With the coronavirus disease 2019(COVID-19)pandemic across the world, numerous variants have emerged.As a high-risk group for COVID-19, the elderly are prone to acute kidney injury(AKI), with atypical clinical features and high proportions of patients with critical illness.Its pathogenesis mainly includes direct damage to the kidney via the angiotensin-converting enzyme 2(ACE2)pathway, the extracellular matrix metalloproteinase inducer(CD147)pathway, and age-related renal dysfunction, inflammatory aging, immune aging and other non-specific mechanisms, which significantly increase the risk of adverse prognosis.Therefore, the establishment of an early warning system for AKI, increasing vaccination coverage, nutritional support, treatment of primary diseases, extracorporeal supportive therapy and other control measures are particularly important to prognosis improvement.This review summarized the pathogenesis, early prevention and treatment of AKI in elderly patients with COVID-19.

Objective To observe the effects of Wuhu Decoction on autophagy and the expressions of IL-8,IL-23 and muc5ac in lung tissue of asthmatic mice induced by exosomes of bone marrow mesenchymal stem cells infected by RSV(BMSCs-Exo-RSV);To explore its mechanism in the treatment of asthma.Methods Totally 40 male SPF C57 mice were randomly divided into blank group,model group,Wuhu Decoction group and ribavirin group,with 10 mice in each group.The blank group was given PBS nasal drops,and the other groups were given BMSCs-Exo-RSV nasal drops once every other day for 7 times.24 hours after the end of modeling,Wuhu Decoction group was given Wuhu Decoction,and ribavirin group was given ribavirin solution,the blank group and model group were given distilled water,once a day,for consecutive 7 d.The general behavior of mice was observed,the peak expiratory flow(PEF)and forced vital capacity(FVC)were detected,HE and Masson staining were used to observe the inflammatory infiltration and collagen deposition in the lung tissue,RT-qPCR was used to detect the expressions of LC3A/B,beclin-1,p62,IL-8,IL-23 and muc5ac mRNA in lung tissue,Western blot was used to detect the expressions of LC3B,beclin-1 and p62 proteins in lung tissue,immunohistochemstry was used to detect the expression of IL-8,IL-23,muc5ac proteins in lung tissue.Results Compared with the blank group,the body mass of mice in the model group decreased,and showed behavioral changes such as shortness of breath,nodding wheezing,lifting of upper limbs,shrugging,vertical hair,scratching nose,etc.,the PEF and FVC were decreased(P<0.01),inflammatory infiltration and collagen deposition in lung tissue increased,the expressions of LC3A/B,beclin-1,IL-8,IL-23 and muc5ac mRNA in lung tissue increased,the expression of p62 mRNA decreased(P<0.01),while the expression of LC3BⅡ,beclin-1,IL-8,IL-23 and muc5ac proteins and the ratio of LC3BⅡ/Ⅰ increased(P<0.01),while the expression of LC3BⅠand p62 protein decreased(P<0.01).Compared with the model group,the symptoms of Wuhu Decoction group and ribavirin group were improved,the PEF and FVC were increased(P<0.01,P<0.05),the inflammatory infiltration and collagen deposition in lung tissue were reduced,the expression of LC3A/B,beclin-1,IL-8,IL-23 and muc5ac mRNA in lung tissue decreased(P<0.01),the expression of p62 mRNA increased(P<0.01),the expressions of LC3BⅡ,beclin-1,IL-8,IL-23 and muc5ac protein and the ratio of LC3BⅡ/Ⅰ decreased(P<0.05,P<0.01),while the expressions of LC3BⅠ and p62 protein increased(P<0.01).Conclusion BMSCs-Exo-RSV can promote autophagy and the expressions of IL-8,IL-23 and muc5ac in lung tissue of mice to induce asthma changes.Wuhu Decoction has therapeutic effect on asthmatic mice by inhibiting autophagy and reducing the expressions of IL-8,IL-23 and muc5ac.

