Objective To investigate the relationship between serum cyclophilin A(CypA),ischemia modi-fied albumin(IMA),galectin-3(Gal-3)levels and oxidative stress and cognitive impairment(CI)in patients with acute cerebral infarction(ACI)complicated with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods A total of 168 patients with ACI complicated with OSAHS who were admitted to the hospital from December 2020 to October 2023 were selected,and the levels of serum CypA,IMA,Gal-3 and oxidative stress indexes[superoxide dismutase(SOD),malondialdehyde(MDA)]in patients with different severity(mild group,moderate group,severe group)were compared.The correlation between serum CypA,IMA,Gal-3 lev-els and oxidative stress indexes were analyzed by Pearson method.The incidence of CI in patients with ACI complicated with OSAHS were statistically analyzed,the levels of serum CypA,IMA and Gal-3 were com-pared between normal cognitive group and CI group,and the risk factors of CI in patients with ACI complicat-ed with OSAHS were analyzed by multivariate Logistic regression model.Results The levels of serum CypA,IMA,Gal-3 and MDA in mild group,moderate group and severe group increased in turn(P<0.05),and ser-um SOD level decreased in turn(P<0.05).Serum CypA,IMA and Gal-3 in ACI patients complicated with OSAHS were negatively correlated with SOD(P<0.05),and positively correlated with MDA(P<0.05).Of 168 ACI patients complicated with OSAHS,79 cases(47.02%)had CI and were included in the CI group.Compared with normal cognitive group,the serum levels of CypA,IMA and Gal-3 in CI group were signifi-cantly increased(P<0.05).Multivariate Logistic regression model analysis showed that apnea hypopnea in-dex(AHI)≥20 times/h,frontal and temporal lobe infarction,elevated CypA level,elevated IMA level,and el-evated Gal-3 level were risk factors for CI in ACI patients complicated with OSAHS(P<0.05).Conclusion The high expression of serum CypA,IMA and Gal-3 in patients with ACI complicated with OS-AHS is significantly correlated with oxidative stress and CI.The increase of serum CypA,IMA and Gal-3 lev-els indicates an increased risk of CI in patients with ACI complicated with OSAHS,and early detection of the three has good clinical value in evaluating the condition of patients with ACI complicated with OSAHS.

Objective To explore the expression and clinical significance of tissue inhibitor of matrix metal-loproteinases(TIMP)-1 and pentraxin-3(PTX3)in the serum of patients with obstructive sleep apnea-hypop-nea syndrome(OSAHS).Methods A total of 120 patients with OSAHS admitted to the hospital from 2021 to 2022 were selected as the study group,and another 114 healthy people who underwent the physical exami-nation in the same period were selected as the control group.The severity of OSAHS was determined accord-ing to the apnea-hypopnea index(AHI)and the minimum oxygen saturation(LSpO2),and the patients were divided into mild group(66 cases)and the moderate-severe group(54 cases).Serum TIMP-1 and PTX3 levels were measured by enzyme-linked immunosorbent assay.Pearson method was used to analyze the correlation between serum TIMP-1,PTX3 and AHI,LSpO2.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum TIMP-1 and PTX3 on the severity of disease in patients with OSAHS.Logistic regression was used to analyze the factors influencing the severity of the disease in OSAHS patients.Results Serum TIMP-1,PTX3 and AHI levels in the study group were higher than those in the control group,and LSpO2 level was lower than that in the control group(P<0.05).The body mass index(BMI),the proportion of hypertension history,the proportion of coronary heart disease history,the levels of total choles-terol,triglycerides,low-density lipoprotein cholesterol,TIMP-1,PTX3 and AHI in the moderate-severe group were significantly higher than those in the mild group,and the high density lipoprotein cholesterol,LSpO2 lev-el was significantly lower than that in the mild group(P<0.05).Pearson method results showed that serum TIMP-1,PTX3 levels were positively correlated with AHI(r=0.428,0.392,P<0.05),and serum TIMP-1,PTX3 levels were negatively correlated with LSpO2(r=-0.645,-5.836,P<0.05).The results of the ROC curve showed that the area under the curve(AUC)of serum TIMP-1 and PTX3 alone predicted the severity of the patients'disease was 0.813 and 0.777,with cut-off values were 2.47 μg/L and 7.23 ng/L,with the sensi-tivity of 70.37%and 77.78%and the specificity of 77.27%and 72.23%,respectively.The AUC for predic-ting the severity of patients'disease by combining the two was 0.866,which was significantly higher than those of serum TIMP-1(Z=2.067,P=0.039)and PTX3 alone(Z=2.331,P=0.020).Logistic regression a-nalysis showed that TIMP-1,PTX3,history of hypertension,and history of coronary artery disease,AHI and LSpO2 were influential factors for severity of disease in patients with OSAHS(P<0.05).Conclusion TIMP-1 and PTX3 are both up-regulated in the serum of OSAHS patients and closely related to the severity of the disease,and they are the influential factors in the severity of OSAHS patients.

