OBJECTIVE To observe the etiological characteristics,serum C-reactive protein(CRP),interleukin-10(IL-10),procalcitonin(PCT)and treatment outcomes of the children with pneumonia.METHODS A total of 350 children with pneumonia who were treated in Jinhua People's Hospital from Sep.2021 to Sep.2023 and 30 healthy children matched with age and gender who received physical examination were recruited as the research subjects.The etiological characteristics,serum CRP,IL-6,PCT and treatment outcomes of the children with pneumonia were observed.RESULTS The etiological isolation rate was 74.00％(259/350)among the 350 children,the chil-dren who had viral infection accounted for 39.38％,the children with Mycoplasma pneumoniae(MP)infection 32.82％,the children with bacterial infection 20.08％,the children with mixed infections 7.72％.The viral infec-tion was prevalent in winter and was more common among the children aged between 1 and 3 years old;Myco-plasma pneumoniae infection was more common among the children aged between 3 and 6 years old.The CRP levels of the viral infection group,the bacterial infection group,the M.pneumoniae infcection group and the mixed infection group were(10.53±1.54),(38.11±9.32),(21.07±6.55)and(33.33±8.11)mg/L,respectively,higher than those of the healthy children and the children negative for etiological test.The PCT levels of the viral infection group,the bacterial infection group,the M.pneumoniae infcection group and the mixed infection group were(0.61±0.17),(2.84±0.51),(1.35±0.31)and(2.41±0.46)ng/ml,respectively,higher than those of the healthy children and the children negative for etiological test.The IL-10 levels of the viral infection group,the bacterial infection group,the M.pneumoniae infcection group and the mixed infection group were(23.47±5.12),(26.45±7.15),(25.45±5.03)and(25.29±6.05)pg/ml,respectively,higher than those of the healthy children and the children negative for etiological test(P＜0.05).The levels of CRP and PCT of the bacterial infection group and the mixed infection group were higher than those of the M.pneumoniae infcection group,and the level of above indexes of the M.pneumoniae infcection group were higher than those of the viral infection group(P＜0.05).Among 259 children who were confirmed positive for etiological test,237 had favorable treatment out-comes,and 22 had poor treatment outcomes.The rate of poor treatment outcomes of the children with viral infec-tion was higher than that of the children with M.pneumoniae infcection(x2=5.930,P=0.015);the rate of poor treatment outcomes of the children with mixed infection was higher than that of the children with M.pneumoniae infcection(x2=9.954,P＜0.001).CONCLUSIONS The children with viral infection are dominant among the children with pneumonia,followed by the children with M.pneumoniae infcection.The rate of poor treatment outcomes of the children with viral infection or mixed infection is relatively high,the children with M.pneumoniae infcection generally have favorable treatment outcomes.The children with viral infection have slight increases of peripheral blood CRP and PCT,while the children with bacterial infection and mixed infection have a remarkable rise.

