Objective:To analyze the predictive factors associated with late-onset sepsis(LOS) in very low birth weight infants,and to develop a risk prediction score scale applicable to these infants three days postnatal.This will provide valuable insights for early diagnosis and timely intervention.Methods:Very low birth weight infants admitted to the Children's Hospital of Fudan University from January 1,2022,to June 30,2024,were selected as research subjects.These infants were categorized into two groups:the LOS group and the non-LOS group,based on whether they developed LOS.LASSO regression analysis,alongside univariate and multivariate regression analyses,was employed to identify predictive factors for LOS in this population.A Logistic model was constructed using the optimal combination of predictive variables,and a risk assessment scale was subsequently developed.The prediction performance of the model was evaluated using the Hosmer-Lemeshow chi-square test and the receiver operating characteristic curve.Results:A total of 444 cases of very low birth weight infants were included,of which 185 had LOS and 259 did not.After screening the variables,seven independent factors were included into the model:birth weight,gestational age,tracheal intubation,abnormal skin color,abdominal distension,elevated C-reactive protein levels,and right hand perfusion index.A predictive scoring scale was developed based on the regression coefficients of each variable,with corresponding risk scores assigned as follows:1,4,3,2,1,1,and 2; a score of ≥3.5 indicated high-risk groups.The Hosmer-Lemeshow test results demonstrated that χ2 = 7.602( P = 0.473).The area under the receiver operating characteristic curve was 0.792 ( P<0.001),with a sensitivity of 73.5% and specificity of 71.0%. Conclusion:The risk score scale developed in this study exhibits significant predictive capability,providing valuable insights for clinical medical personnel to assess the risk of LOS in very low birth weight infants during the early postnatal period.

Aim To investigate the effects of SAHA on the expression of P-gp and the pharmacokinetic pa-rameters of its substrate phenytoin sodium in rats under hypoxic environments.Methods Wistar rats were randomly divided into the normioxic group,the hypoxic model group,and the low-,medium-and high-dose vorinostat(SAHA)groups.Liver tissues were col-lected,and the expression levels of P-gp and HDAC5 were detected by Real-time PCR and Western blot.The morphological changes of liver tissues were ob-served by HE staining.Following intragastric adminis-tration of 50 mg·kg-1 phenytoin sodium to each group,blood samples were collected,and the plasma concentration of phenytoin sodium was determined u-sing UFLC-MS/MS to calculate pharmacokinetic pa-rameters.Results Compared with the normoxic group,the expression of HDAC5 in the liver tissues of hypoxia model rats increased,while the expression of P-gp decreased.After SAHA treatment,HDAC5 expression decreased,and P-gp expression increased.Among the SAHA groups,the medium-dose group showed the most significant effect,and HE staining re-sults indicated that this concentration did not cause damage to rat liver tissues.Compared with the normox-ic group,the AUC,Cmax,and T1/2 of phenytoin sodium in hypoxia model rats were significantly raised.After administration of the medium dose of SAHA,the AUC,Cmax,MRT,and T1/2 were significantly reduced,while CLZ/r was significantly increased.Conclusions Un-der hypoxic environments,the expression of P-gp in rat liver tissue is significantly downregulated,leading to increased systemic exposure of phenytoin,reduced clearance,and consequently elevated blood concentra-tions,raising the risk of central nervous system toxici-ty.In contrast,SAHA suppresses HDAC5 expression,thereby activating P-gp transcription and enhancing its efflux function.This results in decreased systemic ex-posure and improved clearance of phenytoin,signifi-cantly reducing drug accumulation in body and ulti-mately lowering the risk of adverse effects.

