Abstract:Hydrogen is colorless and odorless small molecule gas with biological activity, and it can react with reactive oxygen species. It is believed that hydrogen has biological effects such as anti-oxidation, anti-inflammation and anti-apoptosis, and has extremely high biosafety. Recently, hydrogen application has been involved in various acute and chronic diseases, and benign and malignant diseases. In addition, means of hydrogen utilization is also enriched, including hydrogen inhalation, hydrogen-rich water drinking, intravenous injection or partial use of hydrogen-rich saline and dialysis of hydrogen-rich dialysate. More importantly, the increasing hydrogen-related clinical studies have further demonstrated that hydrogen is effective and safe for diseases. However, the molecular mechanism of hydrogen biological effects is not very clear, and many scholars and the general public lack an understanding of hydrogen development status, which limits the development of hydrogen medicine and the related products. The research and popularization of hydrogen medicine is still a work in progress.

Abstract:Objective To explore the protective effects of molecular hydrogen on high-level low-dose irradiation-induced male reproductive system injury in mice and the underlying mechanism. Methods Cultured spermatogonia-derived cell line GC-1 spg was randomized into control group, hydrogen group, 4 Gy radiation group and 4 Gy radiation+hydrogen group. The apoptotic rate of the cells was detected by flow cytometry assay at 24 h after treatment in each group. Seventy-two male BALB/c mice were randomized into control group, hydrogen group, 0.25 Gy radiation group, 0.25 Gy radiation+hydrogen group, 0.5 Gy radiation group and 0.5 Gy radiation+hydrogen group, with 12 mice in each group. The hydrogen treatment was conducted by hydrogen-rich water administration and high-concentration hydrogen gas inhalation. At 24 h after treatment, the testes were dissected and sectioned for H-E staining, and blood samples from the internal canthus vein were collected to determine the levels of gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone using ELISA. At 4 weeks after radiation, the bilateral epididymides were isolated to prepare sperm suspensions, and the DNA damage of the spermatozoa was examined using the neutral single cell gel electrophoresis. Results The 24 h apoptosis rate of GC-1 spg cells was significantly decreased in the 4 Gy radiation+hydrogen group compared with the 4 Gy radiation group (t=7.186, P<0.01). Hydrogen obviously reverted the histological damage of the testes induced by 0.5 Gy irradiation, significantly inhibited 0.25 Gy and 0.5 Gy radiation-caused surge of FSH (t=3.195 8, P=0.019; t=10.723 4, P<0.05), and significantly ameliorated comet tailing and damage of the sperm DNA at 4 weeks after radiation (tail area t_{0.25 Gy}=16.592 3, t_{0.5 Gy}=15.891 5; tail DNA t_{0.25 Gy}=11.296 5, t_{0.5 Gy}=13.785 0; tail DNA% t_{0.25 Gy}=26.834 0, t_{0.5 Gy}=10.325 7; tail length t_{0.25 Gy}=16.865 4, t_{0.5 Gy}=15.441 2; tail moment t_{0.25 Gy}=26.979 4, t_{0.5 Gy}=13.174 2; Olive tail moment t_{0.25 Gy}=24.752 4,t_{0.5 Gy}=6.896 1; all P<0.05). Conclusion Molecular hydrogen protects male mouse reproductive system from high-level low-dose radiation through reducing spermatogonium apoptosis, adjusting hormone disturbance and ameliorating sperm DNA damage.

