Bone remodeling and bone regeneration are essential for preserving skeletal integrity and maintaining mineral homeostasis.T cells,as key members of adaptive immunity,play a pivotal role in bone remodeling and bone regeneration by producing a range of cytokines and growth factors.In the physiological state,T cells are involved in the maintenance of bone homeostasis through interactions with mesenchymal stem cells,osteoblasts,and osteoclasts.In pathological states,T cells participate in the pathological process of different types of osteoporosis through interaction with estrogen,glucocorticoids,and parathyroid hormone.During fracture healing for post-injury repair,T cells play different roles during the inflammatory hematoma phase,the bone callus formation phase and the bone remodeling phase.Targeting T cells thus emerges as a potential strategy for regulating bone homeostasis.This article reviews the research progress on related mechanisms of T cells immunity involved in bone remodeling and bone regeneration,with a view to providing a scientific basis for targeting T cells to regulate bone remodeling and bone regeneration.

Objective:To analyze the effect of transtracheal pressure (TTP) on the application of a speaking valve in critically ill patients after tracheostomy.Methods:A retrospective analysis was conducted of 50 patients wearing a speaking valve after tracheostomy. Patients who had been wearing a speaking valve for 30min or more were the tolerance group, while those with less than 30min were the intolerance group. Transtracheal pressure was monitored during resting breathing, forced expiration and speaking. Linear regression models were evaluated to isolate the factors best predicting tolerance. The changes in respiratory muscle contraction before and after wearing a speaking valvs were evaluated using ultrasound. The patients′ satisfaction with wearing a speaking valve was also recorded.Results:TTP during speaking significantly predicted tolerance. The baseline values of diaphragmatic thickening fraction and physical functioning also positively predicted tolerance. Acute physiology and chronic health (APACHE II) score was a significant negative predictor. After wearing the speaking valve, the average contraction of the rectus abdominis, external oblique, internal oblique and transverse abdominis muscles increased significantly. Both groups expressed high satisfaction with the speaking valves.Conclusions:Transtracheal pressure during speaking can help predict the tolerance for wearing a speaking valve among critically ill patients after a tracheostomy. Baseline diaphragmatic thickening fraction, physical functioning and APACHE II score can predict the duration of speaking valve tolerance.

Objective To observe the effect of abdominal electrical stimulation combined with high-frequency chest wall oscillation on airway clearance ability in critical ill patients with tracheostomy. Methods From January to June, 2021, a total of 84 critical ill patients with tracheostomy in the department of Critical Care Medicine, Zhongda Hospital, Southeast University, were randomly divided into control group (n = 28),experimental group A (n = 28) and experimental group B (n = 28). All the groups received routine therapy and early activities; while high-frequency chest wall oscillation was added to experimental group A, and abdominal electrical stimulation combined with high-frequency chest wall oscillation were added to experimental group B, for two weeks. Their involuntary cough peak flow (ICPF), Clinical Pulmonary Infection Score (CPIS), diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and thickness of abdominal muscle (Tab) were measured before and after treatment. Results The improvement of CPIS, ICPF and Tab were better in the experimental group B than in the other two groups (P < 0.05). The improvement of DE and DTF were slightly better in experimental group B, however, there was no significant difference among groups (FDE = 0.514, FDTF = 1.582, P > 0.05). The thickness d-values of rectus abdominis, musculi obliquus internus abdominis and musculus transversus abdominis were positively correlated with the d-value of ICPF in the exprimental group B (r > 0.415, P < 0.05). ICPF was highly negatively correlated with CPIS before treatment for all the patients (r = -0.702, P < 0.001). No adverse events occurred during the intervention period. Conclusion Abdominal electrical stimulation combined with high-frequency chest wall oscillation could improve airway clearance ability in critical ill patients with tracheostomy.