Objective:To analyze the predictive factors associated with late-onset sepsis(LOS) in very low birth weight infants,and to develop a risk prediction score scale applicable to these infants three days postnatal.This will provide valuable insights for early diagnosis and timely intervention.Methods:Very low birth weight infants admitted to the Children's Hospital of Fudan University from January 1,2022,to June 30,2024,were selected as research subjects.These infants were categorized into two groups:the LOS group and the non-LOS group,based on whether they developed LOS.LASSO regression analysis,alongside univariate and multivariate regression analyses,was employed to identify predictive factors for LOS in this population.A Logistic model was constructed using the optimal combination of predictive variables,and a risk assessment scale was subsequently developed.The prediction performance of the model was evaluated using the Hosmer-Lemeshow chi-square test and the receiver operating characteristic curve.Results:A total of 444 cases of very low birth weight infants were included,of which 185 had LOS and 259 did not.After screening the variables,seven independent factors were included into the model:birth weight,gestational age,tracheal intubation,abnormal skin color,abdominal distension,elevated C-reactive protein levels,and right hand perfusion index.A predictive scoring scale was developed based on the regression coefficients of each variable,with corresponding risk scores assigned as follows:1,4,3,2,1,1,and 2; a score of ≥3.5 indicated high-risk groups.The Hosmer-Lemeshow test results demonstrated that χ2 = 7.602( P = 0.473).The area under the receiver operating characteristic curve was 0.792 ( P<0.001),with a sensitivity of 73.5% and specificity of 71.0%. Conclusion:The risk score scale developed in this study exhibits significant predictive capability,providing valuable insights for clinical medical personnel to assess the risk of LOS in very low birth weight infants during the early postnatal period.

Objective To analyze and preliminarily verify key genes and pathways in the transcriptome of peripheral blood of lung adenocarcinoma patients with metastasis bone pain(MBP),and to explore its underlying mechanism.Methods Nine lung adenocarcinoma patients with bone metastasis treated in the First Affiliated Hospital of Sun Yat-sen University from May 2020 to May 2021 were selected for retrospective analysis,including 4 patients with typical MBP clinical manifestations and visual analogue scale(VAS)≥4(MBP group)and 5 patients without suffering any pain(control group).Peripheral blood mRNA sequencing was performed to identify differentially expressed genes(DEGs),followed by functional pathways analysis and protein-protein interaction(PPI)network analysis.The most significant modules and hub genes were confirmed and visualized using Cytoscape software.The target miRNAs regulating these hub genes were predicted using Targetscan database,and long non-coding RNA(lncRNA)interacting with these miRNAs were also predicted using lncBase database.The relationships among lncRNA,miRNA and mRNA were visualized to construct a competing endogenous RNA(ceRNA)network through Cytoscape software,and the nodes of this network were verified using quantitative PCR(qPCR).Results A total of 1466 DEGs were identified,including 666 up-regulated genes and 800 down-regulated genes.Chemokine receptor 3(CXCR3),pro-opiomelanocortin(POMC),neuromedin U receptor 1(NMUR1),chemokine ligand 2(CCL2)and endocannabinoid receptor 1(CNR1)were identified as hub genes.The most significant enriched processes and pathways of DEGs included osteoclast differentiation,NOD like receptor signal transduction pathway,type Ⅰinterferon signal pathway,nuclear factor kappa-B(NF-κB)signal pathway,apoptosis/autophagy pathway,chemokine signal pathway,interleukin(IL)-1β pathway.Two ceRNA networks were identified:MALAT1-hsa-miR-124-3p.2-CCL2 and NEAT1-hsa-miR-325-3p-CXCR3.qPCR results showed that the expression levels of CCL2,CXCR3,MALAT1,NEAT1 and hsa-miR-325 were higher in MBP group than these in control group(P<0.05).Conclusions CXCR3,POMC,NMUR1,CCL2 and CNR1 may serve as key genes in the occurrence of MBP and could be important regulatory targets for MBP.The development of MBP in lung adenocarcinoma may be associated with the dysregulation of the networks:MALAT1-hsa-miR-124-3p.2-CCL2 and NEAT1-hsa-miR-325-3p-CXCR3.