OBJECTIVE To observe the etiological characteristics,serum C-reactive protein(CRP),interleukin-10(IL-10),procalcitonin(PCT)and treatment outcomes of the children with pneumonia.METHODS A total of 350 children with pneumonia who were treated in Jinhua People's Hospital from Sep.2021 to Sep.2023 and 30 healthy children matched with age and gender who received physical examination were recruited as the research subjects.The etiological characteristics,serum CRP,IL-6,PCT and treatment outcomes of the children with pneumonia were observed.RESULTS The etiological isolation rate was 74.00％(259/350)among the 350 children,the chil-dren who had viral infection accounted for 39.38％,the children with Mycoplasma pneumoniae(MP)infection 32.82％,the children with bacterial infection 20.08％,the children with mixed infections 7.72％.The viral infec-tion was prevalent in winter and was more common among the children aged between 1 and 3 years old;Myco-plasma pneumoniae infection was more common among the children aged between 3 and 6 years old.The CRP levels of the viral infection group,the bacterial infection group,the M.pneumoniae infcection group and the mixed infection group were(10.53±1.54),(38.11±9.32),(21.07±6.55)and(33.33±8.11)mg/L,respectively,higher than those of the healthy children and the children negative for etiological test.The PCT levels of the viral infection group,the bacterial infection group,the M.pneumoniae infcection group and the mixed infection group were(0.61±0.17),(2.84±0.51),(1.35±0.31)and(2.41±0.46)ng/ml,respectively,higher than those of the healthy children and the children negative for etiological test.The IL-10 levels of the viral infection group,the bacterial infection group,the M.pneumoniae infcection group and the mixed infection group were(23.47±5.12),(26.45±7.15),(25.45±5.03)and(25.29±6.05)pg/ml,respectively,higher than those of the healthy children and the children negative for etiological test(P＜0.05).The levels of CRP and PCT of the bacterial infection group and the mixed infection group were higher than those of the M.pneumoniae infcection group,and the level of above indexes of the M.pneumoniae infcection group were higher than those of the viral infection group(P＜0.05).Among 259 children who were confirmed positive for etiological test,237 had favorable treatment out-comes,and 22 had poor treatment outcomes.The rate of poor treatment outcomes of the children with viral infec-tion was higher than that of the children with M.pneumoniae infcection(x2=5.930,P=0.015);the rate of poor treatment outcomes of the children with mixed infection was higher than that of the children with M.pneumoniae infcection(x2=9.954,P＜0.001).CONCLUSIONS The children with viral infection are dominant among the children with pneumonia,followed by the children with M.pneumoniae infcection.The rate of poor treatment outcomes of the children with viral infection or mixed infection is relatively high,the children with M.pneumoniae infcection generally have favorable treatment outcomes.The children with viral infection have slight increases of peripheral blood CRP and PCT,while the children with bacterial infection and mixed infection have a remarkable rise.

A 48-year-old woman was treated with toripalimab for triple negative breast cancer.She developed symptoms of pollakiuria and urinary urgency after 1st cycle of toripalimab,and was hospitalized for severe abdominal pain after 2nd circle of treatment,after symptomatic treatment,the condition improved.However,after the 3rd,4th,and 5th cycles of medication,the symptoms recurred.The symptoms did not reappear after discontinuing toripalimab.Therefore,ureteritis associated with immune checkpoint inhibitors(ICI)was considered based on case characteristics,urine routine,urine culture,ultrasound and CT findings.According to Naranjo's Assessment Scale,the association between toripalimab and ureteritis was considered"definite".The possibility of ureteritis associated with ICI should be considered if symptoms of urinary tract irritation occur during the use of toripalimab,and urine analysis,urine culture,and imaging examination should be conducted to detect such adverse reactions earlier.

Objective To observe the effects of remimazolam combined with alfentanil in elderly obese patients undergoing painless gastrointestinal endoscopy.Methods A total of 110 elderly obese patients who underwent painless gastrointestinal endoscopy in the hospital from January 2021 to December 2023 were divided into group A and group B according to the random number table method,with 55 cases in each group.Group A and group B were anesthetized with propofol combined with alfentanil and remifentanil combined with alfentanil,respectively.The sedation effect,gastrointestinal motility(serum gastrin and motilin concentrations),postoperative fatigue syndrome(POFS),induction time,examination time,recovery time,room exit time,and intraoperative adverse reactions were compared between the two groups.Results The excellent and good sedation rate in group B was 94.55％,higher than 81.82％in group A(P＜0.05).Group B had shorter recovery time and room exit time[(8.26±1.73)min,(28.51±4.26)min]compared to group A[(12.49±1.27)min,(37.63±5.45)min](P＜0.05).At the time of leaving the post-anesthesia care unit(T2),serum gastrin and motilin levels in group B[(97.53±18.81)pg/ml,(535.43±82.61)pg/ml]were higher than those in group A[(88.59±17.54)pg/ml,(504.62±83.19)pg/ml](P＜0.05).The duration of POFS in group B[(4.36±1.18)h]was longer than that in group A[(3.49±1.37)h](P＜0.05).There was no significant difference in the incidence of intraoperative adverse reactions between group B(7.27％)and group A(18.18％)(P＞0.05).Conclusion The use of remimazolam combined with alfentanil in elderly obese patients undergoing painless gastrointestinal endoscopy provides better sedation,shorter recovery and room exit times,and less inhibition of excitatory gastrointestinal hormone secretion,which is beneficial for the recovery of gastrointestinal motility.However,the duration of POFS is longer.

