Objective Secretion and aggregation dysfunction of platelets are closely related with uncontrollable septic inflammation and abnormal blood coagulation.This study was to investigate the effect of emodin on platelet aggregation (PA) and secretion in mice with late sepsis.Methods We randomly divided 111 healthy SPF male C57BL/6 mice into a sham operation (SO) group, a cecal ligation (CL) group, and an emodin (Em) group and treated those of the Em group intragastrically with emodin after cecal ligation.At 72 hours after operation, we recorded the survival rate of the mice, measured the platelet count and the levels of serum alanine aminotransferase (ALT) and creatinine (Cr), and detected the PA rate by aggregometry, the P-selectin level by flow cytometry, the serum 5-HT concentration by ELISA, and the expressions of Rab27 mRNA and protein by RT-PCR and Western blot, respectively.Results At 72 hours after cecal ligation, the survival rates in the SO, CL and Em groups were 100%, 60% and 66.7%, respectively.The platelet count was significantly decreased in the CL group as compared with that in the SO group ([461.00±64.77] vs [775.00±65.89]×109/L, P<0.05) but remarkably increased in the Em group ([635.20±83.57]×109/L) in comparison with that in the CL group (P<0.05);the levels of ALT and Cr were markedly higher in the CL than in the SO group (ALT: [194.02±31.85] vs [41.55±1.24] U/L, P<0.05;Cr: [1.94±0.29] vs [0.72±0.11] mg/dL, P<0.05), but lower in the Em (ALT: [162.56±31.51] U/L;Cr: [1.53±0.30] mg/dL) than in the CL group (P<0.05);the PA rate and serum 5-HT concentration were significantly reduced in the CL group as compared with the SO group (PA: [12.67±4.04] vs [43.33±2.89]%, P<0.05;5-HT: [13.18±2.31] vs [34.35±5.79] ng/L, P<0.05), but the former was remarkably elevated ([24.67±2.52]%) while the latter showed no significant difference in the Em group ([17.41±2.16] ng/L) as compared with the CL group (P<0.05);the P-selectin expression was markedly higher in the CL than in the SO group ([16.78±1.60] vs [2.33±0.14] %, P<0.05), but lower in the Em ([12.58±2.28] %) than in the CL group (P<0.05).No statistically significant differences were observed at 72 hours postoperatively among the SO, CL and Em groups in the expression Rab27b mRNA (1.85±0.04 vs 1.84±0.02 vs 1.87±0.29, P>0.05).The Rab27b protein expression was markedly lower in the CL and Em groups than in the SO group (0.093±0.015 and 0.140±0.026 vs 10.380±0.036, P<0.05) but with no significant difference between the former two groups (P>0.05).Conclusion Emodin can improve platelet count and aggregation, down-regulate the expression of P-selectin, protect the liver and kidney function, and reduce mortality from late sepsis.

BACKGROUND:Intra-articular injection of sodium hyaluronate is an effective method for the treatment of knee osteoarthritis, with significant effect and less adverse reactions, but the mechanism is unclear. OBJECTIVE:Through testing the malondialdehyde and superoxide dismutase levels in the synovial fluid of knee osteoarthritis before and after injection of sodium hyaluronate, to evaluate the clinical efficacy of sodium hyaluronate in the treatment of knee osteoarthritis. METHODS:Thirty-seven patients with knee osteoarthritis (40 knees) were enroled and divided into mild (n=10, 10 knees), moderate (n=17, 18 knees), and severe (n=10, 12 knees) groups according to the Japan's knee osteoarthritis indications. Patients were subjected to intra-articular injection of 25 mg sodium hyaluronate, once a week for 5 weeks. The levels of malondialdehyde and superoxide dismutase in the synovial fluid before and 4 weeks after treatment were detected, and then clinical effects were evaluated based on the clinical scores according to the Japan’s knee osteoarthritis indications. RESULTS AND CONCLUSION: The indication rating results of the mild and moderate groups were decreased significantly 4 weeks after injection (P < 0.05), but there were no significant difference in the severe group before and after treatment. The malondialdehyde level in the synovial fluid was decreased obviously in the three groups at 4 weeks after injection (P < 0.05), while the level of superoxide dismutase was increased remarkably (P < 0.05). These findings indicate that sodium hyaluronate can treat knee osteoarthritis by reducing the malondialdehyde level and increasing superoxide dismutase level in the synovial fluid, but this method is more suitable for treatment of mild to moderate knee osteoarthritis.

