A 42-year-old male with chest tightness and dyspnea was admitted to the hospital. Chest CT indicated diffuse interstitial lung infiltration. Despite receiving anti-infective therapy, glucocorticoid therapy, and immunosuppressive agents, the patient developed refractory hypoxaemia. Endotracheal intubation and invasive mechanical ventilation failed to improve oxygenation. Therefore the patient was diagnosed with rapidly progressive interstitial lung disease (RP-ILD) accompanied by type Ⅰ respiratory failure. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) was initiated, and oxygenation improved in this patient. The patient subsequently underwent bilateral lung transplantation with veno-arterio-venous (VAV) ECMO support. ECMO machine was withdrawn on day 1, and extubation was achieved on day 9 after surgery. Histopathology revealed fibrotic nonspecific interstitial pneumonia (NSIP) with hyaline membrane formation. The patient developed ICU-acquired myasthenia and received early rehabilitation, with gradual recovery of muscle strength. During follow-up, graft lung function remained stable. This case demonstrates that ECMO can serve as a bridge to lung transplantation in RP-ILD patients.

OBJECTIVE To investigate the mechanism of Bushen huoxue formula in improving pregnancy outcomes in mice with antiphospholipid antibody-related recurrent spontaneous abortion （aPL-RSA）. METHODS SPF female BALB/c mice were randomly divided into normal control group， adjuvant control group， model group， and Bushen huoxue formula group. The aPL-RSA mouse model was established by immunization with β 2 glycoproteinⅠcombined with Freund’s adjuvant. From gestational day 0， the Bushen huoxue formula group was administered 1.653 6 g/（kg·d） of the prescription by gavage， while the other three groups received an equal volume of normal saline， twice daily for 15 consecutive days. The uterine appearance of pregnant mice was observed； individual embryo weight was recorded， and the embryo resorption rate was calculated. The proportion of activated CD41 + CD62p + platelets in platelet-rich plasma （PRP） was detected. Serum levels of thromboxane B2 （TXB2） and platelet factor 4 （PF4） were measured. Morphological changes of placental tissue were observed. The cell apoptosis rate of placental tissue was detected. The levels of malondialdehyde （MDA） content， tot al superoxide dismutase （T-SOD） activity， the interleukin-1β （IL-1β） and IL-18， the protein expressions of matrix metalloproteinase-3 （MMP-3）， MMP-9， nuclear proliferation antigen-67 （Ki67）， superoxide dismutase 2 （SOD2）， Nod-like receptor protein 3 （NLRP3）， apoptosis-associated speck-like protein containing a CARD （ASC）， and caspase-1， as well as the mRNA expressions of superoxide dismutase 2（SOD2）， NLRP3， ASC and caspase-1 of placental tissue were detected. RESULTS Compared with the normal control group and adjuvant control group， the model group showed significant decreases in individual embryo weight， T-SOD activity of placental tissue， and relative expression levels of SOD2 mRNA and protein （ P ＜0.05）； while significant increases were observed in embryo resorption rate， proportion of activated CD41 + CD62p + platelets in PRP， serum levels of TXB2 and PF4， placental cell apoptosis rate， MDA content in placental tissue， relative protein expressions of MMP-3， MMP-9 and Ki67， relative protein and mRNA expression levels of NLRP3， ASC and caspase-1 as well as IL-1β and IL-18 levels （ P ＜0.05）. The model group also exhibited irregular uterine morphology with localized atrophy in some uterine horns； placental tissue showed fragmentation of decidual cells， extensive vacuolization and necrosis of trophoblast cells in the labyrinthine zone， accompanied by vascular reduction. After intervention with Bushen huoxue formula， the above indicators were significantly reversed （ P ＜0.05）， and uterine morphology and pathological damage were markedly improved. CONCLUSIONS Bushen huoxue formula can effectively improve pregnancy outcomes in aPL-RSA model mice， and its mechanism may be closely related to inhibiting platelet activation， reducing oxidative stress injury， enhancing trophoblast cell function， and suppressing the inflammatory response mediated by the NLRP3 inflammasome pathway.

