OBJECTIVE To investigate the effects of Tripterygium wilfordii multiglycoside （TWM） on renal injury in diabetic nephropathy （DN） rats through tumor protein p53/microRNA-214 （miR-214）/UNC-51-like kinase 1 （ULK1） axis. METHODS Male SD rats were randomly divided into normal group （n＝6） and modeling group （n＝28）； the modeling group was fed with high fat and high glucose plus intraperitoneal injection of streptozotocin to establish DN model. The modeled rats were randomly divided into model group， valsartan group [8.33 mg/（kg·d）] and TWM group[6.25 mg/（kg·d）]， with 8 rats in each group. Rats in each group were gavaged with the corresponding medication or normal saline， once a day， for 6 consecutive weeks. After the last medication， liver and renal function indexes [24 h urinary total protein （24 h-UTP）， blood urea nitrogen （BUN）， serum creatinine （SCr）， albumin （ALB）， alanine transaminase （ALT）]， blood lipid indexes （triglycerides， total cholesterol） and blood glucose index （fasting blood glucose） in urine/blood sample of rats were detected in each group. Renal pathologic change was observed， protein and mRNA expressions of p53， ULK1， Beclin-1 and microtubule-associated protein 1 light chain 3 （LC3）， and expression of miR-214 in renal tissue were also determined. RESULTS Compared with the normal group， the renal tubular epithelium of rats in the model group showed obvious edema， cell swelling， accompanied by lymphocyte infiltration； the levels of 24h-UTP， BUN， SCr， ALT and glycolipid indexes， the expressions of p53 protein and mRNA， as well as the expression of miR-214 in rats in the model group and administration groups were significantly increased or up-regulated， while ALB level， LC3-Ⅱ/LC3-Ⅰ， the expressions of LC3 mRNA， the expressions of ULK1， Beclin-1 protein and mRNA were significantly decreased or down-regulated （P＜0.01）. Compared with the model group， the histopathological damage of the kidney in rats was improved in administration groups； the levels of 24 h-UTP， BUN， SCr， ALT and glycolipid indexes， the expressions of p53 protein and mRNA， as well as the expression of miR-214 were all significantly decreased or down-regulated， while ALB level， LC3-Ⅱ/LC3-Ⅰ， the expressions of LC3 mRNA， the expressions of ULK1 and Beclin-1 protein and mRNA were significantly increased or up-regulated （P＜0.01）. CONCLUSIONS TG can alleviate renal damage in DN rats， and improve their liver and renal function， as well as glucose and lipid levels. These effects may be related to the regulation of the p53/miR-214/ULK1 axis and the restoration of cellular autophagy.

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Objective:To discuss the improvement effect of Shenshuai Yingyang Capsule in the renal osteodystrophy model rats and its effect on the bone morphogenetic protein(BMP)-7/Smads signaling pathway,and to clarify the relationship between renal function and bone metabolism in the renal osteodystrophy model rats.Methods:Fifty SPF SD rats were selected,and 10 of which were randomly chosen as control group,and the remaining 40 rats were used to establish the renal osteodystrophy model.Thirty successful modeling rats were divided into model group,positive control group,and Shenshuai Yingyang Capsule group,and there were 10 rats in various groups.The rats in control and model groups were given saline,the rats in positive control group were given 0.01 mg·kg-1 calcitriol,and the rats in Shenshuai Yingyang Capsule group were given 1.2 g·kg-1 Shenshuai Yingyang Capsule,all the rats were treated for 12 weeks.HE staining was used to observe the pathomorphology of femur tissue of the rats in various groups;automatic biochemical analyzer and chemiluminescence were used to detect the kidney function and calcium-phosphorus metabolism indicators in serum of the rats in various groups;real-time fluorescence quantitative PCR(RT-qPCR)method was used to detect the expression levels of BMP-7 and Smad1/5/8 mRNA in femur tissue of the rats in various groups;Western blotting method was used to detect the expression levels of BMP-7,phosphorylated BMP-7(p-BMP-7),Smad1/5/8,and phosphorylated-Smad1/5/8(p-Smad1/5/8)proteins in femur tissue of the rats in various groups.Results:The HE staining results showed that there was normal trabecular arrangement in control group with unchanged osteoblasts and osteoid area.In model group,the trabecular width and average osteoid area were increased,while the number of osteoblasts was decreased.In positive control and Shenshuai Yingyang Capsule groups,the trabecular width and average osteoid area were decreased,and the number of osteoblasts was increased.Compared with control group,the levels of blood urea nitrogen(BUN)and serum creatinine(Scr)of the rats in model group were increased(P<0.05);compared with model group,the levels of BUN and Scr of the rats in positive control and Shenshuai Yingyang Capsule groups were decreased(P<0.05);compared with positive control group,the levels of BUN and Scr of the rats in Shenshuai Yingyang Capsule group were decreased(P<0.05).Compared with control group,the level of calcium ion(Ca2+)in serum of the rats in model group was decreased(P<0.05),and the levels of phosphorus ion(P3-),parathyroid hormone(PTH),and alkaline phosphatase(ALP)were increased(P<0.05);compared with model group,the levels of Ca2+in serum of the rats in positive control and Shenshuai Yingyang Capsule groups were increased(P<0.05),and the levels of P3-,PTH,and ALP were decreased(P<0.05);compared with positive control group,the level of Ca2+in serum of the rats in Shenshuai Yingyang Capsule group was increased,and the levels of P3-,PTH,and ALP were decreased(P<0.05).The RT-qPCR results showed that compared with control group,the expression levels of BMP-7 and Smad1/5/8 mRNA in femur tissue of the rats in model group were decreased(P<0.05);compared with model group,the expression levels of BMP-7 and Smad1/5/8 mRNA of the rats in positive control drug group and Shenshuai Yingyang Capsule group were increased(P<0.05);compared with positive control group,the expression levels of BMP-7 and Smad1/5/8 mRNA in femur tissue of the rats in Shenshuai Yingyang Capsule group were increased(P<0.05).The Western blotting results showed that compared with control group,the expression levels of BMP-7,p-BMP-7,Smad1/5/8,and p-Smad1/5/8 proteins in femur tissue of the rats in model group were decreased(P<0.05);compared with model group,the expression levels of BMP-7,p-BMP-7,Smad1/5/8,and p-Smad1/5/8 proteins in femur tissue of the rats in positive control group and Shenshuai Yingyang Capsule group were increased(P<0.05);compared with positive control group,the expression levels of BMP-7,p-BMP-7,Smad1/5/8,and p-Smad1/5/8 proteins in femur tissue of the rats in Shenshuai Yingyang Capsule group were increased(P<0.05).Conclusion:Shenshuai Yingyang Capsule can improve the kidney function and calcium-phosphorus metabolism disorders in the renal osteodystrophy model rats,promote the proliferation of the bone marrow stromal cells,and enhances the bone metabolism;its mechanism may be related to the activation of BMP-7/Smads signaling pathway.

