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 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.

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 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.

In recent years, with the continuous innovation of modern war mode, weapons and protective equipment, the mechanism and mode of war trauma have also produced great changes. The widespread use of bulletproof vest and improvised explosive devices has led to increasing incidence of genitourinary trauma. The pattern of genitourinary trauma has also transformed from internal structures (kidney, ureters, bladder) to external structures (scrotum, testes, penis, urethra), suggesting that the research focus of genitourinary system war trauma should be gradually transformed to trauma research of lower urinary tract and external genitalia. This article reviews the incidence, treatment and prognosis of genitourinary trauma in several modern wars, and mainly describes the relevant conditions of lower urinary tract and external genitalia trauma and the relevant progress in the treatment in recent years.

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.

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.

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 glycyrrhizic acid (GA) on the inflammatory and fibrotic factors in high glucose-induced glomerular mesangial cells (SV40 MES13). Methods Cultured mouse SV40 MES13 were divided into normal group (NG, 5.6 mmol/L glucose), high glucose group (30 mmol/L glucose) and HG+GA group (30 mmol/L glucose+200 μmol/L GA). The expression levels of inflammatory cytokines interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), IL-6, IL-8 and α-smooth muscle actin (α-SMA) in different groups were detected by Western blotting. The fluorescence intensity of IL-1β, TNF-α and α-SMA in different groups were detected by immunofluorescence. The levels of IL-1β, TNF-α, IL-6 and IL-8 in the culture supernatant of different populations were detected by enzyme-linked immunosorbent assay (ELISA). Results The protein expressions of IL-1β, TNF-α, IL-6, IL-8 and α-SMA in HG group were significantly higher than those in NG group (P<0.01); Compared with HG group, the protein expression levels of IL-1β, TNF-α, IL-6, IL-8 and α-SMA decreased significantly in HG+GA group (P<0.05). The fluorescence intensity of inflammatory cytokines IL-1β, TNF-α and α-SMA increased in HG group than those in NG group (P<0.05); While compared with the HG group, the fluorescence intensity of IL-1β, TNF-α and α-SMA in HG+GA group decreased markedly (P<0.05). The experimental results of ELISA showed that compared with NG group, the levels of IL-1β, IL-6, TNF-α and IL-8 in cell supernatent increased in HG group (P<0.01); while the levels of IL-1β, TNF-α, IL-6, IL-8 in HG+GA group significantly lower than those in HG group (P<0.05). Conclusion Glycyrrhizic acid has certain inhibitory effect on high glucose-induced inflammatory factors and fibrotic factors in glomerular mesangial cells, which may play an important role in prevention of diabetic nephropathy.

Objective To analyze the correlation between the ELL2 gene 1119 T>C polymorphism and the susceptibility to pleomorphic adenoma of the salivary gland. Methods The pedigree of the pleomorphic adenoma family of salivary gland was drawn. The exons of ELL2 gene in 5 members of salivary pleomorphic adenoma family were sequenced. A case-control study was conducted. One hundred and twelve patients with pleomorphic adenoma of the salivary gland who visited the Department of Oral and Maxillofacial Surgery of Shanxi Bethune Hospital from January 2016 to July 2020 were taken as case group, and 176 healthy examinees from January 2019 to January 2020 were taken as control group with age and sex as matching conditions. The 1119 T>C polymorphism of ELL2 genes in the two groups were detected with high resolution melting (HRM) curve. Chi-square test was adopted to analyze the correlation between gene polymorphism and the occurrence of pleomorphic adenoma of the salivary gland, stratified analysis was performed to evaluate the synergistic effect of smoking and genotype, and real time quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to detect the expression level of ELL2 in individuals with different genotypes. Results The 1119 T>C polymorphism site existed in the exon 8 of ELL2 gene in a family with pleomorphic adenoma of salivary gland. The results of case-control study showed that the genotype frequency of homozygous CC was significantly higher in patients with pleomorphic adenoma of salivary gland than that in the controls (24.1% vs. 11.9%, P=0.002). Homozygous CC was associated with increased risk for developing pleomorphic adenoma of salivary gland (OR=3.059, 95%CI 1.494-6.263) in this cohort. Stratification analysis showed that smoking and 1119C allele cooperated to increase the risk of pleomorphic adenoma of salivary gland (OR=3.200, 95%CI 1.460-7.014). The expression level of ELL2 mRNA in CC genotype was significantly higher than that in individuals with CT or TT genotype (P<0.05). Conclusion The genetic variation of ELL2 may play an important role in the occurrence of pleomorphic adenoma of salivary gland, and smoking combined with the 1119C allele increased the risk of this disease.