Objective:To analyze the incidence and risk factors of ocular surface disease among power grid construction workers in plateau.Methods:A total of 11 132 construction personnel from the Ngari prefecture-central Tibet power grid interconnection project were included from 2019 to 2020.Baseline characteristics including age, gender, body mass index, developmental and nutritional status, relevant clinical indicators, etc.and follow-up data regarding incidence of ocular surface diseases were obtained from the medical records of Ali interconnection project staff medical station.The altitude of workplace and residence of the study population were obtained from the website (https: //zh-cn.topographic-map.com/legal/).The mean age of the subjects was (36.17±10.48) years, of which 95.33%(10, 612 subjects) were male.The median follow-up time was 1.53 years.The altitude of the residence and workplace were (1 954.77±940.64) and (4 535.09±232.71) meters, respectively.The incidence of ocular surface diseases in groups with different characteristics was calculated.Differential variables for the incidence of ocular surface diseases were screened by univariate Cox proportional hazards regression model.Influencing factors of ocular surface diseases multivariate were explored by Cox proportional hazards model.This study was approved by the Ethics Committee of Peking University Health Science Center (No.IRB00001052-21066).Results:During the follow-up period, the incidence of ocular surface disease was 9.27% (1 032 cases), and the incidence of conjunctivitis and keratitis was 6.58% (733 cases) and 1.80% (200 cases), respectively.Multivariate Cox proportional hazards regression analysis showed that for every 1 000 meters increase in altitude of residence, the risk of ocular surface disease decreased by 15% ( HR[95% CI]: 0.85[0.80~0.91], P<0.001).For every 100 meters increase in altitude of workplace, the risk of ocular surface disease increased by 5% ( HR[95% CI]: 1.04[1.01~1.07], P=0.006).Decreased blood oxygen saturation ( HR[95% CI]: 1.09[1.02~1.16], P=0.007), hearing pulmonary dry rales (hazard ratio ( HR)[95% CI]: 1.53[1.12~2.09], P=0.007) and heart murmurs ( HR[95% CI]: 4.44[1.43~13.83], P=0.010) were associated with ocular surface disease. Conclusions:The incidence of ocular surface disease in personnel engaged in electric grid construction at high altitudes should not be ignored.High working altitude, low residence altitude, pulmonary dry rales, heart murmurs and low blood oxygen saturation are factors associated with the incidence of ocular surface disease.

A case of multiple intracranial venous sinus thrombosis caused by a calreticulin(CALR)gene mutation in essential thrombocythemia is reported including the diagnosis,treatment process and outcome.The patient was a 39-year-old female presenting with headache,slurred speech and limb weakness.Physical examination revealed unclear speech,dysarthria and decreased muscle strength in the left limb.On the basis of anticoagulation therapy,mechanical thrombectomy,intrasinus contact thrombolysis,decompressive craniectomy and cytoreductive therapy targeting the cause were performed.After treatment,the venous sinuses were completely recanalized and the prognosis was good.There are no relevant literature reports on intracranial venous sinus thrombosis caused by CALR gene mutation in essential thrombocythemia.The diagnosis and treatment strategy of this case provide a reference for the identification and treatment of similar cases in clinical practice.

Objective:To analyze the incidence and risk factors of ocular surface disease among power grid construction workers in plateau.Methods:A total of 11 132 construction personnel from the Ngari prefecture-central Tibet power grid interconnection project were included from 2019 to 2020.Baseline characteristics including age, gender, body mass index, developmental and nutritional status, relevant clinical indicators, etc.and follow-up data regarding incidence of ocular surface diseases were obtained from the medical records of Ali interconnection project staff medical station.The altitude of workplace and residence of the study population were obtained from the website (https: //zh-cn.topographic-map.com/legal/).The mean age of the subjects was (36.17±10.48) years, of which 95.33%(10, 612 subjects) were male.The median follow-up time was 1.53 years.The altitude of the residence and workplace were (1 954.77±940.64) and (4 535.09±232.71) meters, respectively.The incidence of ocular surface diseases in groups with different characteristics was calculated.Differential variables for the incidence of ocular surface diseases were screened by univariate Cox proportional hazards regression model.Influencing factors of ocular surface diseases multivariate were explored by Cox proportional hazards model.This study was approved by the Ethics Committee of Peking University Health Science Center (No.IRB00001052-21066).Results:During the follow-up period, the incidence of ocular surface disease was 9.27% (1 032 cases), and the incidence of conjunctivitis and keratitis was 6.58% (733 cases) and 1.80% (200 cases), respectively.Multivariate Cox proportional hazards regression analysis showed that for every 1 000 meters increase in altitude of residence, the risk of ocular surface disease decreased by 15% ( HR[95% CI]: 0.85[0.80~0.91], P<0.001).For every 100 meters increase in altitude of workplace, the risk of ocular surface disease increased by 5% ( HR[95% CI]: 1.04[1.01~1.07], P=0.006).Decreased blood oxygen saturation ( HR[95% CI]: 1.09[1.02~1.16], P=0.007), hearing pulmonary dry rales (hazard ratio ( HR)[95% CI]: 1.53[1.12~2.09], P=0.007) and heart murmurs ( HR[95% CI]: 4.44[1.43~13.83], P=0.010) were associated with ocular surface disease. Conclusions:The incidence of ocular surface disease in personnel engaged in electric grid construction at high altitudes should not be ignored.High working altitude, low residence altitude, pulmonary dry rales, heart murmurs and low blood oxygen saturation are factors associated with the incidence of ocular surface disease.

