Objective To explore the effect of selective gut decontamination in regulation of inflammatory reaction compared with rhubarb and glycerine enema for catharsis in patients with systemic inflammatory response syndrome ( SIRS ), and to discuss its mechanisms. Methods A prospective randomized controlled trial was conducted. Fifty-seven patients with SIRS admitted to Department of General Surgery of Aviation General Hospital from June 2009 to June 2014 were enrolled. The patients were randomly divided into rhubarb decontaminate group, traditional decontaminate group and blank control group, with 19 cases in each group. Besides the treatment for primary disease, including anti-infection, operation, alleviate pain, nutritional support, and maintaining water and electrolyte balance, the patients in rhubarb decontaminate group received aqueous extract from rhubarb 15-20 g by gastric tube, enema, or peros, twice a day;and those in traditional decontaminate group received glycerine enema or glycerol enema, twice a day; while no gavage or enema was prescribed in blank control group. Peripheral blood was collected before and 72 hours after treatment. Enzyme linked immunosorbent assay ( ELISA ) was used to determine the concentration of lipopolysaccharide ( LPS ) and inflammatory mediators. Results Compared with blank control group and traditional decontaminate group, the levels of interleukins ( IL-1, IL-8 ), LPS, platelet activating factor ( PAF ), tumor necrosis factor-α( TNF-α), andγ-interferon ( IFN-γ) before treatment was similar to that of rhubarb decontaminate group [ IL-1 ( ng/L ): 53.154±5.783, 50.564±5.771, 51.082±6.403, F = 0.994, P = 0.377; IL-8 ( ng/L ): 70.492±6.146, 68.376±6.112, 68.673±8.384, F=0.514, P=0.601;LPS (μg/L ):11.630±2.449, 10.858±2.307, 10.463±2.145, F = 1.261, P = 0.291; PAF (μg/L ): 4.173±0.395, 4.051±0.362, 4.078±0.487, F = 0.446, P = 0.642; TNF-α( ng/L ):132.498±10.772, 129.735±12.881, 127.207±11.514, F=0.963, P=0.388;IFN-γ(μg/L ):45.645±4.558, 43.692±5.578, 43.767±5.028, F = 0.904, P = 0.411 ]. The above parameters after treatment were significantly lower than those before treatment in three groups. The effect on the LPS and pro-inflammatory factors of the rhubarb decontaminate group was more obvious than that of the blank control group and traditional decontaminate group [ LPS (μg/L ): 7.571±1.113 vs. 9.008±1.904, 8.874±1.808, F = 4.416, P = 0.017; IL-1 ( ng/L ): 45.309±3.563 vs. 48.731±4.466, 46.112±4.322, F = 3.557, P = 0.035; IL-8 ( ng/L ): 60.492±5.346 vs. 65.553±5.384, 63.437±5.462, F = 4.213, P = 0.020; PAF (μg/L ): 3.519±0.250 vs. 3.832±0.356, 3.766±0.309, F = 5.450, P = 0.007; TNF-α ( ng/L ): 114.988±8.772 vs. 123.230±10.433, 118.534±9.519, F = 3.525, P = 0.036; IFN-γ(μg/L ):38.683±3.190 vs. 41.831±4.122, 39.161±3.972, F=3.820, P=0.028 ]. Conclusion The usage of selective gut decontamination can inhibit the release of endotoxin and inflammatory mediators in patients with SIRS, and it will get a better effect using rhubarb, and the mechanism may be related to the protection of intestinal mucosal barrier function.

