Objective:To discuss the effect of fluid resuscitation on the occurrence of ferroptosis in vascular tissue and the structure of vascular cells in the rats with blast injury complicated with hemorrhagic shock,and to clarify its mechanism.Methods:A total of 54 healthy adult SD rats were randomly divided into normal group,blast injury complicated with hemorrhagic shock(model)group,and the fluid resuscitation(treatment)group,and there were 18 rats in each group.Among them,10 rats were randomly selected to observe the surival status and another 8 rats were selected to detect the other indexes.The average survival time(ST),24 h and 72 h survival rates of the rats in various groups were observed;the blood pressure(BP),heart rate(HR),and respiratory rate(RR)of the rats in various groups were observed;the levels of serum creatinine(Scr),blood urea nitrogen(BUN),lactate(LAC),glucose(GLU),iron ions,glutathione(GSH),and malondialdehyde(MDA)and the activities of aspartate aminotransferase(AST),alanine aminotransferase(ALT)and lactate dehydrogenase(LDH)in serum of the rats in various groups were detected;Western blotting method was used to detect the expression levels of ferroptosis marker proteins glutathione peroxidase 4(GPX4),solute carrier family 7 member 11(SLC7A11),and heme oxygenase 1(HO-1)proteins in superior mesenteric artery tissue of the rats in various groups;the pathomorphology of the superior mesenteric artery of the rats in various groups was observed.Results:All the rats in normal group survived for 72 h,while the longest ST of the rats in model group did not exceed 9 h.Compared with model group,the ST and 24 h survival rate(SR)of the rats in treatment group were significantly increased(P＜0.05).Compared with normal group,the BP,HR,and RR of the rats in model group were significantly decreased(P＜0.01).Compared with model group,the BP,HR,and RR of the rats in treatment group were significantly increased after fluid resuscitation(P＜0.05).Compared with normal group,the activities of AST and ALT,and the levels of Scr and BUN in serum of the rats in model group were significantly increased(P＜0.01).Compared with model group,the serum levels of LAC and GLU of the rats in treatment group were significantly decreased(P＜0.01).Compared with normal group,the concentration of iron ion,GSH level,MDA level,LDH activity in serum of the rats in model group were significantly increased(P＜0.05);compared with model group,the concentration of iron ion and LDH activity in serum of the rats in treatment group was significantly decreased(P＜0.01).Compared with normal group,the expression levels of GPX4 and SLC7A11 in superior mesenteric artery tissue of the rats in model group were significantly decreased(P＜0.05);compared with model group,the expression levels of GPX4 and SLC7A11 in superior mesenteric artery tissue of the rats in treatment group were significantly increased(P＜0.05).Compared with normal group,the expression level of HO-1 protein in superior mesenteric artery tissue of the rats in model group was increased(P＜0.01);compared with model group,the expression level of HO-1 protein in superior mesenteric artery tissue of the rats in treatment group was increased(P＜0.01).The microscopic pathology results showed that the cell arrangement in the layers of the superior mesenteric artery tissue of the rats in model group was disordered,the swelling was significant and the thickness was increased;the pathological changes in superior mesenteric artery tissue of the rats in treatment group was alleviated.The ultramicroscopic pathology results showed that the endothelial cell structure of blood vessels of the rats in normal group was intact,and there was no swelling in the subendothelial matrix;the vascular endothelial cell membrane of the rats in model group was damaged,there were cytoplasmic dissolution and fragmentation,and the swelling of the subendothelial matrix was significant;the swelling of the vascular endothelial cells in treatment group was alleviated.Conclusion:Ferroptosis occurs in vascular tissue of the rats with blast injury complicated with hemorrhagic shock,and fluid resuscitation can alleviate the structural damage of the vascular cells by inhibiting the vascular tissue ferroptosis.

Objective:To analyze the clinical features of patients with invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS). Methods:The clinical data of 12 patients diagnosed as IKLAS in Zhuzhou Central Hospital from January 2020 to January 2023 were retrospectively analyzed.Results:Among 12 patients there were 6 males and 6 females with an mean age of 65.3±12.2 years (49-90). Nine patients were complicated with type 2 diabetes. The main clinical manifestations were fever ( n=9), chill ( n=6), shiver ( n=4), nausea and vomiting ( n=2), upper abdominal pain ( n=2), fatigue and anepithymia ( n=2), cough and expectoration ( n=1), disturbance of consciousness ( n=1) and hemoptysis ( n=1). The leukocyte count was increased in 8 cases, lymphocyte count decreased in 10 cases, and platelets count decreased in 3 cases. C-reactive protein and procalcitonin levels were elevated, while serum albumin levels were lowered in all patients. The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased in 7 cases each. Liver abscess was located in the right lobe in 8 cases, in the left lobe in 1 cases, and in both lobes in 3 cases. There were 7 patients with single abscess, and 5 patients with multiple abscesses. The etiology was confirmed by liver pus culture ( n=10) and blood culture ( n=5), respectively. The main sites of invasion were lung and blood stream ( n=10 and n=5, respectively). The majority of Klebsiella pneumoniae isolates were antibiotic sensitive strains and the overall drug resistance rate was relatively low. All patients were given antibiotics, and 10 of them also received liver abscess puncture drainage. After treatment, 11 patients were discharged, and 1 died of septic shock. Conclusions:Patients with IKLAS exhibit diverse clinical symptoms, most patients are complicated with diabetes, and the main sites of invasion are in the lungs and blood stream. Timely diagnosis, active screening of extrahepatic infection sites, effective drainage of abscess and appropriate antibiotic treatment can improve the survival of patients.

