Objective:To investigate the protective effect of external diaphragm pacing（EDP）combined with hyperbaric oxygen（HBO）therapy on preventing ventilator-induced diaphragm dysfunction（VIDD）and its related mechanism.Methods:A total of 100 adult male rats were randomly divided into five groups：blank control（BC）group，VIDD group，EDP group，HBO therapy group，and the combination of EDP and HBO therapy（EDP+HBO）group，with 20 rats per group. After tracheotomy，the BC group received no treatment，while the rats in the other four groups were given controlled mechanical ventilation to establish the VIDD rat model. And after successful modeling，the VIDD group did not receive further intervention，and the other three groups were treated accordingly. After 10 days of consecutive treatment，the changes in diaphragm weight（DW）and DW/body weight（BW），contraction force of diaphragm in vitro，and transection area of muscle fibers of each group were measured. Gene and protein expressions of diaphragm-related factors were detected. Results:Compared with the BC group，the DW，DW/BW，the transection area of muscle fibers，and the fiber structure and the contraction force of diaphragm in vitro of the VIDD group were decreased significantly. The expression levels of MHC-1，Keap1，Drp1，atrogin-1，MuRF-l，caspase-3，and beclin1 in the VIDD group were significantly increased while the expression levels of MHC-2，p-Akt，Mfn2，Nrf2，SOD，and GSH-Px were significantly decreased after treatment（ P < 0.05）. Compared with the VIDD group，the EDP+HBO group had higher DW and DW/BW［（0.35 ± 0.02）g vs.（0.63 ± 0.06）g，0.78 ± 0.08 vs. 1.34 ± 0.06，both P<0.05］，stronger contraction force of diaphragm in vitro［（1.15 ± 0.42）N/cm 2vs.（2.19 ± 0.10）N/cm 2， P < 0.05］，declining expression levels of MHC-1，Keap1，Drp1，atrogin-1，MuRF-l，caspase-3，and beclin1，increased expression levels of MHC-2，p-Akt，Mfn2，Nrf2，SOD，and GSH-Px，and much better diaphragmatic function，and all the differences were statistically significant（ P<0.05）. Conclusion:External diaphragm pacing combined with HBO therapy can significantly mitigate and decelerate VIDD by increasing the contraction force of the diaphragm，and reducing the oxidative stress，diaphragmatic atrophy and structural injury.

Objective:To explore the therapeutic outcome of consciousness disorders induced by different brain injury mechanisms.Methods:A total of 130 patients with impaired consciousness after brain injuries treated in Nanjing Zijin Hospital from January 2016 to May 2021 were taken as research subjects. According to the causes of injury，they were divided into cerebrovascular accident group（ n = 37），brain trauma group（ n=68），hypoxic-ischemic encephalopathy group（ n = 7），and cerebral aneurysm group（ n = 18）. The patients in the four groups were all given comprehensive treatment，including hyperbaric oxygen（HBO）therapy，electrical stimulation，acupuncture，passive training，and drug therapy. The Glasgow Coma Scale（GCS）scores and China Nanjing persistent vegetative state scale（CNPVSS）scores of the four groups before treatment and after three months of comprehensive treatment combined with HBO were compared，and the consciousness recovery rate and the overall curative effect of the four groups were also compared. Results:After three months of comprehensive treatment combined with HBO，the GCS scores and CNPVSS scores of the four groups were improved compared with those before treatment（all P < 0.05）；the most significant increase of GCS scores and CNPVSS scores was in the cerebral aneurysm group. The highest consciousness recovery rate was in the cerebrovascular accident group（64.86%，24/37），followed by cerebral aneurysm group（55.56%，10/18），and there were statistically significant differences in the consciousness recovery rate among the four groups（ P < 0.01）. The overall effective rate was in the descending order of cerebrovascular accident group［86.49%（32/37）］，cerebral aneurysm group［83.33%（15/18）］，brain trauma group［69.12%（47/68）］，and hypoxic-ischemic encephalopathy group［42.86%（3/7）］，with statistically significant differences（ P < 0.05）. The cerebrovascular accident group and the cerebral aneurysm group achieve higher consciousness recovery rates and greater improvement in consciousness disturbance compared with the other two groups after three months of comprehensive treatment combined with HBO. Conclusion:Different injury mechanisms affect the therapeutic outcomes of consciousness disorders induced by brain injuries.

