Objective:To evaluate the efficacy of high-flow nasal cannula (HFNC) for assisted weaning from nasal continuous positive airway pressure (NCPAP) in extremely preterm infants (<28 weeks of gestation) with bronchopulmonary dysplasia (BPD).Methods:This multicenter retrospective cohort study enrolled extremely preterm infants with BPD receiving NCPAP beyond one month postnatally at three tertiary hospitals (Fujian Children's Hospital, Fujian Maternity and Child Health Hospital, and Fujian Obstetrics and Gynecology Hospital) from December 2017 to June 2024. After meeting weaning criteria, these infants transitioned to low-flow nasal cannula (LFNC group, n=51) or HFNC (HFNC group, n=60). Primary outcomes were initial weaning success and total NCPAP duration. Secondary outcomes included oxygen therapy duration, time to full enteral feeding, hospital stay, and oxygen therapy at discharge. Safety outcomes encompassed pneumothorax, nasal trauma, new-onset necrotizing enterocolitis, retinopathy of prematurity, sepsis, and grade Ⅲ-Ⅳ intraventricular hemorrhage. Group differences were analyzed using independent t-tests, Wilcoxon rank-sum, and Chi-square tests, with inverse probability of treatment weighting (IPTW) adjusting confounders followed by logistic/linear regression. Results:After IPTW (HFNC group: 54.8 cases; LFNC group: 53.0 cases), no statistically significant differences were observed in baseline demographic and clinical characteristics between groups, including gestational age, birth weight, BPD severity, duration of invasive mechanical ventilation, and duration of antibiotic exposure (all P>0.05). HFNC group demonstrated higher initial weaning success rate [83.2% (45.6/54.8) vs. 61.6% (32.6/53.0), OR=3.087, 95% CI: 1.027-9.281, P=0.044] and a significant reduction of 13.7 days in total NCPAP duration [25.0 (21.0-35.3) vs. 42.0 (29.4-61.0) days, β=－13.700, 95% CI:－21.372 to－6.027, P<0.001]. Secondary outcomes showed no significant differences between HFNC and LFNC groups: oxygen therapy duration [70.0 (51.8-81.9) vs. 68.0 (59.2-83.1) days], time to full enteral feeding [41.0 (31.0-59.0) vs. 45.0 (40.0-61.6) days], hospital stay [87.0 (74.6-98.5) vs. 93.7 (74.0-102.7) days], and oxygen therapy at discharge [16.6% (9.1/54.8) vs. 13.8% (7.3/53.0)] (all P>0.05). Safety outcomes were comparable between HFNC and LFNC groups: pneumothorax [2.8% (1.5/54.8) vs. 5.1% (2.7/53.0)], nasal trauma [3.8% (2.1/54.8) vs. 11.6% (6.2/53.0)], new-onset necrotizing enterocolitis [6.9% (3.8/54.8) vs. 5.5% (2.9/53.0)], and retinopathy of prematurity [14.4% (7.9/54.8) vs. 17.9% (9.5/53.0)] (all P>0.05). Conclusion:HFNC-assisted weaning may improve initial success and reduce NCPAP duration in BPD extremely preterm infants without increasing adverse events versus LFNC.

