OBJECTIVE To investigate the improvement effect of Dihuang yinzi on neurological function of APP/PS1 double transgenic positive mice and its possible mechanism. METHODS APP/PS1 double transgenic positive mice were randomly divided into APP/PS1 positive model group， Dihuang yinzi low-dose， medium-dose and high-dose groups （12， 24， 48 g/kg，by the amount of crude drug）， western medicine group （donepezil hydrochloride 0.8 mg/kg）； APP/PS1 transgenic negative mice were included in as APP/PS1 negative normal group， with 6 mice in each group. Administration groups were given relevant medicine intragastrically； APP/PS1 positive model group and APP/PS1 negative normal group were given constant volume of normal saline intragastrically， once a day， for consecutive 28 d. After the last medication， the ability of learning and memory， intestinal flora diversity （only medium-dose group of Dihuang yinzi）， pathological changes of neural cells in hippocampus， and the expressions of Bcl-2， Bax and brain-derived neurotrophic factor （BDNF） in mice of each group were investigated. RESULTS Compared with APP/PS1 positive model group， escape latency of mice was shortened significantly in Dihuang yinzi medium-dose and high-dose groups， while the times of crossing the platform significantly increased （P＜0.05）. Compared with APP/PS1 positive model group， Chao1 index of Dihuang yinzi medium-dose group was lower， while Shannon index was higher （P＜0.05）； OTU abundance of microbial flora was decreased to some extent； dominant flora was Clostridia o_ Clostridia_ vadinBB60_ Group， verruca G_ UCG_ 005. Compared with the APP/PS1 positive model group， the pathological changes of the nerve cells in the hippocampal CA1 area of mice were improved in the medium-dose and high-dose groups of Dihuang yinzi； the protein expressions of Bcl-2 and BDNF in the hippocampal tissue were significantly increased， while the protein expression of Bax was significantly decreased （P＜0.05）. CONCLUSIONS Dihuang yinzi can enhance the diversity of flora， change the type of dominant flora， and can inhibit the apoptosis of brain neurons， and increase the level of BDNF； its mechanism may be to protect nerve cells by means of gut-brain axis， thereby improving the learning and memory ability of APP/PS1 positive model mice.

Objective:To investigate the feasibility and safety of suprapubic bladder puncture and gland fixation in transurethral enucleation of the prostate.Methods:The clinical data of 15 patients with benign prostatic hyperplasia admitted to the First Affiliated Hospital of Guangxi Medical University from January 2020 to June 2020 were retrospectively analyzed. The age was (70.27±5.35) years old, preoperative serum prostate-specific antigen (PSA) level was (3.03±1.37) ng/ml, preoperative total prostate weight was 80.3(70.49, 96.78)g, preoperative postvoid residual urine volume(PVR)was 80 (55, 108)ml, and the maximum urine flow rate (Q max) was (6.13±2.25) ml/s. The international prostate symptom score(IPSS) was 25(22, 27), quality of life (QOL)score was 5(5, 6), international erectile function index-5 (IIEF-5) score was (15.38±5.10). All 15 patients underwent conventional transurethral plasma enucleation of prostate by using the three-lobe method, and the enucleated gland was pushed into the bladder completely. Then a laparoscopic pneumoperitoneum needle was used to perform suprappubic cystipuncture, and ureteral grasping forceps were inserted through the outer sheath. The forceps were used to fix the enencied gland. A rapid harvesting electric resection was performed in the broad space of the bladder, and the Ellick was rinsed to remove the tissue fragments. Surgical indicators and complications were recorded. The improvement of subjective score (IPSS, QOL, IIEF-5) and objective index (Q max, PVR) was compared between preoperative and postoperative. Results:All the 15 operations were completed successfully and there were no complications such as blood transfusion, capsule perforation, transurethral resection syndrome, bladder injury, bladder puncture site laceration and bleeding. The weight of resected prostate tissue was 44(40, 60)g, with blood loss (79.20±18.93)ml.The time of enucleation operation was (54.13±10.88)min, with harvest cutting time (14.67±2.50)min, evisceration efficiency (0.89±0.08)g/min, harvesting efficiency (3.26±0.36)g/min, bladder irrigation time (2.47±0.52) d. The time of indwelling catheter was (3.73±0.80)d.The postoperative hospital stay was (4.40±0.91) d. Temporary urinary incontinence occurred in 1 case after operation. All patients were followed up for 6 months after operation. The IPSS score was 3(2, 3), QOL score was 0(0, 1), IIEF-5 score was (20.12±2.30), Q maxwas (21.80±2.14) ml/s and PVR was 10(5, 15)ml, which were all significantly different compared with those before surgery ( P<0.05). The symptoms of the patients were significantly improved. Conclusions:Transurethral plasma enucleation of prostate combined with suprapubic bladder puncture and fixed gland is effective in the treatment of benign prostatic hyperplasia. The subjective symptoms and objective examination of patients have been significantly improved, and no adverse operation-related complications have occurred. It is a suitable method for enucleation of prostate in units which are not equipped with transurethral tissue planer.