Objective:To study the therapeutic effects of transcranial direct current stimulation（tDCS）combined with hyperbaric oxygen（HBO）in the treatment of dyskinesia in stroke patients with hemiplegia.Methods:A total of 90 stroke patients with hemiplegia admitted to the Department of Rehabilitation of the First Hospital of Shanxi Medical University between March 2019 and March 2021 were selected. They were divided into observation group and control group according to the random number table method，with 45 patients in each group. All patients underwent conventional rehabilitation treatment. The control group was treated with tDCS，and the observation group was treated with tDCS on the basis of HBO therapy. The lower limb motor ability，balance ability，activity of daily living，nerve defects and surface electromyography parameters were compared between the two groups.Results:After treatment，the Fugl-Meyer Assessment Scale（FMA-L）scores and Berg Balance Scale（BBS）scores of the two groups were significantly increased，and the observation group had significantly higher scores than the control group. The differences were statistically significant（ P < 0.05）. After treatment，the ellipse area of the center of gravity trajectory when eyes opened and closed was significantly reduced in the two groups，and the ellipse area of the observation group was significantly smaller than that of the control group. The differences were statistically significant（ P < 0.05）. After treatment，the National Institutes of Health Stroke Scale（NIHSS）scores of the two groups were significantly reduced，and the observation group had significantly lower scores than the control group. Barthel Index scores of the two groups were significantly increased，and the observation group had significantly higher scores than the control group. The differences were statistically significant（ P < 0.05）. After treatment，the integrated electromyogram（iEMG）was significantly increased in the two groups，and the observation group had significantly higher iEMG than the control group. The synergistic contraction rate（CR）was significantly reduced，and it was significantly lower in the observation group than in the control group. The differences were statistically significant（ P < 0.05）. Conclusion:The combined treatment of tDCS and HBO can effectively improve the motor ability of stroke patients with hemiplegia，restore their balance ability and muscle activity，and promote the nerve function recovery and quality of life.

Objective:To investigate the effect of hyperbaric oxygen（HBO）therapy on the cognitive function in uremic patients with maintenance hemodialysis.Methods:The uremic patients undergoing maintenance hemodialysis in the Department of Nephrology of Zhabei Central Hospital from January 2020 to December 2020 were selected as the research subjects. The Chinese version of Montreal Cognitive Assessment（MoCA）was used to assess the cognitive function of all patients. Eighty-two patients with cognitive dysfunction were identified according to their length of education and MoCA total scores，and were divided into HBO group and control group according to the random number table method，with 41 patients in each group. Patients in the control group were given treatment such as correction of water-electrolyte disturbance，nutritional support，and hemodialysis，while patients in the HBO group were additionally given HBO treatment on the basis of the treatment in the control group. The clearance of toxins，levels of inflammatory factors，cognitive function，and quality of life were compared between the two groups.Results:After treatment，the total scores and factor scores of MoCA，and the total mean scores and factor scores of kidney disease-targeted areas（KDTA）of the HBO group were significantly higher than those of the control group（ P < 0.05）. In the HBO group，the scores of executive ability，abstraction，orientation，language，naming，and attention，and the total scores of MoCA after treatment were significantly increased when compared with those before treatment；in the control group，only the scores of orientation and attention and the total scores of MoCA after treatment were significantly increased（ P < 0.05）. All factor scores and total mean scores of KDTA in both groups were increased significantly（ P < 0.05），except for the score of effects of kidney disease（EKD）in the control group. The clearance rates of blood creatinine（Cr），urea nitrogen（BUN），parathyroid hormone（PTH），β2-microglobulin（β2-MG）and cysteine protease inhibitor C（CysC）in the HBO group were significantly higher than those of the control group（ P<0.05）. And the levels of serum C-reactive protein（CRP），interleukins（IL-6，IL-8），tumor necrosis factor-α（TNF-α），and monocyte chemotactic protein-1（MCP-1）in both groups after treatment were lower than those before treatment，and levels of inflammatory factors in the HBO group were significantly lower than those in the control group，with statistically significant differences（ P < 0.05）. Conclusion:HBO therapy helps remove toxins in uremic patients with maintenance hemodialysis，reduce inflammatory response，and improve the cognitive function and quality of life to a certain extent.

