Since acute respiratory distress syndrome (ARDS) was firstly reported in 1967, the diagnostic criteria and classification standard have evolved continually. Neonatal ARDS has drawn increasing attention in recent years, while research on neonatal ARDS has proceeded slowly, partly because of ambiguity in the definitions and diagnostic criteria of neonatal ARDS. In this comment, we overview the application of the Berlin definition made in 2012, the Montreux definition made in 2017, and the definition of pediatric ARDS update by the Second Pediatric Acute Lung Injury Consensus Conference made in 2023 (PALICC-2 definition) in neonatal ARDS, then compare the similarities and differences among the three definitions. Finally, the differences in classification standard, triggers, morbidity, mortality, poor prognosis, and treatment among the three definitions for neonatal ARDS were analyzed, and the research directions in the future of the definition for neonatal ARDS were proposed.

Objective To observe the effects of total saponins of Trillium tschonoskii Maxim (TST) on vascular cognitive impairment (VCI), neurovascular units (NVUs), and neural circuit integrity in rats. Methods Forty-eight male Sprague-Dawley (SD) rats were randomly divided into sham-operated group, model group, TST group (intragastric administration, 100 mg/kg), and donepezil group (intragastric administration, 0.45 mg/kg), and then subjected to ischemic stroke by 2-VO method (bilateral common carotid artery ligation) or sham surgery. After 28 days of intragastric administration, Mirros water maze test was performed to evaluate the spatial learning and memory abilities of rats in each group. HE and Nissl staining were used to observe the pathological changes of brain tissue in rats. The expression of synuclein (SYN) in rat hippocampus was observed by immunohistochemical staining. Changes in dendritic spines in rat's hippocampal neurons were observed by Golgi staining. Western blotting was used to detect the expression levels of IL-1β, IL-10, vascular endothelial growth factor A (VEGFA), postsynaptic density protein 95 (PSD95), and growth associated protein 43 (GAP43) in rat's hippocampus in each group. Results In Mirros water maze test, rats in model group showed significant prolonged escape latency (P<0.05), and a significant reduction in the number of crossing platforms and the percentage of activity time in the target quadrant (P<0.05) than those in sham-operated group; while rats in TST group and donepezil group showed significant shortened escape latency (P<0.01), and significant increase of the number of times of crossing platforms and the percentage of activity time in the target quadrant (P<0.05) than those in model group. Compared of sham-operated group, model group showed a decrease in the expression of SYN and the number of neurons, Nissl bodies, and dendritic spines in the CA1 region of the hippocampus (P<0.05). Compared with model group, TST group and donepezil group showed an increase in the expression of SYN and the number of neurons, Nissl bodies, and dendritic spines in the CA1 region of the hippocampus (P<0.05). Western blotting showed a significant increase in the expression of IL-1β and VEGF (P<0.05), and a decrease in the expression of IL-10, PSD95, and GAP43 (P<0.01) in rat's hippocampus of model group than those in sham-operated group. Compared with model group, TST group and donepezil group showed a significant decrease in the expression of IL-1β (P<0.05), and an increase in the expression of VEGFA, IL-10, and GAP43 (P<0.05). Conclusions TST could alleviate cognitive impairment through promoting synaptic plasticity and neurovascular unit remodeling in 2-VO model rats, suggesting its significance as a potential drug for apoplexy.

α7 nicotinic acetylcholine receptor (α7nAChR) is widely expressed in the central nervous system and immune system, and plays a neuro-immunoregulatory role. On the one hand, α7nAChR is involved in the transmission of neurotransmitters, the conduction of excitatory signals and the maintenance of synaptic plasticity, which is of great significance for maintaining the normal and stable neurocognitive function. On the other hand, as an important part of the cholinergic anti-inflammatory pathway, α7nAChR is involved in the regulation of physiological and pathological processes such as inflammatory response, oxidative stress, apoptosis and autophagy in the central system, and plays an immunomodulatory and neuroprotective role, thus being potential target for improving perioperative neurocognitive function. This article reviews the biological characteristics of α7nAChR and its effect on perioperative neurocognitive function, in order to provide ideas and methods for clinical improvement of perioperative neurocognitive function in surgical patients.

