Volume 97  ·  Issue 05  ·  2017

Oxygen therapy is the first-line treatment for hypoxemic respiratory failure. It is difficult for ordinary oxygen therapy to meet the demand of high flow and high concentration of oxygen in patients with respiratory failure. Because it cannot provide good warming and humidification, ordinary oxygen therapy often leads to damage of airway mucosal function. non-invasive ventilation (NIV) can reduce the application of invasive mechanical ventilation and avoid the complications related to tracheal intubation and invasive mechanical ventilation. However, NIV has high requirements for the tightness of face mask and the cooperation degree to patients, and the comfort degree is poor, so patients are prone to intolerance. In recent years, high-flow nasal cannula oxygenation (HFNCO) has attracted attention. HFNCO is a warming and humidifying high-flow oxygen therapy method. High-flow gas from an air-oxygen mixer, ventilator or turbine-driven unit is warmed and humidified through an active warming humidifier and a single warming line. The gas flow rate delivered by the device can reach up to 60 L/min and the oxygen concentration can reach up to 100%. When the gas higher than the peak inspiratory flow rate of the patient is given, it can ensure that the inhaled oxygen concentration does not vary depending on the inspiratory flow rate of the patient, so that the supplied oxygen concentration is accurate and stable.

To investigate the feasibility of utilizing the current acute gastrointestinal injury(AGI) grading system, and explore the association of severity of AGI grade with clinical outcome in critically ill patients.

The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24 h were recruited, and all clinical, laboratory, and survival data were prospectively collected. The AGI grade was daily assessed based on GIsymptoms, feeding details and organ dysfunctionon the first week of admission to ICU.The intra-abdominal pressures(IAP) was measured using AbViser device.

Of 550 patients enrolled, mean values for age and APACHE Ⅱ score were (64.9±17.2) years and (19.5±7.4), respectively. 456 patients(82.9%) took mechanical ventilation, and 470 patients were identified for AGI. The distribution of AGI grade on the frist day of ICU admission were 50.6%(Ⅰ grade, n=238), 34.2%(Ⅱ grade, n=161), 12.4%(Ⅲ grade, n=58) and 2.8%(Ⅳ, n=13), respectively, while the distribution of the global AGI grade based on the 7-day AGI assessment of ICU admission were 24.5%(Ⅰ grade, n=115), 49.4%(Ⅱ grade, n=232), 20.6%(Ⅲ grade, n=97) and 5.5%(Ⅳ, n=26), respectively. 28- and 60-day mortality rate was 29.3%(n=161) and 32.5%(n=179), respectively. The patients with AGI had a higher 28-(31.1% vs 18.8%, P=0.025) and 60-day survival rate(34.7% vs 20.0%, P=0.01) than those with non-AGI, and also there were positive correlations between AGI grade and 28- and 60-day mortality(P<0.001). Univariate Cox regression analysis showed that age, the source of medicial admission, diabetes mellitus, coronary heart disease, the use of vasoactive drugs, serum creatinine and lactate, mechanical ventilation, APACHE Ⅱ score, the AGI grade in the first day of ICU admission and feeding intolerance within the first week of ICU stay were significantly(P≤0.02) associated with mortality. In multivariate analysis including all these variables, the source of medical admission(χ²=4.34, P=0.04), diabete mellitus(χ²=3.96, P=0.05), the use of vasoactive drugs(χ²=6.55, P=0.01), serum lactate(χ²=4.73, P=0.03), the global AGI grade in the 7-day of ICU admission(χ²=7.10, P=0.008), and APACHE Ⅱ score(χ²=12.1, P<0.001) remained independent predictors for 60-day mortality.In the further subgroup analysis including 402 patients with 7-day survival, the feeding intolerance within the first week of ICU stay could provide independent and incremental prognostic value of 60-day mortality wtih increased χ²value of Cox regression model(χ²=52.2 vs 41.9, P=0.007) .

