Objective:To evaluate the dynamic changes in fibrinolytic states after initial resuscitation in severe trauma patients, and to analyze the relationship between the changes and clinical outcomes.Methods:A prospective cohort study was conducted on severe trauma patients admitted to the trauma center in Taicang Hospital, affiliated with Soochow University, from July 2021 to December 2022. Resuscitation treatments, including tranexamic acid (TXA), were administered. Thromboelastography was performed at three intervals: upon admission, 1 hour and 8 hours after initial resuscitation. Fibrinolytic states were categorized into three phenotypes based on clot lysis at 30 minutes: fibrinolysis shutdown (SD), physiologic fibrinolysis (PY), and hyperfibrinolysis (HF). The primary outcomes included all-cause mortality at 24 hours and 28 days. Multivariate logistic regression was used to analyze the association between early fibrinolytic changes and clinical outcomes.Results:A total of 132 patients with severe trauma were included. Upon admission, fibrinolytic phenotypes were distributed as follows: SD in 61 patients (46.2%), PY in 59 patients (44.7%), and HF in 12 patients (9.1%). After resuscitation with TXA and other interventions, SD and PY remained predominant, whereas HF further decreased. Compared with the SD and PY groups, the HF group had significantly higher 24-hour mortality (25.0% vs. 3.3% vs. 3.4%, P<0.05) and 28-day mortality (58.3% vs. 32.8% vs. 11.9%, P<0.05), with massive hemorrhage being the primary cause of death. Among the non-HF groups, 28-day mortality was significantly higher in the SD group than in the PY group (32.8% vs. 11.9%, P<0.05), with traumatic brain injury as the leading cause of death. After the exclusion of 12 HF patients, multivariate logistic regression showed that after adjusting for age, Glasgow Coma Scale score ≤ 8, prothrombin time, and 24-hour crystalloid infusion volume, identified persistent SD was a risk factor for 28-day mortality in severe trauma patients, compared with sustained PY status ( OR=7.009, 95% CI: 1.141-43.079, P=0.036). Conclusions:In patients with severe trauma, SD and PY are the predominant fibrinolysis phenotypes after initial and early resuscitation. Persistent SD following resuscitation is significantly associated with an increased risk of 28-day mortality.

Renal fibrosis is a critical factor in progression of chronic kidney disease to end-stage renal disease.Underlying mechanisms driving renal fibrosis remain unclear.Lymphocytes play a pivotal and dual role in initiation and progression of renal fibro-sis.Through secretion of cytokines and chemokines,as well as direct cell-cell interactions,lymphocytes can exert profibrotic effects while also demonstrating antifibrotic potential under certain conditions.This review aims to summarize current research advances regarding interplay between lymphocytes and renal fibrosis and to explore their potential applications in antifibrotic therapies.

Renal fibrosis is a critical factor in progression of chronic kidney disease to end-stage renal disease.Underlying mechanisms driving renal fibrosis remain unclear.Lymphocytes play a pivotal and dual role in initiation and progression of renal fibro-sis.Through secretion of cytokines and chemokines,as well as direct cell-cell interactions,lymphocytes can exert profibrotic effects while also demonstrating antifibrotic potential under certain conditions.This review aims to summarize current research advances regarding interplay between lymphocytes and renal fibrosis and to explore their potential applications in antifibrotic therapies.

The intestinal mucus layer is a barrier that separates intestinal contents and epithelial cells, as well as acts as the "mucus layer-soil" for intestinal flora adhesion and colonization. Its structural and functional integrity is crucial to human health. Intestinal mucus is regulated by factors such as diet, living habits, hormones, neurotransmitters, cytokines, and intestinal flora. The mucus layer's thickness, viscosity, porosity, growth rate, and glycosylation status affect the structure of the gut flora colonized on it. The interaction between "mucus layer-soil" and "gut bacteria-seed" is an important factor leading to the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Probiotics, prebiotics, fecal microbiota transplantation (FMT), and wash microbial transplantation are efficient methods for managing NAFLD, but their long-term efficacy is poor. FMT is focused on achieving the goal of treating diseases by enhancing the "gut bacteria-seed". However, a lack of effective repair and management of the "mucus layer-soil" may be a reason why "seeds" cannot be well colonized and grow in the host gut, as the thinning and destruction of the "mucus layer-soil" is an early symptom of NAFLD. This review summarizes the existing correlation between intestinal mucus and gut microbiota, as well as the pathogenesis of NAFLD, and proposes a new perspective that "mucus layer-soil" restoration combined with "gut bacteria-seed" FMT may be one of the most effective future strategies for enhancing the long-term efficacy of NAFLD treatment.
Humans ; Non-alcoholic Fatty Liver Disease/therapy* ; Gastrointestinal Microbiome ; Probiotics ; Prebiotics ; Fecal Microbiota Transplantation ; Bacteria ; Liver/pathology*

