Objective:To investigate the relationship between ankle stability and associated muscle load around the ankle and the effect of a parachute ankle brace (PAB) on ankle inversion and associated muscle load around the ankle during landing through the simulated paratrooper semi-squat landing field experiment.Methods:In August 2021, 37 male paratroopers were randomly selected as the study objects to perform parachute landing training in the semi-squat posture on the 1.5 m and 2.0 m jump platforms with or without PAB, respectively. The coronal plane tilt angle of ankle joint and the percentage of maximum voluntary contraction (MVC%) of associated muscles around ankle joint during the process were measured and correlation analysis was conducted. And the effect of wearing PAB on the coronal plane tilt angle of ankle joint and the associated muscles around the ankle joint was analyzed.Results:During the semi-squat landing, the MVC% of the tibialis anterior muscle, lateral gastrocnemius muscle and peroneus longus muscle were positively correlated with the ankle coronal plane tilt angle in paratroopers wearing and without wearing PAB, and the correlations were statistically significant ( P<0.05). At the same height, compared with those without PAB, the coronal plane tilt angle of the ankle joint decreased during semi-squat landing in paratroopers PAB, and the differences were statistically significant ( P<0.05). At the landing moment of the same height, compared with those without PAB, the MVC% of lateral gastrocnemius muscle decreased and the MVC% of peroneus longus muscle increased in paratroopers wearing PAB, and the differences were statistically significant ( P<0.05). After the landing moment until the standing stage (100-200 ms) at 1.5 m height, the MVC% of the tibialis anterior muscle decreased in paratroopers wearing PAB compared with those without PAB, and the differences were statistically significant ( P<0.05). In the post-standing stage (200 ms) at 2.0 m height, the MVC% of the tibialis anterior muscle decreased in paratroopers wearing PAB compared with those without PAB, and the difference was statistically significant ( P<0.05) . Conclusion:Wearing PAB can reduce the ankle coronal plane tilt angle, improve ankle stability, reduce the muscle load of the lateral gastrocnemius muscle at the moment of landing, and reduce the load of the tibialis anterior muscle after landing, but increase the peroneus longus muscle load at the moment of landing.

Objective:To investigate the relationship between ankle stability and associated muscle load around the ankle and the effect of a parachute ankle brace (PAB) on ankle inversion and associated muscle load around the ankle during landing through the simulated paratrooper semi-squat landing field experiment.Methods:In August 2021, 37 male paratroopers were randomly selected as the study objects to perform parachute landing training in the semi-squat posture on the 1.5 m and 2.0 m jump platforms with or without PAB, respectively. The coronal plane tilt angle of ankle joint and the percentage of maximum voluntary contraction (MVC%) of associated muscles around ankle joint during the process were measured and correlation analysis was conducted. And the effect of wearing PAB on the coronal plane tilt angle of ankle joint and the associated muscles around the ankle joint was analyzed.Results:During the semi-squat landing, the MVC% of the tibialis anterior muscle, lateral gastrocnemius muscle and peroneus longus muscle were positively correlated with the ankle coronal plane tilt angle in paratroopers wearing and without wearing PAB, and the correlations were statistically significant ( P<0.05). At the same height, compared with those without PAB, the coronal plane tilt angle of the ankle joint decreased during semi-squat landing in paratroopers PAB, and the differences were statistically significant ( P<0.05). At the landing moment of the same height, compared with those without PAB, the MVC% of lateral gastrocnemius muscle decreased and the MVC% of peroneus longus muscle increased in paratroopers wearing PAB, and the differences were statistically significant ( P<0.05). After the landing moment until the standing stage (100-200 ms) at 1.5 m height, the MVC% of the tibialis anterior muscle decreased in paratroopers wearing PAB compared with those without PAB, and the differences were statistically significant ( P<0.05). In the post-standing stage (200 ms) at 2.0 m height, the MVC% of the tibialis anterior muscle decreased in paratroopers wearing PAB compared with those without PAB, and the difference was statistically significant ( P<0.05) . Conclusion:Wearing PAB can reduce the ankle coronal plane tilt angle, improve ankle stability, reduce the muscle load of the lateral gastrocnemius muscle at the moment of landing, and reduce the load of the tibialis anterior muscle after landing, but increase the peroneus longus muscle load at the moment of landing.