The AGI grading system is useful for identifying the severity of gastrointestinal dysfunction, and could be used as a strong predictor of impaired outcome. The results provide evidence to support that feeding intolerance within 7 days of admission to ICU was an independent determinant of mortality.

To compare the change of prognosis and pathogens of adult patients with severe community-acquired pneumonia (CAP) requiring admission to Respiratory Intensive Care Unit (RICU) during different period, and estimate the risk factors of severe CAP.

The clinical data of 186 patients with severe CAP admission to RICU was collected and assessed the trend in outcomes of these patients during three time periods: Period Ⅰ (January 1 2000 to October 31 2006), Period Ⅱ (November 1 2006 to December 31 2010), and Period Ⅲ (January 1 2011 to December 31 2015), analyzed the risk factors by Cox Proportional Hazards regression, and compared the pathogens detection.

The total mortality was 34.9%(65/186)during 16 years, three periods was 41.4%, 35.3% and 27.7% respectively.After adjustment for other variables, the mortality was significant higher for patients admitted during Period Ⅰ than that of Period Ⅲ (HR: 1.900; 95.0%CI 1.053-3.429, P=0.033), and no significant difference for Period Ⅰ compared with Period Ⅱ (HR: 1.394; 95.0%CI 0.774-2.514, P=0.269), Period Ⅱ compared with Period Ⅲ(HR: 1.379; 95.0%CI 0.800-2.375, P=0.248). Cox regression analysis showed the predicting risk factors for prognosis including BUN≥7.14 mmol/L, acute heart failure, acute renal failure, multilobar infiltrates and septic infectious shock ( P<0.05). Multi-variate Cox regression analysis showed that multilobar infiltrates(HR=3.951, 95.0%CI 2.252-6.929, P=0.001) and septic infectious shock(HR=2.044, 95.0%CI 1.131-3.692, P=0.018) were the independent risk factors for prognosis.104 (55.9%) were detected pathogens in 186 patients.The common pathogens were Staphylococcus aureus (18 isolated strains), Legionella pneumophila (16 isolated strains), Streptococcus pneumonia (13 isolated strains). There was no significant difference between bacterial isolation except virus detection(P=0.033).

There has been an improvement in the prognosis of severe CAP.Multilobar infiltrates and septic infectious shock were the independent risk factors for prognosis.Pathogens had changed in SCAP over time, and the detection rate of virus increased gradually.

To explore the effects of phentolamine on hemodynamic of patients with severe sepsis .

From January 2015 to August 2016, using random number table, 59 patients with severe sepsis were divided into research group and the control group by conventional treatment in Department of Emergency, the Second People′s Hospital of Nanning City. The patients of the research group were given phentolamine injection. The CI, ITBVI, EVLWI, SVRI of the patients were monitored by PICCO on 6, 12, 24, 48, 72 h before and after treatment. Measuring clearance of blood lactic acid, lactic acid, comparing two groups of blood lactic acid, lactic acid clearance change tendency, 28 d survival rate and time of the two groups in the ICU of patients was observed.

CI, SVRI, ITBVI of the research group was increased obviously, and EVLWI decreased obviously(P<0.05 orP<0.01)12, 24, 48, 72 h after treatment. The levels of blood lactic acid, lactic acid clearancef the research group improved better than that of the control group(P<0.05 orP<0.01) after treatment of 12, 24, 48, 72 h time points, especially lactate clearance increased significantly than the control group[(27.2±2.2) mmol/L vs(13.9±3.0) mmol/L,t=8.322, P=0.034]on 6 h. Time in ICU and 28 days rate of the research group was less than the control group[(9.8±3.6)d vs(13.0±4.1)d,P=0.004 ; (22.6% vs 35.7%, P=0.021)].

Phentolamine can significantly improve the early condition of hemodynamic and the survival rates of patients with severe sepsis.

To assesse the efficacy and safety of procalcitonin-guided antibiotic treatment of sepsis patients in intensive care units (ICU).

