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.

According to the extracorporeal life support (ECLS) registry report, the use of extracorporeal membrane oxygenation (ECMO) in neonates with severe respiratory failure reached its peak in 1992. With the emergence of new respiratory support methods such as nitric oxide, pulmonary surfactant, and high-frequency ventilation, the number of neonates with ECMO for respiratory support decreased gradually, maintaining at about 1000 cases per year. However, it also means that the neonates who need ECMO support will be in a more severe condition, which requires higher requirements for clinicians. In order to further standardize the technique of neonatal extracorporeal life support, the Extracorporeal Life Support Organization (ELSO) published the guidelines for neonatal respiratory failure in 2020. The guidelines provide suggestions on the technology, patient management and complications during ECMO. This article mainly interprets the patient selection, support mode, technical considerations, management and complications during ECMO.

Objective To explore the role of pulmonary surfactant (PS) combined with budesonide in improving oxygenation and clinical outcomes of neonatal acute respiratory distress syndrome (ARDS). Methods The present study is a historically controlled trial. Infants with ARDS requiring mechanical ventilation and PS replacement therapy were collected from the neonatal unit of Southwest Medical University. Those from January 2022 to November 2022 were set as intervention group (PS+budesonid, n=35), treated with intratracheal instillation of a mixed suspension of budesonide (0.25 mg/kg) and PS (200 mg/kg), and continuous budesonide nebulization (0.25 mg/kg, twice per day) until withdrawal, then compared with a historical cohort, who just received intratracheal instillation of PS (200 mg/kg) (January 2020-December 2021, PS group, n=35). Baseline data such as gender, mode of delivery, 1 min and 5 min Apgar score, birth weight, gestational age, time of onset, and cause of onset were recorded in both groups. The oxygenation and clinical outcomes of infants were compared between the two groups, including: (1) Arterial blood gas analysis indicators, such as partial pressure of oxygen (PaO₂) and oxygenation index (OI) before treatment and at 6, 12 and 24 hours of treatment; (2) Clinical observation and evaluation indicators, such as the time to withdrawal, duration of oxygen supplementation, length of stay, improvement of the radiological images of the lungs at 72 h of treatment, and repeated PS use; (3) Blood chemistry indicators, such as white blood cell (WBC), neutrocyte (NEU), procalcitonin (PCT) before treatment and at 3 and 7 days of treatment; and (4) Observation indicators of complications, weight growth, and mortality outcomes, such as the incidences of intracranial hemorrhage, gastrointestinal hemorrhage, neonatal necrotizing enterocolitis (NEC), and hyperglycemia, weight growth, and fatality rate. Results The differences in baseline data between the two groups were not statistically different (P>0.05). The levels of PaO₂ of the two groups were increased after treatment for different time periods, while the levels of OI were decreased (P<0.001), and the levels of above indexes changed more significantly in PS+budesonide group than those in PS group (P<0.05). The time to withdrawal, duration of oxygen supplementation, and length of stay in PS+budesonide group were shorter than those in PS group; the radiological images of the lungs showed that the pulmonary inflammation absorption was significantly better in PS+budesonide group than that in PS group, while no significant difference between the two groups of infants with repeated PS use. The NEU was significantly higher in PS+budesonide group than in PS group at 3 d and 7 d of treatment (P<0.001); and at 3 days of treatment, the PCT levels were significantly lower in PS+budesonide group than that in PS group (P<0.05). The incidences of intracranial hemorrhage, gastrointestinal hemorrhage, NEC, hyperglycemia, weight growth, and fatality rate were not significantly different between the two groups (P>0.05). Conclusion The use of budesonide in addition to surfactant may improve the oxygenation of neonates with ARDS, improve the inflammatory infiltrates in lungs, shorten the duration of mechanical ventilation and oxygen supplementation, and without short-term complications associated with budesonide use.

