The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Objective:To investigate the changes of plasma prothrombin fragment 1+ 2 (F 1+2), tissue factor positive microparticle (TF+ MP) and thrombin antithrombin complex (TAT) level before and after the treatment of low molecular weight heparin combined with reteplase in patients with malignant tumor and lower extremity venous thrombosis. Methods:From July 2016 to October 2019, 64 patients with malignant tumors and lower extremity venous thrombosis in the Third Hospital of Changsha were selected, they were divided into observation group ( n=32) and control group ( n=32) by simple randomization. The control group was treated with low molecular heparin, and the observation group was treated with low molecular heparin combined with reteplase. The efficacy, clinical symptom improvement time, incidence of adverse reactions, difference in lower limb circumference, blood flow velocity, activated partial thromboplastin time (APTT), prothrombin time (PT), plasma F 1+2, TF+ MP, TAT level before and after treatment were compared between the two groups; the correlations of plasma F 1+2, TF+ MP, and TAT level with clinical symptom improvement time, peripheral diameter difference of lower extremity, blood flow velocity, APTT, and PT were analyzed. Results:The total effective rate of the observation group (87.50%) was higher than that of the control group (65.63%) ( P<0.05); The improvement time of clinical symptoms in the observation group was shorter than that in the control group ( P<0.05); After treatment, the peripheral limb diameter difference of the observation group was lower than that of the control group, and the blood flow velocity was higher than that of the control group ( P<0.05); The APTT and PT in the observation group were higher than those in the control group after treatment ( P<0.05); The plasma F 1+2, TF+ MP, and TAT level in the observation group were lower than those in the control group after treatment ( P<0.05); The levels of plasma F 1+2, TF+ MP, and TAT were positively correlated with symptom improvement time and lower limb circumference difference, and negatively correlated with blood flow velocity, APTT, and PT ( P<0.05); There was no significant difference in the incidence of adverse reactions (18.75%) between the observation group and the control group (12.50%) during the treatment period ( P>0.05). Conclusions:Plasma F 1+2, TF+ MP, and TAT expression in patients with malignant tumors and venous thrombosis of the lower extremity can be used as biological indicators to evaluate the patient's condition and treatment effect. Low molecular weight heparin combined with reteplase can significantly reduce the plasma F 1+2, TF+ MP and TAT level, promote the improvement of symptoms, effectively reduce the peripheral diameter difference of lower extremity, improve blood flow velocity and coagulation function, and has a significant effect.

Objective:To discuss the relationships between the expressions of silence information regulator 6 (SIRT6) and survivin and clinicopathological features of gastric cancer, and to investigate their effects in gastric cancer.Methods:The tumor tissues of 110 gastric cancer patients admitted to the First Affiliated Hospital of Xi′an Jiaotong University from March 2013 to October 2014, as well as 40 adjacent tissues and 20 normal tissues, were selected to detect the expressions of SIRT6 and survivin by immunohistochemistry. The correlations between the expression levels of SIRT6 and survivin and the clinicopathological features and prognosis of gastric cancer patients were analyzed.Results:The positive rates of SIRT6 were 41.8% (46/110), 77.5% (31/40) and 85.0% (17/20) in gastric cancer, adjacent tissues and normal gastric tissues, respectively, and the difference among the three groups was statistically significant ( χ2=23.200, P<0.001). The positive rate of SIRT6 in gastric cancer tissue was lower than that in adjacent and normal tissues ( χ2=14.949, P<0.001; χ2=12.634, P<0.001). The expression of SIRT6 was correlated with tumor differentiation ( χ2=19.654, P<0.001). The positive rates of survivin were 58.2% (64/110), 15.0% (6/40) and 0 (0/20) in gastric cancer, adjacent tissues and normal gastric tissues, respectively, and the difference among the three groups was statistically significant ( χ2=38.449, P<0.001). The positive rate of survivin in gastric cancer tissue was higher than that in adjacent and normal tissues ( χ2=21.976, P<0.001; χ2=22.920, P<0.001). The expression of survivin was correlated with the depth of infiltration ( χ2=20.853, P<0.001). The expression of SIRT6 was correlated with survivin in gastric cancer tissues ( C=0.211, P=0.024). Survival analysis showed that 3-year survival rate was 53.1% in the SIRT6 negative patients, lower than 78.3% in the positive patients, and the difference was statistically significant ( χ2=4.004, P=0.045), while the 3-year survival rates of the survivin positive and negative patients were 53.1% and 78.3%, and the difference was not significant ( χ2=3.717, P=0.054). Cox multivariate regression analysis showed that lymph node metastasis ( RR=6.618, 95% CI: 2.152-20.358, P=0.001) and SIRT6 negative expression ( RR=0.228, 95% CI: 0.081-0.644, P=0.005) were the risk factors for poor prognosis of gastric cancer. Conclusion:SIRT6 is poorly expressed in gastric cancer tissues and is related to the prognosis of gastric cancer, while survivin is highly expressed in gastric cancer tissues. The expression of SIRT6 and survivin is negatively correlated, suggesting that the expression imbalance of SIRT6 and survivin may play an important role in the occurrence and development of gastric cancer.