A prospective, randomised, controlled trial was gone in ICU of Northern Jiangsu People′s Hospital.Between January 2013 and December 2015.One hundred and fifty-six patients assessed for eligibility were randomly assigned to the procalcitonin-guided group (PCT group, 79) or to regular antibiotic group (RAT group, 77). Patients who received antibiotics for presumed infection according to principle of antimicrobial usage.In the procalcitonin-guided group, a non-binding advice to discontinue antibiotics was provided if procalcitonin concentration had decreased by 90% or more of its peak value or to 0.25 μg/L or lower.In the regular antibiotic group, patients were treated according to principle of antimicrobial usage.The general status of the patient, antimicrobial drug use time, length of ICU stay, hospital stay time, number of cases of recurrence in 28 days and number of cases of death in 28 days were compared between the two groups.

There were no statistical significance in age, gender, blood culture positive rate, and chronic underlying diseases (P>0.05). While APACHE Ⅱ score of PCT group was (22.7±4.7) points, which was higher than that of RAT group (19.9±4.2) (P<0.05). Log Rank test results showed that the time of antimicrobial drug usage was significantly reduced in PCT group than RAT group [days: 8.3±0.3, 95% confidence interval (95%CI 7.9-9.1) vs 10.1±0.4, 95% confidence interval (95%CI 9.2-11.3), Log Rank value 31.85, P=0.000]. There was no significant difference in length of hospital stay, ICU stay time, number of cases of recurrence in 28 days and number of death in 28 days between two groups (P>0.05).

Procalcitonin guidance stimulates reduction of duration of treatment and daily defined doses in critically ill patients with a presumed bacterial infection.This reduction does not affect the length of hospital stay, ICU stay time, number of cases of recurrence in 28 days and number of death in 28 days.

To study the alteration of the optic radiations in patients with primary open-angle glaucoma (POAG) by diffusion tensor imaging (DTI) and tractography, and to reveal the correlation between the DTI derived parameters and the severity of the disease.

A total of 24 patients with POAG and 20 age- and gender-matched healthy controls were enrolled in this study from January 2011 to June 2013.All subjects underwent ophthalmoscopy, standard automatic perimetry, intraocular pressure measurement and MRI scanning.All the eyes of POAG patients were evaluated by Hodapp-Anderson-Parrish (HAP) system.Then the stages of bilateral eyes were added together to evaluate the disease severity.Tractography was used to measure the fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) of the optic radiations of these subjects.The results of the two groups were compared.Partial correlation was then used to reveal the correlation between these derived DTI parameters and the severity of POAG.

Compared with health controls, POAG patients showed significant decreased FA (t=-3.299, P=0.002) and AD (t=-2.485, P=0.013), increased RD (t=2.365, P=0.018) in optic radiation .The alteration of MD was not significant (t=0.719, P=0.454). Mean FA values of the optic radiations were negatively correlated with POAG stages (r=-0.643, P= 0.001), while mean RD values (r=0.570, P= 0.004) and mean MD values (r= 0.448, P= 0.028) were positively correlated with POAG stages.No correlation between AD values and severity of POAG was found.

In the optic radiations of POAG patients, the FA values and AD values decrease, while RD values increase, indicating the fiber integrity changes.The alterations of FA, RD and MD are correlated with disease severity.

To compare the clinical efficacy differences between anterograde and retrograde catheterization interventional treatment for acute low extremity deep venous thrombosis(DVT).

The clinical data of 217 patients with acute low extremity DVT between January 2009 and December 2014 were analyzed retrospectively. Group A: 67 patients underwent treated with anterograde catheterization interventional treatment. Group B: 150 patients underwent treated with retrograde catheterization interventional treatment. The degree of thrombolysis in different anatomical sites, clinical effective rate, femoral-popliteal vein valve reflux and the incidence of post-thrombotic syndrome(PTS) were all analyzed.