Objective To compare 6 sub-function scale differences of frontal lobe function rating scale or a Frontal Assessment Battery(FAB)among patients with two subtypes of vascular cognitive impairment(VCI) to provide clues for the distinctive intervention and disease prevention and control of patients with two subtypes.Methods Totally 220 non-dementia vascular cognitive impairment (NDVCI)patients and 68 patients with vascular dementia(VaD)with final diagnosis were selected.The overall function and six sub-function scores were tested by FAB.Analyzing the score difference and probing a progress tendency from NDVCI to VaD were performed.Results The scores of frontal lobe function rating scale were higher in NDVCI(14.0 ± 2.8)than in VaD (9.5±2.0) patients with significant difference(t =29.92,P =0.00).The scales of frontal lobe function rating score of conceptualization ability (t =6.24,P =0.00),intelligence flexibility (t =7.00,P =0.00),antiinterference ability(t =7.21,P =0.00) and attention suppression(t =5.32,P =0.00) were lower in VaD group than in NDVCI group.The conceptualization weight capacity was significantly lower in VaD group than in NDVCI group(0.04 versus 0.32).Conclusions During a transitive process from NDVCI to VaD,it is important to focus on the mutation and deterioration of conceptualization capacity.

Nutrition and food hygiene is a specialized main course of preventive medicine, which is of great significance to promoting the all-round development of students. In the teaching practice, we improve the teaching quality of nutrition and food hygiene by strengthening the quality education of the teachers to improve their professional quality, carrying out theoretical and experimental teaching mode reform, such as carrying out its special form and reorganizing the teaching content, some chapters of the course selection of PBL teaching, optimizing experiment content, increasing the design of experiments, and at the same time changing the traditional assessment methods.

Objective To determine the accuracy of renal blood flow assessment by transesophageal echocardiography (TEE) during carbon dioxide (CO2) pneumoperitoneum.Methods The left renal arterial diameter (RAD) and the Doppler velocity time integral (VTI) were measured by TEE before peumoperitoneum (T0, baseline), at 1, 5, 10, 15, 20 and 30 min of pneumoperitoneum and 1 and 5 min after deflation in 35 patients undergoing elective laparoscopic cholecystectomy. The left renal blood flow (LRBF) and the left renal blood perfusion resistance (LRPR) were calculated according to the following formulae: LRBF = 1/4π x RAD2 x VTI x HR, LRPR = MAP/LRBF.Three months later, the TEE images of 10 cases were randomly selected and reviewed by the same and another research team member to check the repeatability and consistency of the LRBF determination during operation, respectively. The quality of the TEE images was evaluated by another specialist.Results Before pneumoperitoneum, 94% of the TEE images were rated as satisfactory. There was no significant difference between the qualities of the TEE images obtained before and during pneumoperitoneum. The variabilities between the RADs measured by TEE during and 3 months after operation were 9.28% by the same team member and 8.71% by another team member. The variabilities between the VTIs measured by TEE during and 3 months after operation were 5.61% by the same team member and 6.25% by another team member. The linear regression analysis of the LRBF showed that the slope and the intercept were 1.05 and 31.4 ml/min respectively by the same member and 0.92 and 47.3 ml/min respectively by another member. The LRBF was decreased during pneumoperitoneum and the LRPR was increased.Conclusion TEE can be used to accurately monitor the changes in renal blood flow during CO2 pneumoperitoneum.

Objective To investigate the changes in renal blood flow during laparoscopic cholecystectomy.Methods Thirty-two ASA Ⅰ patients (10 male, 22 female) aged 18-64 yr, weighing 45-81 kg undergoing laparoscopic cholecystectomy were included in this study. Anesthesia was induced with midazolam, fentanyl,propofol and vecuronium and maintained with isoflurane inhalation, continuous infusion of propofol and remifentanil and intermittent iv boluses of vecuronium. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 30-40 mm Hg. The probe of transesophageal echocardiography (TEE) was inserted into esophagus after tracheal intubation. The internal diameter and blood flow velocity and time integral of left renal artery and descending aorta were measured by TEE before (baseline) and at 1, 5, 10, 15, 20 and 30 min of pneumoperitoneum and 1 and 5 min after deflation. The blood flow of left renal artery (LRAF) and decending aorta (DAF) were calculated. The maximal decrease in LRAF and DAF and LRAF/DAF were analyzed. Results LRAF and DAF decreased significantly during pneumoperitoneum compared to the baseline and recovered after deflation. LRAF and DAF decreased maximally by 40% (95% confidence interval (95% CI) 31%-49% ) and 38% (95% CI 31%-44% ) at 8.9 min (95% CI 5.5-12.4 min) and 6.7 min (95% CI 4.0-9.5 min) of pneumoperitoneum respectively. There was no significant change in LRAF/DAF ratio during pneumoperitoneum. Conclusion The renal blood flow decreases at 1-30 min of pneumoperitoneum with the maximum degree of decrease about 40% at about 9 min of pneumoperitoneum and the reason is related to the decrease in the cardiac output.