Cardiac arrest is a major health event that poses a major threat to human life and health.Post-cardiac arrest brain injury is the main adverse prognostic factor and cause of death in patients who experience cardiac arrest.Currently,the therapeutic methods and effects are limited.In recent years,with the in-depth research on microbiota-gut-brain communication,it has been found that intestinal microbiota and their metabolites may play a role in the regulation of neuroinflammation in post-cardiac arrest brain injury.Short-chain fatty acids are the key substances in microbiota-gut-brain communication,and the mechanism involves immune,endocrine and neuroregulatory pathways.Supplementation of short-chain fatty acid-producing bacteria or short-chain fatty acids can improve intestinal flora disorder and reduce neuroinflammation after cardiopulmonary resuscitation.As a key mediator in microbial-gut-brain communication,short-chain fatty acids have great potential for the treatment of brain injury after cardiac arrest.This review explores the role and regulatory mechanism of microbiota-gut-brain communication in the neuroinflammation of brain injury after cardiopulmonary resuscitation through immune,endocrine and neuro-regulatory pathways,providing a new idea for the treatment of post-cardiac arrest brain injury.

Objective To investigate the influencing factors of secondary coagulation dysfunction in patients with severe acute pancreatitis(SAP)and establish the prediction model.Methods A total of 298 SAP patients in our hospital from July 2021 to July 2024 were consecutively selected,and those with secondary coagulation dysfunction were included in the observation group,while those without secondary coagulation dysfunction were included in the control group.Multivariate Logistic regression analysis was employed to investigate the risk factors for secondary coagulation dysfunction in patients with SAP and to establish a multivariate joint prediction model.The receiver operating characteristic curve(ROC)and decision curve were used to evaluate the predictive value of the multivariate joint prediction model for secondary coagulation dysfunction in SAP patients.Results The incidence of secondary coagulation dysfunction in SAP patients was 32.21%.The activated partial thromboplastin time(APTT),prothrombin time(PT)and fibrinogen(FIB)were longer in the observation group than those in the control group(P<0.05).Acute physiological and chronic health score Ⅱ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,D-dimer,C-reactive protein and albumin were independent influencing factors of secondary coagulation dysfunction in SAP patients(P<0.05).The regression equation model was established according to the results of multivariate analysis screened variables,logit(P)=-24.747+0.363×APACHEⅡ score+0.952×SOFA score-0.449×albumin+1.768×D-dimer+1.004×C-reactive protein,with a good fit.Regression model predicted that the AUC value of secondary coagulation dysfunction in SAP patients was 0.937.Decision curve analysis results showed that the Logistic regression model could achieve the maximum clinical benefit when the threshold probability was in the range of 0.06 to 0.97.Conclusion A comprehensive assessment of influencing factors can comprehensively evaluate the condition of patients and identify patients at high risk of coagulation disorders at an early stage.

Cardiac arrest is a major health event that poses a major threat to human life and health.Post-cardiac arrest brain injury is the main adverse prognostic factor and cause of death in patients who experience cardiac arrest.Currently,the therapeutic methods and effects are limited.In recent years,with the in-depth research on microbiota-gut-brain communication,it has been found that intestinal microbiota and their metabolites may play a role in the regulation of neuroinflammation in post-cardiac arrest brain injury.Short-chain fatty acids are the key substances in microbiota-gut-brain communication,and the mechanism involves immune,endocrine and neuroregulatory pathways.Supplementation of short-chain fatty acid-producing bacteria or short-chain fatty acids can improve intestinal flora disorder and reduce neuroinflammation after cardiopulmonary resuscitation.As a key mediator in microbial-gut-brain communication,short-chain fatty acids have great potential for the treatment of brain injury after cardiac arrest.This review explores the role and regulatory mechanism of microbiota-gut-brain communication in the neuroinflammation of brain injury after cardiopulmonary resuscitation through immune,endocrine and neuro-regulatory pathways,providing a new idea for the treatment of post-cardiac arrest brain injury.

Objective To investigate the influencing factors of secondary coagulation dysfunction in patients with severe acute pancreatitis(SAP)and establish the prediction model.Methods A total of 298 SAP patients in our hospital from July 2021 to July 2024 were consecutively selected,and those with secondary coagulation dysfunction were included in the observation group,while those without secondary coagulation dysfunction were included in the control group.Multivariate Logistic regression analysis was employed to investigate the risk factors for secondary coagulation dysfunction in patients with SAP and to establish a multivariate joint prediction model.The receiver operating characteristic curve(ROC)and decision curve were used to evaluate the predictive value of the multivariate joint prediction model for secondary coagulation dysfunction in SAP patients.Results The incidence of secondary coagulation dysfunction in SAP patients was 32.21%.The activated partial thromboplastin time(APTT),prothrombin time(PT)and fibrinogen(FIB)were longer in the observation group than those in the control group(P<0.05).Acute physiological and chronic health score Ⅱ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,D-dimer,C-reactive protein and albumin were independent influencing factors of secondary coagulation dysfunction in SAP patients(P<0.05).The regression equation model was established according to the results of multivariate analysis screened variables,logit(P)=-24.747+0.363×APACHEⅡ score+0.952×SOFA score-0.449×albumin+1.768×D-dimer+1.004×C-reactive protein,with a good fit.Regression model predicted that the AUC value of secondary coagulation dysfunction in SAP patients was 0.937.Decision curve analysis results showed that the Logistic regression model could achieve the maximum clinical benefit when the threshold probability was in the range of 0.06 to 0.97.Conclusion A comprehensive assessment of influencing factors can comprehensively evaluate the condition of patients and identify patients at high risk of coagulation disorders at an early stage.

