Inflammatory bowel diseases (IBD) possibly lie in a dysregulated response of the intestinal mucosal immune system towards intestinal microflora under a combined action of genetic and environmental factors.Mucosal dendritic cells are assumed to play key roles in regulating immune responses in the antigen-riched intestinal environment, either by initiating immune responses or by maintaining tolerance. Defects in this regulation are supposed to lead to IBD. This paper reviews the recent research advances in the relationship between IBD and dendritic cells.

Objective To investigate the effect of Astragalus polysaccharides (APS) on 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced colitis in rats and on dendritic cells (DCs) in mesenteric lymph nodes.Methods Forty-four male Sprague-Dawley rats were randomly divided into four groups (n = 11) using simple random sampling: normal control group, TNBS group, APS group, and 5-aminosalicylic acid (5-ASA) group.Experimental colitis was induced in rats by TNBS enema in the last three groups.Rats in APS and 5-ASA groups were treated by gavage with APS (0.75 g ? kg-1 ? d-1) and 5-ASA (100 mg ? kg-1 ? d-1) on the 10 consecutive days following TNBS administration.The rats were then sacrificed and the colonic inflammatory scores of rats were measured, including the scores of disease activity index ( DAI) , macroscopic lesions, and histological damages,as well as the activity of myeloperoxidase (MPO).The expressions of major histocompatibility complex class Ⅱ(MHC Ⅱ ) and costimulatory molecule CD86 on DCs were determined by flow cytometry.Results Compared with the TNBS group, APS group had significantly decreased scores of DAI ( P = 0.007 ) , macroscopic lesions (P =0.017), and histological damages (P = 0.016).Moreover, its level of the activity of MPO dropped but without statistical significance (P =0.183).TNBS group had significantly higher expressions of MHC Ⅱand CD86 molecules on DCs than the normal control group (P = 0.005, P = 0.008), APS group (P = 0.023, P = 0.018), and 5-ASA group (P = 0.017, P=0.013).Conclusion APS may attenuate TNBS-induced colitis in rats and downregulate the activation of DCs in mesenteric lymph nodes.

Objective To investigate the advantages of treating pediatric indirect inguinal hernia by laparoscopic high ligation of hernia.Methods Two hundred and forty-four pediatric indirect inguinal hernia cases were admitted from August 2012 to May 2014,and were divided into conventional surgery group and laparoscopic surgery group according to the operation methods,with 122 cases in each group.The differences between the two groups regarding operation time,bleeding volume,postoperative pain,surgical scars,complications and recurrence were compared.Results Contralateral recessive hernia was observed in 52 cases (46.4％) of laparoscopic surgery group.The differences in operation time [unilateral hernia:(16.1 ± 5.3) min vs (14.3 ±4.4) min],[bilateral hernia:(29.2 ± 6.4) min vs (31.4 ± 5.2) min],bleeding volume [(2.2 ± 1.1) mL vs (2.9 ± 1.4) mL],surgical scars and recurrence between the two groups were not statistically significant,and no scrotal hematoma and latrogenic cryptorchidism were observed in both groups.But the differences regarding post-operative pain,time to ambulation,scrotal swelling were statistically significant (P ＜ 0.05).Conclusions Laparoscopic surgery showed advantages in small operation wound,rapid recover,less complications and possibility of exploration of contralateral processus vaginalis,so it is much more secure and reliable.

