Mechanical ventilation is not only an important treatment method of acute respiratory distress syndrome (ARDS),but also one of the basic treatments in the intensive care unit (ICU).However,mechanical ventilation itself can cause or aggravate acute lung injury,which is called ventilator-induced lung injury (VILI).Currently,clinical pathogenesis of VILI includes four categories such as barotrauma,volutrauma,atelectrauma and hiotrauma.The pathogenesis of mechanical injury has been widely accepted,but the biological injury pathogenesis is unclear.With further research,we found that in the late stage VILI patients occured proliferation of puhnonary fibrosis,which may be formed by partial epithelial-mesenchymal transdifferentiation (EMT).Further study of specific pathogenesis of biotrauma and ARDS pulmonary fibrosis proliferation could provide new ideas for the clinical treatment of VILI.

ObjectiveTo investigate the effect of sivelestat sodium on the prognosis in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).Methods Databases including PubMed, EBSCO, Springer, Ovid, Wanfang data, CNKI and China Biology Medicine (CBM) were searched to identify randomized controlled trials (RCTs) regarding sivelestat sodium treatment for ALI/ARDS published from 1985 to December 2014. The patients in treatment group received intravenous infusion of sivelestat sodium, and those in control group received normal saline. The items for analysis were 28-day mortality, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and oxygenation index on day 3. According to the evaluation method of Cochrane system, data extraction and quality assessment from the literature were carried out. Meta-analysis was performed using RevMan 5.3. The publication bias was analyzed with funnel plot.Results Five RCTs with a total of 780 participants were included, with 389 patients in sivelestat sodium group, and 391 in control group. Meta analysis showed: compared with control group, sivelestat sodium could not lower the 28-day mortality [odds ratio (OR) = 0.91, 95% confidence interval (95%CI) =0.66-1.26,P = 0.58], or shorten the duration of mechanical ventilation or length of ICU stay [duration of mechanical ventilation: mean difference (MD) = -0.02, 95%CI = -0.29 to 0.24,P = 0.87; length of ICU stay:MD = -9.63, 95%CI =-23.34 to 4.08,P = 0.17], but it could improve oxygenation index on day 3 (MD = 0.88, 95%CI = 0.39 to 1.36, P = 0.000 4). Heterogeneity was not significant for the main analysis and no publication bias was shown on funnel plot. Conclusion Sivelestat sodium gave rise to a better oxygenation on day 3, but did not change the length of mechanical ventilation and ICU stay, and it did not improve 28-day mortality in ALI and ARDS.

Objective To investigate the effect of exogenous protectin DX (PDX) on acute lung injury in septic mice.Methods Thirty male C57BL/6 mice,aged 6-8 weeks,weighing 20-25 g,were randomly divided into 3 groups (n =10 each) using a random number table:sham operation group (Sham group),sepsis group (S group) and PDX group.Sepsis was produced by cecum ligation and puncture (CLP) in the mice anesthetized with pentobarbital sodium.At 1 h after CLP,PDX 300 ng was injected intraperitoneally in PDX group,and the equal volume of normal saline was given in Sham and S groups.At 24 h after CLP,the mice were sacrificed,and the broncho-alveolar lavage fluid (BALF) was collected for determination of interleukin-1beta (IL-1β),tumor necrosis factor-alpha (TNF-α),IL-6 and IL-10 concentrations,and the lungs were removed for microscopic examination and for determination of the myeloperoxidase (MPO) activity,wet/dry lung weight ratio (W/D ratio) and phosphorylation of nuclear factor-kappa B (NF-κB) p65.Lung injury scores were calculated.Results Compared with Sham group,the lung injury score,MPO activity,W/D ratio,phosphorylation of NF-κB p65,and concentrations of protein and inflammatory factors in BALF were significantly increased in S and PDX groups (P＜0.05).Compared with S group,the lung injury score,MPO activity,W/D ratio,phosphorylation of NF-κB p65,and concentrations of protein,IL-1β,TNF-α and IL-6 in BALF were significantly decreased,and the concentration of IL-10 in BALF was significantly increased in PDX group (P＜0.05).Conclusion Exogenous PDX can alleviate acute lung injury through inhibiting NF-κB activity in the lung tissues of septic mice.