Objective To investigate the effect of acute exhausted exercise in high temperature environment on the expression of myocardial HSP70 and plasma ANP level of in rats. Methods Forty eight male Sprague-Dawley rats was randomly and equally assigned to the following six groups:control group(C),exercise group(E),one-hour heat exposure group (H), heat exposure and exercise group (HE), exercise and 24 hours after exercise group(E'),heat exposure and 24 hours after exercise(HE'). Each group consisted of 8 rats. Rats in E,HE,E' and HE' ran on a treadmill until exhaustion, while rats in H and H' were exposed in a high temperature environment (33℃ ,50%RH) for one hour. Rats in C,E,HE and H were killed immediately after exercise or heat exposure. Rats in HE' and E' were killed 24 hours after exercise. Samples from myocardium and serum were collected for determining HSP70,ANP and CK-MB. Results(1) HSP70 levels in groups E and E' are significantly higher than that in group C(P<0.05 and P<0.01,respectively),and the level in group HE' is significantly higher than that in groups H and E'(P<0.01 );The HSP70 level in group H is significantly higher than that in group C. (2) The ANP and CK-MB levels in group E are Significantly higher than that in group C.and in group HE is higher than in group H (P<0.05);The HSP70 levels in group E' and HE' significantly decrease comparing to that in groups E and HE (P<0.01). Conclusions(1)Both heat exposure and exercise can induce the increased expression of myocardial HSP70 in rats and the peak expression is seen 24 hours after exercise. The increased expression of HSP70 may have protective effects on the heat-induced myocardial injury. (2) The increased ANP levels in plasma immediately after exhausted exercise improves the blood circulation in myocardium and hints the potential possibility of myocardial damage. However,the high temperature environment does not strengthen the increase of plasma ANP level that caused by exhaustive exercise.

Objective To explore the effectiveness and adverse effect of high frequency oscillation ventilation (HFOV) combined with Sildenafil (SIL) treatment on newborns with persistent pulmonary hypertension (PPHN).Methods A total of 89 cases of PPHN infants collected from Chengdu Women and Children's Central Hospital from Sep.2010 to Sep.2012 were randomly divided into HFOV group,constant mechanical ventilation (CMV) group,HFOV combined SIL group (HFOV + SIL group) and CMV combined with SIL group (CMV + SIL group).The arterial blood gas,pulmonary artery pressure (PAP) and adverse reactions were monitored before and 3 days after treatment.SNK multiple comparison method andx2 test were performed for data before and after treatment among groups for continuous variables and categorical variables,respectively.Results The levels of pa (O2) [(79.1 ± 13.7) mmHg (1 mmHg =0.133 kPa),(77.9 ±14.6) mmHg,(85.4 ±15.2) mmHg],Sa(O2) [(87.8 ±13.4)％,(88.4±15.6)％,(96.1±15.9)％],pa(CO2)[(42.5±11.3) mmHg,(40.2 ±10.5) mmHg,(35.6 ±8.7) mmHg] and PAP [(31.1 ± 8.1) mmHg,(30.4 ± 9.5) mmHg,(25.8 ± 7.3) mmHg] were all improved significantly in CMV + SIL group,HFOV group and HFOV + SIL group compared with those in CMV group[(69.9 ± 12.3) mmHg,(81.1 ± 14.9)％,(48.1 ±9.5) mmHg,(35.6 ±8.9) mmHg] (F =4.629 3,3.673 2,5.865 3,4.849 5,P ＜0.05),especially for HFOV + SIL group(P ＜ 0.05).No significant difference in such indicators was observed between CMV + SIL group and HFOV group (P ＞ 0.05).The effective rate in HFOV + SIL group (90％) was the highest among the 4 groups (x2 =7.938,P ＜ 0.05).During the treatment,all neonates have no adverse reaction.Conclusion The combined use of SIL and HFOV might be a more effective and safer method in the treatment of PPHN of neonate.