Objective:To investigate the application effect of web-based problem-based learning (WPBL) versus traditional teaching in the teaching of geriatric medicine courses.Methods:PubMed, Embase, the Cochrane Library, Web of Science, CNKI, CBMdisc, and Wanfang Data were searched for clinical studies on the application of WPBL in the teaching of geriatric medicine courses in China and globally published up to October 1, 2023. After literature screening, data extraction, and quality assessment, RevMan5.4.1 was used to perform a systematic review.Results:A total of 14 eligible articles were included in this study, with 1 436 medical students as the subjects and geriatric medicine as the content of teaching. The Meta-analysis showed that WPBL teaching had a better effect than traditional problem-based learning or lecture-based learning in the teaching of geriatric medicine courses and could improve the theoretical examination score [mean difference (MD)=3.53, 95% confidence interval (CI)=1.77-5.29, P<0.001], operational skills (MD=5.92, 95%CI=2.67-9.18, P<0.001), critical thinking ability (MD=9.30, 95%CI=5.43-13.18, P<0.001), and teaching satisfaction (MD=1.75, 95%CI=1.49-2.01, P<0.001) among medical students. Conclusions:WPBL in the teaching of geriatric medicine courses can improve the theoretical examination score, operational skills, critical thinking skills, and teaching satisfaction among medical students.

AIM:To investigate the protective ef-fect of plumbagin(PL)against pulmonary fibrosis(PF)and its possible mechanisms.METHODS:Sixty male C57BL/6 mice were randomly divided into control,bleomycin group(BLM),low dose PL group(1 mg/kg)and high dose PL group(2 mg/kg).The mice PF model was replicated using intratracheal injection of BLM(3 mg/kg),and then PL(1 or 2 mg/kg)was injected intraperitoneally for 3 weeks and the animals were executed.HE and Masson staining were used to observe morphological changes in lung tissue and collagen deposition.The activities or levels of superoxide dismutase(SOD),glutathione(GSH),malondialdehyde(MDA)and hy-droxyproline(HYP)were measured in mouse lung tissue;ELISA for interleukin-6(IL-6)in mouse lung tissue.Immunohistochemical detection of nuclear factor-related factor 2(Nrf2)and reduced nicotin-amide adenine dinucleotide phosphate oxidase 4(NOX4)positive cell expression in mouse lung tis-sue.The expression levels of α-smooth muscle ac-tin(α-SMA),collagen Ⅰ(Col Ⅰ),collagen Ⅲ(Col Ⅲ),IL-6,transforming growth factor-β1(TGF-β1),p-Smad2,Nrf2 and NOX4 were detected by Western blotting.RESULTS:Compared with the BLM group,PL treatment attenuated lung parenchymal and in-terstitial injury and extracellular matrix deposition in mice,reduced HYP content(P＜0.01,P＜0.05),de-creased protein expression of α-SMA,collagen Ⅰand Ⅲ(P＜0.01,P＜0.05),diminished IL-6 secretion(P＜0.01);improved the body's antioxidant capacity(increased SOD and GSH activity and decreased MDA content,P＜0.01,P＜0.05),significantly down-regulated TGF-β1,p-Smad2 and NOX4-positive cells and protein expression(P＜0.01,P＜0.05)and up-regulated Nrf2-positive cells and protein expression(P＜0.01,P＜0.05).CONCLUSION:PL may slow down the PF process by modulating the TGF-β1/Smad2 and Nrf2/NOX4 pathways to attenuate inflammato-ry responses and collagen deposition and improve the body's antioxidant capacity.