OBJECTIVE: To investigate the relationship between the sleep duration on peak melatonin secretion and renal function injury in steel workers. METHODS: A judgment sampling method was used to select 7 655 steel workers in a steel production department for health examination and questionnaire survey, and the relationship between renal function injury and non-peak sleep time(equivalent to the reduction of sleep duration on peak melatonin secretion) was analyzed using restriction cubic spline(RCS) model and multi-factor logistic regression. RESULTS: The detection rate of renal injury in the study subjects was 14.5%(1 110/7 655). RCS model analysis results showed that there was a linear dose-response relationship between non-peak sleep time and renal injury(overall correlation test χ~2=16.85, P<0.01, nonlinear test χ~2=3.70, P>0.05). Multivariate logistic regression analysis results showed that the workers of non-peak sleep time more than or equal to 4 515-day had higher risk of renal function injury than the workers of non-peak sleep time less than 4 515-day(P<0.05), with odds ratio and 95% confidence interval of 1.4(1.2-1.7), after adjustment for the potential influencing factors such as individual factors and occupational factors. CONCLUSION: Reduction of peak melatonin secretion sleep duration is correlated with renal function injury in steel workers.

OBJECTIVE: To explore the relationship between shift work and type 2 diabetes in oil workers. METHODS: A total of 2 666 oil workers in an oil group were selected as the study subjects using the typical sampling method. Questionnaire survey was conducted by a self-designed Questionnaire of Health Assessment for Oil Workers, and blood glucose level was measure. RESULTS: The prevalence of type 2 diabetes in the study subjects was 10.1%(268/2 666). The prevalence of type 2 diabetes in shift workers was higher than that in non-shift workers(13.1% vs 6.0%, P<0.01). After adjusting for the influence of confounding factors such as gender, body mass index, family history of diabetes, history of hypertension, history of hyperlipidemia, and physical exercise, multivariate logistic regression analysis results show that the longer the shift work length, the higher the risk of developing type 2 diabetes(P<0.01), workers with shift work(3 shifts in a day, 2 shifts operating) had a higher risk of type 2 diabetes than that in non-shift workers(P<0.05). CONCLUSION: The shift work length and shift workers with 3 shifts in a day, 2 shifts operating can increase the risk of type 2 diabetes in oil workers.

OBJECTIVE: To explore the relationship between Effort-Reward Imbalance(ERI) and insomnia using structural equation modeling. METHODS: A total of 5 769 steel workers from an iron and steel company were selected as study objects by convenient sampling method. The Effort-Reward Imbalance Scale and Five-Item Athens Insomnia Scale were used to investigate their ERI and insomnia respectively. A structural equation modeling was constructed to analyze the relationship between ERI and insomnia. RESULTS: The scores of work effort and internal investment were positively correlated with the score of insomnia [the Spearman correlation coefficient(r_S) were 0.127 and 0.122 respectively, P<0.01]. Work reward scores were negatively correlated with the score of insomnia(r_S=-0.126, P<0.01). We successfully construct a structural equation model between ERI and insomnia in steel workers. According to this model, work effort, work reward and internal investment had direct effect on insomnia [the standardized path coefficient(β) were 0.065,-0.067 and 0.091 respectively, P<0.05]. Work effort and work reward have direct effect on insomnia(the β were 0.048 and-0.010 respectively, P<0.05). CONCLUSION: ERI increases the risk of insomnia. Both effort and internal investment have positive effect on insomnia, while reward has negative effect on insomnia.

