Abstract:Objective To sum up the clinical characteristics and chest computed tomography (CT) findings of severe and critical coronavirus disease 2019 (COVID-19) patients, and to explore the factors affecting the outcomes, so as to provide experience for the clinical diagnosis and treatment of severe and critical COVID-19. Methods The data of 25 severe and critical COVID-19 patients, who were treated in our hospital from Jan. 23, 2020 to Mar. 5, 2020, were collected. The clinical characteristics were retrospectively analyzed, and the clinical and laboratory indexes were compared between cured patients and uncured patients. The laboratory indicators of cured patients were further compared between the progressive and recovery stages. The chest CT findings of the patients were observed, and the lesion volume was quantified to assess the evolution of lung lesions using the CT image-based intelligent pneumonia lesion quantitative analysis software. Results There were 19 male and six female COVID-19 patients, and there were three deaths. The median age of 25 patients was 65 (63, 75) years old, and the body mass index (BMI) was 25.60 (23.51, 28.65) kg/m². Twenty-two patients had a clear epidemiological history. Fever (22 cases) and cough (14 cases) were the most common first symptoms, and 18 patients had underlying diseases. Twelve patients were cured and discharged (median hospital stay was 25.5 d), and 13 patients were not cured, including three deaths and 10 cases with hospital stay>25 d with no remission. Compared with the uncured patients, the cured patients had significantly lower BMI, longer time from onset to progression to severe or critical illness, and higher CD4⁺ T lymphocyte counts (all P<0.05). Multivariate logistic regression analysis showed that high CD4⁺ T lymphocyte count was an independent protective factor for the cure and discharge of severe and critical COVID-19 patients (P=0.031). Compared with those in the progressive stage, the lymphocyte count and CD4⁺ T lymphocyte count of 12 cured patients were significantly higher in the progression stage, and the C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR) and procalcitonin level were significantly lower (all P<0.01). Twenty-one patients received chest CT examination in the progressive stage; and all of them had multiple ground-glass opacities and consolidation shadows of the multiple-lobe lateral band and the dorsal side of bilateral lungs, 20 cases had pleural thickening, 9 cases had a small amount of bilateral pleural effusion, and 8 cases had mediastinal lymphadenopathy. The 12 cured patients received CT examination during the recovery period, and their lesions were all improved to different extents; some patients had irregular fiber grid shadows and stripe shadows; and the pleural thickening and pleural effusion were reduced to different extents. The quantitative analysis curves showed that lesion volume in the 12 cured patients obviously increased in the progressive stage and reduced in the absorption stage, showing an inverted V shape; and lesion volume in the uncured patients (nine cases received CT examination for two or more times) showed a rapid increase in the progressive stage. Conclusion Most severe and critical COVID-19 patients in Shanghai are older, with higher BMI and underlying diseases. Low BMI, slow disease progression, and high CD4⁺ T lymphocyte count are beneficial to the improvement of COVID-19. The main findings of chest CT include multiple ground-glass opacities and consolidation shadows, mainly distributing in the lateral band and the dorsal side of lungs and mostly involving the pleura. The laboratory indexes, including the lymphocyte, CRP, CD4⁺ T lymphocyte, ESR and procalcitonin, and chest CT examination play an important role in the diagnosis, disease monitoring and prognosis assessment of COVID-19.

Abstract:Objective To investigate the computed tomography (CT) features of the coronavirus disease 2019 (COVID-19) and the clinical significance, so as to improve our understanding of CT imaging of this disease. Methods The chest CT features of seven COVID-19 patients, who were diagnosed by virus nucleic acid test from Jan. 25 to Feb. 15, 2020 in Changhai Hospital of Naval Medical University (Second Military Medical University), were analyzed retrospectively. There were six males and one female, aged (51.1±18.8) years (range 29-75 years). All the seven patients received chest CT plain scan examimation. The CT images were interpreted by two experienced senior radiologists, and the distribution, location and density of lesions, number of involved lobes, air bronchogram, mediastinal lymphadenopathy and pleural effusion were analyzed. Results The average time from onset of symptoms to CT examination was 3.6 d (range 1-9 d) in the seven COVID-19 patients. The lesions were distributed in single lung in one case and bilateral lungs in six cases. The lesions involved middle and lateral fields of lungs in five cases and the whole field of lungs in two cases. The lesions showed ground-glass opacity in four cases and mixed shadow in three cases. The lesions involved two or less lobes in four cases and five lobes in three cases. One case had air bronchogram. No mediastinal lymphadenopathy or pleural effusion were found. Conclusion COVID-19 patients have characteristic CT findings, which has important clinical significance for the diagnosis and treatment of COVID-19. However, the diagnosis should be confirmed based on the patient's epidemic history, clinical symptoms and laboratory indicators.