Abstract:Objective To explore the time and dose effects of AKT (a kind of protein serine/threonine kinase) inhibitor GSK2141795 on the apoptosis of human hepatocellular cell line Huh7. Methods Huh7 cells were treated with GSK2141795 at the concentrations of 0, 0.3, 1, 3, 10 and 30 μmol/L for 24 h. A concentration of 10 μmol/L GSK2141795 was selected to treat Huh7 cells for 0, 2, 6, 12, 24 and 48 h. The protein expression levels of AKT and phosphorylated AKT^S473 (p-AKT^S473) were determined by Western blotting and cell apoptosis was detected by flow cytometry. The expression levels of apoptosis-related proteins (Bad, Bcl-2 and Caspase-9) were measured by qPCR and Western blotting. Results With the increase of GSK2141795 concentration, AKT protein level in Huh7 cells was gradually decreased and the p-AKT^S473 protein level was gradually increased within the range of 0-10 μmol/L. With the prolongation of GSK2141795 treatment time, the AKT protein level was gradually decreased and the p-AKT^S473 protein level was gradually increased within the range of 0-24 h. At 48 h of treatment, the AKT protein and p-AKT^S473 protein expression levels were increased compared with 0 h. With the increase of GSK2141795 concentration and treatment time, the proportion of apoptotic cells was gradually increased, the expression levels of apoptotic molecules Bad and Caspase-9 were gradually increased, and the expression level of apoptotic antagonist Bcl-2 was gradually decreased. Conclusion AKT inhibitor GSK2141795 can effectively inhibit AKT protein expression, and induce apoptosis of Huh7 cells through Bad-Bcl-2 pathway in a dose- and time-dependent manner. In addition, the expression level of AKT protein in Huh7 cells can increase again after long-term stimulation by GSK2141795, suggesting the existence of a negative feedback signal loop.

Abstract:Objective To explore the proportion of CCR7^loPD-1^hi follicular helper T cell (Tfh) in peripheral blood of the patients with systemic lupus erythematosus (SLE) and its clinical role. Methods Peripheral blood samples were collected from 31 SLE patients, 29 rheumatoid arthritis (RA) patients, 12 Sjögren's syndrome (SS) patients and 37 healthy controls. Flow cytometry was used to detect the expression levels of C-X-C chemokine receptor 3 (CXCR3), inducible costimulator (ICOS) and signaling lymphocytic activation molecule family member 5 (SLAMF5) on surface of Tfh, and the frequencies of CCR7^loPD-1^hi Tfh and CCR7hiPD-1lo Tfh in peripheral blood. The correlation between the proportion of CCR7^loPD-1^hi Tfh in peripheral blood of SLE patients and clinical indicators and the proportion of plasmablasts was analyzed. Results The expression levels of CXCR3, ICOS and SLAMF5 were significantly higher on the surface of the CCR7^loPD-1^hi Tfh compared with those of the CCR7hiPD-1lo Tfh (t=3.73, 5.06 and 8.27; all P<0.01). The frequencies of CCR7^loPD-1^hi Tfh in the peripheral blood of the SLE and RA patients were 5.79% (2.97%, 8.95%) and 4.57% (2.51%, 7.60%), respectively, which were both significantly higher than that of the healthy controls (2.93%[1.63%, 5.21%], U=314.5 and 332.5, both P<0.01). There was no difference in the frequency of CCR7^loPD-1^hi Tfh in peripheral blood between SS patients and healthy controls (U=183.0, P>0.05). The proportion of CCR7^loPD-1^hi Tfh in peripheral blood of the SLE patients was positively correlated with systemic lupus erythematosus disease activity index (SLEDAI), serum anti-double-stranded DNA (dsDNA) titers and the proportion of plasmablasts (r=0.447 1, 0.517 4 and 0.466 9; all P<0.05). Conclusion Increased proportion of CCR7^loPD-1^hi Tfh in peripheral blood of the SLE patients is associated with increased SLEDAI and increased proportion of plasmablasts; and detecting the Tfh subsets can indirectly reflect the functional status of germinal center and B lymphocytes, which is of great significance for diagnosis, monitoring and prognosis of SLE.