Infectious diseases of the respiratory system are very common in clinical practice,among which pneumonia caused by in-fluenza virus infection is characterized by high morbidity and mortality.Current clinical treatments for respiratory viral infections still face challenges such as drug resistance and poor efficacy.Necroptosis,a form of programmed cell death,is closely associated with the progression of respiratory viral infections.Traditional Chinese medicine modulating necroptosis has demonstrated beneficial therapeu-tic effects in these diseases.This paper introduces the concept and mechanisms of necroptosis,reviews recent research on the relation-ship between necroptosis and respiratory virus infections diseases,and summarizes the therapeutic effects of traditional Chinese medi-cine in regulating necroptosis to intervene in these diseases,aiming to provide insights for the development and clinical application of therapeutic agents for respiratory viral infections.

Objective To explore the impact of neurally adjusted ventilatory assist(NAVA)mode on the weaning outcomes of patients with severe cerebrovascular disease who have weaning difficulty from mechanical ventilation.Methods Patients with severe cerebrovascular disease who had weaning difficulty from mechanical ventilation and were admitted to the Intensive Care Unit(ICU)of Neurosurgery Departement,the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital of Wannan Medical College)from November 2019 to November 2021 were prospectively and consecutively included.They were randomly divided into the NAVA group and the pressure support ventilation(PSV)group using a random number table,with 28 patients in each group.Baseline and clinical data of the two groups were collected,including gender,age,main diagnosis,past medical history(hypertension,stroke,respiratory diseases,diabetes,coronary heart disease),body mass index,acute physiology and chronic health evaluation(APACHE)Ⅱ score,Glasgow coma scale(GCS)score,types of difficult weaning(failure of the first spontaneous breathing trial[SBT],re-intubation within 48 h after the first weaning attempt),and mechanical ventilation time before randomization.SBT and weaning-related indicators after randomization were collected,including respiratory mechanics and parameters before SBT implementation after randomization(peak airway pressure,expiratory tidal volume,positive end-expiratory pressure,inspired oxygen concentration,minute ventilation,mean airway pressure,diaphragmatic electrical activity signal value,neural ventilation efficiency,neural mechanical efficiency),basic vital signs(mean arterial pressure,respiratory heart rate)before weaning after passing SBT,blood routine(white blood cells,hemoglobin)and biochemical tests(albumin,creatinine,troponin,B-type natriuretic peptide)within 48 h before weaning,and arterial blood gas within 30 min before weaning(pH,partial pressure of carbon dioxide,partial pressure of oxygen,bicarbonate ion,oxygenation index).The primary outcome measures included the time required for successful weaning from randomization to day 28(if the patient died or failed to wean successfully before day 28 after randomization,the time required for weaning was defined as 28 d),total mechanical ventilation time after randomization,total weaning success rate from randomization to day 28,total weaning-free time at 7,14,and 28 d after randomization,survival time at 28 d and 90 d after randomization,ICU length of stay,total hospital length of stay,and cumulative weaning success rate from randomization to day 28 in both groups.The secondary outcome measures included tracheotomy rate after randomization,ICU mortality rate,mortality rate at 28 d and 90 d after randomization,incidence of mechanical ventilation-related complications(ventilator-associated pneumonia,acute respiratory distress syndrome,pneumothorax,pleural effusion)during mechanical ventilation after randomization,and