Objective: To investigate the changes of microorganisms and metabolites in joint effusion of patients with Rheumatoid arthritis(RA), Osteoarthritis(OA) and Urarthritis(UA). To provide new ideas for the study of the effect of microbiota on the pathogenesis of arthritis. Methods: Joint effusion samples were collected from 20 patients with RA, 20 patients with OA, and 20 patients with UA. 16S rRNA gene sequencing and untargeted ultra-high performance Liquid chromatography-mass spectrometry(LC-MS) were used to explore the differences in microorganisms and metabolites among the three groups. Pearson correlation analysis was used to detect the correlation between effusion microbiota and metabolites. Results: There were differences in microbial diversity and microbiota composition among the three groups. Combined with VIP>1 from OPLS-DA andP<0.05 from two-tailed Students t-test, 45 differential metabolites(Between RA and OA groups), 38 differential metabolites(Between UA and OA groups) and 16 differential metabolites(Between RA and UA groups), were identified. GO analysis and KEGG pathway analysis showed that the differential metabolic pathways among the three groups were mainly concentrated in citric acid cycle(TCA cycle), nucleotide metabolism, amino acid metabolism and glycolysis pathway. Correlation analysis of joint effusion microbiota and metabolites suggested that bacteria enriched in the three groups of joint effusion, such asPrevotella,Clostridium ruminosus,Prevotellaceae＿UCG-001, were related to many key metabolites such as lysozyme, uric acid, glucose, and L-glutamine. Conclusion This study shows that there are a variety of bacterial flora in joint cavity effusion of RA, OA, and UA patients, and the differential metabolites produced by them are involved in the pathogenesis of the three types of arthritis by affecting a variety of metabolic pathways.

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 explore the effect of the evidence-based practice nursing program for severe patients with physical constraints based on the guideline in Intensive Care Unit (ICU) patients.Methods:From February 2019 to July 2020, 4 663 patients in the Surgical Intensive Care Unit (SICU), Medicine Intensive Care Unit (MICU), Coronary Care Unit (CCU), and Emergency Intensive Care Unit (EICU) of the China-Japan Friendship Hospital were selected as the research object by purposive sampling. The evidence-based practice nursing program for severe patients with physical constraints based on the guideline of Promoting Safety: Alternative Approaches to the Use of Restraints was applied in clinical practice. We recorded the constraint duration, constraint rate, and substitution constraint rate of severe patients after the implementation of the program, and compared the differences in ICU nurses' scores on physical constraint knowledge, attitude, and practice before and after the implementation of the program. Results:Out of 4 663 patients, 871 received restraint, with a restraint rate of 18.68% and a restraint duration of (102.35±82.67) hours. The number of substitution constraint cases was 421, and the substitution constraint rate was 9.03%. The constraint rates in SICU, MICU, CCU and EICU were 23.68% (475/2 006), 28.26% (219/775), 7.29% (97/1 331) and 14.52% (80/551), respectively, and the differences in constraint rates among different departments were statistically significant ( P<0.05). Before and after the implementation of the program, there were statistically significant differences in the scores of ICU nurses on physical constraint knowledge, attitude, and practice dimensions and total scores ( P<0.05) . Conclusions:The evidence-based practice nursing plan program for severe patients with physical constraints based the guideline effectively reduces the rate and duration of physical constraint of ICU patients, improves the substitution constraint rate, standardizes the practice of physical constraint of ICU patients, and ensures patient safety.

OBJECTIVES: To evaluate myocardial injury in neonates born to pregnant women with pregnancy complicated by severe preeclampsia by myocardial work indices. METHODS: A prospective cohort study was performed on 25 preterm infants born to the pregnant women with severe preeclampsia from June 2020 to April 2021 (severe preeclampsia group), and 25 preterm infants born to the pregnant women without severe complications in pregnancy were enrolled as the control group. Echocardiography was performed within 24 hours and at 48-72 hours and 14-28 days after birth to measure conventional parameters. Two-dimensional speckle-tracking echocardiography was performed to construct a noninvasive left ventricular pressure-strain loop based on two-dimensional myocardial strain and left ventricular systolic pressure noninvasively measured, so as to calculate myocardial work indices. RESULTS: Compared with the control group, the severe preeclampsia group had significant reductions in left ventricular global work index and global constructive work within 24 hours after birth (P<0.05), a significant reduction in left ventricular global work efficiency and a significant increase in global waste work at 48-72 hours after birth (P<0.05), and a significant reduction in left ventricular global work efficiency at 14-28 days after birth (P<0.05). CONCLUSIONS Subclinical myocardial injury persists in the neonatal period in preterm infants born to pregnant women with severe preeclampsia.
Echocardiography/methods* ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Pre-Eclampsia ; Pregnancy ; Pregnant Women ; Prospective Studies

