The pathological mechanism of celiac disease is not completely clear, and environmental factors may trigger the occurrence of intestinal inflammatory response in genetic susceptible individuals. Recent researches indicated that, due to the coordinated action of multiple factors such as abnormal intestinal mucosal barrier function and intestinal microbial changes, the homeostasis of intestinal environment is imbalanced, which aggravates the severity of the disease. Gluten-free diet combined with probiotics and other drugs would regulate intestinal microbiota and be conducive to resume intestinal mucosal barrier function,thereafter effectively alleviate the clinical symptoms of patients. However, both the composition of intestinal flora and its role in pathogenesis of the disease needs further consideration. To explore the pathological mechanism of celiac disease and targeted treatment for those factors will become a new perspective for precise prevention and treatment of celiac disease.

During acute respiratory distress syndrome (ARDS) occurs, the pulmonary vasoconstriction increased pulmonary vascular resistance, led to pulmonary arterial hypertension and excessive right ventricular afterload, followed by acute corpulmonale(ACP), aggravated right ventricular function damage, bring about pulmonary edema and hypoxemia, those are the important causes lead to patient death. Healthy people exposed to chronic hypoxia at high altitude for a long period prone to physiological pulmonary hypertension and change of blood viscosity, thus aggravating the severity of ARDS at high altitude. Therefore, the pathophysiological changes of ARDS are different in plateau to that in plain areas, and the diagnostic criteria, clinical manifestations and severity of the disease are also different. In present paper, the factors affecting the aggravation of right heart damage were discussed from a pathophysiological point, and a proposal was made that monitoring and protection of right ventricular function should be paid more attention in plateau and hypoxia environment for ARDS patient, optimizing respiratory support therapy, pulmonary vasodilation therapy and anticoagulant therapy for reducing the iatrogenic injury in treatment and improving the survival rate of ARDS patients.

Objective To investigate the clinical characteristics, short-term and long-term prognosis and influencing factors of patients with Stanford type A aortic dissection (TAAD) complicated with postoperative hypoxemia. Methods Seventy-three patients with TAAD confirmed by chest CT and (or) aortic CT angiography in the First Affiliated Hospital of Chongqing Medical University from January 2017 to March 2021 were enrolled. According to whether the postoperative hypoxemia was complicated with, patients were divided into two groups: with hypoxemia group (n=36) and without hypoxemia group (n=37). The clinical characteristics of TAAD patients with hypoxemia were analyzed. Logistic regression model and Cox proportional risk model were used to analyze the effect of hypoxemia on the short-term and long-term all cause death of TAAD patients. Results The average age and BMI level were significantly higher in TAAD patients with hypoxemia group than those in without hypoxemia group, and the preoperative levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), serum creatinine(Scr), urinary microalbumin (mALB) and TNF-α, IL-6 and high-sensitivity C-reactive protein (hs-CRP) were also significantly higher in with hypoxemia group than those in without hypoxemia group (P<0.05). The short-term mortality was significantly higher in with hypoxemia group than that in without hypoxemia group [22.2% (8/36) vs. 5.4% (2/37); χ²=4.365, P=0.037], but no significant difference between the two groups of patients in the long-term mortality after discharge [13.9% (5/36) vs. 8.1% (3/7);χ²=0.625, P=0.429]. Multivariate logistic regression analysis showed that complication with hypoxemia, age and TNF-α level were the independent risk factors for postoperative short-term hospitalization death in TAAD patients (P<0.05). Multivariate Cox regression analysis showed that age and hs-CRP level were the independent risk factors for death of TAAD patients during follow-up after discharge (P<0.05). While complication with hypoxemia was not an independent risk factor for death of TAAD patients during follow-up after discharge (P>0.05). Conclusion TAAD patients with postoperative hypoxemia have the clinical characteristics of old age, high BMI, high liver and kidney function index and high levels of inflammatory factors, and short-term postoperative death may increase.

Neutrophil extracellular trap (NETs) is a kind of DNA-based skeleton released by neutrophils to the outside of the cell, in which a variety of granular proteins, proteolytic enzymes, antibacterial peptides, and other network structures are embedded.In recent years, studies have confirmed that NETs are highly expressed in a variety of tumors, and tumor microenvironment (TME)is a special environment for tumor cell survival and development, including cellular and non-cellular components. This article mainly explains that TME can stimulate the formation of NETs, and NETs can also promote tumor proliferation, invasion and metastasis by affecting tumor cells, immune cells, endothelial cells, epithelial cells, fibroblasts and extracellular matrix in TME. Finally, the clinical application prospects of NETs as tumor markers and potential therapeutic targets are discussed.