Objective To establish a stable mouse model of chronic myocardial ischemia in coronary artery disease and preliminarily elucidate the electrophysiological mechanisms of T-wave flattening under ischemic conditions.Methods APOE-/-mice were randomly divided into a model group and a lipid-lowering drug(LLD)group and subjected to a high-fat diet for 3 months.C57BL/6J mice fed a normal diet were used as the control group.Electrocardiograms were used to assess the mice before and after modeling,and cardiac perfusion was evaluated via nuclear PET/CT scans.Hematoxylin-eosin and oil red O staining were employed to assess pathological atherosclerosis(AS)plaque formation.Mouse myocardial cells were isolated,and action potentials were recorded.Results After modeling,mice in the model group exhibited a significant increase in cholesterol(CHO)and low-density lipoprotein C(LDL-C),along with the appearance of lipid plaques in the aorta.Lesions in the LLD group were noticeably reduced,and no plaques formed in the control group.Myocardial nuclear scans revealed impaired blood perfusion in the hearts of the model group mice that was significantly lower than that in the LLD and control groups.The electrocardiograms indicated a significant reduction in T/QRS in both the model and LLD groups,with no significant changes observed in the control group.Myocardial cell action potential recordings revealed an accelerated repolarization rate in the inner-layer myocardial cells under ischemia,and a reduction in the inner-to-outer potential difference was identified as the primary electrophysiological mechanism underlying T-wave flattening.Conclusions APOE-/-mice can be used to establish a model of chronic myocardial ischemia.The increased repolarization rate of inner-layer myocardial cells is likely to be the main cause of T-wave flattening in electrocardiograms under ischemic conditions.

Hepatic artery reconstruction is one of the key procedures in liver transplantation. Accidental dissection of the hepatic artery to be reconstructed caused by donor and recipient factors or surgical factors will disrupt the surgical plan, increase the difficulty of arterial reconstruction, significantly prolong the operation time, increase the risk of postoperative arterial stenosis and thrombosis and probably lead to acute allograft failure, which requires emergency surgical interventions or even secondary liver transplantation. Understanding of how to avoid dissection of the artery to be anastomosed during liver transplantation and corresponding treatment will contribute to preventing the incidence of artery-related complications during liver transplantation and improving clinical prognosis of liver transplant recipients. In this article, the causes, prevention and treatment of hepatic artery dissection and hepatic artery reconstruction in donors and recipients during liver transplantation were illustrated.

ObjectiveTo reveal the effect of Wenxin prescription on mitochondrial energy metabolism and silent information regulator 1 （SIRT1）/peroxisome proliferator-activated receptor-γ coactivator-1α （PGC-1α）/recombinant estrogen-related receptor α （ERRα） signaling pathway in rats with myocardial ischemia-reperfusion injury. MethodTotally 90 male Wistar rats of SPF grade were randomly assigned into a sham operation group， a model group， and low-， medium-， and high-dose Wenxin prescription groups， with 18 rats in each group. The rats in low-， medium-， and high-dose Wenxin prescription groups were administrated with 0.99， 1.98， and 3.96 g·kg^-1 granules by gavage， respectively， and those in the sham operation group and model group with the same amount of normal saline. Twenty-one days after pre-administration， the rat model of myocardial ischemia-reperfusion injury was established by ligation of the left anterior descending coronary artery for 30 min and reperfusion for 2 h， and the rats in the sham operation group were only threaded without ligation. Myocardial infarction area was observed through 2，3，5-triphenyl-2h-tetrazolium chloride （TTC） staining， and the myocardial histopathology through hematoxylin-eosin （HE） staining. The levels of creatine kinase-MB （CK-MB） and lactate dehydrogenase （LDH） in serum， cytochrome C oxidase （CCO） and succinate dehydrogenase （SDH） in mitochondrion， and ATP in myocardial tissue were detected according to kit instructions. The mRNA and protein levels of SIRT1， PGC-1α， ERRα， and mitochondrial transcription factor A （TFAM） in myocardial tissue were determined by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot， respectively. ResultCompared with the sham operation group， the model group showed broken and disordered myocardial fibers， cytoplasmic edema， and pyknosis and deviation of nuclei. Moreover， the modeling increased the levels of CK-MB and LDH （P<0.05， P<0.01）， lowered the levels of ATP， CCO， and SDH （P<0.05， P<0.01）， and down-regulated the mRNA and protein levels of SIRT1， PGC-1α， ERRα， and TFAM in myocardial tissue （P<0.05， P<0.01）. Compared with the model group， Wenxin prescription reduced the myocardial infarction area （especially in the high-dose group， P<0.01）， restored the pathological changes， lowered the levels of CK-MB and LDH （P<0.05， P<0.01）， increased the levels of ATP， CCO， and SDH （especially in the high-dose group， P<0.01）， and up-regulated the mRNA and protein levels of SIRT1， PGC-1α， ERRα， and TFAM in myocardial tissue （P<0.05， P<0.01）. ConclusionWenxin prescription can protect rats from myocardial ischemia-reperfusion injury by regulating myocardial mitochondrial energy metabolism via the SIRT1/PGC-1α/ERRα signaling pathway.

