Objective To explore the changes in the expression of CX3CR1 in natural killer (NK) cells from peripheral blood mononuclear cells (PBMC) in sepsis patients and its association with gut microbiota. Methods A total of 24 sepsis patients were selected from January 2020 to January 2021 at Zhongshan Hospital, Fudan University, and 10 healthy volunteers were recruited in January 2021 as healthy controls. Fecal samples and peripheral blood were collected from sepsis patients on the first and fourth days of hospitalization. Sequencing of the V3-4 region of the 16S rDNA gene of gut microbiota was performed using the Illumina MiSeq platform. The peripheral blood samples were isolated by positively selected magnetic beads, and the CD3^－CD56^＋NK cells were identified by flow cytometry. The mRNA expression of CX3CR1 was detected by qPCR, and the changes in CX3CR1 expression and its correlation with gut microbiota were analyzed. Results Compared with healthy control group, the Shannon diversity index of the gut microbiota and the proportion of Firmicutes in sepsis patients decreased; compared with admission day, the Shannon diversity of the gut microbiota in sepsis patients on the fourth day of hospitalization significantly decreased, the proportion of Proteobacteria on phylum level and the relative abundance of Enterococcus and Klebsiella on genus level significantly increased. The CX3CR1 expression of PBMC-NK cells in sepsis patients on the fourth day was significantly lower than that on the admission day (P＜0.001). Compared with surviving patients, CX3CR1 expression in non-surviving patients significantly decreased on the fourth day (P＜0.05). Spearman correlation analysis showed that CX3CR1 expression of PBMC-NK cells was positively correlated with the quantity of gut microbiota and the Shannon diversity index (P＜0.01). Conclusions The expression of CX3CR1 in PBMC-NK cells in sepsis patients decreases with disease progression, and is related to prognosis. Furthermore, its expression is found to be closely related to the gut microbiota.

Objective To analyze the associations between aging and fat deposition in the pancreas, liver, kidneys, and spleen. Methods A total of 40 subjects were enrolled in the study. Fasting venous blood was collected and abdominal 3T MRI with the six-point Dixon-VIBE subsequence was performed. Fat fraction (FF) was quantified, and biochemical indexes related to glucose metabolism, lipid metabolism and liver and kidney functions were determined. Pearson correlation analysis was used to explore the correlations among variables. Results Pancreatic fat fraction (PFF) had an independent positive correlation with age and a non-independently positive correlation with body mass index (BMI, P＜0.05); liver fat fraction (LFF) had an independently positive correlation with BMI and a non-independent association with age (P＜0.05); kidney fat fraction (KFF) had a non-independently positive correlations with both age and BMI (P＜0.05). There were positive correlations between PFF and LFF or KFF (P＜0.05); after adjusted PFF, there was no correlation between LFF and KFF. PFF was positively correlated with fasting C-peptide (FCP) and hemoglobin A1c (HbA1c, P＜0.05); LFF was positively correlated with fasting plasma insulin (FPI) and FCP, and was negatively correlated with high-density lipoprotein cholesterol (HDL-C, P＜0.05); KFF was positively correlated with fasting plasma glucose (FPG), triglyceride (TG) and was negatively correlated with HDL-C (P＜0.05). Spleen fat fraction (SFF) had no correlation with age, BMI and either metabolic parameters. Conclusions Aging significantly affects fat deposition in the pancreas, and may affect fat deposition in the liver and kidneys, with little effect on spleen metabolism.

Objective To investigate the effects of miR-4531/CX3CL1 signaling pathway on the vascular injury in preeclampsia, and to search possible targets for early diagnosis and prevention of preeclampsia. Methods Placental tissue samples were obtained from 10 patients with late-onset preeclampsia and 10 normal pregnant women in the Obstetrics and Gynecology Department of Minhang Hospital, Fudan University from October 2021 to December 2022. The levels of miR-4531 and CX3CL1 were evaluated by qRT-PCR. Cell transfection was performed by lipofectamine 2000 in vitro. The binding relationship between miR-4531 and CX3CL1 was determined by luciferase reporter assay. The apoptosis of neutrophils, the migration, repair, colony formation and cell-free DNA (cfDNA) release of human umbilical vein endothelial cells (HUVECs) were detected. Results MiR-4531 was significantly downregulated, and CX3CL1 was upregulated in placental tissues of preeclampsia patients (P＜0.05). Luciferase report assay confirmed the direct binding relationship between miR-4531 and CX3CL1. Upregulation of miR-4531significantly promoted the migration, proliferation, repair, and inhibited cfDNA release of HUVECs and neutrophils apoptosis in medium under hypoxic condition (P＜0.05). However, downregulation of miR-4531 obviously inhibited the proliferation, migration, repair, and enhanced cfDNA release of HUVECs and neutrophils apoptosis in medium under hypoxic condition (P＜0.05). Conclusions The miR-4531is downregulated in placental tissues of preeclampsia parients and is a potential therapeutic target for preeclampsia. It might cause endothelial damage and an abnormal hypercoagulable state under hypoxic condition by targeting and regulating the CX3CL1 pathway.