There were no statistical differences in the degree of thrombolysis (≥50%) of common iliac vein, external iliac vein and common femoral vein between group A (83.6%, 88.1%, 91.0%)and B (80.7%, 82.0%, 88.0%)(all P>0.05). The degree of thrombolysis (≥50%) of superficial femoral vein in group A(94.0%) was significantly higher than that of group B (75.3%)(P=0.001). There was no significantly difference in the clinical effective rate at discharged between group A (80.6%) and B(76.7%)( P=0.519). During follow-up of 44±15 months, There was no statistical difference in the patency rate of the iliofemoral vein, the valvular regurgitation of patent femoropopliteal vein and the incidence of PTS between group A(70.2%, 25.4%, 35.8%) and B (60.0%, 31.5%, 40.0%)(all P>0.05). The incidence of PTS in patients with iliofemoral vein patency(13.1%) was significantly lower than that in patients with iliofemoral vein occlusion (82.5%)(P<0.01).

The anterograde or retrograde catheterization interventional treatment can be used for treating acute low extremity DVT and get comparable clinical effect.The retrograde catheterization does not increase venous valve damage. The recovery of iliofemoral vein lumen patency is the main task in the treatment of DVT and can significantly reduce the incidence of PTS.

To investigate the change of cerebral microcirculation of chronic cerebral circulation insufficiency(CCCI) patients and the relationship between CCCI and crossed cerebellar diaschisis(CCD)by using 320-detector row of low-dose volume CT perfusion imaging.

A total of 158 patients (103 males, 55 females, from 45 to 82 years old, the mean age was 62.9) with symptoms of CCCI were admitted to the First Affiliated Hospital of Wenzhou Medical University from June 2013 to January 2016. Low-dose CTP imaging of whole brain was performed to them using 320-detector row volume CT scanner. The perfusion parameters such as cerebral blood flow(CBF), cerebral blood volume(CBV), mean transit time(MTT), time to peak(TTP) and DLY in both cerebral blood supply areas and cerebellum were got, so were the 4-dimensional CTA images, and rCBF, rCBV, rMTT and rTTP were calculated by ipsilateral/contralateral value. Comparative t-test and independent t-test were applied to analyzing these parameters quantitatively.Chi-square test and Logistic regression model were applied to analyzing the related clinical risk factors.

(1) All 108 patients in CCCI group showed asymmetric perfusion within two cerebral hemispheres in CTP images. The CBF, CBV of diseased side were lower than the contralateral mirror area (t_CBF=-12.89, t_CBV=-7.031, P_{CBF, CBV}<0.001); the MTT of the diseased side was shorter than the contralateral mirror area (t_MTT =13.310, P_MTT<0.001); the TTP of the diseased side was longer than the contralateral mirror area (t_TTP=-4.012, P_TTP<0.001). The rCBF and rCBV of CCCI group were lower than that in non-CCCI group (t_rCBF=3.079, t_rCBV=2.760, P_{rCBF, rCBV}<0.01), while the rTTP of CCCI group was longer than that in non-CCCI group (t_rTTP=4.846, P_rTTP<0.001). (2)The results ofChi-square test showed that the differences of gender (χ²=4.036, P=0.045), hyperlipidemia (χ²=7.687, P=0.006), as well as smoking (χ²=11.868, P=0.001) had statistical significance between CCCI group and non-CCCI group.Multi-factor Logistic regression analysis showed that hyperlipidemia (OR value=3.736, P=0.016) and smoking (OR value=4.641, P=0.01) were the risk factors of CCCI, while gender had no relationship with it.(3)The incidence of CCD was 18.5% in the CCCI group, and at the same time, the supratentorial corresponding blood supply areas were classified.A total of 10(34.5%) cases were in blood supply area of posterior cerebral artery, 6(20.7%) cases were in blood supply area of middle cerebral artery, 12(41.4%) cases were of anterior cerebral artery, while only 1(3.5%) case was of basal ganglia, in which 4 cases were in blood supply area of posterior cerebral artery, another 4 cases were middle cerebral artery, 7 cases were of anterior cerebral artery and no case of basal ganglia respectively leading CCD alone.

