Sepsis-induced myocardial depression(SIMD),a common complication of sepsis,is one of the main causes of death in patients with sepsis.The pathogenesis of SIMD is complicated,and the process of SIMD remains incompletely understood,with no single or definitive mechanism fully elucidated.Notably,pyroptosis,as a pro-inflammatory programmed cell death,is characterized by Gasdermin-mediated formation of pores on the cell membrane,cell swelling,and cell rupture accompanied by the release of large amounts of inflammatory factors and other cellular contents.Mechanistically,pyroptosis is mainly divided into the canonical pathway mediated by caspase-1 and the non-canonical pathway mediated by caspase-4/5/11.Pyroptosis has been confirmed to participate in various inflammation-associated diseases.In recent years,more and more studies have shown that pyroptosis is also involved in the occurrence and development of SIMD.This article reviews the molecular mechanisms of pyroptosis and its research progress in SIMD,aiming to provide novel strategies and targets for the treatment of SIMD.

Objective To explore the obstacles in palliative care consultation services and put forward the suggestions for improving the services in grade A tertiary hospitals. Methods A semi-structured interview was conducted with 17 medical workers who had requested palliative care consultation services in Peking Union Medical College Hospital. Results The palliative care consultation services were hindered by five obstacle factors including insufficient knowledge of patients and their families about palliative care,unsound understanding of medical workers about palliative care,poor implementation of consultation opinions,limited labor of palliative care team,and poor economic benefits from palliative care.In view of such obstacles,the following suggestions were put forward,which included increasing the acceptance of palliative care by patients and their families,enriching the knowledge of medical staff on palliative care,establishing a new cooperation model between consultation team and medical staff,strengthening the institutional guarantee for the development of palliative care,and establishing and perfecting the laws and policies related to palliative care. Conclusion Although there are many difficulties in the in-hospital palliative care consultation services in grade A tertiary hospitals,the demand and expectation of medical staff for palliative care are still increasing.
Humans ; Palliative Care ; Tertiary Care Centers ; Referral and Consultation ; Hospitalization

Objective: To understand the HIV infection status in male outpatients in sexually transmitted disease (STD) clinics in Tianjin from 2016 to 2020. Methods: According to the sentinel surveillance protocol, continuous cross-sectional studies were conducted between April and June during 2016-2020 to collect the information about the awareness of AIDS related knowledge, related sex behaviors, HIV infection, syphilis prevalence and HCV infection of male STD outpatients in Tianjin with a sample seize of 400 in each sentinel clinic. Results: From 2016 to 2020, a total of 4 000 male STD outpatients were surveyed. The HIV positive rate increased from 1.13% (9/800) to 2.25% (18/800) (trend χ²=14.22, P<0.001), the positive rate of syphilis increased from 9.38% (75/800) to 13.00% (104/800) (trend χ²=7.30, P=0.007) in this population during this period. The overall HCV positive rate was 0.45% (18/4 000). Multivariate logistic regression analysis showed that compared with those who were unmarried, had registered residence in Tianjin, had no temporary sexual behavior in the past 3 months, had no anal sex and had negative syphilis test result, the risk factors of HIV infection in the male STD outpatients included cohabitation (aOR=7.53, 95%CI:2.13-26.62), being from other provinces (aOR=3.64,95%CI:1.58-8.38), having temporary sexual behavior in the past 3 months (aOR=2.24,95%CI:1.03-4.89), having homosexual anal sex (aOR=85.99,95%CI:38.76-190.74) and suffering from syphilis (aOR=6.06,95%CI:3.18-11.56). Conclusion: The detection rates of HIV infection and syphilis in male STD outpatients in Tianjin showed upward trends from 2016 to 2020. Having temporary sexual behavior and anal sex, and suffering from syphilis were the main risk factors of HIV infection in male STD outpatients.
Cross-Sectional Studies ; HIV Infections/epidemiology* ; Homosexuality, Male ; Humans ; Male ; Outpatients ; Syphilis/epidemiology*

