Objective:The study aimed to investigate the effects of exercise on the expression of ferroptosis-related proteins and the associated mechanisms in a post-traumatic stress disorder(PTSD)model induced by transient foot shock.Methods:Thirty-five male C57BL/6J mice(8 weeks old)were randomly divided into three groups:Control group,PTSD group,and Exe+PTSD group.PTSD model mice were established by foot-shock and PTSD behaviors were assessed using a fear conditioning box.Iron distribution areas were detected by Fe3+staining.Western Blot analysis were performed to determine the expression level of ferroptosis-related proteins in the mice.Results:Compared to the control group,the freezing time and Fe3+distribution areas in the cortex and hippocampus were significantly increased in the mice with PTSD(P＜0.05).The levels of ferroportin1(FPN1),glutathione peroxidase 4(GPX4),and brain-derived neurotrophic factor(BDNF)proteins were significantly decreased(P＜0.05),while the expression of high mobility group box 1(HMGB1)protein was significantly elevated(P＜0.05).Exercise significantly reduced freezing time and Fe3+accumulation in the cortex and hippocampus(P＜0.05),and it also up-regulated the expression of FPN1,GPX4,and BDNF proteins(P＜0.05),while down-regulating HMGB1 expression compared to the PTSD group(P＜0.05).Conclusion:This study demonstrates that PTSD induces the ferroptosis-related pathway in mice,and exercise can inhibit iron accumulation and reverse the expression of ferroptosis-related proteins induced by PTSD,there-by alleviating PTSD-like behavior in mice.

Objective:To investigate plasma levels of fibrinopeptide A(FPA)and platelet alpha-granule membrane glycoprotein 140(GMP-140), and to analyze the changes of coagulation activity in elderly patients with primary microvascular angina(PMVA).Methods:In this prospective case-control study, a total of 45 elderly patients(aged 60-80 years, 27 males and 18 females)admitted to our hospital from Jan.2019 to Dec.2020 were diagnosed as PMVA(as microvascular angina group)by clinical symptoms, electrocardiogram, dynamic electrocardiogram and coronary angiography.Forty-three age-and sex-matched elderly subjects who took a medical check-up and had no primary microvascular angina were included as the control group.Plasma levels of FPA, GMP-140 and high-sensitivity C-reactive protein were determined.The levels of systolic blood pressure, diastolic blood pressure, platelet, fasting blood glucose, triglyceride, total cholesterol, high-density lipoprotein and low-density lipoprotein, uric acid, renal function and liver function were detected.Results:The FPA level was higher in the PMVA group than in the control group[(430.32±364.05)μg/L vs.(263.73± 118.29)μg/L, t=2.913, P<0.01]. There was no difference in GMP-140 level between the PMVA group and the control group[(5.78±3.92)μg/L vs.(6.95±1.91)μg/L, t=-1.790, P>0.05]. The high-sensitivity C-reactive protein level was higher in the PMVA group than in the control group[(3.33±5.70)mg/L vs.(0.81±0.86)mg/L, t=2.927, P<0.01]. Conclusions:Compared with the control group, the FPA level is significantly increased with elevated coagulation activity in patients with primary microvascular angina.The increased inflammatory state in the PMVA group might promote the occurrence and development of microvascular angina, but whether the inflammatory state promotes the enhancement of coagulation activity needs further study to confirm.

Objective:To analyze the knowledge graph of the papers published in the core journals of emergency medicine from 2015 to 2019, to present the overall situation of the research in the field of emergency medicine, to highlight the important contents in the research progress, and to unearth the research hotspots reported in the journals of emergency medicine.Methods:The relevant literatures of 7 core journals of emergency medicine were retrieved and exported from CNKI and Wanfang databases published in 2015-2019. A total of 7753 valid literatures were included. The visualization software CiteSpace was used to analyze the information of authors, institutions and keywords in the exported literatures to generate visual graphs.Results:By analyzing the knowledge graph from 2015 to 2019, it is found that Yu Xuezhong, Zhu Huadong, Zhang Jinsong, Zhang Mao, Liu Xinwei, Liu Yin, Xu Jun, and Nie Sinnan were the backbone of the author group in the field of emergency medicine. Emergency Department of Peking Union Medical College Hospital, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Emergency Department of PLA General Hospital, Emergency Medicine Department of Eastern Theater General Hospital, Emergency Department of Xijing Hospital, and Emergency Medicine Department of Shenyang Military Region General Hospital were the institutions with the most publications. In recent 5 years, the core journals of emergency medicine focused on the topics on mortality, acute lung injury, cardiac arrest, prognosis, mechanical ventilation, acute myocardial infarction and hemoperfusion.Conclusions:The visual graphs generated by CiteSpace helps to intuitively understand the critical path, development trend and frontier hot spots of the evolution of the research field of emergency medicine, and provides more basis for future related research.