Objective To investigate the cell origin of interleukin (IL)-22-secreting cell of mice infected with Trichinella spiralis (T.spiralis) at the early encapsulated stage.Methods Twelve Balb/c mice were divided into the infected group and the control group according to body weight by random number table.The infected mice were intragastrically administrated with 300 muscle larvae of T.spiralis,and the control mice were given the same amount of normal saline.The IL-22-secreting cell subsets in mouse splenic lymphocytes were detected by flow cytometry at the fourth week after infection.Results The proportion of IL-22-secreting cells in splenic lymphocytes of T.spiralis infected mice was increased when compared with control group [(0.88 ± 0.25)％ vs (0.28 ±0.17)％,t =-4.899,P ＜ 0.05].There was no significant difference between the proportion of CD3+IL-22+ cells and CD3-IL-22+ cells in the splenic lymphocytes of the infected group [(0.29 ± 0.17)％ vs (0.51 ± 0.17)％,t =-2.195,P ＞ 0.05],and the percentage of CD3-IL-22+ cells were similar between the infected group and the control group [(0.51 ± 0.17)％ vs (0.44 ± 0.22)％,t =-0.600,P ＞ 0.05].The proportion of CD3+IL-22+ cells in the infected group was significantly higher than that in the control group [(0.29 ± 0.17)％ vs (0.07 ± 0.06)％,t =-3.068,P ＜ 0.05],and the percentage of CD4+IL-22+ T cells and γδTCR+IL-22+ T cells were obviously increased in CD3+ lymphocytes [(1.28 ± 0.54)％ vs (0.16 ± 0.07)％,(0.33 ± 0.22)％ vs (0.02 ± 0.00)％,t =-4.997,-3.342,P ＜ 0.05].Conclusions The proportion of IL-22-secreting splenic lymphocytes is increased in mice infected with T.spiralis at the early encapsulated stage.The rise is caused by increased numbers of IL-22-secreting CD3 + lymphocytes,especially CD4+ T cells and γδT cells.

Objective:To investigate the clinical features, therapy and prognosis of human cytomegalovirus(HCMV)pneumonia in pediatric patients, and to analyze the diagnosis value of detecting HCMV DNA in bronchoalveolar lavage fluid(BALF)by real-time PCR.Methods:The clinical characteristics of 58 pediatric inpatients who were HCMV DNA positive in BALF were retrospectively reviewed.All the patients were from Shengjing Hospital of China Medical University from January 2015 to December 2019.Clinical, radiologic, laboratory and microbiologic data was collected for each patient.The study cohort was divided into HCMV productive infection and latent infection consisting of 22 and 36 patients respectively, based on the HCMV active infection in lung or not.Receiver operating characteristic(ROC)curve was used to assess utility of detecting HCMV DNA in BALF and establish a threshold for diagnosis.Results:(1)Compared with patients in latent infection group, the children in productive infection group had a lower age of onset( P<0.05), a higher proportion of male( P<0.05), and more prolonged hospitalization stay( P<0.05). Pulmonary rales, hypoxemia and higher AST, CK, LDH in serum were easier to detect in productive infection group( P<0.05). Higher HCMV DNA copies in BALF was also detected( P<0.01). Patients in productive infection group had significantly more exposure to additional oxygen treatment or mechanical ventilation and systemic hormone therapy( P<0.05), while with poorer outcomes( P<0.05). (2) ROC curve analysis showed that the AUC for HCMV DNA in BALF in diagnosis of HCMV pneumonia was 0.708 with a threshold of 8.83×10 3 copies/mL, a sensitivity of 77.27%, and a specificity of 58.33%. Conclusion:Those who are diagnosed HCMV pneumonia have a lower age of onset with higher male proportion.These children suffered severer clinical signs.The patients with HCMV DNA copies higher than 8.83×10 3 copies/mL in BALF would be more likely to be diagnosed as HCMV pneumonia.