Objective:To observe the feasibility of evaluating right ventricular (RV) function by the method based on left ventricle (LV) pressure-strain ring (PSL) technique in patients with systemic lupus erythematosus (SLE), and to evaluate the efficacy of non-invasive PSL in the diagnosis of dysfunction of both LV and RV.Methods:Thirty-nine patients were enrolled with SLE who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from March 2020 to September 2021 and 57 sex- and age-matched healthy controls underwent assessment by conventional echocardiography, two-dimensional speckle tracking imaging (2D-STI) and myocardial work (MW). The echocardiographic parameters were compared between the groups. The correlations between RVMW parameters and conventional echocardiographic parameters, and between MW parameters and SLEDAI-2K score were analyzed by Spearman correlation analysis.Results:①The two groups did not show any difference at the conventional echocardiographic parameters of the LV systolic function ( P>0.05). In the SLE group, tricuspid regurgitation maximal velocity (TR V max) and right ventricular index of myocardial performance (RIMP) increased, tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular S′ (S′ tv) decreased (all P<0.05), and others did not show statistical difference (all P>0.05). ②The 2D-STI parameters: There were no significant differences in left ventricular global longitudinal strain (LV GLS) ( P>0.05), however RVGLS decreased ( P<0.05). ③The MW parameters of LV and RV: including global constructive work (GCW), global work index (GWI), global wasted work (GWW), and global work efficiency (GWE). In SLE group, LV GWE, RV GWE decreased and LV GWW, RV GWW increased ( P<0.05), others were no significant differences ( P>0.05). ④The correlation analysis: RV GWI positively correlated with TR V max ( rs=0.481). RV GCW positively correlated with TR V max ( rs=0.587). RV GWW positively correlated with right atrial area (RAA) and TR V max ( rs=0.429, 0.610), negatively correlated with S′ tv ( rs=-0.342). RV GWE positively correlated with S′ tv ( rs=0.326) and negatively correlated with RAA ( rs=-0.462) (all P<0.05). SLEDAI-2K score was negatively correlated with LV GLS ( rs=-0.333) and LV GWI ( rs=-0.326) ( P<0.05). Conclusions:The study has shown the impaired systolic function of both LV and RV in patients with SLE. PSL technique, especially RVMV based on LV PSL technique might emerged as a novel measure to evaluate systolic dysfunction in SLE patients.

We explored the pharmacodynamic material basis and network regulatory mechanism of Fufang Yuxingcao Mixture (FYM) for the treatment of fever and inflammation. Targets of the 25 compounds in FYM were predicted according to the reverse pharmacophore method and TCMSP, UniProt database. Gene ontology (GO) function enrichment and pathway analysis of the targets was analyzed by Omicsbean software and the Kyoto Gene and Genome Encyclopedia (KEGG) database. A "compound-target-pathway-pharmacological action-effect" network was established with Cytoscape 3.6.1 software. The lipopolysaccharide (LPS)-induced RAW264.7 cell inflammation model was used to verify the anti-inflammatory effects of FYM and its 10 important components. The network pharmacology experiment showed that 25 compounds affected 97 pathways through 211 targets, of which 15 key targets [including RAC-alpha serine/threonine-protein kinase (AKT1), insulin (INS), vascular endothelial growth factor A (VEGFA), interleukin-6 (IL-6), cellular tumor antigen p53 (TP53), tumor necrosis factor (TNF), transcription factor AP-1 (JUN), caspase-3 (CASP3), matrix metalloproteinase-9 (MMP9), interleukin-8 (IL-8), prostaglandin G/H synthase 2 (PTGS2), proto-oncogene c-Fos (FOS), tyrosine-protein kinase SRC (SRC), c-Jun N-terminal kinase 1 (MAPK8), estrogen receptor 1 (ESR1)] and 46 pathways (including NF-kappa B signaling pathway, Toll-like receptor signaling pathway, MAPK signaling pathway, IL-17 signaling pathway, arachidonic acid metabolism, cAMP signaling pathway, T cell receptor signaling pathway, calcium signaling pathway, inflammatory mediator regulation of TRP channels, chemokine signaling pathway, Th1 and Th2 cell differentiation, natural killer cell mediated cytotoxicity, etc.) were related to anti-inflammatory, antipyretic, immune regulation, and analgesia. In vitro cell experiments showed that FYM and the 10 components (including isoquercitrin, luteoloside, baicalein, wogonin, wogonoside, phillyrin, forsythoside A, chlorogenic acid, isochlorogenic acid A, and sweroside) could significantly reduce the expression of nitric oxide (NO), TNF-α and IL-6 in cell supernatants, indicating that the above 10 components may be the key pharmacodynamic material basis of FYM.