Objective:To investigate the changes of pathogenic bacteria distribution and immune response of urinary tract infection(UTI)after pyeloureteroplasty in children.Methods:A total of 150 children with obstructive hydronephroplasty who received pyeloureteroplasty in Qinghai Women and Children's Hospital from February 2020 to June 2023 were selected as the study objects.The postoperative urine of the children was collected,the pathogens were identified by automatic bacterial analyzer,and the patients were divided into infected group and uninfected group according to the infection status.The detection of pathogenic bacteria in children with UTI was analyzed.The clinical data of the two groups were compared,and the influencing factors of postoperative UTI were screened by Logistic regression analysis,and the prediction model was established and verified.The changes of immune response were compared between the two groups.Results:UTI occurred in 56 cases(37.33%)of 150 children who underwent pyeloureteroplasty.There were 58 strains of gram-negative bacteria,29 strains of gram-positive bacteria and 2 strains of fungi isolated.The main pathogenic bacteria was Escherichia coli.Multivariate Logistic regression analysis showed that serum creatinine(SCr)and hydronephrosis volume/renal volume(HV/RV)levels increased,urinary catheter retention time,urinary bag replacement time and hospital stay were risk factors for UTI after pyeloureteroplasty in children,increased age and elevated albumin(Alb)were protective factors(P<0.05).Through Bootstrap self-sampling,the prediction model had good differentiation and accuracy.There was no significant difference in the levels of CD4+,CD8+and IgM between the two groups before surgery(P>0.05),and the levels of CD4+,CD8+and IgM were signi-ficantly improved between the two groups after surgery,and the improvement degree of the uninfected group was significantly better than that of the infected group(P<0.05).Conclusion:The pathogens of UTI in children after pyeloureteroplasty are mainly gram-nega-tive bacteria,and the immune function is increased 7 days after the operation.

Objective To evaluate the efficacy of case-based learning(CBL)-problem-based learning(PBL)-evidence-based medicine(EBM)integrated teaching method in the standardized training of nephrology resident physicians.Methods Sixty internal medicine trainees who were on a 2-month rotation in the Department of Nephrology between February 1st,2023 and August 31st,2023,were recruited and randomized 1∶1 into the CBL-PBL-EBM group and the CBL group.The scores of the two groups in the theoretical assessment,case analysis,and general skills were compared at the end of the rotation.Results There was no significant difference between experimental group and control group(45.21±3.67 vs 44.02±4.90,P＞0.05).The test scores of test groups were higher than those of control group(42.48±2.35 vs 38.45±3.24,P＜0.05),and the comprehensive scores were higher than those of control group(92.24±1.69 vs 89.21±1.56,P＜0.05).At the same time,the scores of the experimental group in independent learning,literature query ability,critical thinking,and induction and summary ability were al-so significantly better than those of the control group,with statistical significance(P＜0.05).Conclusion The CBL-PBL-EBM teaching method is better than the CBL teaching method,which can effectively achieve the training goals and enhance the overall competence of nephrology trainees.

