Rectus sheath hematoma combined with COVID-19:A case report

BACKGROUND Rectus sheath hematoma(RSH)is uncommon,and because people have limited knowledge about it,it is difficult to recognize the symptoms in time,often delaying optimal treatment.CASE SUMMARY Herein,we report a case of a 77-year-old female with RSH.The patient was treated at our hospital for coronavirus disease 2019.Anticoagulant treatment was administered during this period because of thrombosis.On the 8th d of treatment,the patient complained of abdominal pain.Ultrasonography revealed a solid cystic mass in the pelvic cavity.An emergency laparotomy was performed,and a huge hematoma was found in the deep layer of the rectus abdominis muscle.We used anticoagulants with caution based on the patient’s condition.CONCLUSION Optimal management of patients with RSH s depends on timely diagnosis and when to reintroduce anticoagulants.

Clinical efficacy of tocilizumab treatment in severe and critical COVID-19 patients

BACKGROUND The main pathophysiological basis of coronavirus disease 2019(COVID-19)causing respiratory failure is a cytokine storm and interleukin-6(IL-6)is an important component of the COVID-19 cytokine storm.As a specific antagonist of IL-6,tocilizumab may block the cytokine storm of COVID-19.The Diagnosis and Treatment Guidelines of New Coronavirus Pneumonia(7 th Edition)includes tocilizumab as a recommended drug for immunotherapy in severe and critical COVID-19 patients.However,the specific clinical efficacy of tocilizumab in the treatment of COVID-19 patients is worth studying.AIM To determine the clinical efficacy of tocilizumab in inhibiting the cytokine storm in COVID-19.METHODS In total,19 severe and critical COVID-19 patients were enrolled in this study,and were treated with tocilizumab in Optical Valley Campus of Hubei Maternal and Child Health Care Hospital from February 20 to March 31,2020.The imaging manifestations and clinical data before and after treatment were analyzed retrospectively,including routine peripheral venous blood tests,routine blood biochemical tests,coagulation test,C-reactive protein(CRP),IL-6,and arterial blood gas analysis.RESULTS Of the 19 patients in this group,13(68.4%)had significantly improved symptoms of COVID-19(5 patients were discharged directly and 8 patients were transferred after improvement)following treatment.One case was invalid,1 case was exacerbated,and 4 deaths(21.1%)were observed(all critical cases).The lymphocyte count,CRP,lactic acid,oxygenation index,fibrinogen(FIB)and IL-6 levels were significantly different in the improved group.CONCLUSION Tocilizumab treatment is effective against IL-6 in COVID-19 patients,but it does not completely inhibit the inflammation and cytokine storm in all patients with COVID-19.In the clinical treatment of COVID-19 patients,attention should be paid to the timing of drug administration and other adjuvant treatments.

Inhibition of HBV Replication by VPS4B and Its Dominant Negative Mutant VPS4B-K180Q In Vivo

This study examined the anti-hepatitis B virus （HBV） effect of wild-type （WT） vacuolar protein sorting 4B （VPS4B） and its dominant negative （DN） mutant VPS4B-K180Q in vivo in order to further explore the relationship between HBV and the host cellular factor VPS4. VPS4B gene was amplified from Huh7 cells by RT-PCR and cloned into the eukaryotic expression vector pXF3H. Then, the VPS4B plasmid and the VPS4B-K180Q mutation plasmid were constructed by using the overlap extension PCR site-directed mutagenesis technique. VPS4B and HBV vectors were co-delivered into mice by the hydrodynamic tail-vein injection to establish HBV vector-based models. Quantities of HBsAg and HBeAg in the mouse sera were determined by ElectroChemiLuminescence （ECL）. HBV DNA in sera was measured by real-time quantitative PCR. Southern blot analysis was used to assay the intracellular HBV nuclear capsid-related DNA, real-time quantitative PCR to detect the HBV-related mRNA and immunohistochemical staining to observe the HBcAg expression in the mouse liver tissues. Our results showed that VPS4B and its mutant VPS4B-K180Q could decrease the levels of serum HBsAg, HBeAg and HBV-DNA. In addition, the HBV DNA replication and the mRNA level of HBV in the liver tissues of treated mice could be suppressed by VPS4B and VPS4B-K180Q. It was also found that VPS4B and VPS4B-K180Q had an ability to inhibit core antigen expression in the infected mouse liver. Furthermore, the anti-HBV effect of mutant VPS4B-K180Q was more potent than that of wild-type VPS4B. Taken together, it was concluded that VPS4B and its DN mutant VPS4B-K180Q have anti-HBV effect in vivo, which helps develop molecular therapeutic strategies for HBV infection.