A case of multiple intracranial venous sinus thrombosis caused by a calreticulin(CALR)gene mutation in essential thrombocythemia is reported including the diagnosis,treatment process and outcome.The patient was a 39-year-old female presenting with headache,slurred speech and limb weakness.Physical examination revealed unclear speech,dysarthria and decreased muscle strength in the left limb.On the basis of anticoagulation therapy,mechanical thrombectomy,intrasinus contact thrombolysis,decompressive craniectomy and cytoreductive therapy targeting the cause were performed.After treatment,the venous sinuses were completely recanalized and the prognosis was good.There are no relevant literature reports on intracranial venous sinus thrombosis caused by CALR gene mutation in essential thrombocythemia.The diagnosis and treatment strategy of this case provide a reference for the identification and treatment of similar cases in clinical practice.

ObjectiveTo compare the protective effects of water extracts from fresh and dried Dendrobium huoshanense on gastric mucosa in chronic atrophic gastritis （CAG）. MethodsMale SD rats （n=72） were randomly divided into 9 groups， with 8 rats in each group， which were normal group， model group， Yangwei Shu （4 g·kg^-1） group， low-， medium-， and high-dose fresh D. huoshanense （3.5， 7， and 14 g·kg^-1） groups， and low-， medium-， and high-dose dried D. huoshanense （0.7， 1.4， 2.8 g·kg^-1） groups. The CAG rat model was successfully established by inducing with N-methyl-N'-nitro-N-nitrosoguanidine （MNNG） and other factors for a total of 11 weeks. Then， the rats were intervened with fresh and dried D. huoshanense for 4 weeks. The serum and gastric tissues of the rats were collected. The changes in gastric juice secretion volume and gastric acid pH value in each group were observed. The gastric mucosal injury was observed by naked eyes and hematoxylin-eosin（HE） staining. The gastric mucus secretion level was determined by Alcian blue and periodic acid-Schiff staining（AB-PAS） staining. The expression levels of tight junction proteins Occludin and ZO-1 in gastric tissues were determined by immunofluorescence. The expression levels of serum pepsinogen Ⅰ （PG Ⅰ）， pepsinogen Ⅱ （PG Ⅱ）， gastrin 17 （G-17）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） were determined by enzyme-linked immunosorbent assay （ELISA）. The expression levels of aquaporin 1 （AQP1）， aquaporin 3 （AQP3）， and aquaporin 4 （AQP4） in gastric tissues were determined by Western blot. ResultsCompared with the normal group， the model group showed an obviously reduced gastric juice secretion volume （P0.05）， significantly increased gastric acid pH value （P0.01）， gastric mucosa with obvious atrophy， and a significantly reduced gastric mucus secretion volume （P0.01）. The expression of Occludin and ZO-1 in the gastric mucosal barrier was significantly decreased （P0.01）. The levels of PG Ⅰ and PG Ⅱ in the serum were obviously decreased （P0.05， P0.01）， and the levels of G-17， IL-1β， IL-6， and TNF-α were significantly increased （P0.01）. The expression level of AQP1 in the gastric tissue was significantly upregulated （P0.01）， and the expression levels of AQP3 and AQP4 were significantly downregulated （P0.01）. Compared with the model group， each drug administration group could improve the gastric mucosal atrophy of CAG model rats to varying degrees， obviously increase the gastric juice secretion volume of the model rats （P0.05， P0.01）， significantly decrease the gastric acid pH value （P0.01）， obviously increase the gastric mucus secretion volume （P0.05， P0.01）， obviously decrease the expression levels of G-17， IL-6， IL-1β， and TNF-α （P0.05， P0.01）， obviously increase the expression levels of Occludin， ZO-1， PG Ⅰ， and PG Ⅱ （P0.05， P0.01）， obviously upregulate the expression levels of AQP3 and AQP4 （P0.05， P0.01）， and obviously downregulate the expression level of AQP1 （P0.05， P0.01）. ConclusionThe water extracts of fresh and dried D. huoshanense can exert therapeutic effects on CAG by improving gastric mucosal injury， reducing inflammation， and regulating water metabolism. Moreover， the dried D. huoshanense has a better effect.