Objective To explore the correlations between serum Mas-related G protein-coupled receptor X2 (MRGPRX2), interleukin (IL)-4, IL-5, IL-6, IL-13, IL-23 and IL-33 levels and chronic spontaneous urticaria (CSU). Methods The clinical characteristics and laboratory data from 55 patients with CSU and 21 healthy controls at Huashan Hospital, Fudan University from February 2021 to September 2023 were collected. The disease activity and severity of CSU patients were assessed. Serum level of MRGPRX2 was tested using enzyme-linked immunosorbent assay (ELISA), and levels of IL-4, IL-5, IL-6, IL-13, IL-23, and IL-33 were measured using Luminex multiplex assay in all subjects. Spearman correlation analysis was used to evaluate the correlations between biomarkers and other parameters in CSU patients, and logistic regression analysis was performed to identify factors influencing CSU. Results CSU patients exhibited significantly higher serum levels of MRGPRX2 (2.41[0, 11.51] ng/mL vs 0[0, 2.86] ng/mL, P＝0.015) and IL-23 (0.09[0.04, 0.56] pg/mL vs 0.05[0.03, 0.08] pg/mL, P＝0.033) than healthy controls. There was no difference in levels of other cytokines between the two groups. There was no difference in levels of MRGPRX2 and cytokines between severe and non-severe CSU patients. Correlation analysis showed that serum MRGPRX2 levels in CSU patients were positively correlated with IL-4 (r＝0.345, P＝0.010) and IL-6 (r＝0.395, P＝0.003) levels. Logistic regression analysis indicated that MRGPRX2≥0.055 ng/mL and IL-23≥0.135 pg/mL were independent risk factors for CSU (P＜0.05). Conclusions Serum levels of MRGPRX2 and IL-23 in CSU patients are elevated, which may be involved in the pathogenesis of CSU.

Objective To explore the effect of Jinhoujian spray on postoperative sore throat (POST) after implantation of streamlined liner of pharyngeal airway (SLIPA) in general anesthesia. Methods A total of 100 patients undergoing lower limb fracture surgery with laryngeal mask general anesthesia in Xuchang Central Hospital, Henan University of Science and Technology from January 1, 2024, to May 31, 2024 were randomly divided into Jinhoujian spray group (Jinhoujian group) and lidocaine aerosol group (lidocaine group), with 50 cases in each group. Jinhoujian spray and lidocaine aerosol were applied to both sides of the laryngeal mask sealing cover, and after intravenous induction of general anesthesia, the same anesthesiologist inserted the laryngeal mask using a blind probing standard method. Mean arterial pressure (MAP) and heart rate (HR) were compared between the two groups at different time points: before laryngeal mask insertion (T₀), immediately after insertion (T₁), 3 minutes after insertion (T₂), 5 minutes after insertion (T₃), 10 minutes after insertion (T₄), immediately after mask removal (T₅), 3 minutes after removal (T₆), and 5 minutes after removal (T₇). The incidences of stress responses (coughing, airway spasm, agitation, nausea and vomiting) and adverse reactions (tongue numbness, arytenoid joint dislocation, dysphagia, restricted protective reflexes, and pharyngeal arch injury) after laryngeal mask removal were compared between the two groups. The numeric rating scale (NRS) at 0.5 h, and NRS, hoarseness, and extubation reaction at 24 h after mask removal were compared between the two groups. Results There were no statistically significant differences in baseline data and MAP and HR values at each time point (T_0-7) between the two groups. Compared with the lidocaine group, the patients in Jinhoujian group had a lower incidence of nausea and vomiting after laryngeal mask removal (P＝0.021). There was no statistically significant difference in the numeric rating scale (NRS) score 0.5 h after laryngeal mask removal between the two groups. Compared to the lidocaine group, the patients in Jinhoujian group had significantly lower scores of NRS (P＝0.027), Prince-Henry (P＝0.002), and oral mucositis (P＝0.026) 24 h after laryngeal mask removal . Conclusions Jinhoujian spray can effectively reduce incidence of postoperative nausea and vomiting, alleviate POST and oral mucositis 24 h after laryngeal mask removal, improving patient comfort after lower limb fracture surgery.