Abstract:Objective To explore the prognostic value of preoperative serum pre-albumin in the patients with bladder urothelial carcinoma. Methods A retrospective study was conducted on the clinicopathological data of 320 patients with bladder urothelial carcinoma, who underwent radical cystectomy in Changhai Hospital of Navy Medical University (Second Military Medical University) between Jan. 2006 and Dec. 2014. Receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value of preoperative serum pre-albumin level. χ² test was used to analyze the relationship between preoperative serum pre-albumin level and clinicopathological characteristics. Log-rank test and Kaplan-Meier method were used to analyze the relationship between preoperative serum pre-albumin level and overall survival and relapse-free survival of the patients. Cox proportional hazards model was used to explore the risk factors of prognosis of the patients. Results Based on optimal cut-off value of 249.5 mg/L, the patients were divided into high pre-albumin (≥ 249.5 mg/L) group (162 cases) and low pre-albumin (<249.5 mg/L) group (158 cases). Compared with the patients in the high pre-albumin group, those in the low pre-albumin group were older and more prone to preoperative hydronephrosis, high pathological T staging, high grade classification, distant metastasis and intraoperative transfusion, and the differences were significant (all P<0.05). The patients in the low pre-albumin group had significantly shorter overall survival and relapse-free survival compared with the patients in the high pre-albumin group (both P<0.05). The results of multivariate Cox regression analysis demonstrated that high pathological T staging, lymphatic metastasis, distant metastasis, intraoperative transfusion and low pre-albumin level were independent risk factors for the overall survival (all P<0.05), and high pathological T staging, lymphatic metastasis, distant metastasis and low pre-albumin level were independent risk factors for the relapse-free survival (all P<0.05). Conclusion Low preoperative serum pre-albumin level is an independent prognostic risk factor for the patients with bladder urothelial carcinoma, and preoperative serum pre-albumin can be used as a common indicator for prognosis of bladder urothelial carcinoma patients.

Abstract:Objective To explore the efficacy and safety of intravenous thrombolysis or bridging therapy for acute minor ischemic stroke (MIS) with large artery occlusion. Methods Seventy-three acute MIS patients with large artery occlusion, who admitted to our hospital via stroke green channel within 4.5 h after onset from Sep. 2013 to Jun. 2018, were enrolled in this study, including 55 cases in intravenous thrombolysis group and 18 cases in bridging therapy group. The patients in the intravenous thrombolysis group underwent intravenous thrombolysis treatment with recombinant tissue plasminogen activator (rt-PA), and the patients in the bridging therapy group underwent thrombectomy within time window after intravenous thrombolysis. National Institutes of Health stroke scale (NIHSS) score at admission and modified Rankin scale (mRS) score at 90 days after treatment were evaluated in all patients. The mRS scoring 0-2 was good prognosis, and 3-6 was poor prognosis. Results There were no significant differences in the gender, age, medical history, smoking history, ratio of asymptomatic cerebral infarction, NIHSS score at admission, Glasgow coma scale score, Alberta stroke program early conputed tomography score, door-to-needle time or onset-to-needle time between the two groups (all P>0.05). The rates of good prognosis at 7 d and 90 d after treatment, incidence of symptomatic intracranial hemorrhage and mortality were not significantly different between the two groups (all P>0.05), while the incidence of systemic complications was significantly lower in the intravenous thrombolysis group than that in the bridging therapy group (23.6%[13/55] vs 44.4%[8/18]; χ²=2.434, P=0.019). Conclusion Intravenous thrombolysis and bridging therapy have similar clinical efficacy and safety in treatment of acute MIS with large artery occlusion; although the incidence of systemic complications in patients with bridging therapy is higher than that in patients treated with intravenous thrombolysis, the long-term effects are both good.

