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 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.

Objective To investigate the characteristics on the time of sunshine exposure in Chinese primary and middle school students.Methods A total of 43 771 primary and middle school students were randomly selected from 12 provinces in China.A self-reported questionnaire was used to understand their time of sunshine exposure on weekdays and weekends as well as related family information and behaviors.x2 test was used to compare the hours of sunshine exposure among different groups.Multivariate logistic regression analysis was conducted to identify the influencing factors.Results Results from the current survey indicated that the average time of sunshine exposure on weekdays and weekends were 2.49 and 3.22 hours,respectively.On weekdays,proportions of students with time of sunshine exposure ≤2 h/d or ＞2 h/d were 60.81％ and 39.19％,respectively.On weekends,the proportions became 44.05％ and 55.95％,respectively.On weekdays,the time of sunshine exposure as ≤2 h/d was significantly different among factors as sex,urban or rural area,residential area,self-rating academic performance,type of housing or ways of commuting to school.On weekends,the time of sunshine exposure ≤2 h/d were significantly different among sex,residential areas,self-rating academic performance,type of housing and ways of commuting to school.Data from the multivariate logistic regression analysis showed that the limited sunshine exposure was significantly associated with factors as:type of primary schools,being girls,students living in the urban area or living in central or western areas,with normal or better academic performances,living in a fiat apartment and the time spent on watching video program ＞2 h/d both on weekdays and weekends.Conclusion The time of sunshine exposure seemed not enough among school students and significant differences were seen among different groups.

OBJECTIVETo evaluate the differences in the autophagy activity of alveolar macrophages between patients with different stages of coal workers' pneumoconiosis (CWP).

METHODSA total of 116 coal workers were investigated in the field. Their lung lavage fluid was collected and purified to obtain alveolar macrophages. The morphological characteristics of autophagy were observed by transmission electron microscopy. The expression of autophagy marker (LC3) and autophagy regulators (Beclin1, mTOR, and p-mTOR) was measured by Western blot. The autophagy activity of alveolar macrophages was compared between dust-exposed subjects and patients with stage I, II, and III CWP.

RESULTSThe autophagy activity of alveolar macrophages differed between patients with different stages of CWP, according to transmission electron microscopy. Patients with stage II CWP had significantly higher protein expression of LC3 II/I and Beclin1 in pulmonary macrophages than those with stage ICWP (P < 0.05); patients with stage III CWP had significantly lower protein expression of LC3 II/I and Beclin1 in pulmonary macrophages than those with stage II CWP (P < 0.05), but had significantly higher protein expression of LC3 II/I and Beclin1 than those with stage I CWP (P < 0.05); patients with stage II CWP had a significantly higher protein expression of Beclin1 than the dust-exposed subjects (P < 0.05). Patients with stage II CWP had significantly lower expression of mTOR and p-mTOR in pulmonary macrophages than the dust-exposed subjects and those with stage I CWP (P < 0.05), while patients with stage III CWP had significantly higher expression of mTOR and p-mTOR than those with stage II CWP (P < 0.05).

CONCLUSIONThe autophagy activity of alveolar macrophages varies between patients with different stages of CWP.

Anthracosis ; pathology ; Apoptosis Regulatory Proteins ; metabolism ; Autophagy ; Beclin-1 ; Biomarkers ; Bronchoalveolar Lavage Fluid ; Coal ; Coal Mining ; Dust ; Humans ; Macrophages, Alveolar ; pathology ; Membrane Proteins ; metabolism ; Microtubule-Associated Proteins ; metabolism ; Occupational Exposure ; Pneumoconiosis ; pathology

OBJECTIVESTo explore the association between elevated light levels in classrooms and change in vision acuity among elementary and secondary students.

METHODSA total of 4 elementary (grade 1-5) and secondary (grade 7-8) schools in urban and rural areas in Sujiatun, Shenyang, China were selected by cluster sampling as experimental schools, and lighting systems have been rebuilt to improve the ambient light levels in 56 classrooms in November 2012. The control schools were chosen for the comparable academic burden and adjacent location to experimental schools, 4 schools in all. Cluster sampling of all students in the selected schools as the subjects was carried out. A total of 2 092 students were chosen as experimental group and 1 595 students were in the control group. The luxmeter was used to measure illuminance of classrooms in two groups at baseline, and intervention for 1 month, respectively.Students in both groups were underwent 3 times for vision acuity examination by standard logarithmic visual acuity chart at baseline, intervention for 6 month and intervention for 1 year, respectively. The light levels of desk and blackboard in two groups were compared by Wilcoxon test. Multivariate analysis of covariance with repeated measures was performed to assess three vision acuity results between groups.