Retrospective analysis of influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients

BACKGROUND The novel coronavirus disease 2019(COVID-19)has spread widely around the world with strong infectivity,rapid mutation and a high mortality rate.Mechanical ventilation has been included in the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia(Trial Version 8)as an important treatment for severe and critical COVID-19 patients,but its clinical efficacy in COVID-19 patients is various.Therefore,it is necessary to study the influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients.AIM The aim of this study was to determine the influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients.METHODS A total of 27 severe and critical COVID-19 patients were enrolled in this study and treated with mechanical ventilation at the Optical Valley Campus of Hubei Maternal and Child Health Care Hospital(Wuhan,Hubei Province)from February 20,2020 to April 5,2020.According to the final treatment outcomes,the patients were divided into the“effective group”and“death group.”The clinical data of the two groups,such as the treatment process and final outcome,were retrospectively analyzed in order to determine the specific curative effects on the two groups and the reasons for the differences in such curative effects,as well as to explore the factors related to death.RESULTS This study enrolled 27 severe and critical COVID-19 patients,including 17 males(63.0%)and 10 females(37.0%).Their ages were 74.41±11.73-years-old,and 19 patients(70.4%)were over 70-years-old.Severe COVID-19 patients over 70-yearsold who were treated with mechanical ventilation died in 14 cases(82.4%);thus,this was the peak age.A total of 17 patients died of basic disease,16 of whom had more than two basic diseases.The basic diseases were hypertension,diabetes,and cardiovascular and cerebrovascular diseases.At the same time,13 patients(76.5%)died from an abnormal increase in blood glucose.Among them,eight had diabetes before contracting COVID-19 and five had a stress-induced increase in blood glucose after contracting COVID-19.Diabetic ketoacidosis occurred in one case.The use of tocilizumab may be a double-edged sword that carries a certain risk in clinical usage.Among the patients who died,16(94.1%)went into septic shock at the end.There were significant differences in the degree of infection,cardiac and renal function,and blood glucose between the death group and effective group.CONCLUSION Age,blood glucose,cardiac and renal function,and inflammatory reaction are important indicators of poor prognosis for mechanical ventilation in severe and critical COVID-19 patients.

Effects of acupuncture on expression of VEGF, PLA2 and PGE2 and extracellular matrix collagen and metabolic enzymes in the intervertebral disc of rats with cervical disc degeneration