Abstract:Objective To explore the clinical value of neutrophil-to-lymphocyte ratio (NLR) in predicting prognosis of the patients with intracerebral hemorrhage (ICH). Methods A total of 226 patients who admitted to Changhai Hospital of Navy Medical University (Second Military Medical University) from Jan. 2013 to Aug. 2014 were enrolled in this study, including 126 patients with first-ever ICH and 100 patients with hypertension (control). The counts of white blood cell (WBC), neutrophil, and lymphocyte were analyzed, and NLR value was calculated. The receiver operating characteristic (ROC) curve was used to evaluate the prognostic indicators of ICH, and the multivariate logistic regression model was used to analyze the influencing factors for the prognosis of the ICH patients. Results The WBC count and NLR value were significantly greater in the ICH patients than those in the hypertension patients (both P<0.01). The ICH patients with modified Rankin scale (mRS) score of 3-6 (n=32) had significantly greater counts of WBC and neutrophil, and NLR value versus those with mRS score of 0-2 (n=94, all P<0.05). And the ICH patients with large hematoma (hematoma volume ≥ 30 mL, n=42) had significantly greater neutrophil count and NLR value versus those with small hematoma (<30 mL, n=84; both P<0.05). When 3.001 was accepted as a cut-off value for NLR predicting prognosis, the sensitivity and the specificity were 64.5% and 83.3%, respectively. Multivariate logistic regression analysis revealed that NLR was an independent predictor for ICH prognosis. Conclusion NLR may be used as an indicator to evaluate the prognosis of ICH.

Abstract:Objective To explore the relationship between blood glucose and lipid levels and cognitive function in elderly patients with comorbidity of depression and type 2 diabetes mellitus (T2DM). Methods The clinical data from elderly participants (60 to 79 years old) receiving physical examination between Nov. 1 and Dec. 30, 2017 were collected. According to inclusion and exclusion criteria, 59 cases with comorbidity of depression and T2DM were assigned to comorbid group, 106 depression cases were in depression group, 84 T2DM cases were in diabetes group and 248 were in control group (with no diabetes or depression). The general physiological indicators (height, body mass, waist circumference, hip circumference and blood pressure) were collected, the body mass index (BMI) and waist-to-hip ratio (WHR) were calculated, and blood glucose and lipid levels were determined. The Montreal Cognitive Assessment (MoCA) scale was used to assess the cognitive function of the elderly in each group. The differences in BMI, WHR, blood pressure, blood glucose level and blood lipid level among the groups were compared, and the relationships between these indicators and the adjusted total score and scores in each cognitive domain of MoCA scale were analyzed. Results (1) There were no significant differences in height, body mass, BMI, WHR or diastolic blood pressure (DBP) among four groups (all P>0.05), while the differences in systolic blood pressure (SBP) and pulse pressure (PP) were significant (both P<0.01), with the increase in the diabetes group being most obvious. (2) Compared with the control group, the fasting blood glucose (FBG) level, oral glucose tolerance test (OGTT) 2 h and glycosylated hemoglobin (HbA_1c) level were significantly higher in the comorbid group and the diabetes group (all P<0.01); while there was no significant difference between the control and the depression groups (P>0.05). The triglyceride (TG) level in the comorbid group was significantly higher than that in the control group (P<0.05), and the high-density lipoprotein (HDL) levels in the comorbidity and the diabetes groups were lower than that in the control group (P<0.05, P<0.01). (3) There was no significant difference in the adjusted total score of MoCA scale among the four groups (P>0.05). Compared with the control group, the attention scores of the other three groups were significantly lower (all P<0.01). The elderly in the comorbid group had significantly lower fluency and orientation scores compared with the elderly in the control group (P<0.05, P<0.01), and had significantly lower orientation score compared with the elderly in the diabetes group (P<0.05). (4) Simple linear regression analysis showed that the adjusted total score of MoCA scale was negatively correlated with FBG and HbA_1c levels (b=-0.339, P=0.006; b=-0.482, P=0.023), and the attention score was negatively correlated with FBG, OGTT 2h and HbA_1c levels (b=-0.119, P<0.001; b=-0.040, P=0.002; b=-0.161, P=0.006). (5) Multiple linear regression analysis revealed that FBG level was negatively correlated with the adjusted total score of MoCA scale (B=-0.349, P=0.004). Conclusion Hyperglycemia may be a risk factor of cognitive dysfunction of elderly patients with comorbid of depression and T2DM.