Abstract:Objective To investigate the false negative rate of throat swab nucleic acid test of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to analyze the causes, so as to provide references for the prevention and control of coronavirus disease 2019 (COVID-19) in China. Methods A retrospective analysis was conducted on the throat swab nucleic acid test results of 1 452 COVID-19 patients admitted to Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province from Feb. 19 to Mar. 20, 2020. The negative results before positive results at discharge were judged as false negative results, and the false negative rate was calculated. The discharged patients were followed up to screen for the patients who were positive for nucleic acid test again, and the relationship between the times of consecutive negative nucleic acid tests before discharge and the positive again results was analyzed. Results Among the 1 452 COVID-19 patients, 592 (40.77%) were males and 860 (59.23%) were females. A total of 212 cases (14.60%) had false negative results. Twenty-eight cases (1.93%) were discovered nucleic acid positive again after discharge. Among the 918 patients whose nucleic acid tests were negative for two consecutive times, 24 (2.61%) were positive again, which was significantly higher than that of the patients whose nucleic acid tests were negative for three consecutive times (0.75%, 4/534; χ²=6.21, P=0.012 7). Conclusion The throat swab nucleic acid test of SARS-CoV-2 has a certain proportion of false negative results, which is one of the reasons for COVID-19 patients are found nucleic acid positive again after discharge. Multiple and continuous tests by different testers are recommended before discharge, and negative nucleic acid test for three or more consecutive times can reduce the incidence of nucleic acid positive results again after discharge.

Abstract:Objective To analyze the characteristics and related risk factors of myocardial injury in severe and critical coronavirus disease 2019 (COVID-19) patients and their relationship with the prognosis. Methods The clinical data of severe and critical COVID-19 patients treated in General Hospital of Central Theater Command of PLA from Jan. 2020 to Mar. 2020 were collected. The patients were divided into non-myocardial injury group and myocardial injury group. The baseline data, clinical characteristics, auxiliary examination, treatment and prognosis were compared between the two groups, and the risk factors of myocardial injury and the effect on the prognosis of the severe and critical COVID-19 patients were analyzed. Results A total of 56 patients were included, with 22 in the non-myocardial injury group and 34 in the myocardial injury group. Patients were mostly male in both groups, and there was no significant difference in gender composition between the two groups (P>0.05). Compared with the non-myocardial injury group, the age of onset was significantly higher in the myocardial injury group (78.5[70.8, 89.0] years vs 56.5[50.3, 68.3] years, P<0.01), and the proportions of patients over 65 years old and combined with coronary heart disease were significantly greater (85.3%[29/34] vs 31.8%[7/22] and 38.2%[13/34] vs 9.1%[2/22], both P<0.05). In terms of symptoms, fever (87.5%, 49/56), cough (64.3%, 36/56) and fatigue (46.4%, 26/56) were the most common ones, and there were no significant differences between the two groups (all P>0.05). For the CT findings of the lungs, the proportion of patients having patch-like/plaque-like shadows and ground-glass opacities was significantly greater in the non-myocardial injury group versus the myocardial injury group (72.7%[16/22] vs 38.2%[13/34], χ²=6.364, P<0.05), and other signs were not significantly different between the two groups (P>0.05). Compared with the non-myocardial injury group, the levels of N-terminal pro-B-type natriuretic peptide, D-dimer, procalcitonin and IL-6 were significantly higher in the myocardial injury group (4 939.5[1 817.0, 9 450.3] pg/mL vs 612.5[301.0, 1 029.5] pg/mL, 4 386.5[2 309.5, 9 635.3] ng/mL vs 850.5[343.5, 2 333.8] ng/mL, 0.46[0.23, 3.79] ng/mL vs 0.18[0.13, 0.39] ng/mL, and 138.6[41.9, 464.8] pg/mL vs 65.1[34.7, 99.3] pg/mL, respectively), and the differences were significant (all P<0.01). Multivariate logistic regression analysis showed that age ≥ 65 years old (odds ratio[OR]=18.62, 95% confidence interval[CI] 1.61-215.96, P<0.05) and D-dimer level ≥ 3 000 ng/mL (OR=15.48, 95% CI 1.45-164.77, P<0.05) were the independent risk factors for myocardial injury in severe and critical COVID-19 patients. There were no significant differences in the use of antiviral drugs, antibacterial drugs, or glucocorticoids between the two groups (all P>0.05). The mortality rate was significantly higher in the myocardial injury than that in the non-myocardial injury group (58.8%[20/34] vs 9.1%[2/22], P<0.01). Patients who received tracheal intubation, extracorporeal membrane oxygenation, continuous renal replacement therapy (CRRT) and other invasive life support measures were all in the myocardial injury group. Conclusion Older age, male gender, coronary heart disease and (or) cardiac insufficiency, and elevated D-dimer, procalcitonin and IL-6 are the risk factors of myocardial injury in severe and critical COVID-19 patients. Myocardial injury can aggravate the condition and some patients need invasive circulating breathing support, with poor prognosis and high mortality. Therefore, the above indicators need to be observed more closely and dynamically and active treatment should be given according to related factors.