Myocardial fibrosis （MF） is a common pathological manifestation of various heart diseases. Due to the non-renewable nature of myocardial cells， the occurrence of MF represents irreversible damage to the myocardium. Previous studies have suggested that fibroblast-mediated collagen deposition is the main mechanism of MF. Recent studies have found that there is an immune regulation mechanism in the heart itself， and macrophage activation/polarization plays an important role in MF. With the deepening of traditional Chinese medicine research， scholars have found that traditional Chinese medicine can interfere with MF by regulating the renin-angiotensin-aldosterone system （RAAS） system and the inflammatory process， repairing the extracellular matrix， managing oxidative stress， and maintaining the balance of autophagy. This process is closely related to the activation and M1/M2 polarization of macrophages. Throughout the MF process， macrophage activation is beneficial， but excessive activation will be harmful. In the early stage of MF， appropriate M1 macrophage polarization is conducive to activating immunity and removing harmful substances. In the middle and late stages of MF， appropriate M2 macrophage polarization is conducive to remodeling the damaged myocardium. If macrophage activation is excessive/insufficient， or the balance of M1/M2 macrophage polarization is broken， the effect changes from improvement to destruction. Traditional Chinese medicines that regulate the activation/polarization of macrophages have the effects of replenishing Qi and nourishing Yin， as well as regulating Qi and activating blood， but there are also some heat-clearing， dampness-drying， and detoxification products. Therefore， the occurrence of MF may be caused by Qi and Yin deficiency， damp heat accumulation， and Qi stagnation and blood stasis. By summarizing the biological processes involved in macrophage activation/polarization in MF， this paper expounded on the research progress of traditional Chinese medicine in regulating macrophage activation and M1/M2 polarization from different angles to improve MF， so as to provide a reference for the treatment of MF with traditional Chinese medicine.

Objective Cervical disc herniation(CDH)is one of the common orthopaedic diseases.With the in-depth study of it and the development of cervical implants,the establishment of cervical fusion animal models has become an indispensable part.Notably however,studies of the establishment and evaluation of cervical fusion animal models in China are currently lacking.This study aimed to provide a suitable animal model and evaluation scheme for implants for cervical spine-related research.Methods Small-tailed Han sheep were chosen for anterior cervical discectomy fusion(ACDF)after modified surgery,and a polyetheretherketone(PEEK)interbody fusion cage(Cage)(control group),3D-printed Ti6Al4V Cage(group 1),and new method Ti6Al4V Cage(group 2)were implanted in different cervical segments(C2/3～C4/5)in each sheep,respectively.Hematology and histopathological analyses were carried out after surgery to evaluate recovery of sheep and the biosafety of the materials.Bone in-growth and bone fusion were assessed by X-ray,computed tomography(CT),Micro-CT and quantitative analysis,hard tissue section staining,and biomechanical tests.Results The modified ACDF ovine model was established successfully.There were no significant differences in important hematology indexes(P＞0.05)and histopathological analysis showed no pathological changes,such as inflammatory cell infiltration.The implants had good biosafety.Furthermore,X-ray and CT examinations showed that the position of internal fixation and the interbody fusion were good.Micro-CT and quantitative analysis at 3 and 6 months after operation showed that compared with PEEK Cage group,the bone volume/total volume and trabecular number were significantly increased(P＜0.01)while the trabecular spacing was significantly decreased in the new method Ti6Al4V and 3D-printed Ti6Al4V groups compared with the PEEK Cage group(P＜0.01).Moreover,the new method new method Ti6Al4V Cage group had more bone growth(P＜0.01).Hard tissue section staining demonstrated that the pores of the new method Ti6Al4V Cage and 3D-printed Ti6Al4V Cage had obvious bone growth and relatively dense pores in the new method Ti6Al4V and 3D-printed Ti6Al4V groups,and the combination was slightly better than that of PEEK Cage.Biomechanical evaluation indicated that the new method Ti6Al4V Cage and 3D-printed Ti6Al4V Cage reduced the range of cervical flexion-extension,lateral bending,and axial rotation(P＜0.05)compared with the PEEK cage,as well as enhancing the stability of the cervical vertebra,and the new method Ti6Al4 V Cage was more advantageous(P＜0.05).Conclusions After the establishment of the modified ACDF ovine model,reasonable and effective assessment method were used to demonstrate the suitability and effectiveness of the model and the good biosecurity of all three Cage materials.Compared with the PEEK Cage,the new method Ti6Al4V Cage and 3D-printed Ti6Al4V Cages showed better performances in terms of bone growth and bone fusion,which could enhance the stability of the cervical vertebrae.The new method Ti6Al4V Cage was particularly advantageous.