Aim To investigate whether protein inhibitor of activated STAT3(PIAS3)deficiency exacerbates the occurrence and development of atherosclerosis(As)in female ApoE knockout mice.Methods PIAS3 gene knockout mice with ApoE-/-background(PIAS3-/-/ApoE-/-)and their littermate PIAS3+/+/ApoE-/-mice were bred and fed with a high-fat/high-cholesterol diet for 12 weeks to induce As.Body weight(every week)and plasma lipid levels including to-tal cholesterol,triglyceride,high density lipoprotein cholesterol and non-high density lipoprotein cholesterol(every 4 weeks)of the mice were measured.Oil red O staining,HE staining,immunohistochemistry staining and immunofluores-cence staining were performed on mouse aortic tree and frozen sections of aortic root to evaluate the area,cellular composi-tion and stability of As plaques.Moreover,the expression of estrogen receptor α(ERα)and its co-localization with vas-cular smooth muscle cells(VSMC)in plaques were determined by immunofluorescence staining.Results Compared with PIAS3+/+/ApoE-/-mice,PIAS3-/-/ApoE-/-mice showed no significant differences in body weight,major organ weight(heart,liver,spleen,kidney and epididymal fat)and plasma lipid levels;however,PIAS3 deficiency promoted the forma-tion of As in female PIAS3-/-/ApoE-/-mice.Compared with PIAS3+/+/ApoE-/-mice,PIAS3-/-/ApoE-/-mice showed an increased lipid accumulation and a decreased VSMC content in As plaques(P＜0.05),leading to a decrease in plaque stability.In addition,the expression of ERα in the As plaques of PIAS3-/-/ApoE-/-mice was significantly downregulated(P＜0.05),and there was a obvious co-localization between ERα and VSMC.The reduction of VSMC content in PIAS3-/-/ApoE-/-mouse plaques might lead to a decrease of ERα expression,thereby weakening the anti-As effect of es-trogen.Conclusion PIAS3 deficiency exacerbates the formation of As plaques in female PIAS3-/-/ApoE-/-mice,which might be due to the regulatory effect of PIAS3 on ERα expression in plaques.

Aim To investigate whether protein inhibitor of activated STAT3(PIAS3)deficiency exacerbates the occurrence and development of atherosclerosis(As)in female ApoE knockout mice.Methods PIAS3 gene knockout mice with ApoE-/-background(PIAS3-/-/ApoE-/-)and their littermate PIAS3+/+/ApoE-/-mice were bred and fed with a high-fat/high-cholesterol diet for 12 weeks to induce As.Body weight(every week)and plasma lipid levels including to-tal cholesterol,triglyceride,high density lipoprotein cholesterol and non-high density lipoprotein cholesterol(every 4 weeks)of the mice were measured.Oil red O staining,HE staining,immunohistochemistry staining and immunofluores-cence staining were performed on mouse aortic tree and frozen sections of aortic root to evaluate the area,cellular composi-tion and stability of As plaques.Moreover,the expression of estrogen receptor α(ERα)and its co-localization with vas-cular smooth muscle cells(VSMC)in plaques were determined by immunofluorescence staining.Results Compared with PIAS3+/+/ApoE-/-mice,PIAS3-/-/ApoE-/-mice showed no significant differences in body weight,major organ weight(heart,liver,spleen,kidney and epididymal fat)and plasma lipid levels;however,PIAS3 deficiency promoted the forma-tion of As in female PIAS3-/-/ApoE-/-mice.Compared with PIAS3+/+/ApoE-/-mice,PIAS3-/-/ApoE-/-mice showed an increased lipid accumulation and a decreased VSMC content in As plaques(P＜0.05),leading to a decrease in plaque stability.In addition,the expression of ERα in the As plaques of PIAS3-/-/ApoE-/-mice was significantly downregulated(P＜0.05),and there was a obvious co-localization between ERα and VSMC.The reduction of VSMC content in PIAS3-/-/ApoE-/-mouse plaques might lead to a decrease of ERα expression,thereby weakening the anti-As effect of es-trogen.Conclusion PIAS3 deficiency exacerbates the formation of As plaques in female PIAS3-/-/ApoE-/-mice,which might be due to the regulatory effect of PIAS3 on ERα expression in plaques.