The elderly are the main body of people with sarcopenia which not only seriously affects the quality of life of the elderly, but also brings a heavy burden to the family and society.Maintaining and improving the function of the elderly and preventing the occurrence of sarcopenia in the elderly are the important measures in the health management of the elderly.In order to effectively carry out health education on sarcopenia in the elderly and to popularize relevant health care knowledge, the National Center of Gerontology and the Chinese Geriatrics Society have formulated the "Chinese expert consensus on the core information for the prevention of sarcopenia in the elderly(2021)" , relying on the expert team after several rounds of expert discussions.It provides scientific basis for the management and early intervention of sarcopenia.Let us now try to interpret the consensus on the key knowledge points of the core information sequence.

Objective:To analyze the process of Chinese expert consensus on the core information on prevention of sarcopenia in the elderly(2021)in China, so as to realize the early diagnosis and treatment of sarcopenia and to improve the quality of life in the elderly.Methods:The index system framework was established by literature review and expert questionnaire discussion, and Delphi expert consultation method was adopted to construct the index system.Results:A total of 109 experts(128 person-times)in Geriatrics from various fields participated in Delphi expert consultation.Positive coefficient for four rounds of expert consultation were 88.9%, 100.0%, 100.0% and 100.0% respectively, with expert authority factors being concentrated on 0.78~0.90.Through 4 rounds of Delphi expert surveys, the core information index system for sarcopenia prevention in the elderly has been definitive: Chinese Expert Consensus(2021)consists of nine indicators including "enhancing public scientific awareness of myosis, and so on."Conclusions:The core information index system for sarcopenia prevention in the elderly has high levels of overall convergence, comprehensive coverage, strong authority, stability, comprehensiveness and popularity.

Objective To study the protective effects and preliminary mechanisms of endothelial progenitor cells-derived microvesicles (EPC-MVs) on hypoxic-ischemic brain damage (HIBD) in newborn rats by using the HIBD model.Method Rat endothelial progenitor cells (EPCs) were cultured and microvesicles were extracted from EPCs culture medium by ultracentrifugation.A total of 60 neonatal SD rats were randomly assigned into control group,HIBD group,saline group and EPC-MVs group.The HIBD model was prepared in HIBD group,saline group and EPC-MVs group.After the preparation of the HIBD model,rats in saline group and EPC-MVs group received intraventricular injection with saline and EPC-MVs,respectively.After 72 hours,the rats were sacrificed for brain tissue,cerebral infarction was detected by TTC staining,vascular endothelial growth factor (VEGF) mRNA was tested by real-time PCR,protein western blot was used to detect changes in VEGF protein expression.Result Cells extracted and cultured from the spleen of 12-week-old SD rats were confirmed as EPCs by morphology and flow cytometry.EPC-MVs isolated by high-speed centrifugation from EPCs culture supernatant met the morphological characteristics of microvesicles by transmission electron microscopy.The infarcted brain tissue was not detected in the control group.The cerebral infarction volume ratios of HIBD group,saline group and EPC-MVs group were (80.3 ± 6.3) ％,(77.9 ± 8.9) ％,(35.2 ± 7.7) ％,respectively.The infarct volume of EPC-MVs group was significantly lower than that of HIBD group and saline group (P ＜ 0.001).The expression of VEGF mRNA and protein in HIBD group,saline group and EPC-MVs group were higher than those in control group (P ＜0.001).Among them,EPC-MVs group had the most significant increase,compared with the other three experimental groups,and the difference was statistically significant (P ＜ 0.001).There was no significant difference between saline group and HIBD group in the expression of VEGF mRNA and protein (P ＞ 0.05).Conclusion Intraventricular injection of EPC-MVs can attenuate HIBD in neonatal rats,and the mechanism may be related to up-regulation of VEGF expression.

