7.14±1.63, 7.68±2.12, 7.10±1.73, 8.25±1.94 and 49.69±6.96 in the study group, those scores were 16.93±4.19, 9.42±2.31, 10.53±2.64, 8.06±2.12, 10.39±1.62 and 42.56±4.68 in the control group. The scores of separation anxiety, environmental changes, nursing model changes, the safety of transfer, self-efficacy of care ability and total relocation stress scores were lower in the study group compared to the control group ( t value was 2.400-5.678, P<0.05). After intervention, the scores of FCTI such as care role, strain and provide assistance, handle personal emotions, assess family and community resources and adjust life to meet care needs and total scores were 4.16±0.66, 5.28±0.73, 3.51±0.65, 3.99±0.83, 4.52±1.07 and 21.46±1.73 in the study group, those scores were 7.63±1.30, 6.82±1.08, 4.94±0.94, 5.08±1.09, 7.17±1.51 and 31.65±3.09 in the control group. The scores of care role, strain and provide assistance, handle personal emotions, assess family and community resources and total FCTI scores significantly decreased in the study group compared to the control group ( t value was 5.343-19.268, P<0.05). Conclusion:The liaison nurse-led relocation program can effectively prevent the level of relocation stress and improve the care ability of family members of neurosurgery patients after ICU transfer.

Objective:To investigate the expression of microRNA125a in infiltrating macrophages during myocardial ischemia reperfusion, and to analyze the effect of microRNA125a on the polarization of infiltrating macrophages during myocardial ischemia reperfusion.Methods:The rat model of myocardial ischemia-reperfusion was established. Myocardial injury tissues were taken, infiltrated macrophages were isolated, and RNA was extracted. qRT-PCR was used to detect M1 and M2 markers in macrophages and evaluate the types of infiltrated macrophages. Subsequently the expression level of microRNA125a in infiltrating macrophages was detected. Finally, the effect of microRNA125a on macrophage polarization was further elucidated.Results:Macrophages in myocardium of ischemia reperfusion showed high expression of M1 markers (TNF-alpha and IL-8), presenting M1 macrophages. At the same time, microRNA125a was also highly expressed in this macrophage. Knockdown or overexpression of microRNA125a in macrophages in vitro can affect the macrophages polarization.Conclusions:Macrophages in myocardial ischemia reperfusion are M1 type, and microRNA125a is highly expressed in this macrophage and promotes its migration to M1 type.

Objective To explore the effect of cannabinoid receptor 2(CB2)on orthodontic tooth movement(OTM)rate and periodontal tissue reconstruction of pressure area in mice.Methods Thirty CB2-/-male mice and thirty littermate control WT male mice were individually accepted the orthodontic appliance at their age of 6 weeks.The mice were respectively scarified at 3 days,7 days,14 days and 21 days after the operation.Then the tooth movement distance was examined through the stereomicroscope.Hematoxylin-eosin staining was performed to explore the biological responses of periodontium at the distal mesial root pressure area.Anti-tartrate acid phospha-tase staining was performed to calculate the number and distribution of osteoclasts at the distal mesial root pressure area,and MMP-9 was evaluated by immunohistochemistry to examine the number of MMP-9(+)monocytes and multinucleated cells in the same district as the TRAP staining.Results Compared with those WT mice at 3,7,14 and 21 days,OTM distance showed a gradual increased tendency according with experimental time over 21 days.The widths of periodontal ligament on the pressure side were markedly greater in CB2-/-mice than WT mice at 7,14 and 21 days(P＜0.000 1).The numbers of TRAP positive osteoclasts were significantly greater in CB2-/-mice than those in WT mice at 14 days of OTM(P＜0.001).MMP-9 immunohistochemical staining showed that the number of MMP-9(+)monocytes and multinucleated cells was more in CB2-/-mice than that in WT mice at 14 days of OTM(P＜0.05).Conclusion The absence of CB2 accelerates orthodontic tooth movement under or-thodontic force.The absence of CB2 reinforces bone resorption in orthodontic tooth movement compressive area dur-ing orthodontic tooth movement.

OBJECTIVETo observe the clinical effect differences between infraoccipital needle-knife and massage for cervical vertigo.

METHODSA total of 366 patients with cervical vertigo were randomly assigned into a needle-knife group (186 cases) and a massage group (180 cases). With cases dropping excluded, 183 cases in the needle-knife group and 176 cases in the massage group were included. Needle-knife was used at Fengchi (GB 20), infraoccipitalpoint, etc. in the needle-knife group. The treatment was given for one course, once three days, 5 times as one course. The traditional massage was applied in the massage group for one course, including systematic stroking, kneading, and the application of pressure and plucking, etc., once every two days and 7 times as one course. The dizziness handicap inventory (DHI) score was observed before and after treatment, as well as 3, 6, and 12 months after treatment. The effects were also evaluated.