cumulative survival rate at 90 d after randomization.The human-machine coordination within 24 h after randomization was recorded in both groups including the number and index of ineffective triggering,false triggering,double triggering,premature switching from inspiration to expiration,delayed switching from inspiration to expiration,and triggering delay,as well as the total asynchrony index,with one record every 8 h,each record lasting for 1 min,for a total of 3 min.Results A total of 56 patients with severe cerebrovascular disease who had weaning difficulty from mechanical ventilation were included,with 28 patients in each of the PSV group and the NAVA group.There were no statistically significant differences between the two groups in terms of gender,age,main diagnosis,past medical history,body mass index,APACHE Ⅱ score,GCS score,types of difficult weaning,mechanical ventilation time before randomization,indicators before SBT implementation after randomization and after SBT before weaning(all P＞0.05).(1)The time required for successful weaning from randomization to day 28(9.00[7.00,15.50]d vs.15.50[10.25,22.75]d)and total mechanical ventilation time after randomization(8.50[7.00,12.75]d vs.13.50[10.00,20.00]d)were both lower in the NAVA group than those in the PSV group(all P＜0.05).The cumulative weaning success rate of the NAVA group was higher than that of the PSV group at 28 d after randomization(P=0.039),but there was no statistically significant difference in the total weaning success rate between the two groups from randomization to the day 28(92.9％[26/28]vs.85.7％[24/28],P=0.669).The NAVA group had longer periods without mechanical ventilation within 14 d(5.00[0.00,7.00]d vs.0.00[0.00,3.75]d)and within 28 d(18.00[9.25,20.75]d vs.10.50[0.25,17.75]d)after randomization compared with the PSV group(all P＜0.05),but there was no statistically significant difference in the period without mechanical ventilation within 7 d after randomization between the two groups(P=0.159).The ICU stay of the NAVA group was shorter than that of the PSV group(9.00[6.25,16.75]d vs.14.00[10.25,22.50]d,P=0.015),but there were no statistically significant difference in the total hospital stay and survival time within 28 d and 90 d after randomization between the two groups(all P＞0.05).(2)There was no statistically significant difference between the two groups in tracheotomy rate,ICU mortality rate,mortality rate at 28 d and 90 d after randomization,complications during mechanical ventilation after randomization,and cumulative survival rate at 90 d after randomization(all P＞0.05).(3)In terms of human-machine coordination,the NAVA group had lower frequencies and indices of false triggering(frequency:0.00[0.00,0.00]time/min vs.0.00[0.00,0.58]time/min;index:0.00[0.00,0.00]vs.0.00[0.00,0.02]),ineffective triggering(frequency:0.00[0.00,0.33]time/min vs.1.00[0.33,2.17]time/min;index:0.00[0.00,0.02]vs.0.05[0.02,0.09]),premature switching(frequency:0.00[0.00,0.33]time/min vs.0.33[0.33,1.00]time/min;index:0.00[0.00,0.01]vs.0.02[0.02,0.05]),delayed switching(frequency:0.00[0.00,0.00]time/min rs.1.17[0.00,5.67]time/min;index:0.00[0.00,0.00]rs.0.06[0.00,0.29]),and delayed triggering(frequency:0.00[0.00,0.58]time/min vs.0.67[0.33,1.67]time/min;index:0.00[0.00,0.02]vs.0.05[0.02,0.10])compared with the PSV group(all P＜0.01).The NAVA group had higher frequencies and indices of double triggering(frequency:1.17[0.33,2.00]time/min vs.0.00[0.00,0.00]time/min;index:0.06[0.02,0.11]vs.0.00[0.00,0.00];all P＜0.01),but the total asynchrony index of the NAVA group was lower than that of the PSV group(0.08[0.04,0.14]vs.0.24[0.19,0.51],P＜0.01).Conclusion The NAVA mode can shorten the weaning and mechanical ventilation time of patients with severe cerebrovascular disease who have weaning difficulty from mechanical ventilation,improve human-machine coordination,and has potential advantages in increasing the weaning success rate.