Objective: To investigate the effects of combined exposure to black carbon and lead on the expression of cell adhesion molecules and their regulating microRNAs (miRNAs) in the rat choroid plexus epithelial Z310 cells. Methods: i) Z310 cells were randomly divided into control group, black carbon exposure group, lead exposure group and combined exposure group. The lead exposure group and black carbon exposure group were treated with 10 μmol/L lead acetate and 10 mg/L black carbon, respectively, and the combined exposure group was treated with both in the above doses. After 12.0 hours, the expressions of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and mucosal vascular addressin cell adhesion molecule-1 (MAdCAM-1) in Z310 cells was detected by Western blotting. The expression of miR-326, miR-328-3p and miR-542-3p which regulated ICAM-1 was detected by real-time fluorescent quantitative polymerase chain reaction. ii) Z310 cells or Z310 cells transfected with miRNA-326 mimic were randomly divided into control group, miRNA-326 transfection control group, combined exposure group and miRNA-326 transfection combined exposure group. Cells in the two control groups were not treated. The two combined exposure groups were treated with 10 mg/L black carbon and 10 μmol/L lead acetate for 12.0 hours. The expression of ICAM-1 was detected by Western blotting. Results: i) The relative expression of ICAM-1, VCAM-1 and MAdCAM-1 in the cells of black carbon exposure group and ICAM-1 in the lead exposure group was higher than those in the control group (all P<0.05). The relative expression of ICAM-1 and MAdCAM-1 in the combined exposure group was higher than those in the other three groups (all P<0.05). The relative expression of VCAM-1 in cells of combined exposure group was higher than those in the control group and lead exposed group (all P<0.05). The relative expression of miR-326 in cells of the lead exposure group and black carbon exposure group was lower than those in the control group (all P<0.05). The relative expression of miR-326 in the combined exposure group was lower than that in the other three groups (all P<0.05). There was no significant difference between miR-328-3p and miR-542-3p in the four groups (all P>0.05). ii) The relative expression of ICAM-1 in cells of the miR-326 transfection control group cells was lower than that in the control group (P<0.05), while in the cells in the combined exposure and miRNA-326 transfection combined exposure group, it was higher than that in the control and miRNA-326 transfection control groups (all P<0.05), and lower in the miRNA-326 transfection combined exposure group than in the combined exposure group (P<0.05). Conclusion: Black carbon or lead exposure can upregulate the expression of ICAM-1, VCAM-1 and MAdCAM-1 in Z310 cells. Black carbon and lead combined exposure lead to a synergistic effect on upregulation of ICAM-1 and MAdCAM-1 expression, particularly ICAM-1. The combined exposure of black carbon and lead may upregulate the expression of ICAM-1 by downregulating the expression of miR-326.

