Objectlve To study the significance of injury and posthumous changes to the axonal in brain stem and provide evidence to the forensic discrimination of brainstem injury. Methods Select the cases that died of the primary brainstem injury or other disease randomly, All cases were divided into control group and experimental group, control group and experimental group that were autopsied at the postmortem interval less than 24h or 48h, or longer than 24h or 48h. The brainstem tissue were cut and stained by silver; Two hundred four samples were observed in microscope and selected 9～10 widest axonal to measure its diameter, then analysis the data. Results There is significant difference in axonal diameter of midbrain and mudella between control group (not including those cases died of cardiovascular diseases) and experiment group (P0.05). Conclusion The axonal swelling of the brainstem is closely related with the traumatic injury, so axonal swelling is a finding useful for identification of traumatic brainstem lesions, but death from cardiovascular diseases should be excluded.

Objective:To observe the effect of early rehabilitation exercise on blood pressure of elderly patients with septic shock.Methods:A single-center, prospective, randomized controlled study was conducted in elderly patients with septic shock who were hospitalized in the department of critical care medicine of Huangshan Shoukang Hospital (High-tech Zone Central Hospital of Huangshan) from December 2018 to November 2020. According to the principle of simple random, all patients were divided into control group and intervention group. Both groups were treated with lower limb barometry to prevent deep vein thrombosis, 3 times a day, 30 minutes each time. After comprehensive treatment in the intensive care unit (ICU), the severity of patients was gradually improved, the hemodynamics was relatively stable, and the norepinephrine was reduced to 0.5 μg·kg -1·min -1. The control group continued to receive lower limb barometric treatment without rehabilitation training, while the intervention group began rehabilitation training when the dose of norepinephrine was reduced to 0.5 μg·kg -1·min -1. The duration of norepinephrine use, the length of ICU stay, and the occurrence of adverse events during rehabilitation training in intervention group was recorded. Results:Seventy-two patients were included in the final analysis, 35 in intervention group and 37 in control group. There was no significant difference in gender, age, Oxford acute severity of illness score (OASIS), acute physiology and chronic health evaluationⅡ (APACHEⅡ), mean arterial pressure (MAP) of 3 times and underlying diseases between two groups. Compared with control group, the length of ICU stay and duration of dose of norepinephrine ≤0.5 μg·kg -1·min -1 in intervention group were significantly shorter [length of ICU stay (hours): 193.0 (145.5, 312.0) vs. 242.5 (180.0, 483.5), P < 0.05; duration of dose of norepinephrine ≤0.5 μg·kg -1·min -1 (hours): 120.0 (72.0, 144.0) vs. 144.5 (120.0, 192.0), Z = 2.976, P = 0.003]. In intervention group, 35 patients did not show acute myocardial infarction, arrhythmia, syncope, central venous catheter detachment, and gastric tube detachment during the rehabilitation period, except 1 patient suffered from naked hematuria due to urinary catheter traction, which disappeared the next day after symptomatic treatment. Conclusion:The early rehabilitation exercise was beneficial to the recovery of autonomic blood pressure in elderly patients with septic shock, shorten the time of norepinephrine use and ICU stay.

Coronavirus infection seriously threatens human health. There is no specific medication or vaccine so far. In recent years, domestic and foreign researchers have developed a variety of small-molecule inhibitors against the ligand S protein, RdRp, PL^pro and 3CL^pro of three highly pathogenic coronavirus, SARS-CoV，MERS-CoV，SARS-CoV-2. This article reviews the characteristics of these coronaviruses, action targets, small molecule inhibitors, and structure-activity relationships.