Objective To explore the relationship between superior vena cava-jugular vein oxygen saturation-differential value (ScVO2-SjVO2) and injury severity and prognosis in patients suffered from severe traumatic brain injury,finding out the chnical value.Methods Forty-three patients with severe tranmatic brain injury were selected and divided into two groups according to Glasgow Coma Scale (GCS) score,19 cases were enrolled in GCS 3-5 scores group;24 cases in GCS 6-8 scores group;20 contemporaneous cases in control group had conscious and without traumatic brain injury.The changes of ScVO2-SjVO2 at 0,12,24,48 h after admission of ICU among the groups were observed.In addition according to the degree of change in ScVO2-SjVO2,12 cases were enrolled in ScVO2-SjVO2 ＜ 0.05 group;14 cases in ScVO2-SjVO2 0.05-0.15 group; 17 cases in ScVO2-SjVO2 ＞ 0.15 group.The GCS score and mortality rate in patients after brain injury 28 d among groups were observed.Results GCS 3-5 scores group compared with control group,ScVO2-SjVO2 reduced significantly at 0,12,24,48 h after admission of ICU (-0.071 ±0.032 vs.0.093 ±0.049,-0.097 ±0.052 vs.0.081 ±0.052,-0.035 ±0.031 vs.0.089 ± 0.059,0.036 ± 0.033 vs.0.081 ± 0.064),there were significant differences (P ＜ 0.01).GCS 6-8 scores group compared with control group,ScVO2-SjVO2 dramatically increased at 0,12,24 h after admission of ICU(0.173 ± 0.043,0.158 ± 0.067,0.123 ± 0.073),there were significant differences (P ＜ 0.01 or ＜ 0.05).ScVO2-SjVO2 ＜0.05 group and ScVO2-SjVO2 ＞0.15 group compared with ScVO2-SjVO2 0.05-0.15group,the mortality rate significantly increased,the mortality rate were 8/12,4/17,1/14,respectively,there were significant differences (P ＜0.01).ScVO2-SjVO2 ＜0.05 group and ScVO2-SjVO2 ＞0.15 group compared with ScVO2-SjVO2 0.05-0.15 group,GCS score decreased significantly[(4.17 ± 1.34),(5.88 ±1.35) scores vs.(6.86 ± 1.35) scores],and there was significant difference (P ＜0.01 or ＜0.05).Conclusions When ScVO2-SjVO2 ＜ 0.05,the difference is negatively related to the deg~e of brain injury.When ScVO2-SjVO2 ＞0.15,the difference is positively related to the degree of brain injury;ScVO2-SjVO2 can assess injury severity objectively in patients who suffered from severe traumatic brain injury,and it also expresses the rate of cerebral oxygen metabolism.It can provide a basis for treatment accurately and timely,and judgment prognosis.

Objective To evaluate the role of spinal phosphatidyl-inositol 3-kinase/Akt (PI3k/Akt) signaling pathway in the maintenance of bone cancer pain (BCP) in rats and its relationship with microglial activation.Methods Forty healthy female Sprague-Dawley rats,weighing 180-200 g,were randomly divided into 5 groups (n =8 each):sham operation group (group S) ; PI3K inhibitor LY294002 group (group L) ; group BCP; BCP + dimethyl sulfoxide (DMSO) group (group BCP + D) ; BCP + LY294002 group (group BCP + L).BCP was induced by inoculating Walker 256 mammary gland carcinoma cells into the medullary cavity of the left tibia.At 7-9 days after inoculation,LY294002 2.5 μg/10 μl was injected intrathecally in L and BCP + L groups,normal saline 10 μl was injected intrathecally in S and BCP groups,and 5％ DMSO 10 μl was injected intrathecally in BCP+ D group once a day.Mechanical paw withdrawal threshold (MWT) was measured at 1 day before inoculation and 1,3,5,7,8 and 9 days after inoculation.The rats were sacrificed after MWT was measured on day 9 after inoculation and the L4-6 segments of the spinal cord were removed to determinate the activation of spinal microglia using immunofluorescence.Results Compared with group S,MWT was significantly decreased,and the activation of spinal microglia was increased in BCP,BCP + D and BCP+ L groups.Compared with BCP and BCP + D groups,MWT was significantly increased,and the activation of spinal microglia was decreased in BCP + D group.Conclusion Spinal PI3K/Akt signaling pathway is involved in the maintenance of BCP possibly through activating microglia in spinal dorsal horns of rats.