Objective To study the effect of total knee arthroplasty after limb position on postoperative hemorrhage,to provide basis for clinical diagnosis and treatment.Methods 270 cases of total knee arthroplasty were selected.The patients were divided into groupⅠ,group Ⅱand group Ⅲ according to the random number table method, 90 cases in each group.Patients of group Ⅰ with limb hip and knee were straight,group Ⅱ hip joint elevation of 45 degrees,70 degrees of knee flexion,group Ⅲ hip joint elevation of 45 degrees,the knee extension.All the patients were intervened for 12h after operation,were placed drainage bag 24 hours.The lead flow,preoperative,postoperative hemoglobin and 5 days after the knee joint activity were compared in the three groups.Results Induced flow after surgery in group Ⅰ was (433.4 ±25.3)mL,which was significantly higher than (402.6 ±19.6)mL and (403.5 ± 21.5)mL in group Ⅱand group Ⅲ,and the differences were statistically significant (t =5.253,5.301,all P <0.05),there was no significant difference of induced flow between groupⅡ and group Ⅲ(P >0.05).The hemoglobin levels of the three groups were (92.3 ±4.2)g/L,(114.9 ±6.4)g/L and (113.2 ±7.5)g/L,which were significantly decreased after operation,the differences were statistically significant compared with before operation (t =5.083, 6.034,7.893,all P <0.05),the hemoglobin after surgery of group Ⅰ was significantly lower than group Ⅱ and groupⅢ,the differences were statistically significant (t =6.423,7.043,all P <0.05),there was no significant difference between group Ⅱ and group Ⅲ (P >0.05).There was no significant difference of range of motion in the three groups after 5 days of operation (P >0.05).Conclusion Hip flexion can effectively reduce bleeding after total knee arthro-plasty,the flexion and extension of knee joint had no significant effect on postoperative hemorrhage.

Objective To investigate the clinical effect of modified storage type of autologous blood transfu-sion combined with shed blooding retransformation technique after OrthoPAT for artificial total knee arthroplasty. Methods 70 patients with total knee replacement were randomly divided into observation group and control group, 35 cases in each group.The observation group was treated with the modified storage autotransfusion combined shed blooding retransformation technique after OrthoPAT,while the control group was given conventional allogeneic blood transfusion.The hemoglobin values and blood coagulation function of the two groups at immediately before anesthesia and surgery,10min before autologous blood transfusion and after reinfusion of 15min,after 6h and 24h of surgery were recorded,and the drainage blood total value,allogeneic blood transfusion measurement issues and transfusion rate after 24h were recorded.Results The hemodynamics of the two groups were stable at each time,there were no difference at urine volume (all P >0.05).The coagulation conditions were normal of the two groups at each time,there were no statistically significant differences between the two groups (all P >0.05).The average volume and homologous blood transfusion rate in the observation group were (126.3 ±6.5)mL,1 /35,which were significantly lower than those in the control group [(476.4 ±10.6)mL,2 /35],the differences were statistically significant (t =10.73,χ2 =6.31,all P <0.05).The incidence rate of postoperative complication of the observation group was 5.7%,which was signifi-cantly lower than 22.9% of the control group,the difference between the two groups was statistically significant (χ2 =4.93,P <0.05).Conclusion The improved storage type of autologous blood transfusion combined with shed bloo-ding retransformation technique after OrthoPAT has exact effect for artificial total knee arthroplasty,the incidence of adverse reactions is low,as well as the low blood transfusion rate.