Objective:To study the effects of endothelial progenitor cells (EPC)-derived exosomes on hyperoxia-induced injury in type Ⅱ alveolar epithelial cell (AECⅡ) in neonatal rats.Methods:EPCs of rats were cultured and exosomes were collected using Total Exosome Isolation kit. Primary cultured AECⅡof neonatal rats were randomly assigned into three groups: the control group, the hyperoxia group and the exosome group. The control group was cultured in room air with 5%CO 2, the hyperoxia group was cultured in 95%O 2 with 5%CO 2 and the exosome group was cultured with 0.1 mg/ml EPC-derived exosomes in 95%O 2 with 5%CO 2. Cell viability was detected using cell counting kit-8 (CCK-8) and apoptosis was detected using flow cytometry on d2, d4, and d6. Results:EPC-derived exosomes isolated from EPC culture supernatant were confirmed morphologically using transmission electron microscopy. After co-incubation of Dil-labeled EPC-derived exosomes with AEC Ⅱ for 24 h, Dil fluorescence was detected in the cytoplasm of AEC Ⅱ, indicating exosomes were uptaken by AEC Ⅱ. Compared with the control group, hyperoxia decreased cell viability and increased apoptosis of AEC Ⅱ and the injury was aggravated with the prolongation of hyperoxia duration ( P<0.001). Cell injury in the exosome group was milder than the hyperoxia group ( P<0.001). Compared with the control group, cell viability on d4 and d6 of hyperoxia was lower ( P=0.029 and 0.005 respectively) and cell apoptosis at d6 of hyperoxia was higher in the exosome group ( P=0.007). Conclusions:EPC-derived exosomes may partially attenuate hyperoxia-induced cell injury in neonatal rat AEC Ⅱ.

Objective:To analyze the clinical features of patients with severe dengue (SD) in Guangdong Province, and to improve the understanding of the diagnosis and treatment of SD in China.Methods:The clinical data, laboratory examination and etiological test results of 257 SD cases from 29 dengue fever designated hospitals in Guangdong Province from January 1, 2013 to December 31, 2019 were respectively collected. The relevant indicators of the criteria for severe organ involvement were quantified. Logistic regression analysis was performed to analyze the risk factors for the development of multiple organ failure in SD patients.Results:Among the 257 SD patients, age was (64.1±20.1) years old, with 65.4%(168/257) of them ≥60 years old, 142 were male and 115 were female. One hundred and fifty-two (59.1%) patients had underlying conditions, including 115(44.7%) patients with hypertension. The clinical manifestations were mainly fever (98.4%(253/257)), fatigue (70.0%(180/257)), cough or expectoration (44.4%(114/257)), lethargy or irritability (39.3%(101/257)), vomiting (30.4%(78/257)), abdominal pain or tenderness (20.6%(53/257)), hepatomegaly (2.3%(6/257)), bleeding tendency (59.5%(153/257)), and pleural effusion or ascites (43.6%(112/257)). Platelet count levels were decreased in 90.9%(231/254) of the cases, and 97.1%(234/241) of patients had normal or decreased hematocrit. The most common of severe manifestations were severe organ involvement (61.1%(157/257)), followed by severe bleeding (37.0%(95/257)) and severe plasma leakage (30.0%(77/257)). Severe organ involvements were more common in the kidney (27.6%(71/257)) and heart (26.8%(69/257)). Multivariate logistic regression analysis showed that age (odds ratio ( OR)=1.051, 95% confidence interval ( CI) 1.004 to 1.100, P=0.035), hypertension ( OR=5.224, 95% CI 1.272 to 21.462, P=0.022), elevated aspartate aminotransferase (AST) level ( OR=1.002, 95% CI 1.001 to 1.003, P=0.001), blood urea nitrogen (BUN) ( OR=1.050, 95% CI 1.005 to 1.098, P=0.030), and international normalized ratio (INR) ( OR=4.604, 95% CI 1.601 to 13.238, P=0.005) were risk factors for the development of multiple organ failure in SD patients. The detection results of serum samples form 113 SD patients in acute phase showed that dengue virus (DENV)-1 accounted for 89.4%(101/113), DENV-2 accounted for 9.7%(11/113), and DENV-3 accounted for 0.9% (1/113). Conclusions:Elderly and those with co-existing conditions such as hypertension in SD patients in Guangdong Province are more common. Severe organ involvement such as kidney and heart is the main cause of SD. DENV-1 infection is predominant. Significant elevated levels of AST, BUN and INR may be related to a poor prognosis.