Objective To investigate X‐ray ,CT and MRI features of synovial chondromatosis of the temporomandibular joint (TMJ) .Methods X‐ray ,CT and MRI features of eight patients of synovial chondromatosis of TMJ with histo‐pathologically con‐firmed were analyzed retrospectively .X‐ray examination and CT scanning were performed in all eight patients .Routine MRI scanning was performed in six patients and contrast‐enhanced MRI scanning was performed in two patients synchronously .Results Tumors occured unilaterally in all eight cases ,which occured on the right TMJ in six cases and on the left side in two cases .On X‐ray films , widen joint space and calcificated loose bodies occured in all eight cases .On CT scanning ,cystic‐solid mixed mass around the joint and calcificated loose bodies occured in all eight cases .On MR scanning ,multiple nodular long T1 and short T2 signal occured in six cases . Arthroedema and synovial hyperplasia with iso T1 and iso or slightly long T2 signal in six cases .On contrast‐enhanced MR ,homoge‐neous enhancement occurred in svnovial tissue and the edge of loose bodies in two cases .Conclusion The synovial chondromatosis of TMJ owns typical imaging features .The imaging findings can serve as a reference to improve diagnosis of synovial chondromatosis of TMJ .

Objective To investigate the effects of β-blockers on cardiac protection and hemodynamic in patients with septic shock. Methods A prospective randomized controlled trial was conducted. Forty-one patients with septic shock in accordance with early goal directed treatment and met the target within 6 hours,and admitted to intensive care unit (ICU)of Affiliated Huxi Hospital of Jining Medical College from January 2012 to January 2014 were enrolled. The patients were divided into treatment group (n=21)and control group (n=20)by random number table. The patients in both groups were given the standard treatment,esmolol was giving to patients in treatment group in order to control the heart rate (HR)below 100 bpm within 2 hours,and the patients in control group only received standard treatment. The changes in hemodynamic parameters〔mean arterial pressure(MAP),central venous pressure(CVP), HR,cardiac index(CI),stroke volume index(SVI),systemic vascular resistance(SVRI),global end diastolic volume index(GEDVI)〕,biochemistry metabolic of tissue〔central venous oxygen saturation(ScvO2),lactic acid(Lac)〕,and cardiac markers 〔troponin I (cTnI)〕before and 12,24,48,72 hours after the treatment were recorded. Results①Before treatment,the hemodynamic parameters,tissue metabolism index and cTnI had no significant differences in both groups (all P>0.05).②The hemodynamic parameters after treatment in the control group showed no significant difference compared with that before treatment. HR and CI in the treatment group were gradually declined after treatment,SVRI and GEDVI were gradually increased. There were significant differences in HR,CI,SVRI,and GEDVI between treatment group and control group from 12 hours on〔HR(bpm):93±4 vs. 118±13,CI (L·min-1·m-2):3.3 ±0.8 vs. 4.5 ±0.6,SVRI (kPa·s·L-1·m-2):159.2 ±27.4 vs. 130.5 ±24.2,GEDVI(mL/m2):668 ±148 vs. 588 ±103,P<0.05 or P<0.01〕. MAP,CVP and SVI in the treatment group showed no significant changes. ③Lac after treatment in both groups was decreased slowly,Lac (mmol/L)at 12 hours after treatment was significantly decreased compared with that before treatment (control group:8.8 ±3.2 vs. 9.8 ±3.4,treatment group:9.5±3.1 vs. 10.5±4.1,both P<0.05). The Lac of control group and treatment group were 2.5±1.2 and 2.7±1.1 at 72 hours after treatment,and there was no significant difference between two groups (all P>0.05). The ScvO2 was not decreased in both groups.④Compared with before treatment,cTnI in the control group was gradually increased,peaked at 72 hours,and that in the treatment group was gradually increased,peaked at 24 hours and then gradually declined. Compared with control group,the cTnI (μg/L)in the treatment group was decreased significantly at 24,48,72 hours (1.15 ±0.57 vs. 1.74 ±0.77,0.93 ±0.52 vs. 2.15 ±1.23,0.52 ±0.36 vs. 2.39 ±1.17,all P<0.01). Conclusionsβ-blockers (esmolol) can improve cardiac function and myocardial compliance,reduce the myocardial injury in patients with sepsis shock. Although β-blockers can decrease cardiac output,it has no influence on the circulation function and tissue perfusion.