Abstract:Objective To explore the clinical effect of transrectal ultrasound-guided puncture and cathetering drainage in the treatment of high-position perianal abscess. Methods Eighty patients with high-position perianal abscess, who admitted to Shuguang Hospital of Shanghai University of Traditional Chinese Medicine from Jan. of 2015 to 2018, were randomized into interventional therapy group and surgical treatment group, with 40 cases in each group. The patients in the interventional therapy group were treated with cathetering drainage guided by transrectal ultrasound, and the patients in the surgical treatment group were treated with traditional incision drainage. The clinical effect was evaluated in the two groups, and the pain, fever and exudation scores, white blood cell count, C-reactive protein level, maximal section area of abscess cavity, and wound healing time were compared between the two groups before operation and on 3 days and 7 days after operation. Results The total effective rates of the interventional therapy and surgical treatment groups were 87.5% (35/40) and 80% (32/40), respectively, and the difference was significant (χ²=1.385, P=0.709). On 3 days and 7 days after operation, the pain score, exudation score, white blood cell count, C-reactive protein level and maximum section area of the abscess cavity were significantly lower in the interventional therapy group than those in the the surgical treatment group (all P<0.01). The patients with retrorectal abscess or high intersphincteric abscess in the interventional therapy group had shorter wound healing time versus the patients in the surgical treatment group (both P<0.01). Conclusion Compared with traditional incision drainage, cathetering drainage guided by transrectal ultrasound can reduce pain and decrease exudation of the patients with high-position perianal abscess to effectively control infection.

Abstract:Objective To develop a high-performance liquid chromatography (HPLC) method for simultaneous determination of five flavonoids (chamaechromone, neochamaejasmin A, chamaejasmine, isochamaejasmin and 7-methoxylneochaejasmin A) in the extraction of Stellera chamaejasme L.. Methods An HPLC-diode array detector (DAD) method was established. The HPLC-DAD condition was as follows:chromatographic column was Agilent Eclipse Plus C₁₈ (3.0 mm×100 mm, 3.5 μm); mobile phase A was 0.1% formic acid-water solution; mobile phase B was acetonitrile; gradient of acetonitrile was 20% (0-6 min), 20%-35% (6-10 min) and 35% (10-50 min); flow rate was 0.4 mL/min; equilibration time was 10 min; acquisition time was 50 min; column temperature was 25℃; DAD detection wavelength was 290 nm; and sample injection volume was 5 μL. Results Chamaechromone, neochamaejasmin A, chamaejasmine, isochamaejasmin and 7-methoxylneochaejasmin A were successfully separated using this method, with good linear relationship between 4.680-468.0, 2.016-201.6, 3.784-378.4, 5.520-552.0 and 0.974-97.40 μg/mL, respectively. The precision, stability, repeatability and recovery of the five flavonoids were good with this method. Conclusion HPLC-DAD has good stability and repeatability, and can be used to determine the contents of five flavonoids (chamaechromone, neochamaejasmin A, chamaejasmine, isochamaejasmin and 7-methoxylneochaejasmin A) in Stellera chamaejasme L..

Abstract:Objective To explore the treatment effect and technical safety of ultrasound-guided microwave ablation for hyperparathyroidism of forearm transplanted autograft. Methods Two patients who had undergone parathyroidectomy with autotransplantation (PTX+AT) and maintenance hemodialysis were diagnosed as having hyperparathyroidism of forearm transplanted autograft based on the increased serum intact parathyroid hormone (iPTH) and aggravated accompanying symptoms. The multimodal high frequency ultrasound was performed to examine the autografts, and ultrasound-guided percutaneous microwave ablation was used to treat the hyperparathyroidism of the patients. Curative effect and symptoms of the patients were observed after treatment. Results Ultrasonography clearly showed the location, number, size and blood perfusion of the parathyroid gland autografts in the forearm of the two patients. After measuring the levels of iPTH in the transplanted tissues of the two patients, one with the lowest iPTH level was retained and the others were treated with microwave ablation, and the ablation treatment was technically successful. In the two patients, 5 and 4 parathyroid gland autografts were ablated and the largest ones were 15 mm×6 mm and 13 mm×5 mm, respectively. The levels of iPTH on the graft side and non-graft side were 87.3 ng/L and 79.6 ng/L, and 66.3 ng/L and 65.2 ng/L after 1 day of microwave ablation, respectively. During the follow-up period of 1 year after microwave ablation, calcium, phosphorus and alkaline phosphatase levels of the two patients were decreased and remained stable, bone and joint pains were relieved, and no numbness or abnormal movement of fingers and wrist joints were found in the transplanted side. Conclusion Hyperparathyroidism of forearm transplanted autograft can occur after PTX+AT. Microwave ablation is effective and safe in the treatment of the hyperparathyroidism.