Objective To investigate the long non-coding RNA(lncRNA) MRAK08838 regulates macrophage function to influence the development of asthmatic airway inflammation. Methods MRAK088388 gene knockout (MRAK088388^-/-) mouse model was prepared and allergic asthma was induced by dust mite protein Dermatophagoides farinae 1 (Der f1). The mice were sacrificed after 28 days of modeling, and serum was collected to measure IgE and IgG. The FinePointe RC system was used to measure airway hyperresponsiveness and evaluate lung function in mice. Lung tissue was taken for HE staining, and periodic acid-Schiff (PAS) staining was used to evaluate inflammatory infiltration and mucus secretion in mouse lungs. Fluorescence quantitative PCR was used to detect the expression level of lncRNA MRAK08838 in bronchoalveolar lavage fluid (BALF) cells and lung tissue of asthmatic mice. ELISA was used to detect the levels of inflammatory cytokines IFN-γ, IL-4, IL-5, IL-13, IL-10 and IL-17A. Flow cytometry was used to evaluate the phenotype of macrophages in BALF and lung tissue, as well as the proportion of neutrophils, eosinophils, and alveolar macrophages. The changes of the above indicators were detected in mice by adoptive transfer of bone marrow-derived macrophages (BMDM). Results Under the challengle of Der f1, MRAK088388^-/- mice showed reduced allergic airway inflammation, including reduced eosinophils in BALF and reduced production of IgE and IgG1. In addition, Der f1-treated MRAK088388^-/- mice had fewer M2 macrophages than wild-type asthmatic mice. Wild-type mouse BMDM (M0) and Der f1-treated MRAK088388^-/- mice also showed mild inflammatory response. Conclusion Knockout of MRAK088388 alleviates airway inflammation in asthmatic mice by inhibiting M2 polarization of airway macrophages.
Animals ; Mice ; Mice, Knockout ; RNA, Long Noncoding/genetics* ; Asthma/genetics* ; Macrophages ; Immunoglobulin E