Objective To investigate the effect of resveratrol on airway remodeling induced by ovalbumin(OVA)in asthmatic young mice based on the sphingosine-1-phosphate(S1P)/transforming growth factor-β1(TGF-β1)pathway.Methods Young mice were randomly assigned into normal group,model group,S1P group,resveratrol group,and resveratrol+S1P group,with 12 mice in each group.A mouse model of asthma induced by OVA was established.The Wright Giemsa staining was applied to detect the number of inflammatory cells in bronchoalveolar lavage fluid(BALF).ELISA was applied to detect the levels of interleukin-4(IL),IL-5,and IL-13 in BALF.The colorimetric method was applied to detect the activities of SOD and CAT and the content of MDA in lung tissue.HE staining was applied to observe pathological changes in lung tissue,and the wall area of bronchial tube(Wat)and perimeter of basement membrane(Pbm)were analyzed.Masson staining was applied to observe the area of collagen fibers in lung tissue.Immunohistochemistry was applied to detect the expression of α-SMA in lung tissue.Western blot was applied to detect the expression of E-cadherin,N-cadherin,Snail,SP1,and TGF-β1 proteins in lung tissue.Results Compared with the normal group,the number of eosinophils,lymphocytes,neutrophils,levels of IL-4,IL-5,and IL-13 in BALF,lung tissue MDA content,Wat/Pm ratio,collagen fiber area,α-SMA positive expression,the protein levels of N-cadherin,Snail,SP1,TGF-β1 increased in the model group,while the activities of SOD,CAT,and the protein level of E-cadherin in lung tissue decreased(P＜0.05).Compared to the model group,the number of eosinophils,lymphocytes,neutrophils,levels of IL-4,IL-5,and IL-13 in BALF,lung tissue MDA content,Wat/Pm ratio,collagen fiber area,α-SMA positive expression,the protein levels of N-cadherin,Snail,SP1,TGF-β1 decreased in the resveratrol group,while the activities of SOD,CAT,and the protein level of E-cadherin in lung tissue increased(P＜0.05).The S1P recombinant protein could weaken the inhibitory effect of resveratrol on airway remodeling in asthmatic young mice.Conclusion Resveratrol can inhibit oxidative stress,airway inflammation,and epithelial mesenchymal transition,thereby suppressing airway remodeling in asthmatic young mice.Its effect is related to the inhibition of the S1P/TGF-β1 signaling pathway.

Objective:To evaluate the role of docosahexaenoic acid (DHA) in long-term cognitive impairment after multiple sevoflurane anesthesia in newborn mice.Methods:Clean-grade healthy male C57BL/6 mice, aged 6 days, were used in this study. Ten mice were divided into 2 groups ( n=5 each) by the random number table method: control group (group C) and sevoflurane group (group S). The animals inhaled 3% sevoflurane for 2 h at 6, 7 and 8 days after birth. The DHA content was detected by ultra-high performance liquid chromatography-mass spectrometry at 9 days of age. Fifty-two mice were selected and divided into 4 groups ( n=13 each) by a random number table method: control+ normal saline group (group C+ S), sevoflurane anesthesia + normal saline group (group S+ S), control+ DHA group (group C+ D), and sevoflurane anesthesia+ DHA group (group S+ D). The sevoflurane anesthesia method was the same as the one mentioned above. DHA 50 mg/kg was administered by intragastric gavage from postnatal days 6-19 (at 6, 7 and 8 days after birth, 2 h before anesthesia) in C+ D and S+ D groups. The equal volume of normal saline was given instead in C+ S group and S+ S group. The novel object recognition test was conducted at 37 days of age, and the Morris water maze test was performed at 42 days of age. The corpus callosum and hippocampal tissues were isolated at 47 days of age for examination of the ultrastructure of myelin (with a transmission electron microscope) and for determination of the expression of myelin basic protein (MBP) in hippocampal tissues (by Western blot). The G-ratio was calculated. Results:Compared with group C, the content of DHA in hippocampal tissues was significantly decreased in group S ( P<0.05). Compared with group C+ S, the discrimination index was significantly decreased, the percentage of duration of staying at the target platform quadrant and the number of crossing the original platform were decreased, the expression of MBP was down-regulated, and the G-ratio in the original platform and hippocampus was increased in S+ S group ( P<0.05). Compared with group S+ S, the discrimination index was significantly increased, the percentage of duration of staying at the target platform quadrant and the number of crossing the original platform were increased, the expression of MBP was up-regulated, and the G-ratio in the original platform and hippocampus was decreased in S+ D group ( P<0.05). Conclusions:The mechanism of long-term cognitive impairment following multiple sevoflurane anesthesia may be related to a decrease in the content of DHA, which subsequently leads to myelin structural damage in neonatal mice.