OBJECTIVE: To examine whether the combination of Naoxintong Capsule with standard care could further reduce the recurrence of ischemic stroke without increasing the risk of severe bleeding. METHODS: A total of 23 Chinese medical centers participated in this trial. Adult patients with a history of ischemic stroke were randomly assigned in a 1:1 ratio using a block design to receive either Naoxintong Capsule (1.2 g orally, twice a day) or placebo in addition to standard care. The primary endpoint was recurrence of ischemic stroke within 2 years. Secondary outcomes included myocardial infarction, death due to recurrent ischemic stroke, and all-cause mortality. The safety of drugs was monitored. Results were analyzed using the intention-to-treat principle. RESULTS: A total of 2,200 patients were enrolled from March 2015 to March 2016, of whom 143 and 158 in the Naoxintong and placebo groups were lost to follow-up, respectively. Compared with the placebo group, the recurrence rate of ischemic stroke within 2 years was significantly lower in the Naoxintong group [6.5% vs. 9.5%, hazard ratio (HR): 0.665, 95% confidence interval (CI): 0.492-0.899, P=0.008]. The two groups showed no significant differences in the secondary outcomes and safety, including rates of severe hemorrhage, cerebral hemorrhage and subarachnoid hemorrhage (P>0.05). CONCLUSION The combination of Naoxintong Capsule with standard care reduced the 2-year stroke recurrence rate in patients with ischemic stroke without increasing the risk of severe hemorrhage in high-risk patients. (Trial registration No. NCT02334969).
Adult ; Humans ; Secondary Prevention/methods* ; Ischemic Stroke ; Stroke/prevention & control* ; Cerebral Hemorrhage/complications* ; Double-Blind Method ; Platelet Aggregation Inhibitors

【Objective】To evaluate the feasibility of magnetization transfer（MT）magnetic resonance（MR）imaging for predicting the risk of intestinal fistula in patients with Crohn disease （CD）. 【Methods】 The study prospectively enrolled 12 consecutive patients with CD and abdominal MT imaging were performed before elective surgery. The bowel wall MT ratio normalized to skeletal muscle was calculated；region- by- region correlations with the surgical specimen were performed. Histopathologic evaluation of fibrosis was executed by using Masson trichrome. Wilcoxon rank test ， Spearman rank correlation， and receiver operating characteristic curve （ROC） were used for statistical analysis.【Results】Among 15 surgical intestinal segments from 12 patients，5 lesions were found with intestinal fistula and of them 12 bowel specimens were obtained. The other 10 intestinal segments were without complications and 23 bowel specimens were enrolled. The intestinal fistula bowel showed a significant higher （P=0.045） normalized MT ratio. ROC analysis revealed an area under the curve of 0.674（95%CI：0.537-0.811）for differentiating intestinal fistula bowel from the non- fistula one. The sensitivity，specificity was 93.3% and 51.1% with a cut-off value of 76.8%，respectively. For the Masson score，significant difference（P=0.012）was found between the complicated intestinal specimens and the non-complicated ones. Additionally， the normalized MT ration was statistical correlated with Masson score （r=0.708，P<0.001）.【Conclusion】MT imaging could be a potential method to predict the risk of intestinal fistula in patients with CD.