Objective:To analyze the risk factors of central venous catheter-related thrombosis (CRT) in critically ill patients and develop the model of a nomogram.Methods:A prospective investigation study was conducted on 385 critically ill patients who received central venous catheters during hospitalization in Hengshui People's Hospital from May 2018 to March 2021. Color Doppler ultrasonography was performed daily after catheterization. Patients were divided into thrombosis group and non-thrombosis group according to whether CRT was formed. The patient's gender, age, body mass index (BMI), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, complications, existing tumor, D-dimer level on the 3rd day after catheterization, maximum velocity of right internal jugular vein on the 3rd day after catheterization, mechanical ventilation time, and catheter indwelling time were recorded, and the differences of above indexes between the two groups were compared. Multivariate Logistic regression was performed on the influencing factors with statistical differences between the two groups to establish the nomogram prediction. The receiver operator characteristic curve (ROC curve) and calibration curve were used to evaluate the predictive power of the model.Results:The incidence of central venous CRT in critically ill patients was 16.1% (62/385). Compared with non-thrombosis patients, the thrombosis group patients had higher APACHEⅡscore, the proportion of existing tumor, and D-dimer level on the 3rd day after catheterization [APACHEⅡscore: 17 (15, 19) vs. 15 (12, 18), the proportion of existing tumor: 51.6% (32/62) vs. 35.3% (114/323), D-dimer (mg/L): 0.84 (0.64, 0.94) vs. 0.57 (0.44, 0.76), all P < 0.05], the maximum flow rate of right internal jugular vein was slower on the 3rd day after catheterization [cm/s: 14 (13, 15) vs. 16 (14, 18), P < 0.05]. Univariate analysis showed that high APACHEⅡscore, critical patients with existing tumor, high D-dimer level on the 3rd day after catheterization, and slow maximum flow rate of right internal jugular vein on the 3rd day after catheterization were more likely to develop central venous CRT. Further multivariate Logistic regression analysis showed that high APACHEⅡscore, existing tumor, high D-dimer level on the 3rd day after catheterization and slow maximum flow rate of right internal jugular vein on the 3rd day after catheterization were independent risk factors for central venous CRT in critical patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 0.876 (0.801-0.957), 0.482 (0.259-0.895), 0.039 (0.011-0.139), 1.401 (1.218-1.611), and P values were 0.003, 0.021, < 0.001, < 0.001, respectively]. According to the results of multivariate analysis, the prediction model of the nomogram was constructed. The area under ROC curve (AUC) was 0.820, 95% CI was 0.767-0.872, P < 0.001. The calibration curve showed that the prediction probability of central venous CRT nomogram model in critically ill patients had good consistency with the actual occurrence probability. Conclusions:Existing tumor, high APACHEⅡscore, elevated D-dimer on the 3rd day after catheterization, and decreased maximum velocity of right internal jugular vein on the 3rd day after catheterization are independent risk factors for central venous CRT in critical patients. The prediction model based on the proposed model has good clinical efficacy.