Abstract:Objective To explore the potential mechanisms underlying the prominent efficiency of hyperbaric oxygen therapy (HBOT) in the treatment of severe coronavirus disease 2019 (COVID-19) patients. Methods Five COVID-19 patients, aged from 24 to 69 years old, received HBOT after routine therapies failed to stop the deterioration and progressive hypoxemia in General Hospital of the Yangtze River Shipping. The procedure of HBOT was as follows:compressed to 2.0 ATA (0.1 MPa gauge pressure, patient 1) or 1.6 ATA (0.06 MPa gauge pressure, patient 2-5) at a constant rate for 15 min, maintained for 90 min (first treatment) or 60 min (subsequent treatment), then decompressed to normal pressure for 20 min, once a day; the patients inhaled oxygen with the mask of Built-in-Breathing System continuously; and HBOT was ended when the daily mean pulse oxygen saturation (SpO₂) in wards was above 95% for two days. The symptoms, respiratory rate (RR), SpO₂, arterial blood gas analysis, blood routine, coagulation function, high-sensitivity C-reactive protein (hs-CRP) and chest computed tomography (CT) were collected. Paired t test was used to compare each index before and after treatment. Results After the first HBOT, the symptoms and signs of the five patients began to improve. Supine breathlessness disappeared after HBOT for four times, and digestive tract symptoms completely disappeared and only mild chest pain and breathlessness at rest and in motion remained after HBOT for five times. After finishing HBOT, the RR of the patients was significanlty lower than that before HBOT ([20.80±2.28] min^-1 vs[27.20±5.40] min^-1, P<0.05). After finishing HBOT, daily SpO₂ in wards was increased day by day, and the daily mean SpO₂ recovered to more than 95% after the first, second, third, third and sixth HBOT in the five patients, respectively. After the first HBOT decompression, SpO₂ was (93.60±0.07)%, which was signficantly higher than that before HBOT ([73.20±6.42]%) (P<0.05). SpO₂ values before compression of the second and third HBOT were signficantly higher than that before the first HBOT (both P<0.05). There was no significant difference in the SpO₂ immediately before and after the third HBOT (P>0.05). Before HBOT, the arterial partial pressure of carbon dioxide (PaCO₂) of the patients was (31.48±3.40) mmHg (1 mmHg=0.133 kPa), which was lower than the normal range (35-45 mmHg). After finishing HBOT, arterial partial pressure of oxygen ([130.20±18.58] mmHg), arterial oxygen saturation ([98.40±0.55]%), lymphocyte proportion (0.207 8±0.074 2) and lymphocyte count ([1.09±0.24]×10⁹/L) were significantly higher than those before HBOT ([61.60±15.24] mmHg,[73.20±6.43]%, 0.094 6±0.062 1, and[0.61±0.35]×10⁹/L), while the levels of fibrinogen ([2.97±0.27] g/L) and hs-CRP ([7.76±6.95] mg/L) were significantly lower than those before HBOT ([4.45±0.94] g/L and[30.36±1.27] mg/L) (all P<0.05). The levels of lacttic acid and D-dimer were decreased after HBOT versus before HBOT ([1.13±0.10] mmol/L vs[2.16±1.71] mmol/L,[0.42±0.13] mg/L vs[1.84±1.29] mg/L), but the differences were not significant (both P>0.05). All the five patients had typical lung CT imaging changes of severe COVID-19 before HBOT, which were improved after HBOT. Conclusion Systemic hypoxia induced by persistent hypoxemia may be the main reason for the deterioration of severe COVID-19. The respiratory dysfunction of COVID-19 is mainly alveolar gas exchange dysfunction. HBOT may be the best way to correct the progressive hypoxemia which can not be controlled by atmospheric oxygen supply in severe COVID-19 patients. HBOT can provide enough oxygen supply for the continuous hypoxia tissues, and is beneficial to the recovery of immune function, circulatory function and stress level, so as to improve the condition of patients.