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 analyze the burden and changing trend of testicular cancer in China from 1990 to 2019. Methods Based on the 2019 Global Burden of Disease Database (GBD 2019), analyze the incidence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs) and their variation trend of testicular cancer in Chinese population from 1990 to 2019. Evaluating changes in age standardized rate (ASR) by calculating annual estimated percentage change (EAPC). According to the age grouping, analyze the age distribution characteristics of testicular cancer disease burden by age group. Results In 2019, the incident cases, deaths, age-standardized incidence rate, and age-standardized mortality rate of testicular cancer in China were 17.17×10³, 1.21×10³, 2.39/10⁵, and 0.16/10⁵, respectively. Compared to 1990, incident cases, deaths, and age-standardized incidence rate increased obviously in China, which was consistent with the global change trend, while the increase was higher than the global level. However, both Chinese and global age-standardized mortality rate showed a downward trend. From 1990 to 2019, DALYs, YLLs and YLDs of testicular cancer increased by 29.66%, 9.83% and 720.91% respectively in China. The two age groups, 0-15 years group and 30-35 years group, were with highest incidence of testicular cancer, while the highest disease burden of testicular cancer was 30-35 years. Conclusion From 1990 to 2019, the disease burden of testicular cancer in China showed an upward trend. Adolescents and young adults should be the priority population for screening and prevention due to their higher incidence and disease burden.

Objective To analyze the pathogenic characteristics and drug sensitivity of candidaemia, and construct a short-term mortality risk prediction scoring model. Methods The clinical data of patients with candidaemia admitted to the 909 Hospital of Joint Logistics Support Force from January 2011 to December 2020 were retrospectively analyzed, and the composition of pathogen composition, drug sensitivity test results and incidence of hospitalized patients were analyzed. 324 cases of candidaemia were randomly divided into modeling group (190 cases) and validation group (134 cases), and the risk factors were screened by binary logistic regression. According to the odds ratio (OR) score, the 30 day mortality risk prediction scoring model was constructed, and the predictive performance of the model was verified both in modeling and validation groups. Results 356 strains of Candida including 126 strains of C. albicans (35.39%), 79 strains of C. tropicalis (22.19%), 74 strains of C. parapsilosis (20.79%), 48 strains of C. glabrata (13.48%), 14 strains of C. guilliermondii (3.93%), 8 strains of C. krusei (2.25%), and 7 strains of other Candida (1.97%) were detected in 336 patients with candidemia. The incidence of candidaemia among hospitalized patients increased from 0.20 ‰ in 2011 to 0.48 ‰ in 2020. The resistance rate of candida to amphotericin B was significantly lower than that of fluconazole, voriconazole and itraconazole (P<0.05). Among the 324 cases included in the model, 95 patients died in 30 days after diagnosis, and the mortality rate was 29.32%. The proportion of males, fever, and parenteral nutrition in modeling group was significantly higher than that in validation group (P<0.05), while the proportion of chronic lung disease and surgical history within one month were lower than those in validation group (P<0.05). Logistic regression analysis showed that chronic renal failure, mechanical ventilation, severe neutropenia, failure to receive anti-fungal treatment within 72 hours, and APACHE Ⅱ ≥20 were risk factors for short-term death of candidaemia, the OR values were 3.179, 1.970, 2.979, 2.080, and 2.399, and the risk scores were 6, 4, 6, 4, and 5, respectively. The area under the curve (AUC) of the risk scoring model for modeling group was 0.792 (95%CI 0.721-0.862), and the result of Hosmer-Lemeshow (H-L) test was P=0.305; The AUC of validation group was 0.796 (95%CI 0.735-0.898), and the H-L test result was P=0.329. A risk score ≤8 indicated a low risk group for short-term mortality, a score of 9-15 indicated a medium risk group, and a score ≥16 indicated a high risk group. Conclusions The incidence of candidemia in hospitalized patients is increasing and the mortality is high. The risk prediction score model can effectively predict the short-term prognosis and facilitate the early identification of the prognosis.

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.