Objective:To discuss the effect of acupuncture on learning and memory ability and the expression of neuroglobin (Ngb) of the hippocampus of vascular cognitive impaired (VCI) rats.Methods:VCI rats model was established by repeated ligation of the carotid arteries of the two sides to induce ischemia-reperfusion injury. The successful modeled rats were divided into acupuncture group and a model group according to the random number table method, with 12 rats in each group, and 12 rats were selected as the normal group. The rats in the acupuncture group received acupuncture at "Baihui", "Fengfu" and "Yongquan", 10 times as a course of treatment, a total of 3 courses, and stop acupuncture treatment for 2 days during the courses of treatment. Neurobehavioral scores were measured on the 3rd day after the intervention. Morris water maze was conducted to detect the learning and memory ability of the rats in each group, and Western blot was used to detect the expression of Ngb in the hippocampus of the rats.Results:Compared with the model group, the behavioral score of the acupuncture group decreased after intervention ( P<0.05), the escape latency was significantly shortened ( P<0.05), the number of crossing platforms was increased ( P<0.05), and the hippocampal Ngb (1.18±0.06 vs.0.98±0.04) was significantly increased ( P<0.05). Conclusion:Acupuncture at "Baihui", "Fengfu" and "Yongquan" could promote the expression of Ngb in the hippocampus of rats and improve the learning and memory ability of VCI rats.

In addition to the typical respiratory symptoms, COVID-19 patients present with clinical manifestations of cardiovascular system damage, and they are at higher risk of intensive care or mortality. The mechanism of COVID-19's impact on the cardiovascular system is still unclear, therefore we need to pay close attention to it. Based on the existing research, this paper focused on the concurrent characteristics of the cardiovascular system diseases, summarized the possible mechanisms of cardiovascular system damage, including the coronavirus invaders directly into cardiomyocytes and its conduction system, with complications or accompanying conditions such as cytokine storm, imbalance of oxygen supply and demand, drug influence, stress and other damage to cardiovascular system. Meanwhile, current clinical manifestations and treatment methods of COVID-19 were summarized.

Objective:To explore the morphological characteristics, treatment strategies and clinical results of complex hyperextension tibial plateau fractures.Methods:From October 2017 to January 2019, data of 27 patients with complex hyperextension tibial plateau fractures were retrospectively analyzed. There were 19 males and 8 females with an average age of 43.4 years (range, 23-68 years). According to Schatzker classification of tibial plateau fractures: there are 8 cases of type IV, 5 of type V, and 14 of type VI; according to the three-column theory classification: there are 8 cases of two-column fracture and 19 cases of three-column fracture. Bicondylar fractures were treated with medial Tomofix locking plate and anterolateral L-shaped locking plate through medial and anterolateral approach; tibialmedial condylar fractures was treated with T-shaped plate and posteromedial locking plate through extended medial approach. Patients with anterior tibial fractures were treated with horizontal strip plate through modified anterior median approach. Combined soft tissue or bone injury was repaired. The fracture healing and reduction were evaluated by X-ray and CT scan. The reduction of tibial plateau fracture was evaluated by Rasmussen radiology standard, and the knee joint function was evaluated 12 months after the operation by the score of American hospital for special surgery (HSS).Results:All the 27 surgeries were performedsuccessfully. The operation time was 130-350 minutes, with an average time of 165 minutes. Twenty-seven cases were followed up for 12-24 months, with an average period of 15.8 months. All fractures were healed. The average clinical healing time was 13.5 weeks (range, 10-18 weeks). Twelve months after operation, Rasmussen's radiology score was 13-18, with an average of 16.7 points, among them there were 19 excellent and 8 good. Twelve months after the operation, the score of HSS knee joint was 82-98, with an average score of 93.2 points, and there were 22 cases excellent, 4 cases good and 1 case fair. The excellent and good rate was 96.2% (26/27).Conclusion:Complex hyperextension tibial plateau fractures often combined with tibial bicondylar, medial tibial condyle or anterior tibial fractures. According to the morphological characteristics of complex hyperextension tibial plateau fractures, using appropriate surgical approach and internal fixation, repairing ligament soft tissue structure and reconstructing knee joint stability can achieve satisfactory results.

Objective    To investigate the job satisfaction, emotional state and related factors of medical staff participating in online consultation of West China Internet Hospital during the COVID-19 epidemic. Methods    Through literature review and expert consultation (Delphi method), the questionnaire was developed, and the online consulting medical staff of West China Hospital of Sichuan University were invited to conduct the questionnaire survey from 26 January to 19 June 2020, and finally the statistical analysis was summarized. Results    A total of 132 valid questionnaires were retrieved. Of the 132 subjects, 127 people (96.2%) expressed satisfaction or special satisfaction with the online consulting office format; 103 respondents (78.0%) said that online consulting did not affect or completely did not affect the work and life; 81 people (61.4%) consulted online more than 5 days a week, and 108 people (81.8%) worked within 2 hours a day; the vast majority (97.7%) of the research subjects were satisfied with the content of the training materials and the related support work of the coordination group. Only 29 (22.0%) of the study participants believed that the epidemic caused negative emotions, mainly due to the severity of the epidemic. Conclusion    The online consulting medical staff are satisfied with the office form, training materials and coordination work group of the COVID-19 epidemic, and think that it does not affect their work and life. 22.0% of medical staff have negative emotions, and the severity of the epidemic is   the main reason.