Objective:To explore the risk factors involved in gastritis, gastric intraepithelial neoplasia (GIN) and gastric cancer in Shihezi area.Methods:A total of 7 110 Han nationality patients who underwent gastroscopy at the First Affiliated Hospital of Shihezi University School of Medicine from January 2012 to December 2016 were selected as the research subjects. The data of patients were obtained through medical records and questionnaires. After excluding diseases related to esophagus and duodenum, a total of 4 429 cases were included in the retrospective analysis. Of which, 4 249 were gastritis, 93 were GIN, and 87 were gastric cancer. χ2 test, rank-sum test or Fisher exact probability method were used to analyze the differences of various factors in gastritis, GIN and gastric cancer. Univariate and multivariate logistic regression analysis were used to screen the risk factors for gastritis progression to GIN and gastric cancer. Results:χ2 test and rank sum test showed that there were statistically significant differences in gender, age, history of digestive diseases and distribution of Helicobacter pylori ( HP) infection among the groups of gastritis, GIN and gastric cancer ( P<0.05). The proportion of HP infection decreased gradually with the disease severity. Multivariate logistic regression analysis showed that male ( P<0.001, OR=2.251, 95% CI: 1.461-3.470), elderly ( P<0.001, OR=4.829, 95% CI: 2.241-10.409), a family history of gastric cancer ( P=0.002, OR=3.227, 95% CI: 1.537-6.774) and a history of digestive diseases ( P=0.034, OR=1.644, 95% CI: 1.037-2.607) were independent risk factors for gastritis progression to GIN. Male ( P<0.001, OR=3.254, 95% CI: 2.026-5.225), middle-aged ( P=0.022, OR=2.688, 95% CI: 1.153-6.265) and elderly ( P=0.002, OR=4.734, 95% CI: 1.750-12.807) were independent risk factors for gastritis progression to gastric cancer. In stratified analysis to exclude age and gender, smoking ( P=0.028, OR=4.060, 95% CI: 1.160-14.202) was found to be a risk factor for gastritis progression to GIN in young adults, and obesity ( P=0.032, OR=3.869, 95% CI: 1.121-13.356) was found to be a risk factor for gastritis progression to gastric cancer in women. Conclusion:The degree of HP infection in gastric tissues is negatively correlated with the severity of gastric diseases, suggesting that HP infection may be an early event inducing gastric cancer. Male, the elderly, people with a family history of gastric cancer and a history of digestive diseases, and young smokers in Shihezi are more likely to develop GIN, and male, middle-aged, elderly, and obese women are at increased risk of gastric cancer.

Objective:To evaluate the efficacy and safety of Xiao′er Huangjin Zhike Granules in the treatment of cough caused by acute bronchitis in children, which is defined in TCM terms as a syndrome of phlegm-heat obstructing the lung.Methods:This was a block-randomized, double-blind, placebo-controlled, multicenter clinical trial.From January 2022 to September 2023, 359 children aged 3 to 7 years old diagnosed as acute bronchitis (lung-obstructing phlegm-heat syndrome) were enrolled from 21 participating hospitals and randomly assigned to the experimental group and placebo group in a 3︰1 ratio, and respectively treated with Xiao′er Huangjin Zhike Granules and its matching placebo.Cough resolution/general resolution rate after 7 days of treatment was used as the primary efficacy outcome for both groups.Results:(1)On the seventh day of treatment, the rate of cough disappearance/basically disappearance in the experimental group and placebo group were 73.95% and 57.61% retrospectively, which had statistically significance ( P=0.001).(2)After 7 days of treatment, the median duration of cough disappearance/basic disappearance were 5 days and 6 days in the two groups , with a statistically significant difference ( P=0.006).The area under the curve of cough symptom severity time was 7.20 ± 3.79 in the experimental group and 8.20±4.42 in the placebo group.The difference between the two groups was statistically significant ( P=0.039).(3) After 7 days of treatment, the difference between TCM syndrome score and baseline was -16.0 (-20.0, -15.0) points in the experimental group and -15.0 (-18.0, -12.0) points in the placebo group, with significant difference between the two groups ( P=0.004).In the experimental group, the clinical control rate, the markedly effective rate, the effective rate and the ineffective rate were 49.04%, 28.35%, 16.48% and 6.13% severally; and in the placebo group, the clinical control rate, the markedly effective rate, the effective rate and the ineffective rate were 38.04%, 26.09%, 29.35%, and 6.52% separately, which had statistically significant ( P=0.014).(4) There was no significant difference in the incidence of adverse events or adverse reactions during the trial between both groups.Moreover, while adverse reactions in the form of vomiting and diarrhea were occasionally reported, no serious drug-related adverse event or adverse reaction was reported.(5)The tested drug provided good treatment compliance, showing no statistically significant difference from the placebo in terms of compliance rate. Conclusions:Based on the above findings, it can be concluded that Xiao′er Huangjin Zhike Granules provides good safety, efficacy, and treatment compliance in the treatment of cough caused by acute bronchitis, and lung-obstructing phlegm-heat syndrome, in children.