Objective: To discuss the prevalence and influential factors of stroke among population in Jiangxi Province. Methods: Four cities in urban areas and four counties in rural areas were selected firstly, in which two districts or townships were selected; and then three communities or villages were chosen from each district and township, respectively, using the simple random sampling (SRS) method. Finally 15 269 subjects aging 15 years old or above, living in Jiangxi Province ≥6 months were randomly selected to participate in this survey from November 2013 to August 2014. Information of population characteristics, life behavior way, individual disease history were collected through questionnaire survey, and height, weight, waist circumference, blood pressure, body fat rate, visceral fat index and so on were measured by instruments. Risk factors of stroke prevalence were analyzed by the unconditioned logistic regression analysis. Results: A total of 15 269 participants (6 267 males) from 15 364 eligible participants were included in the statistical analysis. Out of which, 7 793 participants came from urban areas, and their average age was (53.04±17.91) years old. In this study, 226 stroke patients (117 males) were found among15 269 participants, including 122 urban participants and 104 rural participants, whose average age was (67.76±9.74) years old. The prevalence of stroke was 1 480.12/100 000 in 2014, which was separately 1 866.92/100 000 and 1 210.84/100 000 among males and females. The prevalence of people aging (45-49) years old was 413.79/100 000 (6/1 450) , while which among people aging 75 years old and above was 3 311.62/100 000 (61/1 842) . The prevalence of stroke among residents in Jiangxi presented an uprising tendency with age increasing (linear-by-linear association χ²=62.23, P<0.01). The research showed that when other influencing factors including gender, BMI, waist circumference, pulse-pressure difference, VAI, and sleeping time in non-working days were controlled, hypertensive patients had a higher risk of stroke than people without hypertension (OR=6.88, 95%CI: 4.90-9.67), drinkers had a higher risk of stroke than non-drinkers (OR=1.56, 95%CI: 1.17-2.08), compared with people <65 years old, people aged 65-74 years old and ≥75 years old had a higher risk of stroke, the value of OR (95%CI) were 1.88 (1.36-2.59) and 1.97 (1.39-2.80), respectively, compared with people with normal body fat percentage, people whose body fat percentage on high side and people who with high body fat percentage had a higher risk of stroke, the value of OR (95%CI) were 1.71 (1.18-2.48) and 1.74 (1.18-2.56), respectively, people with sleep time >8 h had a higher risk of stroke than those with sleep time of 6-8 h. Conclusion There was a high stroke prevalence among residents in Jiangxi province. Hypertension, drinking, age, BFP and sleep duration were associated with stroke prevalence. Corresponding measures for high-risk population and risk factors should be strengthened to prevent and control the stroke.

Objective: To explore the correlation of monocyte to HDL-C ratio (MHR) and post-operative slow lfow or no relfow in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods: A total of 216 STEMI patients treated in our hospital from 2014-10 to 2016-05 were enrolled. The patients were divided into 2 groups: Slow lfow or no relfow group, the patients with TIMI grade≤2,n=43 and Normal lfow group, n=173. Receiver operating characteristic (ROC) curve was performed to assess the best cut-off value for MHR predicting slow lfow or no relfow with its sensitivity and speciifcity; Logistic regression analysis was conducted to studied weather MHR could be used as an independent risk factor for coronary slow lfow or no relfow in STEMI patients after PCI. Results: Compared with Normal lfow group, Slow lfow or no relfow group had the higher MHR (18.6±9.8) vs (10.9±5.5), P<0.001. Univariate Regression analysis indicated that MHR was a risk factor of slow lfow or no relfow occurrence (OR=2.22, 95% CI 1.58-3.28); multivariate regression analysis presented that MHR was an independent risk factor of slow lfow or no relfow occurrence (OR=1.55, 95% CI 1.01-2.38). ROC curve showed that the best cut-off value for MHR predicting slow lfow or no relfow occurrence was 13.37 with the sensitivity and speciifcity at 67.4% and 70.5% respectively, the area under curve (AUC) was 0.734, 95% CI 0.646-0.822. Conclusion: MHR was an independent risk factor for slow lfow or no relfow occurrence in STEMI patients after PCI.