OBJECTIVES: Idiopathic intracranial hypertension (IIH) is a syndrome that excludes secondary causes such as intracranial space-occupying lesion, hydrocephalus, cerebrovascular disease, and hypoxic ischemic encephalopathy. If not be treated promptly and effectively, IIH can cause severe, permanent vision disability and intractable, disabling headache. This study aims to explore the clinical and image features for IIH, to help clinicians to understand this disease, increase the diagnose rate, and improve the outcomes of patients. METHODS: We retrospectively analyzed 15 cases of IIH that were admitted to Xiangya Hospital, Central South University, during January 2015 to September 2020. The diagnosis of IIH was based on the updated modified Dandy criteria. We analyzed clinical data of patients and did statistical analysis, including age, gender, height, weight, medical history, physical examination, auxiliary examination, treatment and outcome. RESULTS: There were 10 females and 5 males. Female patients were 22 to 42 years old with median age of 39.5. Male patients were 27 to 52 years old with the median age of 44.0. The BMI was 24.14-34.17 (28.71±2.97) kg/m CONCLUSIONS IIH primarily affects women of childbearing age who are overweight. The major hazard of IIH is the severe and permanent visual loss. Typical image signs have high specificity in IIH diagnosis. Prompt diagnosis and effective treatment are significantly important to improve the outcomes of patients.
Adult ; Anemia, Iron-Deficiency ; Female ; Humans ; Intracranial Hypertension ; Male ; Middle Aged ; Pseudotumor Cerebri/diagnostic imaging* ; Retrospective Studies ; Ventriculoperitoneal Shunt ; Young Adult

Objective:To explore the clinical application and long-term safety of hydroxychloroquine sulfate (HCQ) in the treatment of rheumatic diseases.Methods:A multi-center cross-sectional study was conducted between August 2017 and August 2018 in a random sample of eleven medical institutions of rheumatology and immunology in China. Patients who took HCQ for more than 3 months were enrolled into this study. The cumulative dose and long-term side effects of HCQ were recorded. The changes of laboratory indexes before and after treatment with HCQ were analyzed. Categorical variables were presented with counts and proportions, and evaluated by Chi-square test. Continuous parametric data were presented as Mean±standard deviation, and evaluated by Student's t test or Mann-Whitney U test. P-values less than 0.05 were considered statistically significant. Results:A total of 886 patients with rheumatic diseases were enrolled into this study, including 505 cases with systemic lupus erythematosus (57.0%), 210 cases with rheumatoid arthritis (23.7%), 80 cases with Sj?gren's syndrome (9.0%), 57 cases with undifferentiated connective tissue disease (6.4%), 12 cases of systemic vasculitis (1.4%), 10 cases of mixed connective tissue disease (1.1%), 7 cases of myositis (0.8%) and 5 cases with systemic sclerosis (0.6%). The most common long-term side effects of HCQ was skin or mucous lesions (12.4%) and vision problems (8.0%). Other adverse reactions included problems of digestive system (3.0%), nervous system (2.1%), musculoskeletal system (1.1%) and cardiovascular system (0.9%). 140 cases (15.8%) had stopped taking HCQ during the treatment. More than half of them decided to stop taking medicine by themselves. Fifty-four patients (6.1%) stopped using HCQ due to side effects while 24 of them took it again, and another 12 patients (1.4%) stopped the drug due to remission of illness. Patients were divided into three groups according to the cumulative dose of HCQ: less than 500 g, 500-1 000 g and more than 1 000 g respectively. There was significant difference in the incidence of long-term side effects among the three groups ( χ2=6.382, P=0.041). The last group (more than 1 000 g) suffered the highest incidence of long-term adverse reactions (37.1%). No severe adverse drug reactions were observed in this study. Conclusion:Hydroxychloroquine is widely used in the treatment of rheumatic diseases. The incidence of long-term side effects is 20.4%, is 6.1% lead to drug withdrawal, which are especially related to the cumulative doses. It should be adjusted properly according to the clinical application.

Monitoring neuronal activity in vivo is critical to understanding the physiological or pathological functions of the brain. Two-photon Ca imaging in vivo using a cranial window and specific neuronal labeling enables real-time, in situ, and long-term imaging of the living brain. Here, we constructed a recombinant rabies virus containing the Ca indicator GCaMP6s along with the fluorescent protein DsRed2 as a baseline reference to ensure GCaMP6s signal reliability. This functional tracer was applied to retrogradely label specific V1-thalamus circuits and detect spontaneous Ca activity in the dendrites of V1 corticothalamic neurons by in vivo two-photon Ca imaging. Notably, we were able to record single-spine spontaneous Ca activity in specific circuits. Distinct spontaneous Ca dynamics in dendrites of V1 corticothalamic neurons were found for different V1-thalamus circuits. Our method can be applied to monitor Ca dynamics in specific input circuits in vivo, and contribute to functional studies of defined neural circuits and the dissection of functional circuit connections.