RESULTSAfter intervention, the average illuminance of desk (117.5 vs 532.5 lx, Z = -5.38, P < 0.001) and blackboard (75.6 vs 423.5 lx, Z = -5.38, P < 0.001) and uniformity of desk (Z = -4.28, P < 0.001) with new lighting were improved significantly than that with old lighting, however the uniformity of blackboard was lower than baseline significantly (0.64 vs 0.70, Z = -2.34, P = 0.019). The average scores of vision acuity in students at baseline, intervention for 6 month and intervention for 1 year were 4.87 ± 0.23, 4.84 ± 0.25 and 4.85 ± 0.23 in experimental group, and 4.88 ± 0.22, 4.84 ± 0.25 and 4.81 ± 0.27 in control group, respectively. The significant differences between groups were found and F values were 1.41, 0.13, 19.99, P values were 0.235,0.724, <0.001. At last the average vision acuity in experimental group were significantly better than that in control group either among elementary (4.90 ± 0.20) vs (4.87 ± 0.21) score, F = 13.61, P < 0.001 or secondary students (4.73 ± 0.28) vs (4.68 ± 0.32) score, F = 14.25, P < 0.001.

CONCLUSIONSVisual acuity loss could be decreased in students with elevated light levels which may slow the response to myopiagenic stimuli for eyes, therefore the ambient light levels of blackboard and desk in classroom should be improved.

Adolescent ; Child ; China ; Humans ; Lighting ; Schools ; Students ; Visual Acuity

OBJECTIVETo investigate the synergistic effect of transforming growth factor-beta1 (TGF-beta1) and platelet-derived growth factor-BB (PDGF-BB) on the expression of integrin beta3, in periodontal membrane of rat orthodontic tooth.

METHODSAn orthodontic tooth movement model was established. Up to 32 experimental rats were randomly divided into four groups according to a random number table. The four groups were injected with 1% PBS, TGF-beta1 (5 ng), PDGF-BB (10 ng), and combined TGF-beta1 (5 ng) and PDGF-BB (10 ng) in the buccal submucosal, respectively. The volume injected in each group was 0.1 mL. The animals were then sacrificed on the 10th day. The left maxillary first molar and periodontal tissue were taken. Different expressions of integrin beta3 were detected in periodontal tissues through immunohistochemistry. Mean optical density (OD) values of the positive fields were examined. The data obtained were analyzed through ANOVA. The data followed normal distribution, and were compared via t-test.

RESULTSCompared with the control groups, the expression of integrin beta3 was higher in the experimental groupin tension sides (P < 0.01). Significant differences in tension sides between the single-injection groups and the combined group were observed (P < 0.01). Compared with the control groups, the expression of integrin beta3 was higher in the experimental group in compression sides (P < 0.05). In addition, there was no significant differences in compression sides between the single-injection groups and the combined group (P > 0.05).

CONCLUSIONIn terms of local regulatory factors, TGF-beta1 combined with PDGF-BB enhance the expression of integrin beta3 in the periodontal membrane and accelerate periodontal remodeling. The synergistic effect of the two growth factors is better than the single growth factor.

Animals ; Integrin beta3 ; Molar ; Periodontal Ligament ; Platelet-Derived Growth Factor ; Proto-Oncogene Proteins c-sis ; Rats ; Tooth Movement Techniques ; Transforming Growth Factor beta1

Objective To explore the effects of trimetazidine on myocardial free radical inj ury induced by pirarubicin,and to clarify the protective effect and mechanism of trimetazidine on myocardial inj ury induced by pirarubicin.Methods 3 6 Wistar rats were randomly divided into pirarubicin group (n= 1 3 ), trimetazidine intervention group(n=13)and control group (n=10).The rats in pirarubicin group and trimetazidine intervention group were inj ected with pirarubicin 2.5 mg · kg-1 by the vena caudal once a week for 6 weeks. The rats in trimetazidine intervention group were intragastricly infused with trimetazidine 5.4 mg · kg-1 · d-1 one day for 8 weeks before making the model. At the end of the experiment,the malonaldehyde (MDA)level,nitrogen oxide (NO)level,superoxide dismutase(SOD)activity,and nonprotein sulfhydryl (NPSH)level in myocardium tissue were measured. The histological changes of myocardium tissue were detected by electron microscope. Results Compared with control group ,the levels of MDA and NO in pirarubicin group were increased(P<0.05), and the SOD activity and NPSH level in pirarubicin group were decreased(P<0.05).Compared with pirarubicin group,the levels of MDA and NO in trimetazidine intervention group were decreased(P<0.05),the SOD activity and NPSH level in trimetazidine intervention group were increased(P<0.05).Under electron microscope,the myocardiocytes of the rats in pirarubicin group showed irregular arrangement in sacromere structure, shrinkage in nuclear membrane, vacuolation in nuclear matrix, obvious mitochondria swelling, deposition of metachromatin throughout the nucleus,and an indistinct view of intercalated disc with isolation;while in trimetazidine intervention group the nucleus was round and nuclear membrane was indented,myofilament bundles were decreased slightly with a regular arrangement, intercalated disc oriented transversely with partial vague in cell j unction structure, and mitochondria slightly swelled.Conclusion Trimetazidine has the protective effects on the damaged myocardiocytes caused by pirarubicin,and its mechanism may be related to reducing the production of free radicals and decreasing the injury of structures within the cells,such as the nucleus,mitochondria and intercalated disc.