Objective To explore the difference of the left ventricular global longitudinal strain (GLS) and the segment strains between cardiac amyloidosis (CA) and non-obstructive hypertrophic cardiomyopathy (HCM). Methods Twenty patients with immunoglobulin light chain cardiac amyloidosis (AL-CA) as CA group and 20 patients with non-obstructive HCM selected as controls (HCM group) were enrolled from January 2016 to April 2022 in Zhongshan Hospital, Fudan University. All patients underwent two-dimensional speckle tracking echocardiography (2D-STE). The left ventricle GLS and the segmental strains were calculated. The values of these strains to distinguish AL-CA from HCM were analyzed by receiver operating characteristic (ROC) curves and logistic regression analysis. Results In the CA group, the GLS parameters (3P, 4Ch, 2Ch, 3Ch), as well as the left ventricle segmental strains (MID-ANT/LAT, MID-INF/SEPT, BASAL-ANT/LAT, BASAL-INF/SEPT, MID-ANT, MID-INF, BASAL-ANT, BASAL-INF, MID-INF/LAT, BASAL-ANT/SEPT, and BASAL-INF/LAT) were all lower than those in the HCM group (P＜0.01). ROC results showed that GLS(4Ch), GLS(2Ch), GLS(3Ch), GLS(3P), BASAL-ANT/LAT, BASAL-INF/SEPT, BASAL-ANT, BASAL-INF, BASAL-ANT/SEPT and BASAL-INF/LAT had good efficacy in distinguishing AL-CA from HCM. Logistic regression analysis showed that BASAL-ANT/LAT was an independent factor in distinguishing AL-CA from HCM (P＜0.01). The consistency of test results was good. Conclusions The left ventricular segmental myocardial strains show good efficacy in distinguishing AL-CA from HCM, and BASAL-ANT/LAT has highest application value.

Objective To investigate the application value of the global myocardial work parameters in the non-invasive pressure-strain loop (PSL) technology for early assessment of left ventricular systolic function in patients with chronic kidney disease (CKD). Methods A retrospective analysis was performed on 74 patients with normal left ventricular ejection fraction (LVEF) who were hospitalized in the Nephrology Department of Zhongshan Hospital (Xiamen Branch), Fudan University, from August 2021 to December 2021. Based on CKD stages, patients were divided into early group (CKD stages 1-3) and advanced group (CKD stages 4-5). Additionally, 30 healthy volunteers matched for age and gender were selected as the control group. General clinical data, routine left ventricular ultrasound indicators, myocardial strain, and global myocardial work parameters were collected and compared among the three groups. Correlation analysis and multiple linear regression were used to assess the influencing factors of myocardial work. Results There were no statistically significant differences in global work index (GWI) and global constructive work (GCW) among the three groups. Compared to the control group, both CKD groups showed significantly reduced global work efficiency (GWE), along with significantly increased global waste work (GWW, P＜0.05). The absolute value of global longitudinal strain (GLS) in the advanced CKD group (n＝42) was significantly lower than that in the early CKD group (n＝32; [﹣17.09±0.82]% vs [﹣18.33±0.90]%, P＜0.05), and GWE was also significantly lower (93.00%[90.00%, 95.00%] vs 96.00%[92.25%, 96.75%], P＜0.05), while GWW was significantly higher than that in the early CKD group (150.00 mmHg%[105.25 mmHg%, 215.00 mmHg%] vs 88.00 mmHg%[64.25 mmHg%, 144.50 mmHg%], P＜0.05). Correlation analysis showed that GWE was negatively correlated with the absolute value of GLS and peak strain dispersion (PSD; r＝﹣0.396, ﹣0.558, P＜0.05), GWW was positively correlated with absolute value of GLS, and PSD (r＝0.341, 0.610, P＜0.01). Multiple linear regression results indicated that PSD was an independent influencing factor for GWE (β＝﹣0.558, P＜0.001) and GWW (β＝0.538, P＜0.001). Conclusions The myocardial work parameters GWE and GWW in non-invasive left ventricular PSL technology can identify subclinical left ventricular systolic dysfunction in patients with CKD early and quantitatively.