Objective:To assess the differences of the 2016 and 2009 edtion guidelines on diastolic dysfunction in sepsis patients.Methods:A single-center, prospective study was conducted. The relevant information of sepsis patients in Intensive Care Unit (ICU) were analyzed from October 2016 to January 2019. Patients’ transthoracic echocardiography at the first 24 h and 3rd day of their admission and left ventricular diastolic dysfunction were stratified according to the 2009 and 2016 edition guidelines. Patients’ characteristics, arterial blood gas analysis, and blood biochemical indexes were recorded at the first 24 h of the ICU admission. Additionally, the following information were retrieved during ICU stay: site of infection, frequency of adrenaline and dobutamine, maximal dose of norepinephrine, use of hydrocortisone, invasive mechanical ventilation and renal replacement therapy. The rank-sum test of two independent samples was used to compare the differences in the diagnosis of left ventricular diastolic dysfunction.Results:A total of 196 patients with sepsis or septic shock were screened, and 86 patients were excluded. Finally, clinical data of 110 patients were included in the analysis.The median time of the first ultrasound examination in ICU was 17 h. Among the patients with different diastolic function severity in baseline data analysis, only age was significantly different. According to the 2016 edition guidelines, 43 (39%) of 110 patients had diastolic dysfunction and another 30 (27%) had indeterminate diastolic dysfunction within 24 h of ICU admission. According to the 2009 edition guidelines, 40 (36%) patients had diastolic dysfunction and 58 (53%) patients had indeterminate diastolic dysfunction. The diagnosis of left ventricular diastolic dysfunction of different grades was significantly different between the 2016 and 2009 edition guidelines ( Z=4.92, P<0.01). According to the 2016 edition guidelines at the 3rd day of ICU admission, 52 (47%) patients were diagnosed with diastolic dysfunction and 18 (18%) were diagnosed with indeterminate diastolic dysfunction; According to the 2009 edition guidelines, 50 (46%) of these patients were diagnosed with diastolic dysfunction and 45 (41%) had indeterminate diastolic function. Similarly, there was a large difference in diagnosis ( Z=4.60, P<0.01). Subgroup analysis of patients with normal systolic function (ejection fraction > 50%) showed that the diagnosis of left ventricular diastolic dysfunction were significantly different at the first 24 h and the 3rd day of ICU admission ( Z=4.34, P<0.01 and Z=5.71, P<0.01). Conclusions:The 2016 edition guidelines identify a significantly higher incidence of dysfunction in patients with severe sepsis and septic shock compared to the 2009 edition guidelines. Although the 2016 edition guidelines seem to be an improvement, issues remain with the application of guidelines using traditional measures of diastolic dysfunction in this cohort.

Objective To investigate the prognostic impact of left ventricular diastolic dysfunction in septic shock patients in intensive care unit (ICU). Methods A single-center, prospective tudy was conducted. The relevant information of septic shock patients who underwent an echocardiographic assessment during the initial management were analyzed in ICU of Harrison International Peace Hospital Affiliated to Hebei Medical University from June 2016 to October 2017. Hemodynamics were evaluated using transthoracic echocardiography within the first 24 h of shock, and LV diastolic dysfunction is present if the available parameters meet the cutoff values. Patients' characteristics, arterial blood gas analysis, and blood biochemical indexes were recorded in the first 24h at ICU admission. Additionally, the following information were retrieved during ICU stay: site of infection, frequency of adrenaline and dobutamine, maximal dose of norepinephrine, use of hydrocortisone, invasive mechanical ventilation and renal replacement therapy. A multivariate analysis was performed to determine independent risk factors associated with septic shock mortality, and the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of all risk factors on the outcome of patients. Results Among the 138 patients with septic shock hospitalized in the ICU during the study period, 102 patients were enrolled [76 men (75％); aged 64 ± 12 years] and 92 of them (90％) were mechanically ventilated. Thirty patients died in ICU with a mortality rate of 29％. LV diastolic dysfunction was observed in 32 patients (31％). No significant inter-group difference in infection characteristics was found. The death group had significantly higher APACHE Ⅱ score, SOFA score, lactate and creatinine levels than the survival group. Similarly, the death group received a greater dose of vasopressors and required more frequent administration of epinephrine than the survivors. While the dead group exhibited slightly yet significantly larger RV cavity, which was reflected by a significant greater RVEDA/LVEDA ratio (0.77 ± 0.43 vs 0.59 ± 0.17) with no association with paradoxical septal motion. Mean value of lateral e′ maximal velocity was significantly lower in the death group compared with the survival group(10.50 ± 3.80)cm/s vs (12.9 ± 4.6)cm/s. The proportion of LV diastolic dysfunction tended to be higher in the death group than in the survival group (14/30 vs 18/72). In the multivariate analysis, the maximal dose of norepinephrine (OR=1.69, 95％CI:1.05-2.79), the SOFA score(OR=2. 24,95％CI:1.32-3.35) ,e′ lateral maximal velocity (OR=2.23, 95 ％ CI:1.01-5.57), lactate(OR=2.36, 95％CI:1.25-5.43) and LV diastolic dysfunction(OR=1.32,95％CI:1.11-3.15) were significantly associated with septic shock mortality. The area under ROC curve of lateral e′ maximal velocity for predicting death of septic shock patients was 0.63 (95％CI: 0.54-0.78) and the cut-off value was 8.9 cm/s, with a sensitivity and specificity of 76％ and 54％, respectively. Conclusions The present study suggests that LV diastolic function might be associated with ICU mortality in patients with septic shock. A multicenter prospective study assessing a large cohort of patients using serial echocardiographic examinations remains to confirm the prognostic value of LV diastolic dysfunction in septic shock patients.