Objective To investigate the effect of intravenous omega-3 fish oil on the prognosis of patients with sepsis. Methods 1733 patients with sepsis were selected from the Department of Critical Care Medicine of Shenzhen People's Hospital from December 1, 2016 to June 30, 2019. According to the survival situation, these patients were divided into survival group(n=1351) and death group (n=382). The general information, infection site, complications, organ support measures and clinical outcomes were analyzed and compared between the two groups. Multivariate logistic regression and Kaplan-Meier survival analysis were performed to evaluate the effect of intravenous supplementation of omega-3 fish oil on the prognosis of patients with sepsis. Results There were significant differences in gender, age, pulmonary infection, abdominal infection, blood infection,complication, mechanical ventilation, renal replacement therapy and omega-3 fish oil intervention between survival group and death group (P<0.05). There was no significant difference in the proportion of biliary tract infection, urinary tract infection and other site infections between the two groups (P>0.05). Logistic regression analysis showed that men, old age, bloodstream infection,mechanical ventilation support, and renal replacement therapy were risk factors for the survival status of patients with sepsis within 90 days, and intravenous omega-3 fish oil supplementation was a protective factor for sepsis. Survival analysis results show that intravenous supplementation of omega-3 fish oil can improve the 90-day survival rate of patients with sepsis. Conclusion Omega-3 fish oil intervention can improve the prognosis of patients with sepsis, and the clinical application feasibility is high.

Objective To explore the antiviral effects of Astragalus polysaccharide (APS) on human infection induced by respiratory syncytial virus (RSV) and its possible mechanism. Methods Male 3-week-old BALB/c mice were randomly divided into 6 groups (10 each): control group, RSV group, APS low-, medium- and high-dose groups, and ribavirin group. Mice in control group were given 50 μl normal saline through nasal drip after mild anesthesia, those in other groups were given 50 μl RSV-long virus solution [containing 6.8×10⁶ plaque forming units (pfu)] by nasal drip for 2 hours to establish the model. In addition, mice in APS low, medium and high groups were given 100, 200 and 300 mg/(kg.d) APS by gavage once a day for 5 days; and in ribavirin group were given 46 mg/(kg.d) ribavirin by gavage once a day for 5 days. Mice in control group and RSV group were given equal volume of normal saline by gavage. The changes of body weight and lung index were measured and calculated before and after infection. The virus replication was detected by plaque reduction test. The T cell subset levels in peripheral blood were detected by flow cytometry.ELISA was performed to detect the levels of inflammatory factors interleukin-1β (IL-1β), IL-18 and IL-33. Colorimetry was used to detect the oxidative and antioxidant indexes of lung tissue including superoxide dismutase (SOD), glutathione (GSH) and malondialdehyde (MDA), and Western blotting was performed to detect the protein expression of lung tissue. Results Compared with the control group, the body weight decreased (P<0.05), lung index increased (P<0.05), the expression levels of of IL-1β, IL-18 and IL-33 in serum and the lung tissue oxidation index MDA increased (P<0.05), while the expression of antioxidant index SOD and GSH decreased (P<0.05) in RSV group and APS low-, medium- and high-dose groups. In addition, RSV infection increased the proportion of CD4⁺ cells in peripheral blood, decreased the proportion of CD8⁺ cells and increased the ratio of CD4⁺/CD8⁺ (P<0.05),and increased the expression levels of Toll like receptor 4 (TLR4) protein, and promoted the phosphorylation of mitogen-activated protein kinases (MAPK) and nuclear factor κB (NF-κB) (P<0.05) in RSV group, APS low-, medium- and high-dose groups and ribavirin group. While compared with RSV group, APS medium- and high-dose groups and ribavirin group could reverse the above changes (P<0.05). Conclusion APS could inhibit RSV replication, regulate immune response, reduce inflammation and oxidative reaction induced by RSV, and this effect may be related to the inhibition of TLR4/MAPK/NF-κB pathway activation.

Objective To explore the clinical characteristics and prognosis of patients with end-stage renal disease (ESRD)in maintenance hemodialysis (MHD) and complicated with pathogen-positive and -negative pulmonary tuberculosis. Methods A total of 98 ESRD patients complicated with pulmonary tuberculosis, admitted in the Tuberculosis Department and undergone MHD at the Blood Purification Center of the 8th Medical Center of PLA General Hospital from July 2012 to February 2022, were collected,and divided into pathogen-positive group (n=34) and pathogen-negative group (n=64) according to the results of sputum smear, sputum culture of Mycobacterium tuberculosis and molecular biological diagnosis. The clinical characteristics, therapeutic effect and prognosis of the two groups were compared and analyzed. Results Both the pathogen-positive and -negative pulmonary tuberculosis groups were mainly the males (85.3% and 76.6%, respectively) and middle-aged and elderly people [(56.4±15.6) years old and (55.8±15.0) years old, respectively]. The proportion of patients with non-primary glomerulonephritis as main underlying kidney disease, and with cough and sputum as the first manifested symptom, were both higher in pathogen-positive group than in pathogen-negative group (38.2% vs. 17.2% and 91.2% vs. 50.0%, respectively) (P<0.05). The laboratory results showed that the leukocyte, neutrophil, monocyte count,neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR) and C-reactive protein level were higher, while the lymphocyte count was lower in pathogen-positive group than in pathogen-negative group (P<0.05). The chest CT found that the proportion of pleural thickened and cavity formation was higher (P<0.05), while of strip shadow was lower (P<0.05) in pathogen-positive group than in pathogen-negative group. The efficacy of anti-tuberculosis treatment was better in the both groups (94.1% vs. 95.3%). Multivariate logistic regression analysis found that cough and sputum (OR=12.572, 95%CI 2.609-60.581), MLR (OR=8.226, 95%CI 2.479-27.298),pleural thickening (OR=4.740, 95%CI 1.043-21.541) and cavitation (OR=8.462, 95%CI 2.423-29.555) were the risk factors for patients complicated with pathogen-positive pulmonary tuberculosis. Conclusions Significant differences of clinical characteristics existed between the pathogen-positive and -negative tuberculosis patients with ESRD on MHD. Cough and sputum as the first symptom, MLR,pleural thickening and cavitation are the risk factors for the pathogen-positive tuberculosis.