OBJECTIVE: To study the mechanism of tumor necrosis factor( TNF)-α and its receptor( TNFR) signal transduction pathways in regulating cell apoptosis of alveolar macrophage( AM) in coal workers' pneumoconiosis( CWP).METHODS: Twenty-four coal workers with pneumoconiosis at stage Ⅰ were selected as CWP group and four observation subjects exposed to coal were chosen as observation group by using simple random sampling method. The bronchoalveolar lavage fluids of whole-lung lavage of two groups were collected. AMs were separated and purified. Then they were divided into 6 groups: a control group,a superoxide dismutase( SOD) group,a TNF/TNFR group,an anti-TNF-α antibody group,a Caspase-8 suppression group and a nuclear factor-κB( NF-κB) suppression group. The AMs of 6 groups with corresponding treatment were cultivated. After 24 hours,the cells were harvested and proteins extracted. The relative expression of TNF-α,TNFR1,TNFR2,Caspase-8,Caspase-3,NF-κB P50 and NF-κB P65 protein was detected by Western blotting. RESULTS: The protein relative expression of TNF-α,TNFR2,Caspase-8,Caspase-3,NF-κB P50 and NF-κB P65 in CWP group was significantly higher than those in the observation group( P < 0. 05). The protein relative expression of TNF-α,TNFR1,Caspase-8,Caspase-3 and NF-κB P50 in the TNF/TNFR group and the anti-TNF-αantibody group was lower than that of the control group( P < 0. 05). The above indexes in the anti-TNF-α antibody group were lower than that of the NF-κB suppression group( P < 0. 05). The protein relative expression of TNFR1,Caspase-8and Caspase-3 in the TNF/TNFR group was higher than that of the SOD group and the Caspase-8 suppression group( P <0. 05). The protein relative expression of TNFR1,Caspase-8 and NF-κB P50 in the TNF/TNFR group was lower than that of the NF-κB suppression group( P < 0. 05). Among the CWP patients,the relative expression of TNFR2 and NF-κB P65 in the TNF/TNFR group was lower than that of the control group( P < 0. 05),and higher than that of the SOD group( P <0. 05). CONCLUSION: AM apoptosis mediated by TNF-α/TNFR/NF-κB signal transduction pathway plays an important role in the occurrence and development of CWP. The TNF-α/TNFR/NF-κB signal transduction pathways inhibited or blocked at different stages can affect the expression of proteins related to AM apoptosis.

Objective: To explore the clinical and molecular genetic features of a Chinese patient with catecholaminergic polymorphic ventricular tachycardia (CPVT). Methods: Clinical data including resting electrocardiography, echocardiography and treadmill exercise testing of a patient with CPVT admitted to our department in March 2013 were analyzed, and the peripheral venous blood samples of the patient and his family members and 400 ethnicity-matched healthy controls were obtained. All exons and exon-intron boundaries of the six CPVT-related genes including RYR2, CASQ2, TRDN, CALM1, KCNJ2 and ANKB were sequenced to detect the variants related to CPVT. The relationship between the genotypes and phenotypes was analyzed to direct the target therapy. Results: Recurrent syncope induced either by exercise or extreme frightened fear was observed in this patient. There was no positive family history of syncope or sudden death. The resting electrocardiography and echocardiography of the patient were normal, while the exercise testing revealed bidirectional and polymorphic ventricular tachycardia. A cardiac ryanodine receptor gene mutation (R2401H) was identified in this patient, while this mutation was absent in his parents and sister and 400 controls. No variant was detected in the remaining five candidate genes. Treatment with high dose of metoprolol succinate (118.75 mg/d) was effective and patient was free of syncopal attack during the 2 years follow-up. Conclusion This is the first report on RyR2-R2401H mutation in Chinese patient with CPVT, and high dose of metoptolol is the effective therapy option for CPVT related to RyR2 mutation.