Objective To investigate the effect of rats' injuries and its mechanism caused by specific dose of radiation combined with decompression exposure. Methods 81 male SD rats were randomly divided into control group (n=9), radiation group (n=18), radiation+low-load decompression group (n=18), radiation+medium-load decompression group (n=18), and radiation+high-load decompression group (n=18). In addition to control group, the rats were irradiated with ⁶⁰Co γ rays at 4 Gy and then underwent rapid escape experiments. The high-pressure exposure schemes were to stay underwater 57 m for 30 min, 45 min or 60 min and reduce to normal pressure within (30±5) s, respectively. The high-pressure exposure was not carried out in radiation group. The behavior and death of rats in each group were observed 0.5 h after leaving the cabin. Blood (abdominal aorta) and lung tissues were collected at 3 h and 72 h, respectively. The changes of lung wet-dry weight ratio (W/D), lung pathology and serum levels of interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO), intercellular adhesion molecule-1 (ICAM-1) and thromboxane B2 (TXB2) were analyzed. Results Compared with control group and radiation group, radiation+low-load decompression group showed no significant difference in the injury and death rate of rats (P>0.05), while radiation+medium-load decompression group and radiation+high-load decompression group showed significantly increase of the injury and death rate of rats (P<0.05). Compared with control group, other groups showed no significant change in pulmonary W/D at 3 h (P>0.05), and increased at 72 h (P<0.05). HE staining showed that compared with control group, radiation group showed mild lung interstitial edema, while radiation+low-load decompression group showed obvious pulmonary tissue edema and a small number of red blood cells exudated in the alveolar cavity. The edema, congestion and inflammatory cell infiltration of lung tissue were more serious in radiation+medium-load decompression group and radiation+high-load decompression group. Compared with control group and radiation group, all radiation+decompression groups showed an increase in serum levels of IL-1β, IL-6, TNF-α, MDA, NO, ICAM-1 and TXB2 (P<0.05), and a decrease in SOD activity (P<0.05). Compared with radiation+low-load decompression group, radiation+medium-load decompression group and radiation+high-load decompression group showed increase in serum levels of IL-1β, IL-6, MDA, ICAM-1 and TXB2 (P<0.05), and decrease in activity of SOD (P<0.05). Except for control group, serum levels of IL-1β, IL-6, TNF-α, MDA, NO, ICAM-1 and TXB2 were decreased at 72 h compared with 3 h (P<0.05), and SOD activity was increased at 72 h in all groups (P<0.05). Conclusions High-load decompression can increase the injury and death rate of rats exposed to radiation and high pressure. The potential mechanism of the combined injury effect of radiation and decompression was related to inflammation, immune stress, oxidative damage, vasomotor activity and coagulation mechanism.

Objective To investigate the role of dynamin-related protein 1 (Drp-1) and peroxisome proliferator-activated receptor γ coactivator 1-α (PGC-1α) in the lung tissues of neonatal rats with meconium aspiration syndrome (MAS) and its mechanism. Methods Fifty 2-3-week-old SD neonatal rats were randomly divided into five groups (n=10): control group, model group and SN50 low, medium and high concentration groups. In control group, 2 ml/kg of saline was injected into the trachea after tracheal exposure, and 2 ml/kg of meconium suspension was injected into the trachea of the rest of groups; after 24 h, control and model groups were left untreated, and 100 μl of each of SN50 concentrations of 10, 30, and 60 μg/ml was injected into SN50 low, medium, and high concentration groups intraperitoneally; the rats of each group were killed after 6 h, and the chest X-rays, the gross views of the lungs, the lung wet/dry weight ratios (W/D), and the lungs of the rats in control group and model group were examined. After 6 h, the rats in each group were executed, and the pathological changes of lung tissue were observed by chest radiographs, lung gross view, lung wet/dry weight ratio (W/D) and HE staining; Western blotting was used to detect the changes of nuclear factor κB (NF‑κB) (p65), p-NF‑κB p65 (p-p65), Drp-1, and PGC-1α proteins expression in neonatal rat lung tissues, and immuno-histochemistry was used to observe the expression of p65, Drp-1, and PGC-1α related proteins expression in neonatal rat lung tissues. Results Compared with control group, model group showed inflammatory infiltration in the chest radiograph and gross view, and the W/D and lung injury pathology scores were significantly higher (P<0.05); compared with model group, the chest radiograph and gross view of inflammation were slightly reduced in SN50 low, medium and high concentration groups, and the W/D and lung injury pathology scores were significantly lower (P<0.05).Western blotting showed that, compared with control group, the protein expression levels of p-p65 and Drp-1 in the lung tissues of neonatal rats were significantly higher in model group (P<0.05), and the protein expression level of PGC-1α was significantly lower (P<0.05); compared with model group, the protein expression levels of p-p65 and Drp-1 were significantly lower in SN50 low, medium, and high concentration groups (P<0.05), and the difference in the protein expression level of PGC-1α in SN50 low concentration group was not statistically significant (P>0.05), whereas the PGC-1α expression levels in SN50 medium and high concentration groups were significantly higher (P<0.05); the difference in the total p65 protein expression levels in each group was not statistically significant (P>0.05). Immunohistochemical assay results showed that, compared with control group, p65 and Drp-1 protein expression levels were significantly higher in model group (P<0.05), and PGC-1α protein expression level was significantly lower (P<0.05); compared with model group, p65 protein expression level was significantly lower in SN50 low concentration group (P<0.05), and the difference in Drp-1 and PGC-1α protein expression levels were not statistically significant (P>0.05), Drp-1 protein expression level was significantly lower (P<0.05), and PGC-1α protein expression level was significantly higher (P<0.05) in SN50 middle and high concentration groups. Conclusion Fecal inhalation can induce lung tissue inflammation in neonatal rats, and the mechanism may be related to enhanced oxidative stress, promotion of mitochondrial dysfunction, activation of the Drp-1/NF-κB signaling pathway, and inhibition of PGC-1α protein expression.