Objective:To investigate the relationship between serum vascular endothelial growth factor (VEGF), peripheral blood microRNA-126 (miR-126) and the number and distribution of cerebral microbleeds (CMBs).Methods:Consecutive patients with non-acute ischemic cerebrovascular disease admitted to the Department of Neurology, the First Affiliated Hospital of Baotou Medical College from June 2019 to June 2020 were enrolled. The clinical data were collected, 3.0 T MRI examination was performed, and susceptibility-weighted imaging was used to detect CMBs. The serum VEGF concentration was detected by enzyme-linked immunosorbent assay, and miR-126 was detected by fluorescence quantitative polymerase chain reaction. Multivariate logistic regression analysis was used to determine the independent influencing factors of CMBs. Multiple linear regression analysis was used to determine the correlation between serum VEGF concentration, miR-126 in peripheral blood and the number of CBMs. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum VEGF concentration and relative expression of miR-126 in peripheral blood for CMBs. Results:A total of 193 patients with non-acute ischemic cerebrovascular disease were enrolled, including 110 patients (57.0%) in the non-CMBs group, 20 (10.4%) in the strictly lobar CMBs group and 63 patients (32.6%) in non-strictly lobar CMBs group. The comparison among the three groups showed that age might be a risk factor for strictly lobar CMBs, while higher VEGF, higher cystatin C level, lower relative expression of miR-126 in peripheral blood, hypertension and previous stroke or transient ischemic attack might be the risk factors for non-strictly lobar CMBs. Multivariate logistic regression analysis showed that higher serum VEGF concentration was an independent risk factor for non-strictly lobar CMBs (odds ratio 1.186, 95% confidence interval 1.035-1.358; P=0.014), while the higher relative expression of miR-126 was an independent protective factor for non-strictly lobar CMBs (odds ratio 0.154, 95% confidence interval 0-0.269; P=0.026). Multiple linear regression analysis showed that higher serum VEGF concentration ( r=0.848, P<0.001) and the lower relative expression of miR-126 ( r=-0.043, P=0.035) significantly increased the number of CMBs. ROC curve analysis showed that the area under the curve of serum VEGF for predicting non-strictly lobar CMBs was 0.803 (95% confidence interval 0.741-0.865), the optimal cut-off value was 120.55 ng/L, the sensitivity was 70.7%, and the specificity was 75.5%. Conclusions:In patients with non-acute ischemic cerebrovascular disease, there is a significant correlation between serum VEGF concentration and the relative expression of miR-126 in peripheral blood and the number and distribution of CMBs. Serum VEGF can be used as a biomarker for predicting the presence of non-strictly lobar CMBs.