Objective:To study the risk factors of bronchopulmonary dysplasia (BPD) in extremely preterm/extremely low birth weight infants(EPT/ELBWIs).Methods:From June 2019 to March 2022, clinical data of EPT/ELBWIs with gestational age <28 weeks or birth weight <1 000 g admitted to NICU of our hospital were retrospectively analyzed. They were assigned into BPD group and non-BPD group. Multivariate logistic regression analysis was used to find the independent risk factors for BPD and receiver operating characteristic (ROC) curve was used to determine the cut-off value for BPD. The incidences of BPD of the two groups were compared and the correlation between independent risk factors and BPD severity was analyzed.Results:A total of 82 EPT/ELBWIs were enrolled, including 47 (57.3%) in BPD group and 35 (42.7%) in non-BPD group. The BPD group had longer duration of both invasive and non-invasive mechanical ventilation (MV) [24.0(8.0, 38.0)d vs. 6.0 (0.2, 11.6)d, (38.4±14.5)d vs. (32.4±10.9)d], lower birth weight [906 (800, 970)g vs. 980 (880, 1 050)g],higher incidences of ureaplasma urealyticum colonization (48.9% vs. 22.9%) and hemodynamically significant patent ductus arteriosus (hsPDA) (76.6% vs. 51.4%) than the non-BPD group(all P<0.05). Multivariate logistic regression analysis showed that the independent risk factor for BPD was the duration of invasive MV ( OR=1.003, 95% CI 1.001-1.005). The cut-off value of invasive MV duration for predicting BPD was 14.4 d. The duration of invasive MV was positively correlated with BPD severity ( r=0.604, P<0.001). Conclusions:BPD is more likely to occur in EPT/ELBWIs with longer duration of invasive MV.

OBJECTIVE To investigate the improvement effects of azithromycin on bronchopulmonary dysplasia （BPD） in neonatal rats based on hypoxia-inducible factor-1α（HIF-1α）/HIF-2α/vascular endothelial growth factor （VEGF） pathway. METHODS Sixty newborn SD rats were randomly divided into negative control group （NC）， BPD group， azithromycin group and budesonide group （positive control）， with 15 rats in each group. Rats in NC group were given normal breathing air， while rats in other three groups were exposed to high-concentration oxygen for 14 days to establish BPD rat models. After successful modeling， rats in azithromycin group were intraperitoneally injected with azithromycin 200 mg/kg， and rats in budesonide group were atomized with budesonide 1.5 mg/kg once a day for 14 consecutive days， while rats in BPD group and NC group were not treated. Pathological changes of lung tissue， radial alveolar count and mean alveolar intercept of rats were observed in each group. The white blood cell count in bronchoalveolar lavage fluid （BALF） and the levels of tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， IL-1β， superoxide dismutase （SOD）， catalase （CAT） and malondialdehyde （MDA） were detected； mRNA and protein expressions of VEGF， HIF-1α， HIF-2α were also detected. RESULTS Compared with NC group， the lung tissue in BPD group was obviously damaged； the white blood cell count， average alveolar intercept and the levels of TNF-α， IL-6， IL-1β and MDA were significantly increased； the radial alveolar count， SOD and CAT levels， the relative expressions of VEGF， HIF-1α， HIF-2α mRNA and protein were significantly decreased （P＜0.05）. Compared with BPD group， the changes of the above indexes in azithromycin group and budesonide group were significantly reversed （P＜0.05）. CONCLUSIONS Azithromycin can obviously improve the symptoms of BPD in rats， reduce inflammation and oxidative stress， and exert lung protection， the mechanism of which may be realized by activating HIF-1α/HIF-2α/VEGF pathway.