CTP could display the microcirculation situation of abnormal brain tissue perfusion area intuitively and quantitatively. Additionally, it could reflect the degree of relationship between cerebral several blood supply areas and cerebellum.

This study was designed to further clarify the independent predictors of clinically significant bleeding events in bivalirudin-treated patients with acute myocardial infarction(AMI) undergoing percutaneous coronary intervention (PCI).

A total of 3 023 AMI patients from 88 centers of China who underwent PCI and received periprocedural bivalirudin treatment between August 2012 and December 2015 were involved in this study.The primary outcome was clinically significant bleeding events defined as the Bleeding Academic Research Consortium(BARC) grades 2-5, with 30 days after PCI.A multivariate Logistic regression model was performed to identify the independent predictors of the primary outcome.

Bleeding events occurred in 88(2.9%) patients during the 30-day follow up, with clinically significant bleeding (BARC types 2-5) in 22(0.7%) and BARC types 3-5 in 7(0.2%). Multivariate regression analysis revealed radial access (OR: 0.196, 95%CI: 0.074-0.517, P=0.001) as the independent protector of the significant bleeding events, anemia (OR: 2.956, 95%CI: 1.024-8.528, P=0.045) and eGFR<30 ml/min (OR: 7.860, 95%CI: 1.515- 40.776, P=0.014) as independent risk factors.

The rate of clinically significant bleeding complications in Chinese AMI patients undergoing PCI with concomitant use of bivalirudin is low in real-world clinical practice.Radial access is independent protective factor that reduces bleeding events, whereas anemia and eGFR <30 ml/min are independent risk factors that increase bleeding risk.

To determine the expression of Sema3A in serum and peripheral blood mononuclear cells (PBMC) of patients with systemic lupus erythematosus (SLE), to analysis the correlation of Sema3A expression and SLE clinical manifestations and laboratory indexes, and to evaluate the diagnostic value of Sema3A in patients with SLE.

The concentration of serum Sema3A was detected by enzyme-linked immuno sorbent assay (ELISA) in patients with SLE, healthy controls (HC) and diseases controls. In addition, the mRNA expression level of Sema3A was examined in PBMC by real-time polymerase chain reaction. The correlation of serum Sema3A level and clinical and laboratory features of SLE patients were analyzed. Unpaired t test, Kruskal-Wallis test, Mann-Whitney U test, χ ² test, Pearson and Spearman correlation analysis were used to statistical analysis by using SPSS 13.0.

(1) Serum Sema3A concentration in patients with SLE was significantly lower than that in HC groups (P<0.01). (2) Consistent with the serum level, the Sema3A mRNA level in SLE was lower than that in HC (P=0.001). And the mRNA expression of Nrp-1 in SLE was also lower than that in HC (P<0.01). (3) The serum Sema3A level in patients with SLE was positively correlated with haemoglobin (HGB) (r=0.271, P<0.013), platelet (PLT) (r=0.600, P<0.011), complement 3 (C3) (r=0.234, P=0.0027) and complement 4 (C4) (r=0.159, P=0.434) levels. Whereas, the expression of Sema3A was negatively correlated with SLE disease activity index (SLEDAI) (r=-0.286, P=0.036). (4) Area under curve illustrated by ROC curve was 0.876 (95% CI: 0.846-0.906). The best cut-off value for the diagnosis of SLE was 6.31 μg/L, with the sensitivity of 80.6% and the specificity of 77.5%. The Youden index was 0.581. Above results indicated good validity of Sema3A as a diagnostic marker for SLE. (5) The HGB, PLT, C3 and C4 levels in the group of Sema3A- positiveSLE patients (≤6.31 μg/L) were lower than that in negative group (>6.31 μg/L), while CRP level and SLEDAI of positive group was higher than that in negative group( P<0.05). In addition, the positive rate of antinuclear antibodies (P=0.046) and anticardiolipin antibody (P=0.018) in the Sema3A-negative group were also significantly higher than that of negative group.