Objective:To discuss the clinical characteristics and genetic diagnosis of fetal familial hemophagocytic lymphohistiocytosis (FHL).Methods:Clinical data of a case of fetal FHL from Children's Hospital, Capital Institute of Pediatrics was analyzed, and related FHL cases at home and abroad were retrieved from PubMed, CNKI, and Wanfang databases using terms including "fetus", "neonate", and "familial hemophagocytic lymphohistiocytosis", from the establishment of the database to January 3, 2021, to summarize the characteristics of this disease.Results:This index case was found with fetal splenomegaly, free fluid in the abdominal cavity, and enlargement of the ventricle at 39 +3 weeks of gestation, and presented with fever, tachypnea, hepatosplenomegaly, skin ecchymosis and petechia, and lymphadenectasis after birth. Laboratory examination revealed pancytopenia, abnormal liver function, elevated ferritin and triglyceride, and decreased fibrinogen levels. CD107a excitation experiment showed decreased degranulation function of NK cell (ΔCD107a<5%). Hemophagocytosis was observed in the bone marrow smear. Genomic DNA sequence analysis demonstrated compound heterozygous mutations of c.118-308C>T and c.3002T>C in the UNC13D gene. All the above findings led to the diagnosis of FHL3. Despite chemotherapy with dexamethasone and cyclosporin, and symptomatic treatment after admission without hematopoietic stem cell transplantation, the baby died on day 52. A total of 15 papers related to fetal FHL, including 20 infants, were retrieved. Among these 21 cases (including the index case), the main clinical symptoms were fetal edema and hepatosplenomegaly, which may be accompanied by fetal distress and increased amniotic fluid volume, and postnatal fever, dyspnea, rash, and central nervous system involvement. Laboratory and imaging examination results were consistent with the diagnostic criteria for hemophagocytic hyperplasia. As far as we know, the reported fetal FHL gene mutations were PRF1 (FHL2) and UNC13D gene mutation (FHL3), in which reduced expression of perforin and granzyme can be detected, respectively. Dexamethasone, cyclosporin, etoposide, and other chemotherapy and symptomatic treatment are the primary treatments currently, and alternative therapies include intrauterine chemotherapy in the third trimester and postnatal hematopoietic stem cell transplantation. Among the 21 cases, including the index case, intrauterine death occurred in four cases, 13 children died at different times after birth, and only four children survived, among which the eldest one was 12 years old. Conclusions:FHL is a condition with atypical early signs, high mortality rate and treatment difficulties. Fetal FHL should be considered in differential diagnosis in fetuses with edema or hepatosplenomegaly besides hemolysis, infection, autoimmune diseases, and hereditary problems. Therefore, with immunotechnology and gene sequencing, early diagnosis and treatment can be prompted to improve the prognosis of this group of population.