Objective:To observe the effects of hyperbaric oxygen combined with Xingnaojing injection on serum nerve injury，serum factors，and cognitive function in patients with acute carbon monoxide poisoning delayed encephalopathy（ACMPDE）.Methods:A total of 106 cases with ACMPDE who were admitted to the First People’s Hospital of Nanning from July 2018 to July 2020 were selected as the research subjects and divided into control group and research group according to the random number table method，with 53 cases in each group. The control group was given hyperbaric oxygen treatment for 20 days，while the research group was given Xingnaojing injection on the basis of the treatment in the control group for 20 days. The levels of hypersensitive C-reactive protein（hs-CRP），interleukin-6（IL-6），interleukin-10（IL-10），tumor necrosis factor - α（TNF - α），neuron specific enolase（NSE），5-hydroxytryptamine（5-HT），angiopoietin-2（Ang-2），inducible nitric oxide synthase（iNOS），malondialdehyde（MDA），superoxide dismutase（SOD）in the two groups were detected before and after treatment. The Montreal Cognitive Assessment Scale（MoCA），Mini-Mental State Examination（MMSE）and 36-Item Short Form Health Survey（SF-36）were used to evaluate the cognitive function and quality of life of the two groups of patients and to compare the clinical efficacy of the two groups after treatment.Results:The levels of hs CRP，TNF - α and IL-6 in the research group were lower than those in the control group（ P < 0.01），the level of IL-10 in the research group was higher than that in the control group（ P < 0.01），the level of 5-HT in the research group was higher than that in the control group（ P < 0.01），the levels of NSE，Ang-2，and iNOS in the research group were lower than those in the control group（ P < 0.01），the level of SOD in the research group was higher than that in the control group（ P < 0.01），and the level of MDA in the research group was lower than that in the control group（ P < 0.01）.The MMSE，MOCA and SF-36 scores of the research group were higher than those of the control group（ P < 0.01）. After treatment，the total effective rate of the research group（98.11%）was significantly higher than that of the control group（84.91%），and the difference was statistically significant（χ 2 = 4.371， P = 0.037）. Conclusion:Hyperbaric oxygen combined with Xingnaojing injection can improve the level of serum factors in patients with ACMPDE，inhibit inflammatory response，alleviate nerve injury，reduce oxidative stress response，and improve the cognitive function and the quality of life of patients，which is worthy of clinical application.

Objective:To investigate the CT imaging features and the variation patterns of malignant solid pulmonary nodules（MSPNs）in different sizes.Methods:We studied 151 MSPNs of 150 patients with peripheral lung cancer confirmed by surgery and pathology between January 2016 and December 2019. According to their sizes，the nodules were divided into four groups：Group A（21 nodules，diameter ≤ 1.0 cm）；Group B（40 nodules，1.0 cm < diameter ≤ 1.5 cm）；Group C（48 nodules，1.5 cm < diameter ≤ 2.0 cm）；Group D（42 nodules，2.0 cm < diameter ≤ 3.0 cm）. We compared and analyzed the clinical and CT imaging features of the four groups.Results:Most MSPNs in the four groups were located in the upper lobes of the lung，not attached to the pleura and having irregular margins. As the MSPNs increased in diameter，the proportion of regular shapes（round or oval），homogeneous density，air bronchogram sign，lobulation sign，spiculation sign，vascular convergence sign，and pleural retraction sign in the nodules increased significantly（ P < 0.05）. Yet the proportion of calcification，bronchus encapsulated air sign，cavities，and halo sign did not vary significantly among the four groups（ P > 0.05）. Conclusions:The CT imaging features of the MSPNs varied as they grew and the variations followed certain patterns. The knowledge of the variation patterns helps early clinical diagnosis of malignant nodules.

Objective:To evaluate the clinical effects of transurethral thulium laser coagulation combined with hyperbaric oxygen（HBO）therapy in the treatment of radiation-induced hemorrhagic cystitis（RIHC）.Methods:From January 2014 to June 2020，10 patients with gross hematuria were diagnosed as RIHC in the Department of Urology of the Tenth People’s Hospital of Tongji University. Their clinical data were retrospectively analyzed. There were 7 males and 3 females，with an average age of 69.4 yrs（range 47-81）. Their mean baseline hemoglobin level was 91.4 g/L（range 58-123）and mean overactive bladder syndrome score（OABSS）was 7.8（range 3-13）. All patients received transurethral thulium laser coagulation combined with HBO therapy and were followed up at 1，3，6，and 12 months after treatment. The follow-up examination included gross hematuria evaluation，OABSS，detection of hemoglobin，and the count of microscopic red blood cells. Cystoscopies were also performed at month 6 and 12 to assess the therapeutic effects.Results:All patients completed the treatment. No grade 3-4 perioperative complications occurred，and no severe side effects such as severe barotrauma，oxygen poisoning，and decompression sickness were found during HBO therapy. After treatment，the hemoglobin levels at month 1，3，6 and 12 were significantly increased，and the results of OABSS were significantly decreased at all time points. The increases of hemoglobin at month 1 and 3 as well as the decrease of OABSS at month 1 showed statistically significant difference from their former performance，respectively（ P<0.05）. In the follow-up at month 12，the cystoscopies showed that 6 patients were cured，3 patients got their symptoms relieved，while 1 patient still suffered from gross hematuria repeatedly. The total effective rate of the combined treatment was 90%. Conclusion:Transurethral thulium laser coagulation combined with HBO has a high effective rate. It can significantly improve gross hematuria and relieve urinary tract symptoms. Thus it’s an effective treatment method for RIHC.