Objective: To observe the effect of Tuina (Chinese therapeutic massage) on creatine kinase (CK), mitochondrial Ca2+ concentration, and ultrastructure of skeletal muscle in delayed onset muscle soreness (DOMS) model rats.Methods: A total of 130 healthy male Sprague-Dawley rats were randomly divided into a blank group, an exercise control group, a pre-exercise Tuina group, and a post-exercise Tuina group. According to the time points for sample collection, the exercise control group was divided into a 0 h exercise control group, a 24 h exercise control group, a 48 h exercise control group, and a 72 h exercise control group; the pre-exercise Tuina group was further divided into a 0 h pre-exercise Tuina group, a 24 h pre-exercise Tuina group, a 48 h pre-exercise Tuina group, and a 72 h pre-exercise Tuina group; and the post-exercise Tuina group was divided into a 0 h post-exercise Tuina group, a 24 h post-exercise Tuina group, a 48 h post-exercise Tuina group, and a 72 h post-exercise Tuina group. Rats in all groups except for the blank group received DOMS modeling. Professionals performed Nie-Pinching manipulation and finger Nian-Twisting manipulation on the lower limbs of the rats. The samples were collected at 0 h, 24 h, 48 h, or 72 h after exhaustive exercise for each pre-exercise Tuina group. The samples were collected at 0 h, 24 h, 48 h, or 72 h after Tuina for each post-exercise Tuina group. The changes in serum CK, skeletal muscle mitochondrial Ca2+ concentration, and Ca2+-adenosine triphosphatase (ATPase) were determined. The ultrastructure changes of skeletal muscles in each group were observed by a transmission electron microscope. Results: The electron microscope showed that compared with the exercise control group, the skeletal muscle structures of the pre-exercise Tuina group and the post-exercise Tuina group were significantly improved, and the overall performance of skeletal muscle in the pre-exercise Tuina group was more similar to that of the blank group. The level of serum CK in the pre-exercise Tuina group and the post-exercise Tuina group was significantly lower than that in the exercise control group (P<0.01). The Ca2+ concentration of skeletal muscle in the 24 h, 48 h, and 72 h pre-exercise Tuina groups was lower than that in the post-exercise Tuina group at the same time point (P<0.01). The Ca2+-ATPase concentration of skeletal muscle in the 24 h and 72 h pre-exercise Tuina groups was lower than that in the post-exercise Tuina group at the same time point (P<0.05).Conclusion: Tuina effectively prevents muscle damage caused by heavy exercise and long-term exercise, which may be related to the increase of skeletal muscle Ca2+-ATPase activity and mitochondrial Ca2+ transport.

Objective To analysis the role of hydrogen sulfide in the process of venous thrombosis and the correlation with homocysteine.Methods A retrospective case-control study was carried on deep venous thrombosis patients and healthy population in the People's Hospital of Xinjiang Uygur Automous Region from March 2015 to November 2016,which including 169 patients and 169 health persons.Detected the concentration of hydrogen sulfide and homocysteine in plasma of study population,compared their differences in the two groups by using single-factor analysis,and analysed the correlation of the concentration between hydrogen sulfide and homocysteine.The median and quartile spacing were used to express values with abnormal distribution,and Mann-Whitney U test was performed between groups.Pearson or Spearman correlation coefficient were used to describe the correlation between two variables.Results The Plasma concentrations of hydrogen sulfide in both groups were 29.30 nmol/ml (23.89,37.82),32.99 nmol/ml (26.29,39.68) and the plasma concentrations of homocysteine were 15.37 μmol/L(11.64,19.68),12.13 μmol/L(9.65,15.95),their concen trations in two groups have statistic difference (P ＜ 0.05) and were risk factors for deep venous thrombosis;the plasma concentration of hydrogen sulfide and homocysteine was negatively correlated(P ＜ 0.05).Conclusion The plasma concentration of hydrogen sulfide is associated with deep venous thrombosis and a protective factor for deep venous thrombosis;there is a negative correlation between plasma homocysteine and hydrogen sulfide,they may play an interactional role in the process of thrombosis.

Objective To investigate the clinical values of heparinase-modified thromboelastography(hmTEG)in heparin monitoring during continuous renal replacement therapy.Methods A total of 97 cases who were undergoing continuous renal replacement therapy(CRRT)in the intensive care unit of the 94th People's Liberation Army Hospital from Jan 2014 to Jun 2019 were enrolled in this stud-y.The patients were divided into TEG group and APTT group according to different means of heparin monitoring during continuous renal replacement therapy.In total,278 hemofilters were used in all the blood purification therapies.Complication of bleeding,CRRT time,total heparin dose and SOFA(sequential organ failure assessment)score of the patients were compared between the TEG and APTT groups.The filter life span and survival time in hospital were also compared using Kaplan-Meier analysis.Rusults Compared with APTT group,the total heparin dose in TEG group were significantly higher(P＜0.05).The CRRT time of patients and the average filter life span in TEG group were significantly longer than those of APTT group(P＜0.05).Compared to APTT group,the 28-day SOFA in TEG group was significantly lower(P＜0.05).Survival analysis showed that the 28-day risk of death in the patients of APTT group was 2.01 times higher than that in TEG group(P＜0.05).The 72-hour filter life of TEG group was significantly longer than that of APTT group(P＜0.05).Conclusion The use of hmTEG for monitoring heparin in blood purification should be superior in terms of safety and efficacy with longer filter life span and higher survival rate of patients.