AIM: To investigate the effect of tetramethylpyrazine (TMP) on doxorubicin (Dox) induced cardiotoxicity and the role of 14-3-3γ/Bcl-2 protein expression. METHODS: Primary cultured cardiomyocytes were randomly divided into Control group, Dox group, Dox+TMP group and Dox+TMP+pAD/14-3-3γ-shRNA group. After 48 hours, the cell viability was detected by MST, the activity of LDH in culture medium, the activities of Caspase-3, SOD, GSH-Px and the content of MDA were detected; the expression of 14-3-3γ and mitochondrial Bcl-2 was detected by Western blot; ROS generation, mitochondrial membrane potential and mPTP opening were detected by flow cytometry; apoptosis was detected by TUNEL method. RESULTS: After Dox exposed for 48 hours, the viability of cardiomyocytes decreased significantly, the activity of LDH in culture medium increased, the activities of SOD and GSH-Px decreased, the content of MDA increased, ROS generation increased; the mitochondrial membrane potential decreased, mPTP continued to open, caspase-3 activity and apoptosis increased. TMP pretreatment significantly upregulated the expression of 14-3-3γ and mitochondrial Bcl-2, and reversed the above changes simultaneously; pAD/14-3-3γ-shRNA not only downregulated the expression of 14-3-3γ, but also decreased the expression of Bcl-2 in mitochondria. CONCLUSION: TMP pretreatment upregulates the expression of 14-3-3γ and mitochondrial Bcl-2, inhibits oxidative stress, maintains mitochondrial function and reduces Dox induced apoptosis.

Objective To investigate the influence of sorafenib on the expressions of B7-H3 and B7-H4 proteins in different human hepatocellular carcinoma cell lines,including HepG2,Hep3B,BEL-7402,BEL-7404,BEL-7405,QGY-7701,QGY-7703,SMMC-7721,MHCC97H,MHCC97L,HCCLM3 and HCCLM6.Methods Western blotting and MTT assay were used to check the influence of sorafenib on the expressions of B7-H3 and B7-H4 proteins in different human hepatocellular carcinoma cell lines and to test the inhibitory effect of sorafenib on different human hepatocellular carcinoma cell lines.Results Compared with normal human liver cells (HL-7702),the expressions of B7-H3 and B-H4 proteins in different human hepatocellular carcinoma cell lines were significantly up-regulated (P＜0.01).The cytotoxic activity IC50 values of sorafenib to Hep3B,BEL-7404,MHCC97H,HCCLM3 and HCCLM6 were 14.56,9.14,9.46,17.21 and 9.29 μmol/L respectively.After treating Hep3B,BEL-7404,MHCC97H,HCCLM3 and HCCLM6 with sorafenib at the doses of 5,10 and 20 μmol/L separately,the expressions of B7-H3 and B7-H4 proteins were strikingly down-regulated when compared with the control group (P＜0.01).Conclusion The overexpressions of B7-H3 and B7-H4 proteins in different human hepatocellular carcinoma cell lines are a common finding,which can influence tumor immune escape.It may be a new target for prevention and treatment of liver cancer in future.

Objective To analyze the incidence of urinary stone formation in the contralateral kidney of unilateral nephrectomy patients.Methods 1048 patients,including 596 males and 452 females,underwent unilateral nephrectomy from June 2010 to June 2016.Their age ranged from 16-87 years old (mean 58.7 years old).532 patients combined with components of metabolic syndrome and 213 patients with metabolic syndrome.164 patients had a previous history of urolithiasis.The incidence of urinary stone formation in the contralateral kidney after nephrectomy was recorded and analyzed.The urolithiasis incidences in different gender,age,comorbidity and history of urolithiasis patients after uninephrectomy were compared.Results All patients were followed up within 0.5 to 6 years (mean 3.2 years).89 patients suffered from urinary stones in the contralateral kidney after uninephrectomy.The incidence of urinary stone formation in the contralateral kidney was 8.5％ (89/1048),which was higher than that in general population of China.1％-5％.The urolithiasis incidence was 9.1％ (54/596)in male patients and 7.7％ (35/452)in female patients after nephrectomy.The incidence of urinary stone formation was 8.6％ (3/35)in patients aged under 30 years old,12.5％ (34/272) in patients aged 30-49 years old,7.3％ (37/504) in patients aged 50-69 years old,6.3％ (15/237)in patients aged 70 and over.The incidence of urinary stone formation was 12.2％ (65/532) in patients with components of metabolic syndrome after nephrectomy and 19.7％ (42/213) in patients with metabolic syndrome,while the incidence was 4.7％ (24/516)in patients without components of metabolic syndrome.In patients with history of urolithiasis,the incidence was up to 30.5％ (50/164) after nephrectomy,while 4.4％ (39/884)in patients without history of urolithiasis.Conclusions The incidence of urinary stone formation in the contralateral kidney of uninephrectomy patients was higher,especially in patients with metabolic syndrome or urolithiasis history.Patients after unilateral nephrectomy are more vulnerable to urolithiasis.