Abstract:Objective To evaluate the clinical efficacy and safety of hydroxychloroquine sulfate combined with azithromycin in the treatment of refractory common coronavirus disease 2019 (COVID-19) patients. Methods The clinical data of 11 refractory common COVID-19 patients, who were admitted to Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province from Mar. 22 to 25, 2020, were retrospectively collected. The patients all received combined treatment regimens:hydroxychloroquine sulfate orally 200 mg three times daily for 7 days; and azithromycin orally 500 mg once daily on day 1 and then 250 mg once daily from day 2 to day 4. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test of throat swab was performed once daily from day 4 to day 10 after combined administration, and the blood routine and other laboratory indicators were tested within 3 days before administration and on the 8th days after administration. Results All the 11 patients had common COVID-19, seven of them were consistently positive for SARS-CoV-2 nucleic acid test, and four were positive again after negative results. The average course of disease of 11 patients before combined administration was 50.2 days. The treatment process was uneventful. Zero case of SARS-CoV-2 nucleic acid test result turned negative on day 4 after administration, two cases on day 5, two cases on day 6, two cases on day 7, one case on day 8 and one case on day 9. No patients progressed to severe or critical illness, and no severe side effects were found. Conclusion Hydroxychloroquine sulfate combined with azithromycin is safe and effective in the treatment of refractory common COVID-19 patients who have failed in other treatments and are consistently positive for SARS-CoV-2 nucleic acid.

Abstract:Objective To summarize the clinical features and imaging findings of six coronavirus disease 2019 (COVID-19) patients, so as to provide evidences for early diagnosis and clinical intervention. Methods Six COVID-19 patients with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were enrolled from the Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine from Jan. 1 to Feb. 22, 2020. The epidemiological history, clinical manifestations, imaging data and laboratory indicators were retrospectively analyzed. Results All six patients had a clear travel or residence history in Wuhan. Four patients had fever, three had cough, two had upper respiratory tract symptoms such as runny nose and sore throat, and two had systemic symptoms such as headache and muscle ache. Chest computed tomography (CT) showed that all the six patients had abnormal manifestations in bilateral lungs, and the lower lung lesions were more common than the upper lung lesions. The main manifestations were multiple ground-glass opacities, consolidation shadows, "crazy paving" sign and different degrees of fibrosis in lateral field of bilateral lungs. Chest CT examination later after onset showed lung consolidation and severe fibrosis. Conclusion The imaging of COVID-19 has special characteristics. Combined with the epidemiological history, clinical manifestations and the detection of SARS-CoV-2 nucleic acid, COVID-19 can be effectively diagnosed in the early stage.

Abstract:Objective To sum up our experience of hyperbaric oxygen therapy (HBOT) in an elderly critical coronavirus disease 2019 (COVID-19) patient with endotracheal intubation, providing references for the application of HBOT in COVID-19 treatment. Methods and results The patient was 87 years old male and presented coma symptoms on Feb. 3, 2020. Chest computed tomography (CT) showed multiple small flake fuzzy shadows in both lungs. The nucleic acid test of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in bronchoalveolar lavage fluid was positive on Feb.5 and the diagnosis of COVID-19 was confirmed. After symptomatic and supportive treatment, the patient's condition became stable gradually, and the tracheal intubation was removed on Feb. 22. However, the patient was intubated again on Feb. 24 because of loss of coughing and sputum expelling abilities, and the patient's condition was judged to be critical. On Feb. 29, the patient received HBOT for the first time, and medical staff entered the hyperbaric oxygen cabin through the special channel. After HBOT for four times, arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂) of the patient tended to be stable, carbon dioxide retention was alleviated, liver and kidney function improved, and coagulation function recovered. On Mar. 6, SARS-CoV-2 immunoglobulin (Ig) test showed that SARS-CoV-2 IgM was negative and SARS-CoV-2 IgG was positive. The patient was then transferred to general wards. Conclusion HBOT can alleviate CO₂ retention in critical COVID-19 patients, and has a positive effect on reducing hypoxia and protecting important organs. The HBOT infection control procedure is feasible, and the safety of medical staff can be guaranteed by reasonable design.