Abstract:In Afghanistan and Iraqi war, the war mortality has been greatly reduced due to the upgrading of United States medical technology and equipment and the optimization of the rapid evacuation of the wounded. With the improvement of survival rate, pain management is more important in the combat casualty care in United States army. The United States army implements a grading pain management strategy in the 5-level combat casualty care system, which may be an important reference for Chinese military. This paper reviews the current pain management for combat casualty care of United States army, analyzes the advantages and disadvantages of therapeutic drugs and protocols, and highlights the enlightenment on improving pain management in Chinese military in future.

Abstract:Plasmodium falciparum is one of the main parasitic pathogens worldwide. Artemisinin derivatives are the first-line antimalarial drug. Recently, Plasmodium falciparum has been found to be tolerant to the treatment with artemisinin derivatives and its combination with piperaquine in several countries and regions. Scientists have found gene mutations associated with resistance of Plasmodium falciparum to artemisinin derivatives; however the mechanism of piperaquine resistance remains to be further studied. This review sums up the epidemic status and mechanism research of the resistance of Plasmodium falciparum to artemisinin derivatives and piperaquine.

Abstract:Gadolinium-based contrast agents (GBCAs) are widely used in magnetic resonance imaging. Recently, a large amount of evidence indicates that change of magnetic resonance signal in deep brain nuclei is related to repeated injection of GBCAs. Especially in the dentatum and pallidum the gadolinium deposition is most obvious. This paper reviews the research status and policy progress of brain deposition of GBCAs, and introduces the relationship between gadolinium deposition in the brain and the type of GBCAs.

Abstract:Photodynamic therapy (PDT) is a new oncotherapy method. Photosensitizer and matched-light are the key elements of PDT. As a next generation photosensitizers of high purity, sinoporphyrin sodium (DVDMS) has the characteristics of clear structure and high content, low effective dose, short time avoiding light after treatment and good safety. Due to the discovery of ultrasonic sensitivity of DVDMS, great progresses have been made on the research and application of DVDMS-mediated sonodynamic therapy. Research suggests that DVDMS has potentials to be used for anti-tumor, anti-bacterial, treatment of psoriasis, development of therapeutic diagnostic reagents and so on. This review sums up the anti-tumor activities and mechanisms of DVDMS.

Abstract:Objective To investigate the physiological and psychological status of students during the first long distance voyage of Qi Ji-guang Warship and to explore their correlation. Methods From Sep. 17 to Dec. 7, 2017, Qi Ji-guang Warship was on the first long distance voyage mission. On the 60^th day during the voyage, the questionnaire survey was conducted on the students aboard Qi Ji-guang Warship. In all, 150 questionnaires were distributed randomly to respondents. The general information of the students was included in the questionnaire, and the physiological status and psychological status were assessed using Pittsburgh sleep quality index (PSQI) scale, Epworth sleeping scale (ESS), fatigue severity scale (FSS), self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Results A total of 138 valid questionnaires were returned (response rate 92.0%). Forty-two first voyage students (30.4%) complained of health problems. The proportions of the students with poor sleep quality, moderate or excessive daytime sleepiness, high fatigue levels, anxiety and depression were 11.6% (16/138), 45.7% (63/138), 40.6% (56/138), 18.1% (25/138) and 21.0% (29/138), respectively. The PSQI, ESS and FSS scores of the students with anxiety were significantly higher than those of the students without anxiety (8.40±2.93 vs 6.34±3.10, 11.12±5.03 vs 8.70±4.53 and 38.84±12.41 vs 31.55±11.20, all P<0.05). The SAS score was positively correlated with PSQI, ESS and FSS scores (r=0.301, 0.242 and 0.274, all P<0.01). SDS score was positively correlated with PSQI and FSS scores (r=0.256 and 0.209, both P<0.05). Conclusion During long distance voyage, the students aboard have probabilities of poor sleep quality, sleepiness, fatigue, anxiety or depression. Mental status (anxiety and depression) is closely related to physiological status (sleep quality, sleepiness and fatigue), and exerts certain effect on physiological status. Psychological behavior training should be carried out to improve the tolerance, work efficiency and combat ability of students.