Objective To assess the validity and safety of arterial embolization with medical adhesive in treating peripheral artery pseudoaneurysms(PSA).Methods 25 cases of peripheral artery PSA embolized with Fuaile medical adhesive(FMA) were analyzed retrospectively.25 patients included 28 PSA.Super-selective transcatheter arterial embolization was performed in 19 patients (22 PSA) using 3F microcatheter and 6 PSA in 6 patients were embolized through puncturing directly.All the lesions were treated with mixtures of FMA and iodized oil (1：1) during the radiography.The clinical efficacy and complications were recorded.Results The success rate of embolization was 100% during the operation (28/28), and the average volume of FMA used was 1.8 mL(0.5-5.5 mL).One patient with PSA(d>2 cm) still have hematuria 2 days after the operation.The hematuria disappeared after embolization with micro-coil following re-angiography.Bleed stopped after the second embolization with FMA in one patient with brachial artery PSA.No one developed complications associated with therapy and occurred rebleeding in the follow-up period time (3 months).Conclusion The mixtures of FMA and iodized oil can be a useful alternative embolic agent for the treatment of peripheral artery pseudoaneurysm with high success rate, short operation time and definite clinical effect.

Objective To assess the clinical safety and effectiveness of transcatheter arterial embolization by using liquid medical glue ( FLA ) and super-selective catheterization technique in treating renal artery pseudoaneurysm. Methods During the period from Oct. 2009 to Jun. 2014, a total of 23 patients with angiography-proved renal pseudoaneurysm were treated with transcatheter arterial FLA embolization at authors’ hospital. The clinical data were retrospectively analyzed. A total of 28 pseudoaneurysms were detected in the 23 patients, which was caused by iatrogenic injury(18 cases, 21 lesions) or trauma(5 cases, 7 lesions). Super-selective catheterization with 3F micro-catheter was carried out. The micro-catheter was inserted into the parent artery of the pseudoaneurysm, which was followed by angiography. Once the pseudoaneurysm was confirmed by angiography, the mixture of FAL and iodized oil (1 ∶ 1) was injected into the pseudoaneurysm through the micro-catheter. The technical success rate, postoperative hematuria and renal function were determined. Results Successful embolization was achieved for all 28 pseudoaneurysms in 23 patients. The average volume of FAL used in embolization was 0.4 ml (0.2-1 ml). Ectopic embolization of the third-level vessel branches near the parent artery occurred in three cases , while no embolization of second-level vessel branch was observed. Persistent hematuria was seen in one patient even at two days after the treatment, whose pseudoaneurysm’s diameter was >2 cm, and embolization treatment with steel coil had to be performed, and bleeding stopped after the second treatment. During the follow-up period lasting for 3 months, no recurrence of hematuria was seen in the remaining patients. Mild elevation of serum creatinine after the treatment was observed in 4 patients. Conclusion The results of this study indicate that FAL together with the help of micro-catheter super-selective catheterization can effectively and reliably obstruct renal pseudoaneurysm with higher technical success rate and lower re-bleeding rate.

Objective To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) combined with argon-helium cryoablation in treating small renal cancers. Methods During the period from February 2008 to July 2013, a total of 44 patients with small renal cancer were treated with TAE and argon-helium cryoablation at The Medical Imaging Department of Nanjing General Hospital of Nanjing Military Area Command. The renal function was reexamined one month after the treatment. Contrast-enhanced CT or MRI was performed in all patients within 1-3 months after the treatment. By using mRECIST, the therapeutic efficacy was evaluated. All patients were followed up for 12-46 months (mean 28 months). Results A total of 48 lesions in the 44 patients were treated with sequential therapy of TAE and argon-helium cryoablation. Of the 48 lesions, complete remission (CR) was achieved in 38, partial remission (PR) in 6 and stable disease (SD) in 4, the remission rate (CR+PR) was 91.7%. No severe complications occurred in all patients, except one who developed localized hemorrhage during the performance of argon-helium cryoablation, which was improved after symptomatic medication. The mean postoperative hospitalization time was 4 days. Three patients were lost to follow-up, one patient died of esophageal cancer-related complication. The remaining patients were survival during the follow-up period, among them recurrence occurred in five within 13-22 months after the treatment, and the sequential therapy of TAE and argon-helium cryoablation had to be carried out once more. Conclusion For the treatment of small renal cancers, the sequential therapy of TAE combined with argon-helium cryoablation is minimally-invasive, safe and effective, and TAE that is performed before argon-helium cryoablation can reduce the incidence of bleeding occurring in the freezing process. Therefore, this technique should be recommended in clinical practice.