Objective To screen key targets modulating the progression of Rickettsia heilongjiang infection using a mouse infection model by profiling the transcription expression dynamics of immune-related genes. Methods A total of 20 female C3H/HeN mice were randomized into 4 groups (5 mice/group): 0 hpi (hours post-infection), 3 hpi, 3 dpi (days post-infection), and 6 dpi. Animals were infected with 5×10⁶ CFU Rickettsia heilongjiangensis intravenously. We harvested and extracted total RNA from spleens of animals at the indicated time points. After sequencing the total RNA, we further analyzed the sequencing results by GO annotation, R language enrichment, and KEGG visualization function analysis. Results A total of 19 930 mRNAs were specifically transcribed in the spleen post-infection. Using GO annotation and enrichment, we identified three types of immune-related genes with significant changes: first, 35 innate immune-related genes, among which the transcription of irg1 and gbp10 genes involved in the IFN-γ signaling pathway rises most significantly (P<0.05); second, 31 acquired immune-related genes, among which the transcription of gzmb gene involved in the apoptosis pathway rises most significantly (P<0.05); third, 41 inflammatory responses related genes, among which the transcription of ccl4 gene involved in cytokine and cytokine receptor signaling pathway rises most significantly (P<0.05). Conclusions The irg1 and gbp10 genes involved in the IFN-γ signaling pathway, the gzmb gene involved in the apoptosis pathway, and the ccl4 gene involved in the cytokine and cytokine receptor signaling pathway affect the pathogenesis of Rickettsia heilongjiangensis infection.

Bone stress injuries (BSI) is the most common musculoskeletal injuries in military training injuries, including stress injuries of different degrees of bone microstructure (grade Ⅰ to Ⅲ) and end-stage stress fractures (grade Ⅳ). It related to factors such as the gender of the injured and the patients, endocrine hormones in the body, calcium content, body mass index, and lower extremity mechanical structure. It has the characteristics of hidden onset and easy to be ignored in the early stage, which lead to non-combat attrition and sharp increase in treatment expenditures. In this review, risk factors, diagnosis, treatment and prevention protocols for the BSI are concluded and discussed in detail by systematically reviewing these latest literatures published worldwide,which has been aimed at improving the early diagnosis of BSI and providing the theoretical basis for the establishment of "all-round BSI prevention and treatment system".

Objective To clear the developing characteristics of airway Club cells in mice model. Methods The lung tissues and serum were collected from neonatal (1-week-old), infant (3-week-old) and adult (6-week-old) BALB/c mice. The immunofluorescence method was performed to detect the distribution and expression abundance of Club cells in main bronchi and bronchioles. The flow cytometry was used to determine the quantity proportion and proliferation ability, and ELISA was used to detect the levels of Club cell secreted protein (CC16) in lung homogenate and serum. Results The Club cells unevenly distributed in main bronchus of all ages of mice, while was relatively flat and uniform in bronchioles in BALB/c mice model. With increasing of mice age, the mean fluorescence intensity (MFI) of Club cells decreased in main bronchus accompanied by an increase in bronchioles with significant difference (main bronchus: 0.73±0.12, 0.43±0.05, 0.26±0.08, respectively, P<0.05; bronchioles:0.49±0.07, 0.73±0.08, 1.02±0.19, respectively, P<0.05). The proportion of Club cells in airway epithelium was significantly lower in neonatal (9.49%±2.38%) than those in infant (15.45%±3.86%) and adult (17.23%±4.82%) (P<0.05). Meanwhile, the proliferative ability of Ki67 in Club cells was significantly higher in neonatal (6.12%±1.89%) than those in infant (2.36%±0.98%)and adult (1.94%±0.75%) (P<0.01). The CC16 levels in lung homogenates and serum had a statistically significant increase in infant [(89.31±5.41) ng/ml, (25.77±4.68) ng/ml] and adult [(95.74±3.31) ng/ml, (28.02±3.99) ng/ml] than those in neonatal [(64.02±12.70) ng/ml, (13.91±3.36) ng/ml] (P<0.01). Conclusion Small airway is the prominent area for Club cells developing after birth, and neonatal is the critical period for Club cells proliferating and secreting CC16.