Abstract:Ark Peace is a modern hospital ship for marine medical rescue, and is taken as "the tertiary academic hospital floating on the sea". It plays an important role in the ocean-going medical support and military diplomacy of the Chinese Navy. Ultrasound diagnosis, as an indispensable part of hospital ship, provides a solid guarantee for medical services. We summarized our experience on the equipment configuration, staff preparation, reporting system improvement, quality control management and introduction of new technologies on hospital ship during "Mission Harmony-2017" task, and put forward some suggestions for improving the comprehensive diagnosis and medical treatment ability and carrying out diversified military tasks in the future.

Abstract:Objective To explore the clinical characteristics and prognostic factors of spontaneous intracranial hypotension (SIH) patients. Methods The clinical data of patients with SIH, who admitted to Changhai Hospital of Navy Medical University (Second Military Medical University) from 2010 to 2017 and met the SIH diagnostic criteria of international classification of headache disorders, 3^rd edition (ICHD-3), were collected. The effects of the general clinical features, such as gender, age and course of disease, and cerebrospinal fluid pressure and imaging features on prognosis of the SIH patients were analyzed. Results Of 26 SIH patients, 19 patients (73.08%) were cured and 7 patients (26.92%) were relieved. The gender, age, course of disease, severity of headache, headache types and cerebrospinal fluid pressure had no significant effect on the prognosis of the SIH patients. Among the 13 SIH patients with abnormal cranial magnetic resonance imaging findings, such as strenthening signals in cerebral dura, subdural fluid accumulation and brain sagging, 12 patients (63.16%) were cured and 1 (14.28%) was relieved, and the difference was significant (P=0.027). Conclusion SIH patients with headache have a good prognosis; imaging examination contributes to the diagnosis of SIH and may indicate the prognosis.

Abstract:Objective To explore the risk factors of pulmonary embolism (PE) in the patients initially diagnosed as neurointensive care unit hospital-acquired pneumonia (NICUHAP) with increased D-dimer level. Methods A case-control study was taken to observe the clinical data from the patients with NICUHAP who were initially diagnosed in the Tenth People's Hospital of Tongji University between Jan. 2007 and Jan.2018. According to the results of computed tomography pulmonary angiography (CTPA) examination, the patients were divided into PE group and non-PE group. The pulmonary artery occlusion index (PAOI) was calculated in the patients of the PE group. Univariate and multivariate logistic regression analyses were performed to explore the risk factors for PE. Results A total of 129 patients initially diagnosed as NICUHAP were included in this study and received CTPA examination. The median D-dimer levels of PE patients (n=75) and non-PE patients (n=54) were 3.97 mg/L and 0.88 mg/L, respectively, and the difference was significant (P<0.05). The PAOIs of 70 (93.3%) PE patients were below 30%. There was no significant correlation between the D-dimer level and PAOI. Age, coronary heart disease, chronic obstructive pulmonary disease, varicose veins of lower limbs, thoracodynia, shortness of breath, hemoptysis, chest tightness, fever (body temperature>38.5℃), and elevated cardiac troponin I level were possible independent risk factors for PE. Conclusion The patients initially diagnosed as NICUHAP with PE have elevated D-dimer level compared with the patients without PE. There is no significant correlation between D-dimer level and PAOI. The patients initially diagnosed as NICUHAP, who are older than 60 years, or accompanied with coronary heart disease, chronic obstructive pulmonary disease, varicose veins of lower limbs, thoracodynia, shortness of breath, hemoptysis, elevated cardiac troponin I level or with a body temperature below 38.5℃, need CTPA examination to exclude PE.