Objective To investigate the detection and distribution of hospitalized specimens from a tertiary hospital over 5 years. Methods Specimens of sputum, urine, blood, secretions and puncture fluid were collected from patients admitted to the Harrison International Peace Hospital from November 2013 to November 2018. The origin of specimens, the distribution of departments and the distribution of pathogenic bacteria isolated were analyzed retrospectively. Results A total of 61 286 specimens were sent for examination during the 5 years. The top 5 specimens were sputum culture (n = 18 302, 29.9%), sputum smear (n = 11 253, 18.4%), blood culture (n = 9 713, 15.8%), urine culture (n = 6 448, 10.5%) and secretion culture (n = 6 133, 10.0%), accounting for 84.6% (51 849/61 286). Sputum specimens accounted for 48.2% (29 555/61 286) with the largest proportion. The number of specimens from medical wards was much higher than that from surgical wards (specimens: 25 468 vs. 10 521), respiratory medicine, department of critical care medicine and emergency intensive care unit (EICU) were important sources of pathogenic specimens in the hospital, accounting for 29.8% (18 243/61 286) in total. The average positive rate of all specimens was 23.5% (14 424/61 286). The positive rates of sputum culture and urine culture were 29.7% (5 428/18 302) and 35.4% (2 281/6 448), respectively, while the positive rate of blood culture was only 6.6% (643/9 713). Escherichia coli was the most common pathogen in all specimens except for sputum culture and fecal culture. Escherichia coli [40.6% (926/2 281)], Klebsiella pneumoniae [9.2% (210/2 281)], Pseudomonas aeruginosa [8.2% (188/2 281)], Enterococcus faecalis (group D) [6.6% (151/2 281)] and Candida albicans [3.2% (73/2 281)] were the most common pathogens in urine culture. Klebsiella pneumoniae [24.1% (1 309/5 428)], Acinetobacter baumannii [21.3% (1 154/5 428)], Pseudomonas aeruginosa [15.1% (818/5 428)], Escherichia coli [6.5% (351/5 428)] and Maltose oligotrophomonas maltose [5.8% (316/5 428)] were the most common pathogens in sputum culture. Escherichia coli [36.5% (235/643)], Klebsiella pneumoniae [10.9% (70/643)], Pseudomonas aeruginosa [4.8% (31/643)], Staphylococcus epidermidis [3.4% (22/643)] and Staphylococcus humanis [3.3% (21/643)] were the most common pathogens in blood culture. Conclusion Specimens sent for examination by inpatients are mainly from internal medicine wards, mainly from sputum, blood and urine, and the detected pathogens are mainly Gram-negative bacteria.

Objective To evaluate the clinical curative effect of ulinastatin combined with CRRT in the treatment of multiple organ dysfunction syndrome(MODS).Methods Sixty eight patients with MODS who were admitted to ICU from July 2013 to July 2015 were randomly divided into three groups:control group,CRRT group,combined group;Patients' APACHE Ⅱ,SOFA scores level of inflammatory markers were recorded before treatment and after treatment of 72 hours and 7 days.The mortality of the three groups in ICU were compared.Results After 72 hours and a week of treatment,the level of IL-10,IL-6,TNF-α,WBC、PCT、CRP in CRRT group and combined group were significantly better than that of control group(P＜0.05),and combined group were significantly better than that of CRRT group.Compared with the control group,the oxygen index,lactic acid,ALT significantly im proved in CRRT group and combined group were better than control group,after 72 hours and a week of treatment(P＜0.05),and the cornbined group was the most obvious.After a week of treatment,the mortality rate of CRRT group and combined group was significantly better than the control group (P＜0.05),while there was no statistical differences between CRRT group and combined group(P＞0.05).Conclusion Ulinastatin combined with CRRT is an effective method for the treatment of MODS.