Objective:To explore the predictive factors of renal replacement therapy (RRT) in extracorporeal membrane oxygenation (ECMO) patients.Methods:The clinical data of 68 ECMO patients treated at Emergence Department of Jiangsu Provincial Hospital from January 2015 to December 2018 were retrospectively analyzed. Vasoactive-inotropic score (VIS) was used to assess the usage of vasoactive-inotropic drugs on day 1, 2 and 3 of ECMO (24 h VIS, 48 h VIS, and 72 h VIS). According to received RRT or not, patients were divided into the RRT group and non-RRT group. Age, gender, weight, VIS, presence of cardiac arrest before ECMO, ECMO mode, and ECMO treatment time were compared. Logistic regression analysis was used to identify predictive factors for RRT in ECMO patients.Results:Of the enrolled patients, 73.5% of ECMO patients received RRT. The mean age, 24 h VIS, ECMO failure and mortality of the RRT group were significantly higher than those of the non-RRT group ( P <0.05). The use of RRT was 87.8% in elderly ECMO patients (> cutoff age of 38.5 years). According to the cutoff value of 24 h VIS (33.75), ECMO patients were divided into the high VIS group and low VIS group. The rates of RRT and mortality were both exceeded 90% in the high VIS group, which was significantly higher than that of the low VIS group ( P <0.05). Logistic regression analysis showed that age ( OR=1.223) and 24 h VIS ( OR=1.033) were predictive factors of RRT in ECMO patients ( P <0.05). Conclusions:Age and 24 h VIS show the predictive value for RRT in ECMO patients.

Objective? To explore the effects of transtheoretical model on patients after percutaneous coronary intervention (PCI). Methods? Totally 200 patients who received PCI and 1-4 cardiovascular stents in the 4 wards of the Department of Cardiology, Tenth People＇s Hospital of Shanghai between March and September 2018 were selected by convenient sampling and divided into the control group (n=100) and the intervention group (n=100) according to the random number table. The Short Form Health Survey (SF-36) was used to evaluate the effects of intervention. Results? The total SF-36 score, overall physical health score and overall mental health score were (84.17±15.67), (80.56±15.76) and (84.93±15.66), respectively after the intervention, higher than those of the control group (t=-21.44, -21.063,-34.729; P＜0.001), which were (62.58±13.24), (63.87±12.34) and (62.69±10.45), respectively. Conclusions? The transtheoretical model used in follow-up visits after PCI helps to improve patients＇ quality of life, which is worth promoting in clinical practice.

