Objective:To investigate the clinical efficacy of continuous veno-venous hemodia-filtration (CVVHDF) combined with hemoperfusion (HP) HA380 in the treatment of heat stroke patients with multiple organ dysfunction syndrome (MODS).Methods:A retrospective and observational study was conducted. A total of 15 patients with heat stroke combined with MODS who were admitted to the department of intensive care unit (ICU)of Suizhou Central Hospital/Hubei University of Medicine from July to September 2022 were selected as the study objects. All 15 patients were treated with CVVHDF combined with HA380 based on the comprehensive management strategy for severe illness. Organ function indicators [including total bilirubin (TBil), aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), creatinine (Cr), cardiac troponin T (cTnT), myoglobin (Myo), MB isoenzyme of creatine kinase (CK-MB), sequential organ failure assessment (SOFA)] and inflammatory indicators [including white blood cell count (WBC), neutrophil count (NEU), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6)] were collected. The improvements of the above indexes at admission, after the first HP, after the second HP, after the third HP, and on the 5th day of treatment were compared. Combined with the clinical outcome of patients, the comprehensive efficacy of CVVHDF combined with HA380 in the treatment of severe heat radiation disease was evaluated.Results:There were 10 males and 5 females among the 15 patients. The average age was (64.5±11.5) years old. There were 6 cases of classical heat stroke and 9 cases of exertional heat stroke. Glasgow coma scale (GCS) was 3-8 at admission; SOFA score was 9-17 within 12 hours after admission; acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) was 25-45 within 24 hours after admission. After treatment, the IL-6 level and SOFA score gradually decreased, and there were significant differences in the decrease after the second HP compared to admission [IL-6 (ng/L): 48.37 (15.36, 113.03) vs. 221.90 (85.87, 425.90), SOFA: 8.3±3.3 vs. 11.1±2.4, both P < 0.05]. The PCT level reached its peak after the first HP [12.51 (6.07, 41.65) μg/L], and then gradually decreased, and the difference was statistically significant after the third HP [1.26 (0.82, 5.40) μg/L, P < 0.05]. Compared those at admission, Cr level significantly improved after the first HP (μmol/L: 66.94±25.57 vs. 110.80±31.13, P < 0.01), Myo significantly decreased after the second HP [μg/L: 490.90 (164.98, 768.05) vs. 3?000.00 (293.00, 3?000.00), P < 0.05], After the third HP, the CK level also showed significant improvement [U/L: 476.0 (413.0, 922.0) vs. 2?107.0 (729.0, 2?449.0), P < 0.05]. After CVVHDF combined with 3 times HP treatment, the patient's inflammatory response was gradually controlled and organ function gradually recovered. On the 5th day of the disease course, WBC, PCT and IL-6 levels were significantly improved compared to admission, and AST, CK, LDH, Cr, Myo, CK-MB, and SOFA score were significantly corrected compared with those on admission. The 24-hour survival rate of 15 patients was 86.67%, and the 24-hour, 7-day and 28-day survival rates were both as high as 73.33%. The average mechanical ventilation time of 11 surviving patients was (101.8±22.0) hours, the average continuous renal replacement therapy (CRRT) time was (58.8±11.0) hours, the average length of ICU stay was (6.3±1.0) days, and the average total hospitalization was (14.6±5.2) days. Conclusion:CVVHDF combined with HP HA380 in the treatment of heat stroke patients with MODS can effectively improve organ function and alleviate the inflammatory storm, which is an effective means to improve the rescue rate and reduce the mortality of severe heat stroke patients.

Objective To investigate the safety and feasibility of peripheral vascular intervention via the ipsilateral transulnar access(TUA)due to failure of transradial access(TRA)puncture.Methods The clinical data of 2546 peripheral vascular interventions via TRA,which were performed at authors'hospital between January 2019 and December 2021,were retrospectively analyzed.Among the 2546 interventions,TRA puncture failed in 37 procedures,and in 27 of these patients the ipsilateral TUA puncture had to be adopted.The puncture success rate,surgical success rate and puncture approach-related complications of TUA of the 27 patients receiving ipsilateral TUA puncture were analyzed.Results The success rate of ipsilateral TUA puncture after TRA puncture failed was 96.3％(26/27),and in one patient transfemoral access(TFA)puncture had to be substituted because of the ulnar artery spasm.The total success rate of interventional procedures was 96.3％(26/27).No serious complications occurred,and the incidence of minor complications was 19.2％(5/26).Conclusion Preliminary results indicate that for the experienced TRA operators,using ipsilateral TUA puncture due to failure of TRA puncture is a safe and feasible strategy choice.