Abstract:Objective To explore the effect of learning burnout on subjective well-being of military medical university students and the mediating role of psychological capital. Methods The learning burnout questionnaire, well-being scale and psychological capital scale were used to survey 796 military medical university students. The correlation of subjective well-being and psychological capital with learning bornout was analyzed. A intermediary function equation was established and the mediating effect of psychological capital was tested. Results The subjective well-being score of military medical university students was 4.42±0.77, psychological capital scale score was 4.48±0.67, and learning burnout score was 2.45±0.69. The subjective well-being, psychological capital and learning burnout scores were different among different grades, the subjective well-being scale and psychological capital scale scores of freshmen were significantly higher, and the learning burnout score was significantly lower than those of the junior students (t_{subjective well-being}=12.45, P<0.01; t_{psychological capital}=6.01, P<0.01; and t_{learning burnout}=-13.96, P<0.01). The learning burnout was negatively related to the subjective well-being and the psychological capital (r=-0.539, P<0.01, and r=-0.721, P<0.01). The psychological capital was positively related to the subjective well-being (r=0.596, P<0.01). The psychological capital had a partial mediating effect between learning burnout and subjective well-being, and the proportion of the mediating effect of total effect was 57.90%. Conclusion The subjective well-being not only can directly predict learning burnout of the students in military medical universities, but also indirectly predict the learning burnout through psychological capital. Improving subjective well-being of military medical university students is helpful for alleviating the learning burnout, and the mediating role of psychological capital should be emphasized at the same time.

Abstract:Objective To analyze the current global status of critical care medicine and to explore the research focus. Methods The papers concerning critical care medicine published between 2007 and 2017 were retrieved and analyzed using Web of Science, Journal Citation Report (JCR) and Echarts software. The titles and abstracts were extracted and analyzed using VOSviewer software to identify the high frequency key words. Meanwhile, the changes of countries with important contribations in the output ranking of papers were analyzed in the field of critical care medicine research from 2007 to 2017. Results A total of 51 928 papers met the inclusion criteria, and 45 696 were original articles and 6 232 were reviews. The high frequency key word thermogram showed that the focuses of critical care medicine terminology included management, function, observational study, trauma and trial. The United States remained the leading role in critical care medicine paper output from 2007 to 2017. In 2007 and 2017, the paper number of United States accounted for 43.74% (1 872/4 280) and 46.78% (2 288/4 891) of total papers, respectively. Conclusion The management, function, observational study, trauma and trial are focuses in the field of critical care medicine research and the United States remains the leading role in critical care medicine research.

Abstract:Objective To explore the application of surgical treatment of hypertensive intracerebral hemorrhage (hICH) in patients with long-term oral aspin administration; Methods: In this retrospective study, we included 10 (hICH) patients with long-term oral aspin administration who were treated with operation in Neurosurgical Department of Changzheng Hospital of Second Military University from Aug. 2014 to Aug. 2016. Data Concerning patients’ clinical demographics as well as 3-month follow up were collected. Surgical procedures and effects for hICH were analyzed together. Results: 5 patients underwent craniotomy, among which 3 were conducted by emergency operation. There 3 patients had difficulties in surgical hemostasis and 2 of them suffered rebleeding after operation. All of these patients survived in 3-month follow-up with Glasgow Outcome Scale (GOS) between 2-4. 5 patients had emergency drainage for hematoma and the blood was easy to drain out. 2 patients died in 14 and 37 days, and the rest had a GOS of 2 in 3 months. Conclusion: hICH patients with long-term oral aspin administration tended to have larger hematoma volume. Aspin should be stopped and it’s favorable to have blood transfusion before individualized surgery.

Abstract: