Objective To investigate the impact of quercetin(Que)on postherpetic neuralgia(PHN)and chemokine ligand 3(CCL3,namely MIP-1α)/C-C chemokine receptor 1(CCR1)/C-C chemokine receptor 5(CCR5)signaling pathway in rats.Methods Sixty rats were divided into the control group(Con),the PHN group(model group),the L-Que(30 mg/kg)group,the M-Que(60 mg/kg)group,the H-Que(120 mg/kg)group and the H-Que+pathway activator MIP-1α(120 mg/kg Que+0.4 mg/kg recombinant MIP-1α)group.The mechanical paw withdrawal threshold(PWT)and thermal pain threshold(TWL)of rats were detected in each group.The kit was used to detect adenosine,Adenine ribonucleotide(AMP),adenosine diphosphate(ADP)and tumor necrosis factor in spinal dorsal horn samples-α(TNF-α),and interleukin-1 β(IL-1 β)levels in spinal dorsal horn samples.HE staining was applied to observe the pathological sections of spinal dorsal horn.Immunofluorescence staining was used to detect the activation of microglia in spinal dorsal horn.Western blot assay was applied to detect MIP-1α/CCR1/CCR5 signaling pathway protein expression.Results In the PHN group,the dorsal horn of the spinal cord was ruptured,the arrangement of nerve bundles was disordered,and inflammatory cell infiltration,edema,and slight atrophy of neurons appeared.Compared with the Con group,the PWT value,adenosine,AMP and ADP levels were obviously decreased in the PHN group(P＜0.05),and TWL value,TNF-α,IL-1β levels,the number of Iba1-positive microglia,MIP-1α,CCR1 and CCR5 protein levels were obviously increased(P＜0.05).After treatment with Que,the disordered arrangement of nerve bundles was improved,the infiltration of inflammatory cells was reduced,and the phenomenon of neuronal atrophy disappeared.Compared with the PHN group,the PWT value,adenosine,AMP and ADP levels were obviously increased in the L-Que group,the M-Que group and the H-Que group(P＜0.05).TWL value,TNF-αand IL-1β levels,the number of Iba1-positive microglia,and MIP-1α,CCR1 and CCR5 protein levels were obviously decreased(P＜0.05).The effect of Que was dose dependent.Compared with the H-Que group,PWT value,adenosine,AMP and ADP levels were obviously decreased in the H-Que+MIP-1α group(P＜0.05),and TWL value,TNF-α,IL-1β levels,the number of Iba1 positive microglia,MIP-1α,CCR1 and CCR5 protein levels were obviously increased(P＜0.05).Conclusion Que may reduce the inflammatory response in rats by inhibiting the MIP-1α/CCR1/CCR5 signaling pathway,thereby reducing PHN.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To explore the effectiveness of deep learning image reconstruction (DLIR) algorithm compared to adaptive statistical iterative reconstruction (ASIR-V) algorithm in improving the quality of low-dose brain CT images.Methods:Retrospective inclusion of patients who underwent brain CT examination in the People's Liberation Army General Hospital from November 2021 to August 2022. Four different algorithms were used to reconstruct low-dose CT scans of all patients to obtain 30% intensity ASIR-V (ASIR-V-30%) images, low intensity DLIR (DLIR-L) images, medium intensity DLIR (DLIR-M) images, and high intensity DLIR (DLIR-H) images. The regions of interest were selected from four sets of images, including superficial white matter, superficial gray matter, deep white matter, and deep gray matter, and their CT values and standard deviations were measured for calculating signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).Subjective evaluation of image quality was conducted by three neuroimaging physicians based on the Likert 5-component scale. The objective and subjective scores of the 4 groups of images were analyzed using ANOVA or Kruskal Wallis. If there are overall differences, pairwise comparisons were conducted within the group.Results:A total of 109 patients were enrolled, including 104 males and 5 females, aged 65-110 years (89.16 ± 9.53) years. The radiation exposure of brain CT low-dose scanning was (0.93 ± 0.01)mSv, significantly lower than that of conventional scanning (2.92 ± 0.01) mSv ( t = 56.15, P < 0.05). The differences in objective image quality analysis of ASIR-V-30%, DLIR-L, DLIR-M, and DLIR-H images of low-dose CT in SNR deep gray matter, SNR deep white matter, SNR superficial gray matter, SNR superficial white matter, CNR deep gray white matter, and CNR superficial gray white matter were statistically significant( F =98.23, 72.95, 68.43, 58.24, 241.13, 289.91, P < 0.05). Among them, DLIR-H images had the lowest noise in deep gray matter, deep white matter, superficial gray matter, and superficial white matter, and had statistically significant differences compared to other image groups ( t = 167.43, 275.46, 182.32, 361.54, P < 0.05). The subjective score of DLIR-H image quality was superior to ASIR-V-30%, DLIR-L, and DLIR-M, with the statistically significant difference ( t = 7.25, 8.32, 9.63, P < 0.05). Conclusions:Compared with ASIR-V, DLIR algorithm can effectively reduce image noise and artifacts in low-dose brain CT, and improve SNR and CNR. The subjective and objective image quality evaluation of DLIR-H is the best.