Objective: The aim of this study was to investigate the effects of probe puncture on the expression of VEGF, PLA2 and PGE2 and extracellular matrix collagen and metabolic enzymes in the intervertebral disc of rats with cervical disc degeneration. Methods: Rats were randomly assigned to the following three groups (n = 25 per group): sham operation group (cut neck and then suture), model group (treated by modeling), and acupuncture treatment group (continuous daily) 30 minutes, complete course of treatment consisted of 14 days, 2 days between two courses);mRNA expression levels of VEGF, PLA2 and PGE2 were analyzed by qRT-PCR;protein levels of VEGF, PLA2 and PGE2 proteins were determined by Western blotting;Immunohistochemical staining was used to detect type I and type II collagen;TNF-α, IL-1β, MMP-1 and MMP-3 levels were detected by enzyme-linked immunosorbent assay;TUNEL assay was used to evaluate acupuncture treatment for cervical disc degeneration The effect of apoptosis. Results: The expression levels of VEGF, PLA2 and PGE2 mRNA and protein in the model group were higher than those in the sham operation group, while the acupuncture treatment group reduced the expression levels of VEGF, PLA2 and PGE2 mRNA and protein in the model group (P<0.05). The type I collagen was positively correlated with disc degeneration, and type II collagen was negatively correlated with disc degeneration. In the model group (0.18±0.05, 0.11±0.03), the expression level of type I collagen was higher than that of the sham operation group (0.12±0.03), the expression level of type II collagen was decreased (0.19±0.04), and the acupuncture treatment group was able to restore the model. Collagen levels of group I (0.14±0.03) and type II (0.17±0.03) were different between the three groups (P<0.05). Compared with the sham operation group, the model group was TNF-α, IL-1β, The expression levels of MMP-1 and MMP-3 were increased, while the acupuncture treatment group reduced the expression levels of TNF-α, IL-1β, MMP-1 and MMP-3 in the model group (P<0.05). The nuclear membrane of the model group was destroyed, the nucleus became denser, and the cells in the acupuncture treatment group showed a relatively intact nuclear membrane. The number of TUNEL-positive cells in the model group (131.17±12.15) was increased compared with the sham-operated group (64.53±8.73). Compared with the model group, the number of TUNEL-positive cells in the acupuncture treatment group decreased (P<0.05). Conclusion: Acupuncture can reduce the expression of type I collagen and metabolic enzymes in VEGF, PLA2 and PGE2 and extracellular matrix of cervical intervertebral disc degeneration, and increase the expression of type II collagen.

Clinical efficacy of bushen huatan huoxue recipe in combination with acupuncture in treating patients suffering from polycystic ovary syndrome with insulin resistance

Objective:To investigate the clinical efficacy and effects on sex hormone level and glucose metabolism indexes of acupuncture therapy combined with the Bushen Huatan Huoxue Recipe in patients with polycystic ovary syndrome(PCOS)with insulin resistance(IR).Methods:The patients with PCOS-IR admitted from December 2021 to December 2022 were randomly divided into two groups,30 cases in each group.The comparison one and the observation one were given the relevant treatment of metformin and traditional Chinese medicine combined with acupuncture,respectively.The evidence points,sex hormone indexes and glucose metabolism indexes were compared between the two groups before and after treatment,and the insulin resistance index(HOMA-IR),glucose area under the curve(GLU-AUC)and blood insulin area under the curve(INS-AUC)were calculated.Results:The evidence points of the observation group of patients were less than the pre-treatment and comparison groups;after treatment,the follicle-stimulating hormone(FSH)level of patients in the observation group was more than the control and pre-treatment groups(P<0.05),and the ratio of luteinizing hormone(LH)to follicle-stimulating hormone(FSH)was less than that of the comparison and pre-treatment groups(P<0.05),and the levels of LH and testosterone(T)were reduced to varying degrees in both groups around the time of treatment(P<0.05).The patients in the observation group had lower levels of 0.5hPG than those in the comparison group and pretreatment(both P<0.05),and the levels of 3hPG in both groups were lower than those before treatment(P<0.05).The oral OGIRT in each of the two groups after treatment was lower than that of pretreatment(P<0.05).HOMA-IR and INS-AUC of the observation group were lower than those of the control group and pre-treatment(P<0.05).Conclusion:The treatment of PCOS-IR patients with Bushen Huatan Huoxue Recipe combined with acupuncture can improve the sex hormone,glucose metabolism level and insulin resistance.