Objective To study the clinical manifestations and antibiotic sensitivity features of early-and late-onset invasive infections caused by group B Streptococcus (GBS). Methods A total of 96 infants with invasive GBS infections were enrolled prospectively from seven tertiary hospitals of GBS Infection Research Cooperative Group in southwest Fujian, such as Xiamen Maternal and Child Care Hospital, etc., from January 2016 to June 2018. According to the onset time of infection after birth, they were divided into early-onset GBS disease (GBS-EOD) group (<7 d, n=67) and the late-onset GBS disease (GBS-LOD) group (7-89 d, n=29). Clinical manifestations, disease spectrum, complications and outcomes of the two groups were compared. Drug sensitivity test was carried out using disk diffusion test. Chi-square or Fisher's exact test, two independent sample t-test or Mann-Whitney U tests were used for statistical analysis. Results (1) The average ages at onset in GBS-EOD and GBS-LOD groups were (15.8±6.7) h (0.5-142.0 h) and (25.0±8.1) d (9-89 d), respectively. The incidence of tachypnea, pallor, fever and convulsion were noted in 68.7% (46/67) vs 44.8% (13/29), 52.2% (35/67) vs 17.2% (5/29), 23.9% (16/67) vs 65.5% (19/29) and 7.5% (5/67) vs 48.3% (14/29) of GBS-EOD and GBS-LOD groups with χ2 values of 6.282, 10.199, 15.146 and 21.237 (all P<0.05). The main clinical manifestations of GBS-EOD were tachypnea and pallor, while most of the patients in the GBS-LOD group developed fever and convulsions. (2) The incidence of pneumonia, sepsis, meningitis, sepsis complicated by septic joints, pneumonia complicated by sepsis, sepsis complicated by meningitis and pneumonia complicated by sepsis and meningitis were noted in 43.3% (29/67) vs 20.7% (6/29), 9.0% (6/67) vs 17.2% (5/29), 0.0% (0/67) vs 3.4% (1/29), 0.0% (0/67) vs 6.9% (2/29), 31.3% (21/67) vs 13.8% (4/29), 6.0% (4/67) vs 31.0% (9/29) and 10.4% (7/67) vs 6.9% (2/29) of GBS-EOD and GBS-LOD groups. There was a statistically significant difference in the disease spectrum between the two groups (Fisher's exact test, all P<0.001). Compared with the GBS-LOD group, the GBS-EOD group had a higher incidence of pneumonia [85.1% (57/67) vs 41.4% (12/29), χ2=19.116, P<0.001] and a lower incidence of meningitis [16.4% (11/67) vs 41.4% (12/29), χ2=6.922, P=0.009]. Complications such as acute respiratory distress syndrome (ARDS), pulmonary hemorrhage, shock and persistent pulmonary hypertension of the newborn (PPHN) occurred much more in the GBS-EOD group than the GBS-LOD group [28.4% (19/67) vs 6.9% (2/29), 13.4% (9/67) vs 0.0% (0/29), 11.9% (8/67) vs 10.3% (3/29), 4.5% (3/67) vs 0.0% (0/29), χ2=13.683, P<0.001]. (3) Among the 96 patients, 23 (24.0%) had meningitis and 73 (76.0%) developed pneumonia and sepsis. Meningitis resulted in a higher fatality rate [17.4% (4/23) vs 4.1% (3/73), χ2=4.564, P=0.035] and longer average hospital stay [(37.2±12.6) vs (14.1±5.3) d, t=7.831, P<0.001] than pneumonia and sepsis. Seven out of the 19 meningitis survivors developed intracranial complications. (4) The overall fatality rate in this study was 7.3% (7/96) and no significant difference was found between GBS-EOD and GBS-LOD group [7.5% (5/67) vs 6.9% (2/29), χ2=0.010, P=0.982]. Among the 67 GBS-EOD infants, 58 (86.6%) occurred within 24 h and five of them died, but no death was reported in the other nine cases occurred after 24 h. (5) Totally 96 strains of GBS were isolated with 100% sensitivity to penicillin, ampicillin, cefazolin and meropenem, and 97% to vancomycin. Around 79.3%-91.0% of GBS isolates were resistant to clindamycin and erythromycin. Conclusions Clinial features vary greatly in GBS-LOD and GBS-EOD cases. Infants with meningitis have poor prognosis. The drug resistance rate of GBS to erythromycin and clindamycin are relatively high.