OBJECTIVE: To investigate the current status of antibiotic use for very and extremely low birth weight (VLBW/ELBW) infants in neonatal intensive care units (NICUs) of Hunan Province. METHODS: The use of antibiotics was investigated in multiple level 3 NICUs of Hunan Province for VLBW and ELBW infants born between January, 2017 and December, 2017. RESULTS: The clinical data of 1 442 VLBW/ELBW infants were collected from 24 NICUs in 2017. The median antibiotic use duration was 17 days (range: 0-86 days), accounting for 53.0% of the total length of hospital stay. The highest duration of antibiotic use was up to 91.4% of the total length of hospital stay, with the lowest at 14.6%. In 16 out of 24 NICUs, the antibiotic use duration was accounted for more than 50.0% of the hospitalization days. There were 113 cases with positive bacterial culture grown in blood or cerebrospinal fluid, making the positive rate of overall bacterial culture as 7.84%. The positive rate of bacterial culture in different NICUs was significantly different from 0% to 14.9%. The common isolated bacterial pathogens Klebsiella pneumoniae was 29 cases (25.7%); Escherichia coli 12 cases (10.6%); Staphylococcus aureus 3 cases (2.7%). The most commonly used antibiotics were third-generation of cephalosporins, accounting for 41.00% of the total antibiotics, followed by penicillins, accounting for 32.10%, and followed by carbapenems, accounting for 13.15%. The proportion of antibiotic use time was negatively correlated with birth weight Z-score and the change in weight Z-score between birth and hospital discharge (r=-0.095, -0.151 respectively, P<0.01), positively correlated with death/withdrawal of care (r=0.196, P<0.01). CONCLUSIONS Antibiotics used for VLBW/ELBW infants in NICUs of Hunan Province are obviously prolonged in many NICUs. The proportion of routine use of third-generation of cephalosporins and carbapenems antibiotics is high among the NICUs.
Anti-Bacterial Agents ; Birth Weight ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Intensive Care Units, Neonatal ; Surveys and Questionnaires

Objective Systemic sclerosis sine scleroderma (ssSSc) is a rare type of systemic sclerosis,comparison between ssSSc and other types of systemic sclerosis (SSc),ssSSc is carried out in this study.Methods We reported a patient with Raynand's phenomenon,esophagus,intestine and lung involvement,positive ANA,anti-Scl-70 antibody,but had no skin sclerosis.Results For visceral involvement,ssSSc was not different from limited cutaneous systemic sclerosis (lcSSc),The incidence of pulmonary hypertension was higher in patients with ssSSc,lower with calcinosis,finger ulcer and acral dissolution,and the incidence of ssSSc and lcSSc interstitial lung disease was higher than that of diffuse cutaneous systemic sclerosis,(dcSSc).Conclusion Although ssSSc do not have skin sclerosis,however,visceral involvement is more extensive.Early diagnosis and treatmeat is extremely important.