Assessment of Left Atrial Function in Diabetes Mellitus by Left Atrial Volume Tracking Method

The value of the left atrial volume tracking (LAVT) method in the evaluation of left atrial (LA) function in patients with diabetes mellitus (DM) was examined in this study.Fifty-eight DM patients as DM group and 40 healthy people as normal control group were enrolled in this study.EUB-6500 echocardiographic imaging system with LAVT was applied to display and analyze the LA volume curve imaging on LV apical two and four chamber views.The maximal LA volume at end-systole (LAV max),LA volume at the onset of ECG-P wave (LAV p),the minimal LA volume at end-diastole (LAV min) from the LA volume curve were acquired and recorded.All values above were standardized by body surface area (BSA).Then the passive,active and total LA volume (LAVIpass,LAVIact,LAVItotal) and empting rate (%LAVIpass,%LAVIact,%LAVItotal),effective passive and active empting rate (%eLAVIpass,%eLAVIact),and the proportionality of passive empting volume and active empting volume were calculated.The LAVIp,LAVIact,LAVItotal,%LAVIact,%LAVItotal and %eLAVIact were significantly higher in the DM group than those in the control group,whereas the LAVIpass,%LAVIpass,%eLAVIpass and LAVIpass/act were lower (all P【0.05).For the LA volume change in DM,the active empting volume was enhanced at end-diastole.It was concluded that LAVT is a potentially useful tool to evaluate the function of LA.

Mild Encephalopathy/Encephalitis with a Reversible Splenial Lesion(MERS):A Report of Five Neonatal Cases

Mild encephalopathy/encephalitis with a reversible splenial(MERS) lesion is a clinic-radiological entity. The clinical features of MERS in neonates are still not systemically reported. This paper presents five cases of MERS, and the up-to-date reviews of previously reported cases were collected and analyzed in the literature. Here we describe five cases clinically diagnosed with MERS. All of them were neonates and the average age was about 4 days. They were admitted for the common neurological symptoms such as hyperspasmia, poor reactivity and delirium. Auxiliary examinations during hospitalization also exhibited features in common. In this report, we reached following conclusions. Firstly, magnetic resonance imaging revealed solitary or comprehensive lesions in the splenium of corpus callosum, some of them extending to almost the whole corpus callosum. The lesions showed low intensity signal on T1-weighted images, homogeneously hyperintense signal on T2-weighted images, fluid-attenuated inversion recovery and diffusion-weighted images, and exhibited an obvious reduced diffusion on apparent diffusion coefficient map. Moreover, the lesions in the magnetic resonance imaging disappeared very quickly even prior to the clinical recovery. Secondly, all the cases depicted here suffered electrolyte disturbances especially hyponatremia which could be easily corrected. Lastly, all of the cases recovered quickly over one week to one month and majority of them exhibited signs of infections and normal electroencephalography.

Altered Expression of Differential Genes in Thoracic Spinal Cord Involved in Experimental Cholestatic Itch Mouse Model

The spinal origin of cholestatic itch in experimental obstructive jaundice mouse model remains poorly understood. In this study, the jaundice model was established by bile duct ligation （BDL） in mice, and differential gene expression patterns were analyzed in the lower thoracic spinal cord involved in cholestatic pruritus after BDL operation using high-throughput RNA sequencing. At 21st day after BDL, the expression levels of ENSRNOG00000060523, ENSRNOG00000058405 and ENSRNOG00000055193 mRNA were significantly up-regulated, and those of ENSRNOG00000042197, ENSRNOG00000008478, ENSRNOG00000019607, ENSRNOG00000020647, ENSRNOG00000046289, Gemin8, Serpina3n and Trim63 mRNA were significantly down-regulated in BDL group. The RNAseq data of selected mRNAs were validated by RT-qPCR. The expression levels of ENSRNOG00000042197, ENSRNOG00000008478, ENSRNOG00000019607, ENSRNOG00000020647, ENSRNOG00000046289 and Serpina3n mRNA were significantly down-regulated in BDL group. This study suggested that cholestatic pruritus in experimental obstructive jaundice mouse model is related with in the changes of gene expression profiles in spinal cord.