With the extension of the global population's lifespan and the increasingly severe aging problem,cardio-vascular diseases have become the leading cause of death among the elderly population.Most cardiovascular diseases orig-inate from the formation of atherosclerotic plaques.In addition to common risk factors such as dyslipidemia,diabetes,hy-pertension,smoking,and obesity,circadian rhythm disruption is also regarded as an important but often overlooked risk factor for atherosclerosis.The circadian rhythm is involved in regulating key physiological processes such as inflammation and metabolism,which in turn affect the pathological processes of arteriosclerosis and thrombosis.In this process,the key genes that maintain the stability of the circadian rhythm,namely clock gene,play a crucial role.Clock gene have an important role in the pathological mechanism of atherosclerosis,and they may become potential new targets for the preven-tion and treatment of atherosclerosis.This paper reviews the latest research progress on the mechanism of action of clock gene in the occurrence and development of atherosclerosis.These findings may provide new ideas for the diagnosis and treatment of atherosclerosis.

Objective To investigate the efficacy of leaflet augmentation technique to repair the recurrent mitral valve (MV) regurgitation after mitral repair in children. Methods A retrospective analysis was conducted on the clinical data of children who underwent redo MV repair for recurrent regurgitation after initial MV repair, using a leaflet augmentation technique combined with a standardized repair strategy at Fuwai Hospital, Chinese Academy of Medical Sciences, from 2018 to 2022. The pathological features of the MV, key intraoperative procedures, and short- to mid-term follow-up outcomes were analyzed. Results A total of 24 patients (12 male, 12 female) were included, with a median age of 37.6 (range, 16.5–120.0) months. The mean interval from the initial surgery was (24.9±17.0) months. All children had severe mitral regurgitation preoperatively. The cardiopulmonary bypass time was (150.1±49.5) min, and the aortic cross-clamp time was (94.0±24.2) min. There were no early postoperative deaths. During a mean follow-up of (20.3±9.1) months, 3 (12.5%) patients developed moderate or severe mitral regurgitation (2 severe, 1 moderate). One (4.2%) patient died during follow-up, and one (4.2%) patient underwent a second MV reoperation. The left ventricular end-diastolic diameter was significantly reduced postoperatively compared to preoperatively [ (43.5±8.6) mm vs. (35.8±7.8)mm, P<0.001]. Conclusion The leaflet augmentation technique combined with a standardized repair strategy can achieve satisfactory short- to mid-term outcomes for the redo mitral repair after previous MV repair. It can be considered a safe and feasible technical option for cases with complex valvular lesions and severe pathological changes.

The primary role of transfer RNA(tRNA)is to connect a specific amino acid to its 3' end, use its anticodon to match the codon on messenger RNA(mRNA), and deliver the corresponding amino acid to the ribosome for protein synthesis.tRNA exists in two forms: precursor tRNA and mature tRNA.When acted upon by enzymes like Dicer, elaC ribonuclease Z 2(ELAC2), angiopoietin(ANG), and other ribonucleases, tRNA is broken down into tRNA-derived stress-induced RNA(tiRNA)and tRNA-derived fragments(tRF).Recent advancements in RNA sequencing technology have led to increased interest in tiRNA and tRF, shedding light on their roles in various physiological and pathological processes.tRNA-derived small molecules(tsRNA)function similarly to microRNA(miRNA), influencing gene expression and protein synthesis.They show promise as diagnostic markers and potential therapeutic targets for age-related diseases.This review offers a comprehensive analysis of tsRNA classification, biological functions, research advancements, and clinical applications in age-related conditions.

Understory planting of medicinal plants is a new planting mode that connects Chinese herbal medicine(CHM) with forest resources.The complex and variable understory environmental factors will inevitably affect the yield and quality of understory CHM.This research summarized the research progress on understory planting of medicinal plants based on forest types and environmental factors within the forest from the perspectives of understory light, air temperature and humidity, soil characteristics, and the interaction between crops within the forest.The results showed that the complex and variable light, temperature and humidity, and soil factors(such as fertility, acidity and alkalinity, and microorganisms) under the forest could affect the yield and quality of medicinal plants to varying degrees through physiological activities such as photosynthesis and respiration, resulting in a significant increase or decrease in yield and quality compared to open field cultivation.In addition, the competition or mutual benefit between different crops within the forest could lead to differences in the yield and quality of understory medicinal plants compared to open field cultivation.A reasonable combination of planting could achieve resource sharing and complementary advantages.Therefore, conducting systematic research on the effects of understory environmental factors on the yield and content of medicinal plants with different growth and development characteristics can provide theoretical guidance and technical references for formulating comprehensive strategies for understory planting of medicinal plants, such as selecting suitable medicinal plant varieties, optimizing planting density, and conducting reasonable forest management, thus contributing to the sustainable development and ecological protection of CHM.
Plants, Medicinal/growth & development* ; Forests ; Soil/chemistry* ; Environment ; Ecosystem ; Temperature