Objective:To analyze the changes of mean arterial pressure (MAP) and end expiratory carbon dioxide (ETCO 2) in patients after emergency endotracheal intubation (ETI). To explore the values of MAP and ETCO 2 monitoring in early prediction of severe cardiovascular collapse (CVC) after emergency ETI. Methods:The clinical data of adult patients who underwent ETI from March 2015 to May 2020 were collected consecutively in the emergency departments of Peking Union Medical College Hospital. The values of MAP and ETCO 2 were observed and recorded at 5, 10, 30, 60 and 120 min after intubation. According to whether severe CVC occurred after ETI, the patients were divided into the severe CVC group and non-severe CVC group. The values of MAP and ETCO 2 were compared at the same time points between the two groups and the adjacent time points within the groups. The correlation between MAP and ETCO 2 after ETI was also analyzed. ROC curve was used to analyze the ability of MAP and ETCO 2 at 5 min and 10 min after ETI to predict severe CVC. Results:Totally 116 patients were enrolled in this study, among them 75 (64.7%) cases had severe CVC after ETI. The majority were male and elderly patients in the severe CVC group. The values of MAP and ETCO 2 in 5, 10, 30, 60 and 120 min after ETI in severe CVC group were significantly lower than those in the non-severe CVC group. The values of MAP and ETCO 2 in the two groups showed simultaneous decrease from 5 min to 30 min after ETI, reached the lowest value at 30 min after ETI, and appeared the synchronous recover from then to 120 min after ETI. After ETI, the changes of MAP was correlated with that of ETCO 2 ( rs = 0.653, P<0.01). At 5 min after ETI, MAP could predict severe CVC (AUC=0.86, P<0.01), MAP≤72 mmHg was the best cutoff value (sensitivity 78.7%, specificity 87.8%); ETCO 2 could also predict severe CVC (AUC=0.85, P<0.01), and ETCO 2≤35 mmHg was the best cutoff value (sensitivity 77.3%, specificity 85.4%). At 10 min after ETI, MAP could predict severe CVC (AUC = 0.90, P<0.01), MAP≤67 mmHg was the best cutoff value (sensitivity 89.3%, specificity 85.4%), ETCO 2 could also predict severe CVC (AUC=0.87, P<0.01), and ETCO 2≤33 mmHg was the best cutoff value (sensitivity 81.3%, specificity 78.0%). There was no significant difference in the ability of prediction between any two indexes of the MAP and ETCO 2 at 5 min and 10 min after ETI ( P>0.05). Conclusions:Patients with severe CVC after ETI have early signs of decreased MAP and ETCO 2, but the delayed recognition and insufficient intervention may be related to the occurrence and development of severe CVC. MAP and ETCO 2 at the early stage after ETI have high accuracy in predicting severe CVC. MAP≤72 mmHg, ETCO 2≤35 mmHg at 5 min after intubation, MAP≤67 mmHg and ETCO 2≤33 mmHg at 10 minutes after intubation all suggest the possibility of severe CVC.

Objective To investigate the value of laparoscopy in the treatment of children with cryptorchidism.Methods Clinical data of 76 children with middle and high cryptorchidism were retrospectively analyzed,in which 41 cases were treated by traditional operation,and 35 cases underwent laparoscopic testicular descending fixation.The operative time,hospitalization time and incidence rate of postoperative complications were compared.Results Compared with open surgery,the laparoscopic testicular fixation had less traumatic,faster recovery and few postoperative complications such as testicular retraction.Conclusion Compared with open surgery,laparoscopic testicular descending fixation has obvious advantages,and it can be considered as the first choice for high and middle cryptorchidism.

Objective To investigate the value of laparoscopy in the treatment of children with cryptorchidism.Methods Clinical data of 76 children with middle and high cryptorchidism were retrospectively analyzed,in which 41 cases were treated by traditional operation,and 35 cases underwent laparoscopic testicular descending fixation.The operative time,hospitalization time and incidence rate of postoperative complications were compared.Results Compared with open surgery,the laparoscopic testicular fixation had less traumatic,faster recovery and few postoperative complications such as testicular retraction.Conclusion Compared with open surgery,laparoscopic testicular descending fixation has obvious advantages,and it can be considered as the first choice for high and middle cryptorchidism.