Objective To investigate the beneficial effect of Kai-Xin-San combined with fluoxetine in improving depression-like behaviors on chronic unpredictable mild stress(CUMS)induced depression model mice.Methods The present study aimed to assess the potential of Kai-Xin-San in combination with fluoxetine to ameliorate depression-like behaviors in a CUMS induced mouse depression model.Behavioral tests,such as the sucrose preference test were employed to evaluate the efficacy of the treatment.Additionally,the levels of suppressed stress factors were measured using the ELISA method.The morphology of hippocampal tissue was evaluated using the HE staining method,Nissl Staining and TUNEL staining methods.Furthermore,western blotting analysis was utilized to determine the expression levels of proteins such as Caspase-3,and Caspase-9.Results The co-administration of Kai-Xin-San and fluoxetine resulted in a significant increase in sucrose preference rate in model mice.This effect was comparable to that of fluoxetine alone at the standard clinical dose.Furthermore,the combination treatment up-regulated the levels of suppressed stress factors,reduced the apoptosis of hippocampus induced by depression and regulated the apoptosis signaling pathway in hippocampus.Conclusion The combination of Kai-Xin-San and fluoxetine has been shown to be an effective treatment for depression-like behavior in animal models,resulting in a reduction in the required clinical dosage of fluoxetine.This effect may be attributed to the up-regulation of neurotransmitter expression,inhibition of stress axis activation,and central nervous inflammation.

Objective To develop a portable nuclear radiation detector with low-energy γ-nuclide recognition capability for rapid measurement of the dose levels in low-energy radiation fields and identification of nuclides. Methods A digital multi-channel circuit was developed for a detector based on the room temperature semiconductor cadmium zinc telluride, nuclide recognition was achieved using an intelligent nuclide recognition algorithm, and the energy response function G(E) was used to calculate the real-time ambient dose equivalent rate H*(10). Results The portable spectrometer had a minimum detectable energy of 20 keV, and the typical energy resolution for low-energy X-rays was > 4.10% at 59.5 keV and 20℃, enabling accurate identification of ²⁴¹Am nuclide. Conclusion The device has a good measurement performance for low-energy γ/X rays, effectively addressing the limitations of existing devices for monitoring low-energy radiation fields, and provide reliable technical methods for monitoring and emergency response in spent fuel reprocessing plants or nuclear material production plants.

Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated proteins (Cas) system is a hotspot of gene editing and gene expression research, in which CRISPR/Cas13 system provides a new direction for RNA interference and editing. In this study, we designed and synthesized the corresponding gRNAs of CRISPR/Cas13a and CRISPR/Cas13b systems in non-homologous end joining (NHEJ) pathway, such as Ku70 and Lig4, and then detected the expression of ku70 and lig4 in HEK293T cells. The CRISPR/Cas13a system could efficiently knockdown the mRNA expression of ku70 and lig4 more than 50%, and CRISPR/Cas13b system also suppressed ku70 and lig4 about 92% and 76%, respectively. Also, CRISPR/Cas13a, b systems could down-regulate Ku70 and Lig4 proteins level to 68% and 53%, respectively. The study demonstrates that the CRISPR/Cas13 system could effectively knockdown the expression of RNA and protein in HEK293T cells, providing a new strategy for gene function and regulation research.
CRISPR-Cas Systems ; DNA Ligase ATP ; genetics ; Gene Expression Regulation ; genetics ; Gene Knockdown Techniques ; HEK293 Cells ; Humans ; Ku Autoantigen ; genetics

Traditional medicine endows medical staff with the role of "moral person";however,with the development of market economy,the role of medical staff has gradually changed to "economic person" in medical activities.Under the role of "economic person",there is an increasing number of medical disputes and injuries of medical staff,with more and more serious consequences.This article analyzes the behavior characteristics of the rights and obligations of "moral person" and "economic person" and the causes of medical disputes under the role of "economic person".Since the lack of honesty has become the product of the new role of medical staff,patients have a doubtful attitude towards medical staff,and the defects in system guidance and management system make it more difficult to settle medical disputes.This article provides a new perspective for building a harmonious doctor-patient relationship and puts forward the hypothesis of "honest economic person",so as to achieve the dialectical unity of the dual identities of "moral person" and "economic person".Under the role of "honest economic person",adherence to honesty and trustworthiness,pursuit of maximum medical benefits,emphasis on the social benefits of medical treatment,and material and spiritual incentives for medical staff can help to alleviate the conflict of interests between doctors and patients and reduce medical disputes.