Objective:To study the influence of thrombus aspiration combined tirofiban on patients with acute ST seg-ment elevation myocardial infarction (STEMI)after primary percutaneous coronary intervention (PCI).Methods:A total of 98 patients,who received primary PCI because of STEMI in our hospital from Jan 2012 to Mar 2013,were selected.They were divided into thrombus aspiration group (n=48,received pure thrombus aspiration)and com-bined treatment group (n = 50,received thrombus aspiration combined intracoronary tirofiban injection during PCI).Coronary angiography (CAG)instantly after PCI and follow-up condition during hospitalization and six months after discharge were compared between two groups.Results:(1)Compared with thrombus aspiration group after PCI,there were significant rise in TIMI blood flow grade [(2.3±0.6)grades vs.(2.7±0.3)grades],per-centage of TIMI flow grade 3 (72.9% vs.90.0%)and ST segment regression >50% rate within 90min after PCI (52.1% vs.74.0%),P < 0.05 or < 0.01,and significant reduction in percentage of postoperative no-reflow (18.8% vs.4.0%,P =0.038)in combined treatment group in hospital;(2)After six-month follow-up,left ven-tricular ejection fraction (LVEF)of combined treatment group was significantly higher than that of thrombus aspi-ration group [(58±6.3)% vs.(51±5.6)%,P <0.05].Conclusion:Thrombus aspiration combined tirofiban can effectively reduce coronary thrombus burden and improve cardiac function in STEMI patients during primary PCI.

Objective To investigate the role of NF-κB/survivin signal pathway in the intima hyperplasia of rat carotid balloon injury restenosis model.Methods NF-κB siRNA lentivirus vector(titer was 1 × 108 TU/ml)was established.Carotid balloon injury restenosis model was made in 33 SD rats.The rats were divided into 4 groups according to different processing methods,including negative control (NC) group (n =11),NF-κB siRNA group(n =11),NF-κB siRNA + YM155 (survivin inhibitor) (n =11),the uninjured carotid artery served as the normal control group(n =1 1).After 7 days,the carotid sample(n =5 each group)were harvested to detect the NF-κB and survivin mRNA expression by RT-PCR.The carotid sample were harvested on 28 days (n =6 each group) for HE staining and measuring intima hyperplasia.Immunohistochemical method was also used to detect the expression of intima proliferation cell nuclear antigen (PCNA) and media α-SM-actin.Results (1) After 7 days,NF-κB and survivin mRNA expression was significant higher in NC group than in normal control group (P ＜ 0.05),the NF-κB mRNA expression was significantly lower in NF-κB siRNA group than in NC group (P ＜ 0.05) and similar between NF-κB siRNA group and NF-κB siRNA + YM155 group.The survivin mRNA expression was significantly lower in NF-κB siRNA group compared to NC group (P ＜ 0.05) and significantly higher in NF-κB siRNA group than in NF-κB siRNA + YM155 group (P ＜0.05).(2) After 28 days,intima hyperplasia was observed in NC (0.13 ±0.01),NF-κB siRNA (0.11 ±0.01) and NF-κB siRNA +YM155 group(0.09 ±0.01)mm2(P ＜ 0.05).Media area was similar among NC group,NF-κB siRNA group and NF-κB siRNA + YM155 group (P ＞ 0.05).L/M ratio was gradually reduced among NC group(1.55 ± 0.07),NF-κB siRNA group(0.92 ± 0.08),NF-κB siRNA + YM155 group(0.76 ±0.06,all P ＜0.05).Similar results were found in the residual restenosis rate:NC group (58.71 ± 0.02) ％,NF-κB siRNA group (32.13 ± 0.05) ％,NF-κB siRNA + YM155 group (26.42 ± 0.03) ％ (all P ＜ 0.05) and expression of vascular smooth muscle cell PCNA:NC group(45.32 ± 7.21) ％,NF-κB siRNA group(36.54 ± 6.42) ％,NF-κB siRNA + YM155 group(28.57 ± 6.31)％ (all P ＜ 0.05).On the contrary,the IOD of α-SM-actin in media increased gradually:NC group (0.055 ± 0.006),NF-κB siRNA group (0.072 ± 0.011),NF-κB siRNA + YM155 group(0.084 ±0.008,all P ＜ 0.05).Conclusion Inhibiting NF-κB expression can significant decrease intima hyperplasia in this model,and this effect may be mediated by inhibiting survivin and reducing the proliferation of vascular smooth muscle cells.