Down-regulation of Helios Expression in Tregs from Patients with Hypertension

Regulatory T cells（Tregs） play a pivotal role in the pathological development of hypertension.Helios,a transcription factor from the Ikaros family,was recently reported to be a bona fide marker for natural Tregs or activated Tregs with suppression function,however,little has been known about its role in hypertension.This study was aimed to find whether Helios＋ Tregs really play a vital role in hypertension.A total of 60 hypertension patients,and 46 normotension subjects were enrolled in this study.Frequencies of different Tregs subsets in peripheral blood were measured by flow cytometry.Plasma cytokine level was determined by ELISA.The m RNA expression of Foxp3 and Helios in purified CD4＋ T cells was detected by RT-PCR.Proportion of CD4＋Foxp3＋Helios＋ Tregs was decreased significantly in patients with hypertension（62.52%±1.18% vs.71.89%±1.03%,P〈0.01）,and it was correlated with plasma level of IL-10 positively（r=0.505,P〈0.05） and plasma level of IFN-gamma negatively（r=–0.551,P〈0.05）.The m RNA expression of Foxp3（7.23±1.00 vs.10.58±0.54,P〈0.05） and Helios（8.47±0.95 vs.15.52±2.0,P〈0.05） was decreased in CD4＋ T cells from patients with hypertension.Helios＋ Tregs were decreased in patients with hypertension and may play a protective role in hypertension progression.

Timing of convalescent plasma therapy-tips from curing a 100-yearold COVID-19 patient using convalescent plasma treatment: A case report

BACKGROUND Convalescent plasma therapy is used for the treatment of critically ill patients for newly discovered infectious diseases,such as coronavirus disease 2019(COVID-19)pneumonia,under the premise of lacking specific treatment drugs and corresponding vaccines.But the best timing application of plasma therapy and whether it is effective by antiviral and antibiotic treatment remain unclear.CASE SUMMARY We describe a patient with COVID-19,a 100-year-old,high-risk,elderly male who had multiple underlying diseases such as stage 2 hypertension(very high-risk group)and infectious pneumonia accompanied by chronic obstructive pulmonary disease and emphysema.We mainly describe the diagnosis,clinical process,and treatment of the patient,including the processes of two plasma transfusion treatments.CONCLUSION This provides a reference for choosing the best timing of convalescent plasma treatment and highlights the effectiveness of the clinical strategy of plasma treatment in the recovery period of patients with COVID-19 pneumonia.

Insomnia and Coronary Artery Diseases:A Mendelian Randomisation Study

Objective:Observational studies indicate that insomnia may increase the risk of developing and/or dying from cardiovascular diseases,especially coronary artery disease(CAD).Our purpose is to explore the underlying causal relationship between genetic variants susceptible to insomnia and the risk of CAD by Mendelian randomization analysis.Methods:The study was conducted using publicly available statistical data on genetic variants identified from a genome-wide association meta-analysis of insomnia(n=113,006 individuals)and a genome-wide association meta-analysis of CAD(n=184,305 individuals),which consisted of both cases and non-cases.The genetic association between variants and CAD was assessed by the variants’association with insomnia,and estimations were integrated by an inverse-variance weighted meta-analysis.Results:Among the Mendelian randomized analytical sample,8 variants were associated with insomnia complaints and CAD.And there was no pleiotropic association with the latent confounders.In addition,in the inverse-variance weighted meta-analysis(the estimations combined from the 8 variants),the odds ratio was 1.15(95%CI:1.05–1.25;P=0.002)for CAD,and in the weighted method analysis,the odds ratio was 1.14(95%CI:1.03–1.27;P=0.015)for CAD.Conclusions:All of the data indicated that some valuable variants might involve in the development of CAD by leading the insomnia.Therefore,insomnia might be a causal factor for CAD,and improving the quality of sleep might be a new way for populations with insomnia to prevent CAD.