Objective:To analyze the effect of inhibiting excessive mitochondrial fission mediated by dynamic related protein 1 (Drp1) on the function of injured cells and mitochondria in the septic myocardium, and to explore the protective effect of maintaining mitochondrial dynamic balance in the pathogenesis of sepsis induced cardiomyopathy(SIC).Methods:Rat H9C2 cardiomyocytes were cultured and stimulated with lipopolysaccharide (LPS) to establish a model of SIC. Mitochondrial division inhibitor 1 (Mdivi-1) was given 30 min before LPS stimulation. They were divided into the control group, LPS stimulated group (LPS), Mdivi-1 control group (Mdivi-1), and LPS+Mdivi-1 intervention group (LPS+Mdivi-1). CCK-8 was used to detect the cell viability, and lactate dehydrogenase (LDH) was used to detect cellular damage. A MitoTracker probe was used to observe mitochondrial morphology by laser scanning confocal microscopy, JC-1 staining was used to detect mitochondrial membrane potential level, a DCFH-DA probe was used to detect total ROS level, and an AnnexinV-FITC/PI probe was used to detect the cell apoptosis ratio. The expression levels of mitochondrial fission protein Drp1 and fusion proteins Optic Atrophy 1(Opa1) and Mitofusin2 (Mfn2) were detected by real-time PCR and Western blot. One-way ANOVA was used to compare the differences between groups, and the LSD- t test was used for pairwise comparisons between groups. Results:Compared with the control group, cell viability, the average length of mitochondria and the mitochondrial membrane potential were decreased, and ROS production, the cell apoptosis rate and LDH were increased in the LPS group (all P<0.05). After Mdivi-1 intervention, compared with the LPS-stimulated group, the cell viability was increased, myocardial cell damage was reduced, the average length of mitochondria was prolonged, mitochondrial dysfunction was alleviated, and the cell apoptosis rate was inhibited in the LPS+Mdivi-1 group (all P<0.05). Conclusions:Mdivi-1 might inhibit mitochondrial fission mediated by Drp1, maintain mitochondrial dynamic balance, alleviate mitochondrial dysfunction and protect myocardial cells from LPS-induced injury.

Objective: To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants. Methods: The general clinical data of preterm infants with gestational age 24-36^{+ 6} weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed. Results: The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ²=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ²=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ²=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis. Conclusions HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.

Objective To investigate the effects of Wuzhi capsules on tacrolimus concentration in heart transplant recipients and provide evidence for individualized dose optimization of tacrolimus.Methods Forty heart transplant recipients receiving Wuzhi capsules were enrolled in this study.Tacrolimus trough concentration was compared before and after coadminstration of Wuzhicapsules.Furthermore,polymorphisms of CYP3A4 * 1G and CYP3A5 * 3 were also detected to clarify correlations between genotypes and effects of Wuzhi capsule.Results Dose-normalized concentration of tacrolimus after coadministartion with Wuzhi capsules was 2.02-fold higher than before,the results of which was not associated with CYP3A4 * 1G and CYP3A5 * 3 genotypes.Wuzhi capsule could significantly decrease the total bilimbin (T-BiL),but not other hepatic and renal function.Conclusion Dose-normalized concentration of tacrolimus in heart transplant recipients is remarkably increased by Wuzhi capsule.The elevated trough levels rarely result in hepatic and renal toxicity.Wuzhi capsule is a safe,effective,and stable drug to increase the trough concentration of tacrolimus.

Objective To identify the expression of PTPRD in esophageal squamous cell carcinoma (ESCC)and analyze its correlation with pathological features and patient survival.Methods Immunohistochemistry analysis was applied to detect the expression level and location of PTPRD in 236 patients with ESCC.Clinical and pathological features were collected and a 5 years’follow-up after surgery were performed.Results Statistic analysis showed that expression of PTPRD in ESCC was lower than in normal esophageal epithelial cells (22.0% vs 57.2%,P =0.000).The expression of PTPRD was correla-ted to the differentiation grade,depth of tumor invasion and lymph nodes metastasis.The expression of PTPRD was higher in group with well differentiation,less invasion depth and no lymph node metastasis (P =0.013,0.025,0.019).The expres-sion of PTPRD was not correlated to age or gender (P =0.170,0.787).The survival analysis showed that thegroup with more PTPRD expression had better prognosis.Conclusion PTPRD was correlated to progression and prognosis of ESCC.It may be a new potential tumor suppressor gene of ESCC,and its expression level might may a useful marker for predicting prognosis for ESCC patients.

OBJECTIVETo observe clinical efficacy of using free anterolateral thigh flaps with iliotibial tracts in repairing skin and soft tissue defects around the knee joints with patellar ligament defects.