Abstract:Objective To study the infection control of patients with coronavirus disease 2019 (COVID-19) during the hyperbaric oxygen therapy, so as to provide references for hyperbaric oxygen therapy in public health events in the future. Methods A hyperbaric oxygen therapy and nursing team in wards and a full-time infection control nurse post were set up, the responsibilities of infection control nurses were defined, nosocomial infection monitoring was carried out, and meticulous management in all aspects of infection control was carried out. The hand hygiene compliance rates (number of hand hygiene execution/total number of hand hygiene indicators×100%) of doctors, nurses and patients were compared before and after supervision by full-time infection control nurses. After the implementation of the hyperbaric oxygen chamber disinfection, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test was performed on multiple sites inside and outside the hyperbaric oxygen chamber and wards every week. Hyperbaric oxygen therapy was given to four COVID-19 patients in mobile single air compression chamber and the therapy effects were observed. Results After supervision by full-time infection control nurses, the hand hygiene compliance rates of the doctors, nurses and patients were all improved (82.94%[175/211] vs 73.27%[148/202], 94.70%[268/283] vs 89.39%[236/264], and 78.41%[69/88] vs 46.64%[24/55]), and the differences were significant (χ²=5.663 5, 5.308 4, and 17.997 2, all P<0.05). After the implementation of the hyperbaric oxygen chamber disinfection, the SARS-CoV-2 nucleic acid test results were negative on the door handle, inside and outside of the hyperbaric oxygen chamber, the surface of the transfer bed and the surface of ward supplies during the first and second weeks. The pulse oxygen saturation (SpO₂) and the walking distance in six minutes of patients were both increased after hyperbaric oxygen therapy compared with those before hyperbaric oxygen therapy ([91.62±3.65]% vs[85.63±4.52]% and[346.3±43.6] m vs[272.2±61.9] m), and the differences were significant (t=2.062 1 and 1.957 4, P=0.042 and 0.049). The symptoms such as chest tightness and shortness of breath were significantly improved after hyperbaric oxygen therapy. Computed tomography reexamination showed that the inflammatory lesions of lungs had subsided to different extents. Conclusion Hyperbaric oxygen nursing team and infection control nurse post can promote and supervise the implementation of the infection control system and infection control measures, ensuring the infection monitoring of COVID-19 patients and the safety of patients and medical staff.

Abstract:Objective To understand the sleep quality and psychological status of officers and soldiers in naval force stationed in Hubei, China during the coronavirus disease 2019 (COVID-19) epidemic, and to explore the influencing factors, so as to maintain the physical and mental health of officers and soldiers during the epidemic. Methods Pittsburgh sleep quality index (PSQI) scale, patient health questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7) and impact of event scale-revised (IES-R) were used to evaluate the sleep and psychological status of officers and soldiers in a naval force stationed in Hubei province. Results A total of 238 questionnaires were sent out, and 232 valid questionnaires were collected, with an effective rate of 97.5%. The median score of PSQI scale was 2.00 (1.00, 5.00), and poor and very poor sleep qualities accounted for 5.6% (13/232) and 0.9% (2/232), respectively. The median score of PHQ-9 was 0.00 (0.00, 2.00), and mild, moderate and severe depression accounted for 12.1% (28/232), 0.9% (2/232) and 0.4% (1/232), respectively. The median score of GAD-7 was 0.00 (0.00, 0.00), and mild anxiety was found in 7.8% (18/232) participants. The median score of IES-R was 1.00 (0.00, 5.00), and mild and moderate psychological stress accounted for 12.5% (29/232) and 1.3% (3/232), respectively. Conclusion The sleep quality and psychological status of the officers and soldiers from the naval force stationed in Hubei are generally good during the COVID-19 epidemic. A small proportion of them have mild psychosomatic disorders, such as poor sleep quality, depression, anxiety and psychological stress reaction. Psychological counseling and humanistic care should be given to better maintain the physical and mental health of naval forces and ensure their combat capability.

Abstract:Objective To predict the coronavirus disease 2019 (COVID-19) epidemic situation based on the infectious disease dynamics susceptible-exposed-infected-recovered (SEIR) model, so as to provide guidance for effective control of the epidemic. Methods Python crawler automatic update function was used to collect the epidemic data released by the National Health Commission of China. An improved infectious disease dynamics SEIR model, which can automatically correct the COVID-19 basic reproductive number (R₀), was constructed to predict the development trend of COVID-19 epidemic in Hubei Province of China and South Korea. Results The peak of the COVID-19 epidemic in Hubei Province of China predicted by the model would appear on Feb. 21, 2020. The number of confirmed COVID-19 cases would be about 50 000 on Feb. 19 and would fall to below 30 000 on Mar. 4, and the epidemic would end on May 10. According to the actual data released by the National Health Commission of China, the peak number of confirmed COVID-19 patients was 53 371. The model predicted that an epidemic peak in South Korea would be on Mar. 7, and would end at the end of April. Conclusion This improved infectious disease dynamics SEIR model established in the early stage of COVID-19 epidemic has achieved relatively accurate prediction. The timely and effective intervention by relevant government departments has significantly affected the development of the epidemic. The epidemic situation in other countries in East Asia, such as South Korea, is still on the rise in March, suggesting that China needs to be on guard against the risk of imported epidemic.

Abstract:Coronavirus disease 2019 (COVID-19) has been confirmed to transmit by contact and respiratory droplets, and possibly by aerosols. Medical staff of oral and maxillofacial surgery departments need close contact with head and face of patients during the diagnosis and treatment, and aerosols may be generated during the operation. The risk of infection exposure is high, and the ward management is facing severe challenges. During the COVID-19 epidemic, the diagnosis and treatment in oral and maxillofacial surgery wards should be carried out reasonably after comprehensive assessment of patient condition. We put forward relevant prevention and control measures during the epidemic from the aspects of patient treatment, ward infection prevention and control, supply management, emergency plan, and training of medical staff, so as to provide references for prevention and control of the epidemic in oral and maxillofacial surgery wards.