Objective:To explore the efficacy and safety of TiRobot combined with three-dimensional imaging in the minimally invasive surgery for pelvic fractures.Methods:A retrospective analysis was conducted of the 40 patients with pelvic fracture who had been treated by fixation with S1 and S2 sacroiliac screws at Department of Orthopaedics and Traumatology, Yangjiang People's Hospital from January 2019 to May 2021. They were divided into 2 groups according to their treatment methods. In the TiRobot group of 20 cases subjected to percutaneous sacroiliac screw fixation assisted by TiRobot combined with three-dimensional imaging, there were 13 males and 7 females with an age of (38.2 ± 8.8) years. In the manual group of 20 cases subjected to fixation with manual placement of sacroiliac screws under conventional C-arm fluoroscopy, there were 11 males and 9 females with an age of (37.3 ± 9.2) years. The 2 groups were compared in terms of fluoroscopy time for screw placement, guide needle adjustment, operation time, intraoperative blood loss, visual analogue scale (VAS) 72 hours after operation, postoperative hospital stay, time to ambulation, excellent to good rate of screw placement, complication rate, fracture union time, Majeed score at 6 months after operation, and excellent to good rate of functional evaluation.Results:There was no significant difference between the 2 groups in their preoperative general data, showing they were comparable ( P > 0.05). In the TiRobot group, fluoroscopy time for screw placement [(8.2 ± 2.9) s], guide needle adjustment [(0.4 ± 0.2) times], operation time [(67.4 ± 5.5) min], and intraoperative blood loss [(36.5 ± 8.0) mL] were significantly less than those in the manual group [(40.4 ± 4.5) s, (8.6 ± 0.7) times, (78.4 ± 7.2) min, and (41.6 ± 7.8) mL], postoperative VAS [3.0 (4.0, 5.0) points] was significantly lower than that in the manual group [4.0 (5.0, 6.0) points], the excellent to good rate of screw placement (100%, 40/40) was significantly higher than that in the manual group (85.0%, 34/40), and the complication rate (5.0%,1/20) was significantly lower than that in the manual group (35.0%, 7/20) (all P < 0.05). There was no significant difference between the 2 groups in postoperative hospital stay, time to ambulation, fracture union time, Majeed score, or excellent to good rate of functional evaluation ( P > 0.05). Conclusion:In the minimally invasive surgery for pelvic fractures, TiRobot combined with three-dimensional imaging leads to positive outcomes, because it can reduce operation time and radiation exposure, improve accuracy of screw placement, and increase safety.

Background Aedes albopictus is the dominant mosquito species in residential areas in Shanghai. There are many types of small containers with accumulated water in residential areas, providing a large number of breeding environments for Aedes alpopicuts and leading to an increasing transmission risk of mosquito-borne diseases. Objective To use random forest to predict breeding of Aedes mosquitoes in small aquatic container habitat in two concentrated reconstruction communities of rural areas in Shanghai, and to understand associated influence of environmental factors on the breeding of Aedes mosquitoes in the process of urbanization.Methods Small-scale habitat surveys of Aedes mosquitoes were carried out in two suburb concentrated reconstruction communities (Community A and B) in Shanghai, and the environment where the habitat was located was recorded and analyzed in both communities. The habitat where eggs, larvae, or pupae were found was recorded as positive. Spatial weight matrix was applied on a household basis, and global Moran's I index was used to carry out spatial autocorrelation analysis on the small-scale habitat and positive habitat in the environment of the two communities. When Moran's I is greater than 0, it means that the data present a positive spatial correlation; when Moran's I is less than 0, it means that the data are spatially negatively correlated; when Moran's I is 0, the spatial distribution is random. Combining the results of P and Z values, we explored the spatial distribution characteristics of small-scale habitat and positive habitat in the community environment. Random forest algorithm in machine learning was used to classify and sort environmental-related factors, and predict the breeding of Aedes mosquitoes in small aquatic habitat; receiver operating characteristic (ROC) curve was used to carry out model fitting evaluation. Results The environmental factors including building location (χ²=23.35, P<0.001), open space (χ²=8.83, P=0.003), and having trees (χ²=11.02, P=0.001) had a significant impact on the positive rate of small-scale habitat. The results of spatial characteristics analysis showed that the global Moran's I index of small-scale habitat was −0.092 (Z=−1.09, P=0.274) in Community A and 0.034 (Z=0.52, P=0.602) in Community B, and the global Moran's I index of positive habitat was −0.092 (Z=−1.14, P=0.255) in Community A and 0.070 (Z=0.95, P=0.342) in Community B. Since the P values of Community A and B were greater than 0.1 and the Z values were between −1.65 and 1.65, for both small-scale habitat and positive habitat the spatial characteristics were randomly distributed and no significant spatial aggregation was found. In the fitted random forest algorithm classification prediction model with the top 10 characteristic factors of importance, the area under curve (AUC) value was 0.95, and the prediction fitting effect was satisfactory. The results of classification and sorting indicated that counts of household small-scale habitat and positive habitat were the most important factors for breeding. Conclusion The random forest model constructed by environmental factor indicators can be used to predict the breeding situation of Aedes mosquitoes in small-scale aquatic habitat, and provide a basis for scientific prevention and control of mosquito breeding for the target area.