Objective To evaluate the safety and efficacy of botulinum toxin type A for injection in the treatment of post-stroke upper limb spasticity (dosage was 200 U,or 240 U if combined with thumb spasticity).Methods The study was a multi-center,stratified block randomized,double-blind,placebocontrolled trial.All the qualificd subjects were from 15 clinical centers from September 2014 to February 2016.They were randomized (2∶1) to injections of botulinum toxin type A made in China (200-240 U;n =118) or placebo (n =60) in pivotal phase after informed consent signed.The study was divided into two stages.The pivotal trial phase included a one-week screening,12-week double-blind treatment,followed by an expanded phase which included six-week open-label treatment.The tone of the wrist,finger,thumb flexors was assessed at baseline and at weeks 0,1,4,6,8,12,16 and 18 using Modified Ashworth Scale (MAS),disability in activities of daily living was rated using the Disability Assessment Scale and impaction on pain,muscle tone and deformity was assessed using the Global Assessment Scale.The primary endpoint was the score difference between botulinum toxin type A and placebo groups in the tone of the wrist flexor using MAS at six weeks compared to baseline.Results Muscle tone MAS score in the wrist flexor of botulinum toxin type A and placebo groups at six weeks changed-1.00 (-2.00,-1.00) and 0.00 (-0.50,0.00) respectively from baseline.Botulinum toxin type A was significantly superior to placebo for the primary endpoint (Z =6.618,P ＜ 0.01).The safety measurement showed 10 subjects who received botulinum toxin type A had 13 adverse reactions,with an incidence of 8.47％ (10/118),and three subjects who received placebo had three adverse reactions,with an incidence of 5.00％ (3/60) during the pivotal trial phase.All adverse reactions were mild to moderate,none serious.There was no significant difference in adverse reactions incidence between the botulinum toxin type A and the placebo groups.During the expanded phase three subjects had four adverse reactions and the incidence was 1.95％.All adverse reactions were mild,none serious.Conclusion Botulinum toxin type A was found to be safe and efficacious for the treatment of post-stroke upper limb spasticity.Clinical Trial Registration:China Drug Trials,CTR20131191

Objective To investigate the effect of iodine-125 seed implantation in the treatment of unresectable pancreatic carcinoma.Methods A total of 26 pancreatic carcinoma patients were retrospectively analyzed.Patients undergoing palliative operation in combination with iodine-125 seed implantation.jundice recovery,objective tumor response,pain relieved,clinical benefit response,median survival time and complication were investigated.Results Half of cases with jundice has reduced and totally normal in 3 weeks.Abdominal pain was relieved in 94.7％ patients,average recovery duration was (5.0 ± 1.5) d.18 cases had gastroenterol function disorder (69.2％),gastroparesis in six cases (23％) and average recover time was (16 ± 5.1) d.24 of 26 cases were follow up study,median survival time was (12 ± 5.1) months,objective tumor response was smaller than preoperation in 9,no change in 10 and 5 cases became larger than before.Conclusions Palliative operation in combination with iodine-125 seed implantation is safe and effective in the treatment of unresectable pancreatic carcinoma.