Objective: To identify the characteristics including clinical features and pulmonary computed tomography (CT) features of heart failure and novel coronavirus pneumonia(COVID-19). Methods: This study was a retrospective study. A total of 7 patients with Heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1, 2019 and February 15, 2020 were enrolled. The baseline clinical and imaging features of the two groups were statistically analyzed. Results: There was no significant difference in age and sex between the two groups, but the incidence of epidemiological contact history, fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group (12/12 vs. 2/7, P=0.001; 12/12 vs. 4/7, P<0.001). While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7, P<0.001; 0/12 vs.7/7, P<0.001). For imaging features, both groups had ground-glass opacity and thickening of interlobular septum, but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19 (4/7 vs. 1/12, P=0.04). In heart failure group, the ratio of the expansion of small pulmonary veins was also higher (3/7 vs. 0, P=0.013), and the lung lesions can be significantly improved after effective anti-heart failure treatment. Besides, there are more disease with rounded morphology in COVID-19 (9/12 vs. 2/7, P=0.048) . Conclusions More patients with COVID-19 have epidemiological history and fever or respiratory symptoms. There are significant differences in chest CT features, such as enlargement of pulmonary veins, lesions distribution and morphology between heart failure and COVID-19.

Primary Sj?gren′s syndrome (pSS) is a relatively common autoimmune systemic disease. The pathogenesis of pSS has not been fully elucidated. With the deepening of research, it is found that high mobility group protein box 1 (HMGB1) is associated with the pathogenesis of pSS, and immunomodulatory abnormalities have become a research hotspot. This article reviewed the association between HMGB1 and immune imbalance in the pathogenesis of pSS.

Objective:To evaluate the safety and efficacy of balloon occlusion technique combined with total arch replacement and frozen elephant trunk in the treatment of complex aortic arch diseases.Methods:The clinical data of 100 patients undergoing balloon occlusion technique combined with total arch replacement and frozen elephant trunk surgery in Fuwai Hospital from August 2017 to September 2018 were retrospectively reviewed, and the early clinical results were analyzed.Results:The average circulatory arrest time was(5.2±3.1) min. The lowest nasopharyngeal and bladder temperature was(27.9±1.0) ℃ and(29.2±1.2) ℃, respectively. One patient died in hospital due to multiple organ failure caused by acute liver failure, and a total of 4 patients died within 30 days. Other postoperative complications included cerebral infarction in 3 cases, paraplegia in 2 cases, low cardiac output syndrome requiring IABP assistance in 1 case, renal failure requiring continuous dialysis in 5 cases, redo for bleeding in 4 cases, reintubation in 3 cases, recurrent laryngeal nerve injury in 1 case, and osteofascial compartment syndrome in 1 case.Conclusion:Balloon occlusion technique combined with total arch replacement and frozen elephant trunk is safe and feasible in the treatment of complex aortic arch diseases. Its organ protection effect still needs to be confirmed by large sample comparison study.

Objective To study the surgical treatment strategy of acute type A aortic dissection involving coronary artery on the basis of Fuwai type and evaluate the clinical efficacy. Methods 50 patients with coronary involvement were retrospec-tively analyzed from April 2014 to August 2016. The treatment mothod was based on Fuwai type,mainly including coronary ar-tery repair(CAR)and coronary artery bypass grafting(CABG). The clinical effect of this surgical strategy in the perioperative and follow-up period was analysed. Results A total of 50 patients were included. Of which,38 patients were treated with CAR, 12 patients CABG,including 3 remedial bypass and 2 prophylactic bypass. All patients were followed up from 4 to 32 months,with an average time of 18. 6 months. In group CABG, 1 patient died of multiple organ failure after surgery,and the other patients had no major adverse cardiovascular events and deaths during perioperative period and follow-up period. Conclu-sion This strategy for the treatment of involved coronary arteries based on the Fuwai type has some guiding significance on the surgical treatment of acute type A aortic dissection.