The aim of this paper was to explore the effects of triptolide( TP),the effective component of Tripterygium wilfordii on improving podocyte epithelial-mesenchymal transition( EMT) induced by high glucose( HG),based on the regulative mechanisms of Nod-like receptor protein 3( NLRP 3) inflammasome in the kidney of diabetic kidney disease( DKD). The immortalized podocytes of mice in vitro were divided into the normal( N) group,the HG( HG) group,the low dose of TP( L-TP) group,the high dose of TP( HTP) group and the mannitol( MNT) group,and treated by the different measures,respectively. More specifically,the podocytes in each group were separately treated by D-glucose( DG,5 mmol·L~(-1)) or HG( 30 mmol·L~(-1)) or HG( 30 mmol·L~(-1)) + TP( 5 μg·L~(-1))or HG( 30 mmol·L~(-1)) + TP( 10 μg·L~(-1)) or DG( 5 mmol·L~(-1)) + MNT( 24. 5 mmol·L~(-1)). After the treatment of HG or TP at 24,48 and 72 h,firstly,the activation of podocyte proliferation was investigated. Secondly,the protein expression levels of the epithelial markers in podocytes such as nephrin and ZO-1,the mesenchymal markers such as collagen Ⅰ and fibronectin( FN) were detected,respectively. Finally,the protein expression levels of NLRP3 and apoptosis-associated speck-like protein( ASC) as the key signaling molecules of NLRP3 inflammasome activation,as well as the downstream effector proteins including caspase-1,interleutin( IL)-1β and IL-18 were examined,severally. The results indicated that,for the cultured podocytes in vitro,HG could cause the low protein expression levels of nephrin and ZO-1,induce the high protein expression levels of collagen Ⅰ and FN and trigger podocyte EMT. Also HG could cause the high protein expression levels of NLRP3,ASC,caspase-1,IL-1β and IL-18 and induce NLRP3 inflammasome activation. On the other hand,the co-treatment of TP( L-TP or H-TP) and HG for podocytes could recover the protein expression levels of nephrin and ZO-1,inhibit the protein expression levels of collagen Ⅰ and FN and ameliorate podocyte EMT. Also the co-treatment of TP( L-TP or H-TP) and HG could down-regulate the protein expression levels of NLRP3 and ASC,inhibit NLRP3 inflammasome activation and reduce the protein expression levels of the downstream effector molecules including caspase-1,IL-1β and IL-18. On the whole,HG could activate NLRP3 inflammasome and induce podocyte EMT in vitro. TP at the appropriate dose range could inhibit NLRP3 inflammasome activation and ameliorate podocyte EMT,which may be one of the critical molecular mechanisms of TP protecting againstpodocyte inflammatory injury in DKD.
Animals ; Caspase 1/metabolism* ; Cells, Cultured ; Diabetic Nephropathies ; Diterpenes/pharmacology* ; Epithelial-Mesenchymal Transition ; Epoxy Compounds/pharmacology* ; Glucose ; Inflammasomes/metabolism* ; Interleukin-18/metabolism* ; Interleukin-1beta/metabolism* ; Mice ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism* ; Phenanthrenes/pharmacology* ; Podocytes/drug effects*

The relationship between saponin content of in different parts of the organization and expression of ginsenoside biosynthesis related gene was obtained by the correlation analysis between saponin content and gene expression. The 14 tissue parts of were studied, six saponins in Samples (ginsenoside Rg₁, Re, Rb₁, Rc, Rb₂ and Rd), group saponins and total saponins were determined by high performance liquid chromatography and vanillin-sulfuric acid colorimetric method. Simultaneously, the expression levels of 7 ginsenoside biosynthesis related genes ( and ) in different tissues of were determined by Real-time fluorescence quantitative PCR. Although 7 kinds of ginsenoside biosynthesis related enzyme gene in the involved in ginsenoside synthesis, the expression of and P450 genes had no significant effect on the content of monosodium saponins, grouping saponins and total saponins, and had significant or extremely significant on the contents of single saponins Re, Rg1, Rb1, Rd, group saponin PPD and PPT, total saponin TMS and total saponin TS (<0.05 or <0.01). The biosynthesis of partial saponins, grouping saponins and total saponins in was affected by the interaction of multiple enzyme genes in the saponin synthesis pathway, the content of saponins in different tissues of was determined by the differences in the expression of key enzymes in the biosynthetic pathway. Therefore, this study further clarified that and was the key enzyme to control the synthesis of saponins in by correlation analysis, the biosynthesis of ginsenosides in was regulated by these five kind of enzymes in cluster co-expression of interaction mode.
Biosynthetic Pathways ; Chromatography, High Pressure Liquid ; Ginsenosides ; biosynthesis ; genetics ; Panax ; genetics ; Plant Roots ; Saponins ; biosynthesis ; genetics

OBJECTIVETo observe the effects of increased-intensity conditioning regimen with FBCA (Fludarabine, Busulfan, Cyclophosphamide, and Antithymocyte globulin) for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acquired severe aplastic anemia (SAA).