RESULTSThe total effective rate was 92.3% (169/183) in the needle-knife group, which was better than 85.2% (150/176) in the massage group (<0.05). Compared with those before treatment, the DHI scores at all the observation time points after treatment were improved in the two groups (all<0.05), with better improvements after treatment as well as 3 and 6 months after treatment in the needle-knife group (all<0.05). There was no significant difference in the improvement of DHI scores between the two groups 12 months after treatment (>0.05). The recurrence rate was 10.3% (12/117) in the needle-knife group, and it was 10.7% (11/103) in the massage group 12 months after treatment (>0.05).

CONCLUSIONSInfraoccipital needle-knife achieves apparent effect for cervical vertigo, which is superior to massage in short period.

We report a critically ill pregnant woman in the third trimester with severe pneumonia due to COVID-19 who presented to Xiaolan People's Hospital of Zhongshan in February 2020. The 32-year-old patient was admitted at 35 +2 gestational weeks with a 4-day history of a sore throat and a fever for three hours. The patient had been to Xiaogan City, Hubei Province, and the symptoms occurred during a period of self-isolation after back home. The condition of the patient deteriorated rapidly, with left-sided chest and back pain, shortness of breath, dizziness, progressing to respiratory failure and septic shock 7 hours after her admission. In view of her critical condition and a history of two previous cesarean sections, an emergency cesarean section was performed. Blood gas analysis of the mother before the operation suggested respiratory failure, respiratory acidosis, and metabolic acidosis. During the operation, a baby boy was born. The Apgar score of the boy, birth weight of 2 700 g, was one at 1, 5 and 10 minutes despite the resuscitation efforts. The neonate died after withdrawing treatment. The patient was treated with tracheal intubation ventilator and other supportive treatments after the operation. The result of the new coronavirus nucleic acid test, taken on admission, but which was reported after delivery, was positive. The patient was transferred to the designated hospital for further treatment and was recovering with the withdrawal of extracorporeal membrane oxygenation and ventilation support at 26 and 36 days after surgery, respectively.

Modern medicine has made remarkable achievements in safeguarding people's life and health, however, it is increasingly found that in the face of complex diseases, selective targeting of single target is often difficult to produce a comprehensive rehabilitation effect, and is prone to induce drug resistance, toxic side effects. Traditional Chinese medicine (TCM) has a long history of clinical application, and its clinical value in the treatment of complex diseases such as cardiovascular and cerebrovascular diseases, digestive diseases, skin diseases, rheumatism and immunity diseases, and adjuvant treatment of tumors has been proven to have obvious advantages. However, its modern research is relatively lagging behind, and in the face of the aging society and the characteristics of the modern disease spectrum, the traditional knowledge-driven research paradigm seems to be stuck in a bottleneck and difficult to make greater breakthroughs. Focusing on the key issues of TCM development in the new era, the clinical value-oriented strategy becomes to be a new research paradigm of TCM inheritance and innovation development, and dominant diseases would be the focus of the TCM inheritance and innovation development, which has been highly valued in recent years by the TCM academia and the relevant national management departments. Based on the clinical value, a series of policies are formulated for the selection and evaluation of the TCM dominant diseases (TCMDD), and exploratory researches about the clinical efficacy characteristics, the modern scientific connotation interpretation were carried out. The clinical value-oriented research paradigm of TCMDD inheritance and innovation development has been initially formed, which is characterized by strong policy support as the guarantee, systematic and standardized selection and evaluation methods as the driving force, scientific and effective research on internal mechanisms as the expansion, and effective clinical guidelines and principles as the transformation, which is of great value in promoting the high-quality development of the industries and undertaking of TCM. In this paper, the main policy support, selection and evaluation methods, therapeutic effect characterization, and modern scientific connotation research strategies of TCMDD in recent years have been comprehensively sorted out, with a view to providing the healthy and benign development of the research on TCMDD.

Cognitive dysfunction is one of the common central nervous systems (CNS) complications of diabetes mellitus, which seriously affects the quality of life of patients and results in a huge economic burden. The glymphatic system dysfunction mediated by aquaporin-4 (AQP4) loss or redistribution in perivascular astrocyte endfeet plays a crucial role in diabetes-induced cognitive impairment (DCI). However, the mechanism of AQP4 loss or redistribution in the diabetic states remains unclear. Accumulating evidence suggests that peripheral insulin resistance target tissues and CNS communication affect brain homeostasis and that exosomal miRNAs are key mediators. Glucose and lipid metabolism disorder is an important pathological feature of diabetes mellitus, and skeletal muscle, liver and adipose tissue are the key target insulin resistance organs. In this review, the changes in exosomal miRNAs induced by peripheral metabolism disorders in diabetes mellitus were systematically reviewed. We focused on exosomal miRNAs that could induce low AQP4 expression and redistribution in perivascular astrocyte endfeet, which could provide an interorgan communication pathway to illustrate the pathogenesis of DCI. Furthermore, the mechanisms of exosome secretion from peripheral insulin resistance target tissue and absorption to the CNS were summarized, which will be beneficial for proposing novel and feasible strategies to optimize DCI prevention and/or treatment in diabetic patients.