Objective To investigate the incidence and the prognosis of acute kidney injury (AKI) and to find out the risk factors associated with the outcome for better understanding and preventing AKI among inpatients. Methods All the hospitalized patients were screened by Lab Administration Network of Renji Hospital,Shanghai Jiaotong University School of Medicine from Jan.to Dec.2009.Study cohort was comprised of all the patients with AKI defined by Acute Kidney Injury Network (AKIN) and with complete clinical data recorded.The incidence,etiology and distribution characteristics, prognosis of AKI in hospitalized patients were retrospectively analyzed.Logistic regression analysis was used to investigate the risk factors of patients and renal outcome. Results A total of 934 patients with AKI were enrolled.The incidence of AKI in hospitalized patients was 2.41％ (934/38 734).The ratio of male to female was 1.88∶1.Age was (60.82±16.94) years old.Increasing incidence could be seen with age rising.There was 63.4％ AKI found in surgical department,35.4％ in internal medicine department and 1.2％ in obstetric and gynecologic department.Pre-AKI,acute tubular necrosis (ATN),acute glomerular and renal vascular injury (AGV),acute interstitial nephritis (AIN) and post-AKI were accounted for 51.7％,37.7％,3.8％,3.5％ and 3.3％ of the causes of AKI,respectively.On day 28,the survival rate was 71.8％,complete renal recovery rate was 65.7％,partial renal recovery rate was 16.9％ and renal loss rate was 17.4％ among all the patients with AKI.The mortality of AKI with stage Ⅰ,Ⅱ and Ⅲ among inpatients was 24.8％,31.2％ and 43.7％ respectively.Multivariate Logistic regression analysis showed that renal injury drugs [odds ratio (OR)=2.313],hypotension (OR=4.482),oliguria (OR =5.267),the number of failure organs except kidney (OR =1.376) and requiring renal replacement therapy (RRT)(OR=4.221) were independent risk factors for death among AKI patients.The number of failure organs except kidney (OR=1.529) and RRT (OR=2.117) were independent risk factors for kidney loss. Conclusions AKI is one of the most common complications in hospitalized patients.The mortality is high and renal outcome is poor after AKI.The prognosis is closely associated with the severity of AKI.Renal injury drugs,hypotension,oliguria,the number of failure organs except kidney and requiring RRT are independent risk factors for death among AKI patients,while the number of failure organs except kidney and requiring RRT are independent risk.factors for renal loss.

Objective:To evaluate the accuracy of CHANNEL process in predicting difficult airway of patients in emergency department.Methods:From July 2016 to December 2019, we selected patients who underwent airway management in the emergency department of Peking Union Medical College Hospital. They were evaluated by CHANNEL and improved Mallampati (modified Mallampati test, MMT) classification at the same time. After completion, the glottis was exposed under direct laryngoscope, and then Cormack Lehane classification was performed. Difficult airway was defined as Cormack-Lehane grade Ⅲ or Ⅳ. The receiver-operating characteristics curve was used to evaluate the accuracy of MMT and CHANNEL in predicting difficult airway.Results:122 of 312 patients who underwent emergency airway management were included in the study. The sensitivity of CHANNEL in predicting difficult airway was 100%, the specificity was 90.1%, the area under the curve(95% confidence interval) was 0.948(0.907~0.988).Compared with MMT, the area under the curve of CHANNEL in predicting difficult airway was significantly increased( P<0.05). Conclusion:CHANNEL can accurately predict difficult airway of patients in the emergency department.

Objective:To promote emergency airway management from the perspective of training and to explore the training mode of emergency airway management based on clinical procedures.Methods:Airway management training courses were designed according to the clinical treatment principle centered on patient safety in combination with actual clinical procedures. The course took the CHANNEL process of airway management as the main line and focused on artificial ventilation, oxygen therapy and rapid induction of intubation techniques. During the teaching, we took the clinical handling process as the main line, and adopted methods of equipment display, video presentation and on-site explanation. Courses were freely registered or oriental enrollment. Online questionnaires were used to collect feedback from the students after class and were then analyzed.Results:A total of 15 training sessions were held in 13 cities across the country, with 566 participants, and 185 questionnaire responses were received. About the content of single course, participants thought that the first three parts were difficult to understand, including oxygen therapy (48, 25.9%), CHANNEL process explanation and practice (48, 25.9%) and rapid induction of intubation process (47, 25.4%). After class, 41 participants (22.2%) changed work procedures of emergency airway management, 140 (75.7%) partially changed work procedures of emergency airway management, and 4 (2.2%) still used the original work procedure.Conclusion:The course of emergency airway management based on clinical procedures meets the current clinical needs and can better improve the training of clinical competency.

Diabetic retinal neurodegeneration is a serious complication of diabetes mellitus, manifested by apoptosis and gliosis, and its pathogenesis is closely related to the oxidative stress induced by high glucose levels. The increase in blood glucose in the body leads to excessive production of reactive oxygen species and the downregulation of antioxidant defense signaling pathways, which leads to oxidative stress in the body, which in turn induces apoptosis, mitochondrial damage and autophagy, resulting in diabetic retinal neurodegeneration. Antioxidant stress therapy with gene therapy, flavonoids, recombinant Ad-β-catenin carriers, and autophagy inducers to exert neuroprotective effects. In the future, more clinical trials are needed to explore the effective dosage and side effects of drugs, and to develop new drugs and treatment strategies for oxidative stress to prevent and treat diabetic retinal neurodegeneration and protect retinal nerve function.