Abstract:Coronavirus disease 2019 (COVID-19) has become a pandemic threatening public health. Its pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can be transmitted from person to person through droplets, contact and other ways. How to avoid further spread of the virus when patients with suspected or confirmed COVID-19 receive treatment in the operating rooms or intensive care units has become the focus and difficulty faced by medical staff. Here we discussed the dissemination characteristics of SARS-CoV-2, the perioperative environments, the disease management and infection control measures under specific operation.

Abstract:Objective To investigate the expression of microfibril-associated protein 5 (MFAP5) in bladder cancer tissues and its biological effects on bladder cancer cells. Methods The surgical resection specimens of bladder cancer patients, who were diagnosed in Shanghai General Hospital of Shanghai Jiao Tong University, were collected, and the expression level of MFAP5 was detected using immunohistochemistry. The cancer-associated fibroblasts (CAFs) and normal fibroblasts (NFs) were isolated and purified from bladder tumor tissues and normal bladder tissues, respectively. The mRNA expression levels of MFAP5 in CAFs, NFs, and four kinds of human bladder tumor cell lines (T24, 5637, UMUC3 and J82) were detected using quantitative real-time polymerase chain reaction. The correlation of MFAP5 expression with the progression and malignancy of bladder cancer was analyzed using the bladder cancer expression profile data derived from the Cancer Genome Atlas (TCGA) database and the GSE13507 database of Gene Expression Omnibus (GEO). The T24 and 5637 cells were treated with recombinant human MFAP5 protein to detect the effect on cell migration and invasion, as well as the expression of migration-associated proteins. Results MFAP5 was mainly expressed in the stroma of bladder cancer tissues, and its expression level was related to T stage and tumor grade of bladder cancer (both P<0.05). The mRNA expression level of MFAP5 in CAFs was significantly higher than those in NFs, and T24, 5637, UMUC3 and J82 cells (all P<0.01). The results of TCGA and GSE13507 database both showed that the overall survival of bladder cancer patients with high expression of MFAP5 was significantly shorter than that of patients with low expression of MFAP5 (both P<0.05). Gene set variation analysis showed that the expression level of MFAP5 increased with the degree of tumor malignancy (P<0.01), and its expression was closely related to expression of epithelial-mesenchymal transition-related genes such as cadherin 2, Twist1, matrix metalloproteinase 9 (MMP9), and zinc-finger E-box-binding protein 1 (ZEB1) (all P<0.01). In T24 and 5637 cells, the stimulation of recombinant human MFAP5 protein could up-regulate the expression of epithelial-mesenchymal transition-related proteins, including N-cadherin, MMP9, ZEB1 and Twist, and enhance the migration and invasion abilities (all P<0.01). Conclusion MFAP5 may be a potential molecular marker for predicitng the invasion and progression of bladder cancer.

Abstract:Objective To screen the differentially expressed long non-coding RNAs (lncRNAs) in glioblastoma, and to explore its role in the growth and invasion of glioblastoma. Methods Eight matched glioblastoma tumor tissues and peritumoral tissues were selected for high-throughput hybridization experiments, and the lncRNA with largest expression difference was screened. Human glioblastoma cell models with overexpression and interference expression of the lncRNA were established. Cell counting kit-8 (CCK-8) was used to detect the cell proliferation ability, flow cytometry was used to detect the apoptosis level, and Transwell assay was used to detect the cell invasion and migration abilities. Results The lncRNA MIR210HG, which was highly expressed in glioblastoma tissues, was screened out, and the glioblastoma cell models with overexpression and interference expression of lncRNA MIR210HG were successfully constructed. In vitro experiments showed that after overexpression of lncRNA MIR210HG, the apoptosis level of the glioblastoma cells was decreased, and the proliferation, invasion and migration abilities were increased, and after interference expression of lncRNA MIR210HG, the apoptosis level of the glioblastoma cells was increased, and the proliferation, invasion and migration abilities were decreased, with significant differences compared with control group (all P<0.05). Conclusion LncRNA MIR210HG can inhibit the apoptosis of glioblastoma cells, and promote cell proliferation, invasion and migration; and it may serve as a new target of glioblastoma therapy.