Objective:To investigate the effects of hyperbaric oxygen（HBO）combined with Temozolomide（TMZ）on the cell cycle and apoptosis of lung cancer A549 cells，and to study its mechanisms.Methods:After the cell culture，the human lung cancer A549 cells were divided into control group，HBO group，TMZ group，and HBO+TMZ group according to the experimental design，and were given，respectively，no treatment，50 μmol/L TMZ for 24 h，0.2 MPa HBO for 3 h，and 0.2 MPa HBO pretreatment for 3 h followed by 50 μmol/L TMZ for 24 h. The cell proliferation was detected by Cell Counting Kit-8（CCK-8）experiment；the cell apoptosis and cell cycle were detected by flow cytometry；the expression of AKT/mTOR signaling pathway proteins in A549 cells was detected by Western blotting.Results:The survival rate of A549 cells in the HBO+TMZ group was significantly lower than those of the other three groups（ P < 0.05 or P < 0.01）. The apoptosis rates in the control group，HBO group，TMZ group，and HBO+TMZ group were（6.73 ± 1.47）%，（8.52 ± 0.87）%，（32.78 ± 3.49）%，and（49.61 ± 5.74）%，respectively；the apoptosis rate in the HBO+TMZ group was significantly higher than those in the other three groups，and the differences were statistically significant（ P < 0.05）. The results of cell cycle experiment showed that the number of A549 cells in G2/M phase was increased in the HBO+TMZ group with a cell percentage of 35.81%，which was significantly higher than those of the other three groups（ P < 0.05）. The expression levels of p-AKT and mTOR proteins in A549 cells in the HBO+TMZ group were significantly lower than those in the other three groups（ P < 0.01）. Conclusion:The combination of HBO and TMZ can greatly improve the inhibition on the proliferation and induce apoptosis of lung cancer A549 cells，which is achieved by regulating the AKT/mTOR signaling pathway to block the A549 cells in the G2/M phase.

Objective:To investigate the effect of hyperbaric oxygen（HBO）on the resistance of gastric cancer AGS cells to irinotecan（ITC）and its related regulatory mechanisms.Methods:Gastric cancer AGS cells were cultured in vitro，and the cells were divided into four groups according to the experimental design：control group，ITC group，HBO group，and HBO + ITC group. The effect of ITC combined with HBO on the proliferation rate of gastric cancer cells was detected by Cell Counting Kit-8（CCK-8）；the changes of apoptosis rate after ITC combined with HBO treatment of AGS cells were detected by flow cytometry；and the changes in the expression of apoptosis-related and drug resistance-related proteins in AGS cells were detected by Western blotting assay. Results:Compared with control group and HBO group，the proliferation of AGS cells in the HBO + ITC group was further inhibited，and its proliferation rate was significantly lower than those of the control group and HBO group（ P<0.01），and also lower than that of the ITC group（ P<0.05）. Compared with those in the control group and the HBO group，the apoptosis rate of AGS cells in the HBO+ITC group was significantly higher than those in the control group and the HBO group（ P<0.01），and also higher than that in the ITC group（ P < 0.05）. In the ITC group and HBO+ITC group，the expression of apoptosis-related and drug resistance-related proteins，including Bcl-2，caspase-9 and P-gp，were significantly decreased，while the expression of Bad，caspase-3 and PARP were significantly increased，and the differences were statistically significant（ P<0.05 or P<0.01）. Compared with the control group and HBO group，p-JNK expression was increased and STAT3 expression was decreased in the ITC group（ P<0.01）；compared with the ITC group，p-JNK expression was increased and STAT3 expression was decreased in the HBO+ITC group（ P<0.05 or P<0.01）. Conclusion:HBO combined with ITC can effectively inhibit the proliferation of gastric cancer AGS cells，affect the apoptosis of AGS cells by regulating the JNK/STAT3 signaling pathway，and improve the cells’ drug resistance to a certain extent.

Objective:To investigate the grade of varicocele and its impact on semen quality of officers and soldiers stationed in coastal areas.Methods:The research subjects were 146 patients with left-sided varicocele and 32 healthy men selected from the male officers and soldiers who had visited the Beidaihe Sanatorium of PLA Joint Logistics Support Force. They were given physical and ultrasonic examination of spermatic vein and were divided into different groups by ultrasonic grading according to the inner diameter of their spermatic vein. Their semen quality was routinely analyzed.Results:There was no significant difference in semen volume or sperm deformity rate among the groups（ P > 0.05）. As varicocele aggravated，the sperm survival rate，sperm density，and the proportion of Grade A + B sperm all decreased significantly in the groups of clinical type II and III compared with those in the groups of normal type，subclinical type，and clinical type I（ P < 0.05）. Conclusion:The incidence of varicocele in officers and soldiers of coastal garrisons is significantly higher than that in the general population. The varicocele grade is closely related to the semen quality. Varicocele of clinical type I and below has less impact on the semen quality.