Objective To analyze the clinicopathological features, diagnosis and differential diagnosis of bronchiolar adenoma (BA) with primary lung cancer. Methods Data of 17 BA patients complicated with primary lung cancer in Dalian University Affiliated Xinhua Hospital from January 2020 to December 2022 were collected, and the clinical data, histopathological features and immunohistochemical features were summarized. Results 17 patients included 7 males and 10 females, with 49-82 years old. There were 2 squamous cell carcinoma and 15 adenocarcinoma. BA was mostly nodular, without capsule. It had a clear boundary with the surrounding lung tissue, with a major diameter of 0.3-1.5 cm. The section of BA was gray-white, gray-red, gray-brown, with medium-soft texture, and a few had obvious mucus. Microscopically, it was composed of luminal cell layer and basal cell layer, and luminal cells contain mucus cells, ciliated cells, cubic cells and columnar cells. According to the composition of luminal cells, BAs were divided into proximal type and distal type. There were 5 proximal type and 12 distal type, including 1 case of atypical distal BA. Immunohistochemistry results showed that in typical BAs, CK5/6, p63 and p40 were positive in basal cells, thyroid transcription factor-1 was positive in luminal cells and basal cells, and the proliferation index of Ki-67 was 1%. Conclusions BA is a benign tumor, and is a bilayer structure mainly composed of luminal cells and basal cells. However, when the absence or discontinuity of basal cells, BA is easily misdiagnosed as malignancy, which should be highly vigilant.

Objective To summarize the pathological morphological features, diagnosis, and differential diagnosis of adult-onset Still disease (AOSD), and to improve clinical understanding of the disease. Methods A retrospective analysis was conducted on the morphological characteristics, immunophenotypes, and molecular detection results of lymph node biopsies from three AOSD patients. Results Case 1: lymph node biopsy tissue showed significant lymphoid follicular hyperplasia, accompanied by parafollicular hyperplasia; the germinal centers exhibited a starry-sky phenomenon, with no obvious histiocyte proliferation foci, plasma cells, or neutrophils; immunohistochemical staining showed that CD3 and CD5 T lymphocyte were positive in the paracortical area, CD20 and CD79α markers showed that B lymphocytes were mainly located in the follicular area, CD21 follicular dendritic cells and CD68 histiocytes were positive. Case 2: lymph node puncture tissue showed paracortical hyperplasia, a decrease in the number of follicles, and a reduction of follicular volume; there were no obvious histiocyte proliferation foci, plasma cells, or neutrophils; immunohistochemical staining showed positive CD3, CD5 T lymphocytes in the paracortical area, and CD20, CD79α B lymphocytes in the follicular region. Case 3: lymph node puncture tissue showed partial preservation of the normal lymph node structure, the paracortical area was diffusely proliferated, and the histiocyte hyperplasia was patchy with partial necrosis, and obvious nuclear debris, scattered plasma cells and eosinophils can be seen and no obvious neutrophil infiltration in the necrotic area; immunohistochemical staining of case 3 showed that CD21 and CD23 follicular dendritic cells were positive, and Bcl-2, Bcl-6, CD3, CD5, CD20, CD79α, and multiple myeloma protein 1 (MUM1) were positively expressed in some lymphocytes; the Ki-67 proliferation index was high, approximately 70%; a few plasma cells were positive for CD138, with individual cells positive for CD1α; CD10 and CyclinD1 were negative; histiocytes were positive for myeloperoxidase (MPO); and EBER was negative for in situ hybridization. The results of TCR gene rearrangement and IG gene rearrangement in the three cases were negative. Conclusion The immunophenotype of AOSD is diversity, and its dignosis depends on the clinical and pathological morphological features and immunophenotype, excluding infectious diseases, malignant tumors and lymphoma, etc.

Objective To compare the reflux characteristics between reflux esophagitis (RE) patients with Los Angeles (LA) classification grade A and grades B/C based on esophageal pH-impedance monitoring results. Methods A total of 74 RE patients at Zhongshan Hospital (Xiamen Branch), Fudan University from June 2021 to June 2024 were enrolled, and were divided into the LA-A group (n＝46) and the LA-B/C group (n＝28) based on the endoscopic diagnosis results. The general clinical data, symptom questionnaire score, and esophageal 24-hour pH-impedance monitoring results were compared between the two groups. Results There were no statistically significant differences in demographic data and the response rate of acid suppression therapy between the two groups. 24-hour esophageal pH-impedance monitoring results showed that there were no statistically significant differences in upright, supine, and total reflux indices, including reflux episodes, acid exposure time (AET), AET percentage (AET%), long acid reflux episodes, longest reflux duration, and total DeMeester score between the two groups. There were no statistically significant differences in distal reflux episodes, proximal reflux episodes, and high reflux (acid, weak acid, and non-acidic reflux) episodes, mean nocturnal baseline impedance (MNBI) between the two groups. The rates of pathological reflux (AET%≥6%) in LA-A group and LA-B/C group were 67.4% and 71.4%, respectively; there were no statistically significant differences in the ratio of AET% composition and the count of impedance reflux exceeding 80 during 24 h between the two groups. Conclusions LA-A grade RE based on the endoscopic diagnosis facilitates the identification of gastroesophageal reflux disease in the Chinese population