Objective To explore two primary domains of social cognition in different phases of bipolar disorder.Methods Twenty-nine manic bipolar patients,36 remitted bipolar patients,30 first-degree relatives of patients with bipolar disorder and 30 healthy participants were recruited.Social cognition was assessed by the Facial Emotion Perception Test,Fauxpas Task and the Hinting Task.Results The manic bipolar patients performed significantly lower scores [emotion perception (90.1 ± 19.0),fauxpas (18.2 ± 10.4),hinting(6.6 ± 1.1)] than the control group [emotion perception (104.9 ± 9.8),fauxpas (28.4 ± 8.1),hinting(7.3 ± 0.8)] on all the test (P ＜ 0.05).The remitted patients [fauxpas (22.0 ± 9.3),hinting(6.4 ±0.7)] and the first-degree relatives [fauxpas(24.3 ±7.4),hinting(6.7 ± 1.3)] performed significantly more poorly than the healthy control on the fauxpas task and the hinting task (P ＜ 0.05),but not on the emotion perception(P ＞0.05).Conclusions Impaired emotion perception in bipolar disorder may be state-dependent and the theory of mind deficit observed in the bipolar patients group is may be a trait deficit.The evidence of impairment in the first degree relatives group suggests that the theory of mind may be affected by heredity or family rearing and educating environment.

Objective To explore two primary domains of social cognition in different phases of bipolar disorder.Methods Twenty-nine manic bipolar patients,36 remitted bipolar patients,30 first-degree relatives of patients with bipolar disorder and 30 healthy participants were recruited.Social cognition was assessed by the Facial Emotion Perception Test,Fauxpas Task and the Hinting Task.Results The manic bipolar patients performed significantly lower scores [emotion perception (90.1 ± 19.0),fauxpas (18.2 ± 10.4),hinting(6.6 ± 1.1)] than the control group [emotion perception (104.9 ± 9.8),fauxpas (28.4 ± 8.1),hinting(7.3 ± 0.8)] on all the test (P ＜ 0.05).The remitted patients [fauxpas (22.0 ± 9.3),hinting(6.4 ±0.7)] and the first-degree relatives [fauxpas(24.3 ±7.4),hinting(6.7 ± 1.3)] performed significantly more poorly than the healthy control on the fauxpas task and the hinting task (P ＜ 0.05),but not on the emotion perception(P ＞0.05).Conclusions Impaired emotion perception in bipolar disorder may be state-dependent and the theory of mind deficit observed in the bipolar patients group is may be a trait deficit.The evidence of impairment in the first degree relatives group suggests that the theory of mind may be affected by heredity or family rearing and educating environment.

Objective To assess the association of synovial cyclic citrullinated peptide(CCP)expression with T helper 17(Th17) cells/Regulatory T cells (Treg) imbalance,the histological and clinical features of synovitis in rheumatoid arthritis (RA).Methods CCP expression in synovial specimens from 39 patients with RA and 35 controls was detected by immunohistochemistry assay(IH) using 6×His tagged anti-CCP single chain fragment V (ScFv) antibodies,which were generated by pHEN2 phagemid recombinant antibodies display system.The frequencies of Th17/Treg cells in the peripheral blood mononuclear cells (PBMCs) were determined by flow cytometry (FCM).Th17/Treg cells associated cytokines were analyzed by enzyme-linked immunosorbent assay (ELISA).The histological scores and clinical features of synovitis were included in the study.Chi-square test and ANOVA were used for statistical analysis.Results ① The prevalences of synovial C CP expression were significantly different between RA group and the control(76.9％ and 11.4％ respectively,X2=31.9,P＜0.01).② The frequencies of Th17 cells,Th17/Treg ratio,Th17 cells associated cytokines as IL-6,IL-17a,IL-23,TNF-α,and the Treg cells associated cytokines TGF-31,the serum and synovial fluid anti-CCP antibodies in the RA patients with synovial CCP positive expression were significantly higher in RA patients with CCP positive than those with CCP negative.Disease activity score DAS28 index and histological features quantified variations of the synovial biopsy specimens (synoviocyte hyperplasia,focal aggregates of lymphocytes,and diffuse infiltrat(e)s of lymphocytes) in RA were higher in synovial CCP positive expression patients than in the negative.Conclusion Synovial CCP expression is strongly associated with the Th17/Treg imbalance and synovitis,which may play a crucial role in the pathogenesis of RA.