Objective: To assess the clinical characteristics and identify the risk factors in the acute myocardial infarction (AMI) patients complicating with ventricular septal rupture (VSR). Methods: A retrospective study was performed on 96 AMI patients complicating with VSR, who were hospitalized in the Second Xiangya Hospital of Central South University, Hunan Provincial Peoples′ Hospital, the First Affiliated Hospital of University of South China, the Second Affiliated hospital of University of south China, Xiangtan Central Hospital from December 2007 to May 2017. There were 46 females and the age was (66.2±10.7) years (from 43 to 90 years). Patients were divided into in-hospital survival group (n=64) and in-hospital death group (n=32). The 96 patients were also divided into the early death group (survived ≤2 weeks after admission, n=50) and non-early death group (survived>2 weeks after admission, n=46). Multivariate logistic regression was used to analyze the independent risk factors of the early death. Results: Location of VSR was available in 71 patients, VSR was located at the apical or anterior septum near the apical region in 64.0% (32/50) patients with the anterior AMI, VSR was located at the posterior wall and basal inferior segment in 57.1% (12/21) patients with non-anterior AMI. Compared to the in-hospital survival group, patients in the in-hospital death group were older ((69.6±11.3) years vs. (64.6±10.1) years, P=0.031), incidence of non-ventricular aneurysm (71.9% (23/32) vs. 37.5% (24/64), P=0.001) and anterior AMI (84.4%(27/32) vs. 62.5%(40/64), P=0.028) was significantly higher in the in-hospital death group than in the in-hospital survival group. The comparison between the early death group and non-early death group showed that older age, female, no history of angina or myocardial infarction, Killip grade>Ⅲ, and non-ventricular aneurysm were related to increased risk of the early mortality in this patient cohort. Logistic regression analysis revealed that female (OR=5.109,95%CI 1.19-22.00, P=0.012), no history of angina or myocardial infarction (OR=23.34, 95%CI 3.44-158.37, P=0.001), Killip grade>Ⅲ(OR=5.35, 95%CI 1.26-22.66, P=0.019) and non-ventricular aneurysm (OR=6.30,95%CI 1.67-23.73, P=0.005) were independent risk factors for early death in this patient cohort. Conclusion The risk factors of in-hospital death include older age, non-ventricular aneurysm and anterior AMI. Female, no history of angina or myocardial infarction, Killip grade>Ⅲ and non-ventricular aneurysm are independent risk factors for the early death of AMI patients complicating VSR.

Objective To compare of sevoflurane and propofol on cerebral oxygen metabolism and postoperative cognitive function during anesthesia maintenance.MethodsSeventy emergency trauma patients admitted to Zhoushan Hospital from August 2014 to August 2015, whom were randomLy divided into two groups (n=35 each): The control group anesthesia maintained by propofol;while the observation group were maintained with sevoflurane anesthesia.The changes of cerebral oxygen metabolism were compared between the two groups at different time points during anesthesia maintenance, and the Mini-Mental State Examination(MMSE) score, Trail-Making Test(TMT)completion time and the incidence of adverse reactions after recovery were also compared.ResultsThe SjvO2 values of each group were much higher in 2 min after induction (T2), 2 min after tracheal extubation (T3) than those before anesthesia (T1), while the Da-jvO2 and COER values were significantly decreased in T2 and T3 than those in T1, and the differences were statistically significant (P<0.05).These values were wihtout significant difference between the two groups in each period.The TMT completion time of the control group was prolonged than before induction, while the MMSE score was decreased than before induction, and the differences were statistically significant (P<0.05).There was no significant difference in TMT completion time and MMSE score in the observation group before and after induction.The incidence of adverse reactions between the two groups was not statistically significant.The eye opening time, orientation recovery time and anal exhaust time of control group were much later than those in observation group, and the differences were statistically significant (P<0.05).ConclusionSevoflurane and propofol can meet the need of maintaining the cerebral oxygen balance during anesthesia maintenance, but sevoflurane anesthesia has fewer influences in post-operation cognitive function.

Myocardial ischemia-reperfusion injury (MI/RI) is an inflammatory cascade process involving the interaction of multiple factors.In recent years,more and more evidence suggests that NOD-like receptor pyrin domain containing 3 (NLRP3) inflammasome,an important component of the innate immune system,is closely associated with the inflammatory damage of MI/RI.Furthermore,blockage of NLRP3 inflammasome or the release of its downstream pro-inflammatory cytokines may provide new therapeutic targets for this disorder.