ObjectiveTo discuss the treatment of complications post-pancreticoduedenectomy by reviewing the experiences from 62 cases.MethodsSixty-two cases of pancreticoduedenectomy from March 2001 to April 2011,mean age 59.3 ±4.1 years,were reviewed.All cases were divided into early group 24 cases and recent group (38 cases) by the difference in following aspects:perioperative management,the way of pancreatic bowel anastomosis and material choice,the vessels management,materials using in preventing leakage and bleeding.The differences in leakage,bleeding,infection,the stomach retention,biliary infections,liver abscess and incision infection in two groups were compared.ResultsThe early group showed pancreatic leakage in 10 cases,bleeding in 4 cases,celiac infection in 10 cases,gastric retention in 9 cases,biliary infections in 11 cases,liver abscess in 6 and infection of incision in 7 cases,respectively.Recent groups were in 4,0,0,0,1,2 and 3 cases,respectively.The comparisons showed the complications had reduced significantly in recent group than in the early group (x2 =77.08,P ＜ 0.001 ).ConclusionsMinimally invasive and high quality materials use,strengthening the perioperative management are the effective measures to reduce the postoperative complications.

Objective To investigate the effect of different etiology on the serum level of carbohydrate antigen 125 (CA125) in elderly patients with chronic congestive heart failure (CHF), and to assess any correlation of CA125 with serum level of B-type natriuretic peptide (BNP). Methods The 155 aged patients with New York Heart Association (NYHA) class Ⅲ or Ⅳ were enrolled and grouped into four reasons of hypertension, coronary heart disease (CHD), cardiomyopathy and other reasons, and 25 healthy old persons as control.CA125 and BNP levels were measured by automatic chemiluminescent immunoassay and enzyme immunoradiometric assay, respectively. Results CA125 level in patients with CHF was (83.4±6.6)U/L for hypertension, (36.8±1.4)U/L for CHD, (38.1±1.6)U/L for cardiomyopathy and (38.4±1.4)U/L for other reasons, which significantly higher than for healthy controls [(14.3±1.15) U/L, P＜0.05].Especially, CA125 level in hypertension group was notable higher than in other reasons of group (P＜0.05), and was positively related to BNP level (r=0.67,P＜0.05). Conclusions Serum CA125 level is a predictor for clinical pathogen of CHF.Therefore, it may be a useful additional marker for the evaluation of clinical treatment of these patients

Objective To study the complications after laparoscopic bile duct exploration.MethodsTwo approaches for bile duct exploration were used in 105 patients: (1) laparoscopic transcystic common bile duct exploration (LTCBDE) was used for patients with gallstones with choledocholithiasis and cystic duct dilation. No T tube was used for drainage, (2) Laparoscopic common bile duct exploration (LCBDE) was used for patients with gallstones with choledocholithiasis but without cystic duct dilation. The common bile duct was sutured primarily without T tube drainage in those patients with a small number of stones. T tube drainage was used in those patients with many stones or severe edema at the lower end of the common bile duct. ResultsWe carried out LTCBDE+ LC in 70 patients and LCBDE+LC in 35 patients, 14 patients had T tube drainage and 21 patients had no T tubes in the latter group of patients. Postoperatively, there were ascites in 17 patients (LTCBDE 6 and LCBDE 11 ), biliary peritonitis in 5 patients (1 LTCBDE and 4 LCBDE), abdominal pain in 13 patients (LTCBDE 4 and LCBDE 9), and fever in 11 patients (LTCBD 3 and LCBDE 8). All the complications responded to conservative treatment. 14 patients in the LCBDE group had residual stones.Choledochoscopy was used to remove the residual stones.There was no pancreatitis. Conclusions Adequate preoperative workup, good clinical judgment and precise treatment skill help to reduce complication rates after operation for gallstones with choledocholithiasis.

Objective To study the morphological changes of the cyctic duct in bile duct stones secondary to choledocholithiasis.Methods The results of imaging examinations before cholecystectomy and biliary exploration with laparoscopy and cholechodoscopy were respectively analyzed in 108 patients.Meanwhile, the cystic duct morphology, diameter and dilatation during the operation were determined to investigate the features of changes in its morphology.Results Gallstones were confirmed in all of the 108 cases by B-model ultrasonography preoperatively.The gallstone was positive in common bile duct in 76 cases.Common bile duct dilatation was seen in 75 cases and cystic duct dilatation in 21.Common bile duct dilatation was found in 81 cases by MRCP and in 45 by CT.Cystic duct dilatation was found in 36 cases by MRCP and in 19 by CT.Cystic duct variety was found in 9 cases by MRCP.Laparoscopic transcyctic common bile duct exploration(LTCBDE)was performed in those patients with short and wide cystic duct.Conclusion MRCP is the effective method for considering the outlooks of the cystic duct in bile duct stones secondary to choledocholithiasis.