Objective To investigate the role of pulmonary neuroendocrine cells (PNEC) and γ‑aminobutyric acid (GABA) in patients with pulmonary neuroendocrine tumors (PNET). Methods The pathological specimens of 29 cases of PNET treated in the eighth Medical Center of Chinese PLA General Hospital from October 2018 to January 2022 were collected. The morphological characteristics were observed by HE staining, and the expression levels of synaptophysin (Syn), chromogranin A (CgA), CD56, Ki-67, CD86 and CD163 were observed by immunohistochemical staining. Calcitonin gene-related peptide (CGRP) and glutamic acid decarboxylase (GAD) 65/67 in different types of PNETs were detected by double antibody immunofluorescence co-staining, and the correlation between GAD65/67 positive PNEC and macrophage polarization was analyzed. Results The results of HE staining showed that all four types of PNET tissues had neuroendocrine (NE) characteristics: rosette structure and organ nesting or palisade pattern, but they were different, and the proportion of mitotic cells from low to high was typical carcinoid (TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC) and small cell lung cancer (SCLC). The results of immunohistochemical staining showed that the positive expression rate of Syn and CgA and the positive degree of Syn, CgA and CD56 in carcinoid (TC and AC) were significantly higher than those in LCNEC and SCLC (P<0.05). The Ki-67 indices of the four types of PNET are: TC <5%, AC 5%-20%, LCNEC and SCLC >75% respectively. The number of PNEC in carcinoid was significantly higher than that in LCNEC, SCLC and paratumoral tissues (P<0.05), but there was no significant difference in the number of PNEC between LCNEC and SCLC and para-tumor tissues (P>0.05). The results of immunofluorescence staining showed that the number of GAD65/67 positive cells co-expressing GAD65/67 in 95%PNEC was significantly higher than that in LCNEC, SCLC and para-tumor tissues (P<0.05), but there was no significant difference between LCNEC and SCLC GAD65/67 positive cells and para-tumor tissues (P>0.05). The results of immunohistochemical staining also showed that the number of CD86 positive M1 macrophages was significantly higher than that of CD163 positive M2 macrophages in para-tumor tissues (P<0.05), while M2 macrophages were significantly more than M1 macrophages in AC, LCNEC and SCLC (P<0.01). Correlation analysis showed that the number of GAD65/67 positive PNEC cells in PNET was negatively correlated with the number of CD163 positive M2 macrophages in tumor stroma (r=-0.6336, P=0.0174). Conclusions PNEC is the main source of GABA in lung tissue and plays an immunomodulatory role in the lung, which may be involved in the progression of PNET.

Objective To analyze the risk factors for severe illness caused by coronavirus disease 2019 in Fuzhou city. Methods The data of 4081 confirmed cases with current address in Fuzhou was collected from China Information System for Disease Control and Prevention from January 1 to June 30, 2023. The epidemiological data of those cases was investigated such as the demographic characteristics, clinical manifestations and past medical history, etc. The risk factors of severe cases were analyzed by using the logistic regression. Results 4081 confirmed cases had been reported including 671 severe cases and 3410 non-severe cases. The demographic characteristics of severe cases, such as the proportion of male, age and current address in community were higher than that of non-severe cases, vaccination rate was lower than non-severe cases (59.02% vs. 80.12%), the differences are statistically significant (P<0.001). The clinical manifestations such as interval time between onset and visit (P=0.001), fever (P=0.002), difficulty in breathing/shortness of breath (P=0.001) were the factors related to severe illness. The past medical histories such as history of chronic lung disease, history of heart cerebrovascular disease of severe cases, were higher than that of non-severe cases (P<0.001). Multivariate logistic regression showed that the male, the higher age, current address in community, no vaccination, the longer interval time between onset and visit, fever, difficulty in breathing/shortness of breath, the history of chronic lung disease, the history of heart cerebrovascular disease raised the risk of becoming severe cases. The healing time for severe cases was longer than that for non-severe cases (P<0.001). Conclusion Sex, age, current address, vaccination, interval time between onset and visit, fever, difficulty in breathing/shortness of breath, history of chronic lung disease, and history of heart cerebrovascular disease are the influencing factors for severe illness.