Abstract:Objective To evaluate the efficacy of sequential therapy with tumor necrosis factor inhibitor (TNFi) and conventional synthesis disease-modifying anti-rheumatic drugs (csDMARDs) in delaying imaging progress and maintaining function of the affected hip in ankylosing spondylitis (AS) patients. Methods AS patients with hip pain and limited activity were enrolled in this study. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured regularly, and ankylosing spondylitis disease activity score based on C-reactive protein (ASDAS_CRP) was performed to evaluate the disease activity. Etanercept (a TNFi) and csDMARDs were used sequentially according to the disease activity. Before sequential therapy and 3, 6 and 12 months after sequential therapy, the subjective symptoms were assessed by visual analogue scale, the condition was assessed using ASDAS_CRP and Bath ankylosing spondylitis disease activity index (BASDAI), the body function was assessed using Bath ankylosing spondylitis function index (BASFI), and the imaging changes of hip joint lesions were assessed using Bath ankylosing spondylitis radiology index-hip (BASRI-hip) and minimum joint space width (mJSW). Results A total of 51 patients (38 males[74.5%] and 13 females[25.5%]) aged from 10-56 years were enrolled, and the onset age was 9-40 years. No hip arthroplasty was performed due to limited hip function or further damage of hip joint structure. Based on assessments in ankylosing spondylitis (ASAS) Work Group criteria, 70.59% (36/51), 84.31% (43/51) and 96.08% (49/51) patients met the ASAS20 criteria and 58.82% (30/51), 78.43% (40/51) and 86.27% (44/51) patients met the ASAS40 criteria 3, 6 and 12 months after sequential therapy, respectively. At the follow-up points of 3, 6 and 12 months, the overall trends of CRP level and ESR, patient global assessment score, ASDAS_CRP, BASDAI score and BASFI score were significantly decreased (all P<0.05), while the overall trends of BASRI score and mJSW were not significantly changed (both P>0.05). Conclusion Sequential therapy with etanercept (a TNFi) and csDMARDs can effectively inhibit inflammation, avoid further damage of hip joint, improve joint function, and keep the hip joint space width in AS patients.

Abstract:A standardized neurocognitive test battery is needed to study the effects of military isolated and confined environments on the cognitive functions of personnel. The cognitive tests currently in use have the following problems:inconsistency among different studies, no clear psychological processes, the presence of practice effect, absence of related normative data, and insufficiency in sensitivity, difficulty, and comprehensiveness. Therefore it is proposed that the neurocognitive tests for military isolated and confined environments should meet the following requirements:(1) easy to carry and easy to carry out the test; (2) the test time should be as short as possible (≤ 30 min); (3) suitable for repeated measuring, and the subjects can reach a stable level quickly; (4) preferably a complete set of test, the cognitive function should be comprehensively and should be closely related to specific tasks; (5) the test should be based on the norm of military isolated and confined environments and the changing curve with time, which can be used as controls; (6) the reliability and validity of the cognitive test should have been tested; (7) with high sensitivity and appropriate test difficulty; (8) the psychological process involved in the cognitive test is clear and simple, making it easy for result interpretation; and (9) the brain areas activated by cognitive test should be clear, which is convenient for further neuropsychological research. Cognition, American National Aeronautics and Space Administration (NASA) neurocognitive test battery for spaceflight, almost perfectly fits the above nine requirements. In the future when our army develops the neurocognitive test tools based on NASA Cognition, we should emphasize the following four focuses:improving the portability of the cognitive test device, developing computerized adaptive cognitive tests, clarifying the inclusion criteria of cognitive tests, and developing parallel tests with consistent psychometrics characteristics.

Abstract:Exploration and utilization of polar resources are important for China's "Strategy Xinjiangyu". Extreme conditions such as coldness, low pressure, low oxygen and strong ultraviolet radiation in polar environment can lead to a series of adaptive and pathological changes of the cardiovascular system, autonomic nervous system and circadian rhythm. In polar environment, the risk of cardiovascular diseases is increased, and the injury of vascular endothelial cells and the change of cardiovascular structure and function are the important mechanisms. The supplement of dietary nitrate and the use of anti-sympathetic drugs may be the potential preventive measures. Cold stimulation, low oxygen and ultraviolet radiation can affect the balance of autonomic nervous system, which may be the key factor of body function changes in polar workers. In addition to the extreme climate and geographical conditions, polar workers also face polar day and night which changes the circadian rhythm. Researches have shown that melatonin secretion is highly related to the circadian rhythm, suggesting that maintaining the normal secretion of melatonin may be an effective way to regulate circadian rhythm. In addition, various extreme conditions in the polar environment can also lead to respiratory, digestive and endocrine system diseases. It is necessary to clarify the adaptability, pathological changes and mechanisms of human body in polar environment, providing references for polar workers to adapt to the polar environment and polar medical research.