Objective:To investigate the effects of ligamen remnant preservation on knee joint function and proprioception recovery in patients with anterior cruciate ligament (ACL) injuries during ACL reconstruction under arthroscope.Methods:The clinical data of 266 patients with ACL injuries,who were treated in the 174th hospital of PLA from January 2010 to March 2016,were retrospectively analyzed.All the patients underwent ACL reconstruction under arthroscopy,among them,163 patients with remnant preservation were chosen as remnant preservation group;103 patients with completely clearing remnant preservation in the operation,as non remnant preservation group.All the patients were followed up for more than 12 months,and the knee function and proprioception recovery of the two groups were evaluated.Results:There were no significant differences in the knee ipsilateral Lysholm score,international knee documentation committee knee assessment scale (IKDC) score,passive activity detection threshold,passive angle regeneration test results between the two groups before operation,9 and 12 months after operation (P＞0.05).The Lysholm scores and IKDC scores of the two groups at each time point were significantly higher than those before operation,the passive activity detection threshold and passive angle regeneration test results were significantly lower than those before operation (P＜0.05).The Lysholm scores and IKDC scores in the remnant preservation group 3 and 6 months after operation were higher than those in the non remnant preservation group,the passive activity detection threshold and the passive angle regenerated test results were lower than the non remnant preservation group,the difference was statistically significant (P＜0.05).Conclusion:Remnant preservation in the ACL reconstruction under arthroscopy can accelerate the recovery of knee joint function and proprioception,and satisfactory clinical results are achieved,which is worth popularizing.

Objective To compare the efficacy of single-tunnel single-bundle and double-bundle reconstruction in patients with anterior cruciate ligament reconstruction.Methods A total of 64 patients with anterior cruciate ligament rupture in our hospital were randomly divided into single-bundle group with 32 cases and double-bundle group with 32 cases, given single-tunnel single-bundle anterior cruciate ligament reconstruction, and single-tunnel double-bundle anterior cruciate ligament reconstructions.The IKDC, Tegner, Lysholm and KT-2000 scores were compared in two groups preoperation and at 12 months after operation.Results Thee were no significant difference in sex, age, injured site and injured time in the two groups(P>0.05).The IKDC, Tegner and Lysholm scores after operation were higher than operation before, and the KT-2000 scores was lower than operation before in two groups, and the differences were statistically significant(P<0.05).But there were no significant differences in IKDC, Tegner, Lysholm and KT-2000 scores between two groups before and after treatment(P>0.05).Conclusion The subjective and objective function scores of two groups showed no significant difference.But single-tunnel double-bundle for anterior cruciate ligament reconstruction is characterized by simplicity, firmly fixation and effectively restoration of knee stability.

Objective To compare the efficacy of single-tunnel single-bundle and double-bundle reconstruction in patients with anterior cruciate ligament reconstruction.Methods A total of 64 patients with anterior cruciate ligament rupture in our hospital were randomly divided into single-bundle group with 32 cases and double-bundle group with 32 cases, given single-tunnel single-bundle anterior cruciate ligament reconstruction, and single-tunnel double-bundle anterior cruciate ligament reconstructions.The IKDC, Tegner, Lysholm and KT-2000 scores were compared in two groups preoperation and at 12 months after operation.Results Thee were no significant difference in sex, age, injured site and injured time in the two groups(P>0.05).The IKDC, Tegner and Lysholm scores after operation were higher than operation before, and the KT-2000 scores was lower than operation before in two groups, and the differences were statistically significant(P<0.05).But there were no significant differences in IKDC, Tegner, Lysholm and KT-2000 scores between two groups before and after treatment(P>0.05).Conclusion The subjective and objective function scores of two groups showed no significant difference.But single-tunnel double-bundle for anterior cruciate ligament reconstruction is characterized by simplicity, firmly fixation and effectively restoration of knee stability.

Objective To evaluate the risk of chondral injury during anterior cruciate ligament (ACL) reconstruction using a double cross-pin femoral fixation device via the anteromedial portal in Chinese cadavers. Methods Nine specimens of the knee (6 left ones and 3 right ones) were taken from 5 male and 4 female conservative cadavers of Chinese adult. The average age of the cadavers were 34.8 (26 to 45)years old. Femoral tunnel drilling and cross-pin guide insertion were performed using the Rigidfix Cross Pin device through the anteromedial portal. The ACL reconstructions were simulated at 3 entrance points of the cross-pin (0°, 45° and 90° relative to the horizontal plane) . The risks of chondral injury were statistically analyzed when the cross-pin entrance point was at the 3 different positions relative to the femoral chondral surface. Results The incidence of chondral injury was 100% when the Rigidfix cross-pin guide was at 90° relative to the horizontal plane. When the Rigidfix cross-pin guide was at 45° and 0° the incidences of chondral injury were 66. 7% and 22. 2% respectively. Conclusion Since there is always a risk of chondral injury when the Rigidfix cross-pin device is used to reconstruct ACL via the anteromedial portal, the anteromedial portal is not recommended for the ACL reconstruction using Rigidfix femoral fixation.