Objective To establish a simple and sensitive method for the determination of plasma drug concentration in rats after intragastrical and intravenous administration of paclitaxel loaded nanoparticles and to evaluate its pharmacokinetic characteristics .Methods AgilentTC-C18 column (250 mm × 4 .6 mm ,5 μm) was used for HPLC at the flow rate 1 ml/min with ketoconazole as internal standard and methanol acetonitrile water (45:20:35) as the mobile phase .The statistical mo-ment method was applied to calculate the pharmacokinetic parameters and to evaluate pharmacokinetic characteristics .Results There was a good liner relationship (r=0 .9997) when rat blood concentration of Paclitaxel ranged from 0 .5 to 20μg /ml .The accuracy and precision were in line with the requirements of biological sample analysis .The t1/2 were 3.86 ,3.76 ,3.35 and 2 .62 h after intravenous injection of three lab-made paclitaxel nanoparticles and paclitaxel solution via rat tail vein .The t1/2 were 5 .28 and 3 .72 h respectively after intragastrical administration of lab-made paclitaxel nanoparticles and paclitaxel suspen-sion .Conclusion This method can be used for the pharmacokinetic study of paclitaxel nanoparticles in rats .The paclitaxel loaded nanoparticles exhibited significantly longer in vivo retention time than paclitaxel injection and paclitaxel suspension .

To explore the effects of Taushinone ⅡA on the proliferation, apoptosis and gene ex- pression of p53 and bcl-2 in human gastric carcinoma MKN-45 cells. Cell count and MTT assay were used to study the proliferation-inhibiting effect of Tanshinone ⅡA on MKN-45 cells. The effect of Tanshinone ⅡA on the cell cycle and apoptosis of MKN-45 cells were examined by propidium io- dide (PI) staining and flow cytometry. Semi-quantitative RT-PCR was used to further verify the ex- pression of p53 and bcl-2 gene after exposure to Tanshinone ⅡA in MKN-45 cells. The results showed that Tanshinone ⅡA significantly inhibited the growth and proliferation of MKN-45 cells in a dose- and time-dependent manner (P<0.05). Tanshinone ⅡA arrested MKN-45 cells in G2/M phase which led to an obvious accumulation of G2/M phase cells while decreased number of G0/G1 phase cells. This resulted in apoptosis of MKN-45 cells and the apoptosis rate was as high as 43.91% after treatment with 2.0 μg/mL Tanshinone ⅡA for 96 h. It was also found that Tanshinone ⅡA up-regulated expression of p53 gene and down-regulated expression of bcl-2 gene. The cytostatic and antiproliferative effect of Tanshinone ⅡA makes it a promising anticancer agent for the treatment of gastric carcinoma.

Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.

Fibromyalgia syndrome （FMS） is a refractory， chronic non-articular rheumatic disease characterized by widespread pain throughout the body， for which there are no satisfactory therapeutic drugs or options. There are rich Chinese medical therapies， and some non-drug therapies， such as acupuncture， Tai Chi， and Ba-Duan-Jin， have shown satisfactory efficacy and safety and definite advantages of simultaneously adjusting mind and body. FMS is taken as a disease responding specifically to traditional Chinese medicine （TCM） by the National Administration of Traditional Chinese Medicine in 2018. In order to clarify the research progress in FMS and the clinical advantages of TCM/integrated Chinese and Western medicine， the China Academy of Chinese Medicine organized a seminar for nearly 20 experts in Chinese and Western medicine， including rheumatology， psychology， acupuncture and moxibustion， and encephalopathy， with the topic of difficulties in clinical diagnosis and treatment of FMS and advantages of TCM and Western medicine. The recommendations were reached on the difficulties in early diagnosis and solutions of FMS， mitigation of common non-specific symptoms， preferential analgesic therapy， TCM pathogenesis and treatment advantages， and direction of treatment with integrated Chinese and Western medicine. FMS is currently facing the triple dilemma of low early correct diagnosis， poor patient participation， and unsatisfactory benefit from pure Western medicine treatment. To solve the above problems， this paper suggests that rheumatologists should serve as the main diagnostic force of this disease， and they should improve patient participation in treatment decision-making， implement exercise therapy， and fully utilize the holistic and multidimensional features of TCM， which is effective in alleviating pain， improving mood， and decreasing adverse events. In addition， it is suggested that FMS treatment should rely on both TCM and Western medicine and adopt multidisciplinary joint treatment， which is expected to improve the standard of diagnosis and treatment of FMS in China.