Abstract:Objective To investigate the effect of propofol on cognitive function in young obese rats, and to explore its relationship with heme oxygenase 1 (HO-1), superoxide dismutase 1 (SOD1) protein expression and plasma S100 calcium-binding protein β (S100β) expression. Methods A total of 140 male SD rats aged 21 days were randomly divided into normal diet group (n=40) and high-fat diet group (n=100), and the rats were fed with a normal diet and a high-fat diet, respectively. After 4 weeks of feeding, 40 rats of the high-fat diet group with body mass ≥ the average body mass+1.4 times of the standard deviation of the normal diet group were designated as obese rats. The rats in the normal diet group were randomly divided into the normal lipid emulsion solvent group (NL group) and the normal propofol group (NP group), and the 40 obese rats were randomly divided into the obese lipid emulsion solvent group (OL group) and the obese propofol group (OP group), with 20 rats in each group. The rats in the propofol groups were intraperitoneally given propofol 100 mg/kg, and those in the lipid emulsion solvent groups (control groups) were intraperitoneally given lipid emulsion solvent 100 mg/kg, once a day for 7 days. On the first day after drug withdrawal, Morris water maze test was performed to evaluate the spatial learning and memory abilities of rats in each group. Meanwhile, the plasma S100β protein content of each group was detected by enzyme-linked immunosorbent assay, the expression levels of HO-1 and SOD1 protein in hippocampus were detected by Western blotting, and the changes of neurons in hippocampus CA1 area were observed by hematoxylin-eosin staining. Results Compared with the OL group, the escape latency time was significantly prolonged on 1-5 days (all P<0.05), the third quadrant residence time was significantly shortened (P<0.05), the times of crossing platform was significantly decreased (P<0.05), the expression of plasma S100β protein was significantly increased (P<0.05), the relative expression levels of HO-1 and SOD1 protein in hippocampus were significantly decreased (both P<0.05), and the number of neurons in hippocampal CA1 area was significantly decreased (P<0.01) in the OP group. Compared with the NL group, the escape latency time of the NP group was significantly prolonged on 1-2 days (both P<0.05), and there were no significant differences in other indexes mentioned above (all P>0.05). Conclusion Propofol can down-regulate the expression of anti-oxidant factors HO-1 and SOD1 in the hippocampus of young obese rats, leading to increase of S100β expression and oxidative stress and eventually causing cognitive impairment.

Abstract:Objective To explore the characteristics of diagnosis, treatment and prognosis of primary hepatic lymphoma (PHL), so as to better understand the tumor. Methods The diagnosis and treatment of a patient with PHL misdiagnosed as hepatic hemangioma were reported, and the domestic literatures were reviewed from 1975 to 2019 to sum up the diagnosis, treatment and prognosis characteristics of PHL. Results This patient had no specific clinical manifestations, and was misdiagnosed as hepatic hemangioma in other hospital. Magnetic resonance imaging (MRI) examination in our hospital showed that the tumor had malignant features and vessel floating sign, suggesting the possibility of malignancy. The patient was treated with resection of multiple hepatic tumors+hepatoduodenal lymph node dissection+cholecystectomy. Postoperative pathological results showed that the tumor was composed of large patches of lymphoid cells with few cytoplasm and atypical nuclei; the tumor had no obvious envelope; and the peripheral liver tissues were infiltrated. Immunohistochemical staining showed that the cells in follicular zone were mostly CD20 (+), and the cells in germinal center were CD10 (+), Bcl-6 (+) and Bcl-2 (-), Ki-67 (80%). Primary hepatic B-cell non-Hodgkin lymphoma (B-NHL) was diagnosed finally. A total of 376 PHL patients were reported in 91 domestic literatures, with an average age of 48.8±9.6 years and a male-to-female ratio of 1.69:1. The imaging was characterized by single lesion and vessel floating sign, lack of blood supply. The levels of lactic dehydrogenase were increased in 146 cases (38.8%). Totally 132 cases (35.1%) were misdiagnosed and the final diagnosis depended on pathological findings. Survival analysis results showed that the prognosis of B-NHL patients was significantly better than that of T-cell non-Hodgkin lymphoma (T-NHL) patients (median overall survival time:36.4 months vs 20.7 months, P=0.009); the prognosis of mucosa-associated lymphoid tissue lymphoma patients was significantly better than that of diffuse large B-cell lymphoma patients (52.0 months vs 30.0 months, P=0.049); and the prognosis of B-NHL patients treated with surgery combined with postoperative chemotherapy was significantly better compared with those treated with surgery alone and those treated with chemotherapy alone (45.6 months vs 23.9 months and 7.7 months, P=0.016). Conclusion Primary hepatic lymphoma is a rare tumor without characteristic clinical features, and its diagnosis needs to be combined with medical history, clinical manifestations, and imaging and laboratory examination. Once PHL is confirmed, it should be treated actively by surgery combined with chemotherapy or comprehensive chemotherapy.