Objective To investigate the prognostic value of plasma thrombomodulin(TM)in patients with septic shock.Methods A retrospective analysis was conducted on the clinical data of 180 patients with septic shock admitted to the intensive care unit of the 908th Hospital from May 2018 to November 2022.The patients were divided into survival group(106 cases)and death group(74 ca-ses)based on the 30-day follow-up outcomes.Propensity score matching(PSM)was used to match 57 surviving patients with 57 de-ceased patients in a 1∶1 ratio,based on confounding factors such as age,gender,underlying diseases,primary infection site,laborato-ry results and disease severity scores.TM and other coagulation molecular markers were compared between the two groups,and logistic regression,receiver operating characteristic(ROC)curve,survival and correlation analyses were performed.Results After PSM,the TM levels in the death group(18.3[13.2,22.3]TU/mL)were significantly higher than those in the survival group(13.7[9.0,18.3]TU/mL)(P＜0.05).Multivariate logistic regression analysis showed that TM was an independent risk factor for 30-day mortality in the patients with septic shock(OR=1.137,95％CI:1.023-1.262,P＜0.005).ROC curve analysis revealed that the areas under the curve(AUCs)for predicting 30-day mortality were 0.665,0.627 and 0.600 for TM,Acute Physiology and Chronic Health EvaluationⅡ(APACHE Ⅱ)and Sequential Organ Failure Assessment(SOFA)scores,respectively.Kaplan-Meier survival analysis stratified by the optimal TM cut-off value(17.9 TU/mL)showed that the 30-day survival rate of the TM＜17.9 TU/mL group was 1.56 times that of the TM≥17.9 TU/mL group(Log-Rank test,P＜0.000 1).Spearman correlation analysis demonstrated that TM levels were positively correlated with APACHE Ⅱ(r=0.10,P＜0.005)and SOFA scores(r=0.35,P＜0.005).Conclusion Plasma TM has showed a good predictive value for assessing the prognosis of patients with septic shock and may serve as a potential biomarker for determining the prognosis of septic shock.

Objective To investigate the value of thromboelastography ( TEG) in evaluating the prognosis of polytrauma patients. Methods A retrospective case control study was conducted to analyze the clinical data of 155 polytrauma patients admitted to 94th Hospital of People's Liberation Army from September 2015 to December 2017. There were 118 males and 37 females, aged 18-88 years [(49. 0 ± 1. 3)years]. Injury severity score (ISS) was (26. 4 ± 11. 0)points. According to the prognosis of patients 90 days after injury, the patients were divided into survival group ( 143 patients ) and death group (12 patients). The ISS on admission, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Glasgow coma score ( GCS ) , systolic blood pressure ( SBP ) , respiratory rate ( RR ) and outcome of 90 days after injury were collected. Red blood cells( RBC) , hemoglobin( Hb) , plasma prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , fibrinogen ( FIB) , international normalized ratio ( INR) , thrombin time ( TT) , platelet count ( PLT) and TEG-related indicators within 2 hours after ICU admission were collected. TEG-related indicators including TCG clotting reaction time ( R ) , clot formation rate (K), clot formation kinetics (α angle), maximum amplitude (MA), coagulation index (CI), blood clotting strength (G), elasticity constant (E) and clot lysis time (CLT) were collected within 2 hours after admission to ICU. The changes of TEG-related indicators were compared between the two groups, and logistic regression analysis and receiver operating characteristic ( ROC) curve analysis were performed. Results Compared with the survival group, ISS and APACHE II scores in the death group were significantly higher, while GCS, SBP, RR, RBC and Hb were significantly lower (P<0. 05). Compared with the survival group, death group showed significantly prolonged PT [(21. 1 ± 9. 1) s vs. (16. 5 ± 4. 3)s] as well as reduced FIB [(1. 7 ± 1. 5)g/L vs. (2. 7 ± 1. 7)g/L] (P<0. 05). Compared with the survival group, the K value in the death group was significantly prolonged [5. 2(1. 8,8. 0)min vs. 2. 9(2. 1,4. 2)min] (P<0. 05). Compared with the survival group, death group showed significant decrease in G value (3762. 4 ± 3346. 7 vs. 6366. 5 ± 3886. 1), E value (75. 3 ± 67. 0 vs. 127. 3 ± 77.7),αangle[(38.4±19.7)°vs. (49.4±16.6)°],MA[(37.4±17.5)mmvs.(52.0±13.3)mm], CI [-6. 8(-9. 5, 1. 5) vs. -2. 9 ( -5. 9, -0. 7)] and CLT [39. 2 (32. 5, 46. 9) min vs. 46. 4 (32. 7, 60.8) min] (P<0. 05). There were no significant differences in APTT, TT, INR, PLT and R between the two groups (P>0. 05). Logistic regression analysis showed that MA was significantly associated with the prognosis of polytrauma patients (OR=1. 15, 95％ CI 1. 04-1. 28, P<0. 05). The area under the ROC curve of MA was 0. 756 (P <0. 05). When the MA threshold was 43. 1 mm, the sensitivity, specificity, positive predictive value and negative predictive value of predicted survival were 77. 5％, 76. 9％, 76. 1％ and 97. 3％, respectively. Conclusion TEG index MA can determine the prognosis of polytrauma patients, and the mortality rate is significantly increased at MA<43. 1 mm.