Sema3A and Nrp-1 was both decreased in serum and PBMC of SLE patients, suggesting that the circulating expression of Sema3A and Nrp-1 was seriously defected in SLE. Circulating Sema3A was significantly correlated with disease activity and blood damage in patients with SLE. The result of ROC curve showed that Sema3A had the potential to be a new diagnostic biomarker in SLE.

To evaluate the treatment effects of preoperative long-acting somatostatin analogue (SSA) combined trans-sphenoidal endoscopic surgery for patients with growth hormone (GH)-secreting pituitary macroadenomas.

Retrospective analysis was carried out on 20 patients with GH-secreting pituitary macroadenomas who were treated with preoperative SSA and trans-sphenoidal endoscopic surgery in our apartment from January 2010 to January 2016. We also selected 20 patients with only trans-sphenoidal endoscopic surgery treatment and 20 patients with preoperative SSA and non-trans-sphenoidal endoscopic surgery treatment. The changes of tumor imaging, endocrine and blood pressure before and after treatment were analysed.

The Gross total resection (GTR) rate of invasive GH-secreting pituitary macroadenomas of preoperative SSA combined trans-sphenoidal endoscopic surgery group (8/13) were higher than that if only trans-sphenoidal endoscopic surgery group (4/16) and preoperative SSA combined non endoscopic surgery group (1/8) (P<0.05). Meanwhile, preoperative SSA combined trans-sphenoidal endoscopic surgery group had significantly improved the GH levels, blood glucose, lipid metabolism and blood pressure levels (P<0.05).

The trans-sphenoidal endoscopic surgery on patients with GH-secreting pituitary macroadenomas has a significant improvement on GH levels, blood glucose, lipid metabolism and blood pressure levels. Through the treatment of preoperative long-acting SSA, the gross total resection rate is higher than other two groups.

To observe mutual interactions between macrophages(Mφ) and glioma stem cells (GSCs)in dual-color tracing model in vitro, to identify the biological characteristics of fusion cells in multiple levels, and to analysis the relevant molecular mechanisms.

Red fluorescent protein(RFP) gene was stably transfected into human GSCs cell line SU4. Mφ cells were obtained from Balb/c nude mice with enhanced green fluorescent protein (EGFP) expression. Then two cells were co-cultured in dual-color tracing platform. RFP/EGFP double positive cells with high proliferation ability were mono-cloned. The fusion cells were verified by Western blot, fluorescence in situ hybridization, immunocytochemistry and chromosome karyotype analysis.The biological characteristics of fusion cells were further analyzed, together with relevant molecular changes.

RFP / EGFP double positive cells were obtained through in vitro co-culture. RFP and EGFP coexpression were proved at transcriptional and translational levels in the fusion cells. They also co-expressed GSCs marker Nestin and Mφ marker CD68, and karyotype analysis showed two types of characteristic chromosomes, which confirmed that the fusion cells originated from spontaneous fusion between SU4-RFP and Mφ.Fusion cell proliferation rate and invasion ability were higher than SU4-RFP, which were relevant with down-regulation of miR-146b-5p and activation of STAT3. Fusion cells transfected with miR-146b-5p showed a higher apoptosis rate(18.83%) and lower tumor formation(4/5).

Mφ could fuse with GSCs spontaneously in local tumor micro-environment. The proliferation and invasion abilities of fusion cells were higher than their parent cells, which were relevant with down-regulation of miR-146b-5p and activation of STAT3. It revealed the possible mechanisms of malignant progression of gliomas.

To investigate the effects and possible mechanisms of ursodeoxycholic acid (UDCA) on myocardial fibrosis in mice.