Objective To investigate the synergistic effect of transforming growth factor-β1 (TGF-β1) and platelet-derived growth factor-BB (PDGF-BB) on the expression of integrin β3 in periodontal membrane of rat orthodontic tooth. Methods An orthodontic tooth movement model was established. Up to 32 experimental rats were randomly divided into four groups according to a random number table. The four groups were injected with 1%PBS, TGF-β1 (5 ng), PDGF-BB (10 ng), and combined TGF-β1 (5 ng) and PDGF-BB (10 ng) in the buccal submucosal, respectively. The volume injected in each group was 0.1 mL. The animals were then sacrificed on the 10th day. The left maxillary first molar and periodontal tissue were taken. Different expressions of integrin β3 were detected in periodontal tissues through immunohistochemistry. Mean optical density (OD) values of the positive fields were examined. The data obtained were analyzed through ANOVA. The data followed normal distribution, and were compared via t-test. Results Compared with the control groups, the expression of integrin β3 was higher in the experimental groupin tension sides (P<0.01). Significant differences in tension sides between the singleinjection groups and the combined group were observed (P<0.01). Compared with the control groups, the expression of integrin β3 was higher in the experimental group in compression sides (P<0.05). In addition, there was no significant differences in compression sides between the single-injection groups and the combined group (P>0.05). Conclusion In terms of local regulatory factors, TGF-β1 combined with PDGF-BB enhance the expression of integrin β3 in the periodontal membrane and accelerate periodontal remodeling. The synergistic effect of the two growth factors is better than the single growth factor.

OBJECTIVETo investigate the combined effects of platelet-derived growth factor-BB (PDGF-BB) and insulin-like growth factor-I (IGF-I) on the expression of integrin (beta3 protein in the periodontal tissues of the compressing side of orthodontic tooth in rats.

METHODSEstablishing orthodontic movement model in Sprague-Dawley rats, which were injected with 10 ng PDGF-BB, 200 ng IGF-I alone or in combination in the buccal submucosal area of the orthodontic tooth. The injection was applied every other day. The experiment continued for ten days and then the rats were sacrificed. The expression of integrin (beta3 protein in periodontal ligament tissues of the compressing side was detected by immunohistochemical techniques.

RESULTSThe expression of integrin (beta3 protein in periodontal ligament tissues of the compressing side of each experimental group was significantly increased compared with that of the control group (P<0.01). Meanwhile the maximum mean optical density value of integrin (beta3 protein expression was attained in the combination group which showed a significant increase compared with the PDGF-BB group (P<0.05) and the IGF-I group (P<0.01).

CONCLUSIONThe combination of exogenous PDGF-BB and IGF- I in orthodontic tooth movement may enhance the expression of integrin (beta3 protein in periodontal ligament cells and PDGF-BB and IGF-I may have a synergistic effect during orthodontic tooth movement.

Animals ; Cells, Cultured ; Fibroblasts ; Insulin-Like Growth Factor I ; Integrins ; Periodontal Ligament ; Platelet-Derived Growth Factor ; Proto-Oncogene Proteins c-sis ; Rats ; Rats, Sprague-Dawley ; Somatomedins ; Tooth Movement Techniques

Objective　To investigate the relationship between the expression and regulation of osteopontin (OPN) and urolithiasis. Methods　Normal and stone model rats were treated with 1,25-dihydroxyvitamin D3 (D3), vitamin K, testosterone or estradiol for 7 days, and the expression of osteopontin and its mRNA were detected with immunohistochemistry and Northern blot, respectively. Crystals deposited in rat kidneys were observed with a polarization microscope. The concentrations of crystal components in rat urine were determined. Results　The results showed that vitamin K, testosterone and estradiol up-regulated the expression of OPN mRNA and its protein, thus decreasing the precipitation of calcium oxalate in rat kidneys. D3 increased the concentration of calcium in urine, and accelerated the sedimentation of calcium oxalate in rat kidneys. Conclusions　These findings indicate that OPN may be an important macromolecule in the normal endogenous inhibition of the formation of urolithiasis. Vitamin K, testosterone and estradiol inhibit the formation of stones via up-regulating the expression of OPN in kidneys, while D3 over dose may accelerate the process.