Objective To investigate the effects of enteral immunonutrition supplemented with omega-3 polyunsaturated fatty acid (ω-3 PUFA) on the incidences and severity of ventilator associated pneumonia com- plications, inflammatory response, and the prognosis in patients with severe traumatic brain injury (sTBI) un-dergoing ventilator therapy. Methods From January 2015 to June 2017, 64 patients of sTBI were selected and randomly divided into experimental group (ω-3 PUFA, n=32) and control group (n=32). White blood cells (WBC) and the proportion of neutrophils (N%) were evaluated by cell analyzer. Meanwhile, the serum levels of C-reactive protein (CRP) and procalcitonin (PCT) were tested with enzyme linked immunosorbent assay. After 14-days treatment, the Glasgow coma scale (GCS) score, APACHE Ⅱ score, clinical pulmonary infec-tion score (CPIS), pulmonary function and prognoses were also compared between the two groups. Results As compared with the control group, the experimental group had lower incidences of ventilator associated pneumonia (66% vs. 56%, P=0. 048), reduced degree of lung infection and lower CPIS (8. 25±0. 60 vs. 7. 47±0. 53); higher lung function indexes [FVC: (2. 89±0. 19) L vs. (3. 46±0. 22) L, P=0. 010;FEV1: (2. 35±0. 16) L vs. (2. 84±0. 24) L, P=0. 040; FEV1/FVC %: (49. 11±3. 34)% vs. (56. 00± 2. 64)%, P=0. 038) ]; lower serum levels of inflammatory responses [WBC: (11. 83±0. 74) ×109/L vs. (9. 51±0. 90) ×109/L, P=0. 029; N%: (79. 11±1. 51)% vs. (72. 71±1. 16)%, P=0. 041; CRP:(85. 15±8. 42) mg/L vs. (63. 96±5. 72) mg/L, P=0. 001; PCT: (6. 43±0. 47) μg/L vs. (4. 83±0. 39) μg/L, P=0. 013] 14 days after enteral immunonutrition supplemented with ω-3 PUFA. As compared with the control group, the experimental group received better prognosis with GCS scores increasing ( 8. 69 ± 0. 41 vs. 9. 52±0. 59, P=0. 038), APACHE Ⅱ scores decreasing (14. 74±1. 01 vs. 12. 68±0. 89, P=0. 049), the time of mechanical ventilation [ (13. 23±1. 17) d vs. (10. 88±1. 24) d, P=0. 024] and the hospitalization days [ (23. 29±2. 45) d vs. (18. 42±1. 96) d, P=0. 012] reduced on the 14th day, mechanical ventilation withdraw rate within 14 days increasing [24/32 (75%) vs. 27/32 (84%), P=0. 030] on the 14th day. Conclusion Enteral immunonutrition supplemented with ω-3 PUFA can effectively reduce the incidence of ventilator associated pneumonia, alleviate the degree of infection and the inflammatory response in patients with sTBI undergoing ventilator therapy possibly improving condition and prognosis, which is worthy of being widely used.

Objective To investigate the effects of enteral immunonutrition supplemented with omega-3 polyunsaturated fatty acid (ω-3 PUFA) on inflammatory response,intestinal mucosal barrier function and the prognosis in patients with severe traumatic brain injury (sTBI).Methods 122 patients of sTBI hospitalized between January 2015 and December 2016 were randomly divided into experimental group (ω-3 PUFA,n=61) and control group (n =61).The serum levels of tumor necrosis factor-α (TNF-α),interleukin (IL)-6 and neuron specific enolase (NSE) were tested with enzyme linked immunosorbent assay.Meanwhile,D-lactate acid and intestinal fat acid binding protein (I-FABP) were evaluated by enzymology spectrophotometer method.After 14 days of treatment,the Glasgow Coma Scale (GCS) scores,Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores and prognoses of both groups were compared.Results The serum levels of inflammatory factors (TNF-α and IL-6),intestinal mucosal barrier function indicators (D-lactate acid and I-FABP) and NSE proteins significantly increased after sTBI (P =0.01).Compared with the control group,the experimental group on day 3 had significantly lower serum levels of inflammatory factors [TNF-α:(107.77± 19.79) μg/Lvs.(151.76±21.65) μg/L,P=0.01;IL-6:(76.85±7.15) μg/Lvs.(105.27±10.12) μg/L,P=0.01] and intestinal mucosal barrier function indicators [D-lactate:(69.81 ±6.32) μg/L vs.(89.80± 8.75) μg/L,P=0.03;I-FABP:(40.81±6.73) μg/Lvs.(56.60±8.58) μg/L,P=0.01].On day 7,the experimental group had significantly lower expression of NSE proteins than the control group [(13.63± 2.53) μg/L vs.(19.12±3.00) μg/L,P=0.02].The experimental group received better prognosis compared to the control group on day 14 [GCS scores:(9.74±0.76) vs.(8.44±0.53),P=0.04;APACHE Ⅱ scores:(14.67±1.37) vs.(17.53±1.47),P=0.03].The experimental group also had fewer days in hospitalization [(19.37±2.27) d vs.(25.42±2.61) d,P=0.01].Conclusion Enteral immunonutrition supplemented with ω-3 PUFA can effectively regulate the inflammatory response,and reduce impairment to the intestinal mucosal barrier function and damage to neurons in patients with sTBI.