Objective To evaluate the efficacy of surgery, chemotherapy and surgery combined chemotherapy for retinoblastoma (RB), and analyze the prognostic factors of RB patients. Methods Clinical data of 1188 RB patients registered in the Surveillance, Epidemiology and End Results (SEER) database from January 2000 to December 2019 were retrospectively analyzed. The baseline characteristics of patients treated with surgery, chemotherapy or surgery combined with chemotherapy were balanced by inverse probability of treatment weighting (IPTW). Log-rank test analysis was used to compare the survival probability of patients in the 3 groups, and Cox regression models were used to analyse the factors influencing the prognosis of RB patients. Results A total of 1188 RB cases were included in this study, including 426 cases in surgery group, 200 cases in chemotherapy group and 562 cases in surgery combined with chemotherapy group. After IPTW weighting, baseline data such as age, sex and race were balanced (P>0.05). Log-rank test results showed that the survival curves of the three groups were significantly different before and after weighting (P<0.05). After weighted, the survival of patients in surgery group was significantly better than that in chemotherapy group and surgery combined chemotherapy group (P<0.05), and there was no statistical significance between chemotherapy group and surgery combined chemotherapy group (P>0.05).The weighted patient survival probability at 1st, 3rd and 5th years were 99.7%, 98.9% and 98.6% in surgery group; 97.4%, 95.8% and 95.8% in chemotherapy group; and 97.9%, 95.8% and 95.0% in surgery combined chemotherapy group. Cox regression analysis showed that compared with surgery group, the specific risk ratio of death was 1.367 (95%CI 1.100-1.700) in chemotherapy group and 1.132 (95%CI 0.963-1.330) in combined chemotherapy group. Compared with patients with 1 RB lesion, the patient-specific mortality risk ratio for patients with 2 or more RB lesions was 0.399 (95%CI 0.268-0.594). Conclusions Patients with RB have higher survival rates probability after treatment. After controlling the influence of age, sex and other factors, the effect of surgery was better among the three treatment methods. Multifocality may be an independent prognostic factor in RB patients.

Objective To explore the differential diagnostic indicators of adult-onset Still's disease (AOSD) from other fever of unknown origin (FUO). Methods The clinical data and laboratory indicators of 177 AOSD patients and 163 FUO patients who were hospitalized in the First Affiliated Hospital of Army Medical University from January 2010 to May 2021 were collected, and the patients were randomly divided into training group and verification group. Statistically significant variables were extracted from univariate analysis for receiver operating characteristic (ROC) curve analysis and the best cut-off value of the variables was obtained. The differential diagnostic indicators were extracted by multivariate logistic regression analysis and nomogram model was constructed. ROC curve, calibration curve, and decision curve analysis were used to evaluate the accuracy and stability of nomogram. Results Univariate analysis revealed that there were significant differences in 4 clinical features (arthralgia, rash, pharyngeal pain, myalgia) and 14 laboratory parameters [white blood cell count (WBC), monocyte percentage, neutrophil percentage, lymphocyte percentage, platelet count, C-reactive protein, interleukin-6 (IL-6), ferritin, globulin, immunoglobulin A, and immunoglobulin G (IgG), creatine kinase, creatinine and complement C3]. Multivariate analysis suggested that arthralgia, WBC ≥9.995×10⁹/L, IL-6 ≥98.13 ng/L, ferritin ≥507.37 ng/ml, globulin ≤36.58g/L, IgG ≤13.59g/L, complement C3 ≥1.27 g/L were related with AOSD. The area under curve (AUC) values of training group and verification group were 0.917 (95%CI 0.883-0.951) and 0.869 (95%CI 0.802-0.936), respectively. The calibration curves showed good consistency. The decision curve analysis showed that training group and verification group had a large positive rate of return in the wide risk range of 5%-85% and 10%-85%, respectively. Conclusions This study has established a relatively accurate AOSD differential diagnosis model. The combination of arthralgia, WBC, IL-6, ferritin, globulin, IgG and complement C3 may help to distinguish AOSD from other causes of FUO.

The progress and clinical application of troponin detection technology have continuously improved the diagnosis rate of acute myocardial infarction (AMI), which effectively shortens the time of necrotic myocardial reperfusion. Earlier studies have found that high-sensitivity troponin (hs-cTn) is elevated to varying degrees in patients with chronic kidney disease (CKD). Therefore, when patients with CKD have AMI, the application of hs-cTn is limited to a certain extent, and with the lack of chest pain symptoms and the non-specificity of electrocardiogram performance in patients with CKD, it is particularly difficult to make a quick and accurate diagnosis of such patients. Based on this, this article will summarize the application of hs-cTn in AMI, the clinical characteristics of patients with CKD combined with AMI, how to improve the diagnostic accuracy of patients with CKD combined with AMI, and the value of hs-cTn in risk stratification and prognosis assessment of such patients to provide clinical medical staff with reference for early intervention or revascularization of patients.