To observe the expression of transforming growth factor(TGF) -β1, CTGF, MMPs and the degree of myocardial fibrosis, 61 male Kunming mice were randomly divided into normal group, low dose UDCA group, high dose of UDCA group, spironolactone group, and the control group.Isoproterenol (ISO) injection was given subcutaneously (30 d) to make the model of myocardial fibrosis.Corresponding anti-fibrosis drugs (UDCA or spironolactone) were given by gavage.HE staining and Masson staining were performed to explore the inflammation and fibrosis in the myocardium.The expression of collagen Ⅰ and collagen Ⅲ protein was detected by immunohistochemistry to evaluate the degree of fibrosis among the groups.Western blot was used to detect the expression of transforming growth factor, (TGF)-β1, connective tissue growth factor (CTGF), matrix metalloproteinase (MMP)-2, -9, tissue inhibitor of metalloproteinase (TIMP)-4, -1 and anti-phospho-NFKBIA (p-IκB-α) inhibitor of NF-κB (IκB) protein in myocardium.

HE and Masson staining results showed that in the normal group, myocardial fibrosis is less, while the control group showed a large amount of fibrotic tissue (P<0.05). Tissue fibrosis in the low/high dose UDCA group and spironolactone group was significantly reduced compared with the control group (P<0.05), in which high dose of UDCA reduces fibrosis more significantly.Immunohistochemistry results showed that collagen Ⅰ and collagen Ⅲ protein expression was significantly increased (P<0.05). Whereas in the low/high UDCA dose group and spironolactone group, collagen Ⅰ and collagen Ⅲ expression were significantly decreased (P<0.05), the high UDCA dose group decreased more significantly.Western blot results suggest that TGFβ-1 expression in the myocardial tissue was significantly increased compared to the normal group (P<0.05), whereas low/high UDCA dose group and spironolactone group, TGFβ-1 protein expression were significantly decreased [UDCA(1.52±0.16), (1.02±0.12), (1.01±0.21)vs (2.73±0.12),P<0.05], in which high UDCA dose group TGFβ-1 protein expression level decreased more significantly.However, there was no significant difference in the expression of CTGF, MMP2/9 and TIMP1/4 protein among the groups (P>0.05). UDCA decrease p-IκB-α expression and increase IκB protein expression dose-dependently.

UDCA can relieve isoproterenol induced myocardial fibrosis and reduce the myocardial collagen Ⅰ and collagen Ⅲ deposition in a dose dependent manner.Down-regulating of TGFβ-1 protein expression through the inhibition of TGR5-NF-κB signal transduction pathway might be a potential mechanism underlying UDCA′s effects.

relapsing polychondritis (RP) is a rare autoimmune disease that can involve the cartilage structures of multiple organs such as the ear, nose, larynx, trachea, bronchi and surrounding joints, and develop progressively aggravated inflammatory lesions. RP combined with central nervous system damage is extremely rare and can be manifested as an acute or subacute pathogenesis, and nervous system damage can occur at any stage of RP. In this study, we retrospectively summarized 3 cases of RP-related central nervous system damage, and summarized and analyzed the diagnosis and treatment process.

3D Printing technology, also known as "additive manufacturing" technology (also known as additive manufacturing), refers to a process of making three-dimensional entities by computer control, contrary to traditional material removal processing methods, using "layered manufacturing, layer by layer superposition" method^[1]。 It is a rapid prototyping technology that provides efficient solutions for fast and precise personalized manufacturing, and has been hailed as one of The important symbols of The third industrial revolution by The Economist magazine in The UK^[2]。

Systemic sclerosis is an autoimmune disease characterized by extensive fibrosis of multiple organs, microvascular disease, innate immunity and adaptive immune disorders^[1]Its clinical manifestations are heterogeneous, and the pathogenesis is still unclear. Macrophages and T cells are mainly involved in vascular inflammatory infiltration, and act on fibroblasts by releasing pro-inflammatory factors and pro-fibrotic factors to cause tissue fibrosis^[2]。 Vascular disease is also one of the first symptoms of the disease. Progressive vascular disease can lead to further decrease in the number of capillaries, thickening of blood vessel walls, proliferation of vascular smooth muscle cells, narrowing of cell cavities, and ultimately tissue hypoxia and oxidative stress^[3]。 It has recently been found that abnormal expression of chemokines plays an important role in systemic sclerosis.