METHODSFrom January 2000 to June 2011, twenty-two patients (male 12, female 10) with SAA underwent allo-HSCT with FBCA conditioning regimen which consisted of fludarabine (30 mg·m⁻²·d⁻¹×5 d), busulfan (3 mg/kg×2 d), cyclophosphamide (60 mg·kg⁻¹·d⁻¹×2 d) and ATG (2.5 mg·kg⁻¹·d⁻¹×5 d). GVHD prophylaxis was performed by cyclosporine and short-term course methotrexate. Nine patients received mobilized peripheral blood stem cells transplantation and 13 patients underwent mobilized peripheral blood combined with bone marrow stem cells. Fourteen cases were human leukocyte antigen (HLA)-matched related donors, while the other 8 cases were HLA-haploidentical transplantation. Engraftment was documented by short tandem repeats with polymerase chain reaction (STR-PCR) on approximately day + 30, + 90, + 180, + 1 year and + 2 year, respectively. Long-term survival and transplantation-related complications were analyzed.

RESULTSAll patients obtained prompt and sustained hematopoietic reconstitution. Median time for neutrophil and PLT engraftment was 15 (range: 11-22) days and 16 (range: 12-27) days, respectively. All patients were full donor chimerism identified by STR-PCR. 2 of the total 22 cases (9.1%) had grade I-III acute GVHD and 3 (15.8%) was chronic GVHD. Three patients (13.6%) died of transplantation related mortality and the other 19 cases were disease-free survival with a median time of 24 (range: 0.5-140.5) months. The causes of death were cytomegalovirus pneumonia (n=1), acute GVHD (n=1) and severe pulmonary infection (n=1).

CONCLUSIONIncreased-intensity of FBCA conditioning regimen could favor donor stem cell sustained engraftment for allo-HSCT in SAA.

Adolescent ; Adult ; Anemia, Aplastic ; therapy ; Child ; Child, Preschool ; Female ; Graft Survival ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Male ; Middle Aged ; Tissue Donors ; Transplantation Conditioning ; methods ; Transplantation, Homologous ; Vidarabine ; analogs & derivatives ; Young Adult

OBJECTIVETo analyze the distribution characteristics of the main semen parameters of healthy semen donors and normal fertile men in Shanghai, compare the semen quality between the two groups, and investigate the normal reference values of the semen parameters of the fertile population in Shanghai.

METHODSWe obtained semen samples from 100 healthy donors and 41 fertile men, performed semen analyses according to the WHO (2010) guidelines, and determined the semen volume, sperm concentration, sperm progressive motility, total sperm count and total progressively motile sperm count. We analyzed the distribution of the semen parameters of the normal fertile men, and obtained the lower limits of their normal reference values.

RESULTSThere were no statistically significant differences in the main semen parameters between the healthy donors and normal fertile men (P < 0.05). The lower reference limits for the semen parameters of normal fertile men in Shanghai (P < 0.05) were as follows: sperm concentration > or = 27.3 x 10(6)/ml, sperm progressive motility > or = 8.1%, semen volume > or = 0.82 ml, total sperm count > or = 44.73 x 10(6) per ejaculate, and total progressively motile sperm count > or = 24.68 x 10(6) per ejaculate.

CONCLUSIONFor the evaluation of male fecundity, total sperm count and total progressively motile sperm count may be two better predictors than others.

Adult ; China ; Fertility ; Humans ; Male ; Reference Values ; Semen ; Semen Analysis ; Sperm Count ; Sperm Motility ; Spermatozoa ; Tissue Donors ; Young Adult