METHODSTwelve patients with skin and soft tissue defects around the knee joints and patellar ligament defects were hospitalized from June 2010 to June 2014. The defects of skin and soft tissue ranged from 7 cm × 6 cm to 16 cm × 12 cm in area, and patellar ligament ranged from 5 to 12 cm in length and 2.5 to 4.0 cm in width. Free anterolateral thigh flaps with iliotibial tracts were used to repair these defects. During reconstruction of patellar ligament, both ends of iliotibial tract were successively folded to form tendon-like three-layer structure at first, and then the newly formed structure was wrapped around the broken ends of patellar ligament and fixed with suture. The flap size ranged from 9 cm × 8 cm to 18 cm × 14 cm. The iliotibial tract ranged from 7 to 14 cm in length and 8 to 12 cm in width. The donor sites were closed by grafting with autologous split-thickness skin harvested from thigh or trunk, and parked with gauze. Immediately after operation, the knee joints were fixed in extension with orthosis for 6 weeks. Weight bearing training of affected limbs being kept in extension position was started from 2 weeks after operation, and flexion and extension exercise of affected knee joints was begun from 6 weeks after operation. Before operation and 12 months after operation, the degree of pain around the knee joints and knee joint function were evaluated with the international knee documentation committee knee uation form, and the ranges of flexion and extension of knee joints were also evaluated. The integrity of reconstructed patellar ligament was assessed by color Doppler ultrasound from 6 to 12 months after operation. The occurrence of surgery-related complications was observed in all patients within 12 months after operation.

RESULTS(1) After operation, all flaps survived well, and all wounds healed well. (2) The average score of pain around the knee joint was increased from 31 points before operation to 77 points in 12 months after operation. The average score of knee joint function was increased from 14 points before operation to 65 points in 12 months after operation. Before operation, the average ranges of flexion and extension of knee joint were respectively 89° and 65°, and they were respectively increased to 130° and decreased to 15° in 12 months after operation. From 6 to 12 months after operation, color Doppler ultrasound showed that the condition of reconstructive patellar ligaments in all patients was good without the need for further surgical intervention; the superficial sensation of the flaps was recovered in different degrees. No surgery-related complication was observed in all patients within 12 months after operation.

CONCLUSIONSFree grafting of anterolateral thigh flap with iliotibial tract is an effective and reliable method for repairing skin and soft tissue defects around the knee joints combined with patellar ligament defects, and the surgical procedure can recover function and appearance of knee joint satisfactorily.

Extremities ; Fascia Lata ; Humans ; Knee ; Knee Joint ; Patellar Ligament ; surgery ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; Surgical Flaps ; Thigh ; Wound Healing

Objective To explore the curative effect of the microsurgical excision and spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty for the treatment of spinal canal schwannoma.Methods The clinical data of 18 patients with spinal schwannomas,admitted to our hospital from September 2011 to June 2014,were analyzed retrospectively.All these 18 patients were treated by microsurgical excision and spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty,and were followed up for 3-18 months (mean:10 months).After the surgery,vertebral canal MRI was adopted to evaluate the tumor,and CT three-dimensional reconstruction or X-ray of the spine was used for assessing the vertebral canal formation,and Frankel grading standard was employed to evaluate the recovery of spinal cord function.Results All tumors in 18 patients were excised with the help of a microscope,and no endorachis and nerve roots were damaged during the surgery.After the surgery,the patients showed significantly improved symptoms and signs without the leakage of cerebrospinal fluid,infection of incisional wound,tumor recurrence,spinal stenosis and spinal instability.At 3 months after the surgery,Frankel grading standard was adopted to assess the recovery of the spinal cord function,and the results showed grade D in 4 patients and grade E in 14 patients.Conclusion Microsurgical excision and spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty is an effective way in treating spinal canal schwannoma as it can completely expose the tumor,maximize the excision extension and decrease the spinal cord injury;meanwhile,the spinal canal is formed well and the spine is stable after the surgery.

Objective To study the correlation between the levels of IP-10 mRNA in peripheral blood mononuclear cells (PBMCs) and prognosis of acute-on-chronic hepatitis B virus related liver failure (HBV-ACLF).Methods Fifty patients diagnosed with HBV-ACLF were administered a combined modality therapy and followed up until death or for 3 months.In addition,20 patients with chronic hepatitis B(CHB),20 patients with hepatitis B related cirrhosis and 20 healthy volunteers were matched for use as control.The levels of IP-10 mRNA in PBMCs were detected at baseline and last follow-up visit and compared between groups by statistical analysis.Results At baseline,the CHB group had a significantly higher level of IP-10 mRNA in PBNCs than the healthy control group(t =-6.972,P ＜0.01).However,the level of IP-10 mRNA in PBMCs of the liver failure group was significantly higher than that of boththe CHB group(t =2.510,P ＜ 0.05) and the healthy control group (t =8.648,P ＜ 0.01).When patients within the liver failure group were divided by survival and death occurring during the 3-month follow-up period,the patients who died were found to have a significantly higher level of IP-10 mRNA in PBMCs than the surviving patients(P ＜ 0.01).The area under the curve of ROC curve is 0.81,and cut off value is 0.9255.Conclusion The level of IP-10 mRNA in PBMCs is positively correlated with risk of death in patients with HBV-ACLF,and its detecting might predict the prognosis of HBV-ACLF.