Objective:To evaluate the efficacy of high-flow nasal cannula (HFNC) for assisted weaning from nasal continuous positive airway pressure (NCPAP) in extremely preterm infants (<28 weeks of gestation) with bronchopulmonary dysplasia (BPD).Methods:This multicenter retrospective cohort study enrolled extremely preterm infants with BPD receiving NCPAP beyond one month postnatally at three tertiary hospitals (Fujian Children's Hospital, Fujian Maternity and Child Health Hospital, and Fujian Obstetrics and Gynecology Hospital) from December 2017 to June 2024. After meeting weaning criteria, these infants transitioned to low-flow nasal cannula (LFNC group, n=51) or HFNC (HFNC group, n=60). Primary outcomes were initial weaning success and total NCPAP duration. Secondary outcomes included oxygen therapy duration, time to full enteral feeding, hospital stay, and oxygen therapy at discharge. Safety outcomes encompassed pneumothorax, nasal trauma, new-onset necrotizing enterocolitis, retinopathy of prematurity, sepsis, and grade Ⅲ-Ⅳ intraventricular hemorrhage. Group differences were analyzed using independent t-tests, Wilcoxon rank-sum, and Chi-square tests, with inverse probability of treatment weighting (IPTW) adjusting confounders followed by logistic/linear regression. Results:After IPTW (HFNC group: 54.8 cases; LFNC group: 53.0 cases), no statistically significant differences were observed in baseline demographic and clinical characteristics between groups, including gestational age, birth weight, BPD severity, duration of invasive mechanical ventilation, and duration of antibiotic exposure (all P>0.05). HFNC group demonstrated higher initial weaning success rate [83.2% (45.6/54.8) vs. 61.6% (32.6/53.0), OR=3.087, 95% CI: 1.027-9.281, P=0.044] and a significant reduction of 13.7 days in total NCPAP duration [25.0 (21.0-35.3) vs. 42.0 (29.4-61.0) days, β=－13.700, 95% CI:－21.372 to－6.027, P<0.001]. Secondary outcomes showed no significant differences between HFNC and LFNC groups: oxygen therapy duration [70.0 (51.8-81.9) vs. 68.0 (59.2-83.1) days], time to full enteral feeding [41.0 (31.0-59.0) vs. 45.0 (40.0-61.6) days], hospital stay [87.0 (74.6-98.5) vs. 93.7 (74.0-102.7) days], and oxygen therapy at discharge [16.6% (9.1/54.8) vs. 13.8% (7.3/53.0)] (all P>0.05). Safety outcomes were comparable between HFNC and LFNC groups: pneumothorax [2.8% (1.5/54.8) vs. 5.1% (2.7/53.0)], nasal trauma [3.8% (2.1/54.8) vs. 11.6% (6.2/53.0)], new-onset necrotizing enterocolitis [6.9% (3.8/54.8) vs. 5.5% (2.9/53.0)], and retinopathy of prematurity [14.4% (7.9/54.8) vs. 17.9% (9.5/53.0)] (all P>0.05). Conclusion:HFNC-assisted weaning may improve initial success and reduce NCPAP duration in BPD extremely preterm infants without increasing adverse events versus LFNC.

Objective:To construct a service index system suitable for palliative care institutions at all levels, and provide reference for medical institutions to carry out programmed palliative care services.Methods:From April 2020 to June 2021, using expert focus group method, combined with domestic and foreign literature review and pilot work experience, the flow chart of hospice care service was preliminarily drawn, and the service indicators were formulated. Delphi expert letter consultation method was used to conduct two rounds of consultation among 16 experts, and finally the palliative care service index system was formed.Results:The positive coefficient of experts in the two rounds of Delphi expert letter consultation were 16/20 and 16/16, the authority coefficient was 0.828, 0.831, and the Kendall harmony coefficient was 0.236, 0.389, respectively. Finally, the palliative care service index system consisted of 8 indicators for primary level, 18 indicators for secondary level and 40 indicators for tertiary level.Conclusions:The established palliative care service index system is scientific and reliable, which can provide reference for all levels of hospice care institutions to carry out programmed services.

This study aimed to identify Inulae Herba, Inulae Flos and their closely related species using the ITS2 bar-code, and secure the quality and clinical curative effect of these medicinal materials. DNA was extracted from Inula linariifolia, I. japonica, I. britanica, which are the original species of Inulae Herba and Inulae Flos, together with their closely related species. The ITS2 sequence was amplified by PCR and sequenced bidirectionally. Sequence assembly and generation of consensus sequence were conducted by the CodonCode Aligner. The genetic distances were comput-ed using MEGA 5.0 in accordance with the Kimura-2-parameter (K2P) model, and the phylogenetic tree constructed by the neighbor-joining (NJ) method. The results showed that the ITS2 sequences of the various species have stable variable sites. The intraspecific genetic distances among Inulae Herba and Inulae Flos were obviously lower than the interspecific genetic distance among the above two medicinal materials and its adulterants. The NJ tree based on ITS2 sequences can clearly differ from Inulae Herba, Inulae Flos and their closely related species. It is concluded that ITS2 sequence can be used as DNA barcode to identify Inulae Herba, Inulae Flos and their closely related species.