Objective:To explore the value of conventional MRI radiomics for predicting occult cervical lymph nodes (LNs) metastases in early-stage oral tongue squamous cell carcinoma (OTSCC).Methods:The preoperative MRI data of 77 cases of early-stage OTSCCs (cT1-2N0M0) in Shanghai Ninth People′s Hospital from January 2015 to December 2019 were retrospectively analyzed. All patients underwent primary lesion resection with selective neck dissection and the pathologic reports of LNs couldal be obtained. In total, 168 LNs (51 positive and 117 negative metastases) were enrolled and allocated into training set ( n=112) and validation set ( n=56) with a ratio of 2∶1 using random number table. The volumes of interest of LNs on T 2WI and contrast enhanced T 1WI (ceT 1WI) were delineated by two doctors using ITK-SNAP software. The 1 046 radiomics features of each sequence were extracted using 3D Slicer software. Data dimension reduction was done by inter-observer agreement analysis and univariate analysis. The least absolute shrinkage and selection operator regression analysis were used for selecting optimal feature subsets and constructing radiomics signature for each sequence. Mann-Whitney U test was used to compare the differences of node size and radiomics scores between the LNs with positive and negative metastases. The receiver operating characteristic (ROC) curve was used to explore the performance of LNs size, T 2WI radiomics signature and ceT 1WI radiomics signature in predicting occult LNs metastases. Stepwise logistic regression was used to determine the independent predictors. Results:Fifteen and 10 optimal features were selected to construct radiomics signature for T 2WI and ceT 1WI respectively. The short diameter, T 2WI radiomics signature and ceT 1WI radiomics signature showed significant differences between LNs with positive and negative metastases in the both training and validation sets (all P<0.05), with the areas under the ROC curve of 0.67, 0.83 and 0.82 in the training set, and 0.69, 0.78 and 0.70 in the validation set, respectively. In the stepwise logistic regression analysis, T 2WI radiomics signature was identified as the independent predictor in the both sets (training set: OR=5.92, P<0.001; validation set: OR=2.53, P=0.012). Conclusion:Conventional MRI radiomics can provide a good potential to predict occult LNs metastases in early-stage OTSCC.

Fumarate hydratasedeficient renal cell carcinoma(FH-RCC)is s a rare and highly aggressive and metastatic form of renal cell carcinoma. Clinical diagnosis is relatively challenging, and there is a lack of recognized systemic treatment options. Therefore, in clinical practice, it is necessary to have a deeper understanding of this disease and fully integrate family history, imaging findings, and pathological manifestations for clinical identification, and genetic testing shoule be conducted when necessary. Improved patient prognosis can be achieved through the selection of appropriate curative surgery or systemic treatment strategies.