【Objective】 To investigate the association between the long-stranded non-coding ribonucleic acid (lncRNA) MRAK088388 and allergic asthma in children. 【Methods】 A total of 15 healthy children and 15 children with asthma were monitored for disease progression over a 2-year period. Blood samples were collected from patients during the chronic phase of the disease for lncRNA/mRNA expression microarray analysis. Competing endogenous RNA networks (MRAK088388/miR-30a/ATG5) were identified by bioinformatics analysis. In vitro cultured bronchial epithelial (16HBE) cells were used to quantify gene and associated protein expression levels by real-time fluorescent quantitative polymerase chain reaction (qPCR) and protein blotting, respectively. Cell Counting Kit-8 and transwell assays were used to assess the proliferation and migration of 16HBE cells and verify the effects of MRAK088388, miR-30a and ATG5 on asthma. 【Results】 Six lncRNA-miRNA-mRNAs were identified by correlation analysis. By qRT-PCR analysis, MRAK088388/miR-30a/ATG5 was selected to construct the ceRNA network in this study. mRAK088388 and ATG5 expressions were high in the peripheral blood of children with asthma, while the expression of miR-30a was low (P<0.05). The expression level of E-cadherin was significantly higher in 16HBE cells after si-MRAK088388+TGF-β1 group, while the expression levels of Vimentin and α-SMA were significantly lower (P<0.05), indicating that knockdown of MRAK088388 inhibited the epithelial mesenchymal transition in 16HBE cells. Compared with si-NC+ TGF-β1 group, the cell morphology of si-MRAK088388+TGF-β1 group was similar to that of the control group, indicating that MRAK088388 knockdown attenuated TGF-β1-induced cell morphological changes; in addition, MRAK088388 knockdown inhibited TGF-β1-induced proliferation and migration of 16HBE cells. MRAK088388 was confirmed by qPCR and protein blotting to promote the progression of childhood asthma by targeting the miR-30a/ATG5 axis. 【Conclusion】 Childhood asthma is associated with the MRAK088388/miR-30a/ATG5 axis, and MRAK088388 is involved in the process of childhood allergic asthma by negatively regulating miR-30a expression and regulating elevated ATG5 expression levels to affect bronchial epithelial cell mesenchymal transition, proliferation, and migration.

Objective ： To study the effect of temperature and light intensity on photosynthetic fluorescence parameters, volatile oil content, and growth of Atractylodes lancea and provide reference for the rational selection of cultivation environment for A. lancea. MethodWe determined the photosynthetic indexes (such as net photosynthetic rate, water use efficiency, and carboxylation rate), light response curve, CO₂ response curve, fluorescence parameters, and the content of four volatile oils in A. lancea under two temperature treatments (32 °C and 22 °C) and two light treatments (full light and shade). ResultThe net photosynthetic rate and water use efficiency of A. lancea under high temperature + strong light were significantly higher than those under high temperature + weak light and low temperature + strong light. The ability of A. lancea to use weak light at low temperature was the strongest, while the utilization rate of weak light under strong light significantly reduced. The photosynthetic rate of A. lancea at low temperature was more susceptible to light intensity and CO₂ concentration than that at high temperature. The maximum photosynthetic rate and apparent quantum efficiency under weak light were significantly higher than those under strong light. The photoreaction efficiency at high temperature was higher than that at low temperature. The total amount of volatile oil in A. lancea treated with high temperature + weak light was the highest, reaching 4.582%. Compared with high temperature + strong light, high temperature + weak light significantly increased the content of hinesol and β-eudesmol in A. lancea by 91.7% and 35.7%, respectively, and low temperature + strong light significantly increased the content of hinesol by 87.5%. The content of β-eudesmol in low temperature + weak light treatment was significantly lower than that in high temperature + weak light treatment. ConclusionTThe growth of A. lancea was affected by the interaction between temperature and light. The light and temperature conditions required for the accumulation of volatile oil were not consistent with those suitable for the growth and development of A. lancea. A. lancea responded to the changes of light and temperature conditions by regulating the synthesis and accumulation of volatile oil.

Objective:To investigate the efficacy and safety of bronchoscopic lavage in children with severe adenoviral pneumonia.Methods:Patients with severe adenovirus pneumonia who were admitted to ICU department of Hunan Children′s Hospital for bronchoscopy were collected from February to June 2019 and divided into lavage group( n=36) and non-lavage group( n=15) in line with whether lavage was performed.Their results, namely, bronchoscopic diagnosis, blood gas analysis before and 2 hours, 24 hours and 48 hours after bronchoscopy, improvement time of clinical symptoms(fever and pulmonary moist rales), the positive rate of pathogen detection and mortality rate, main vital signs such as heart rate, respiratory rate, mean arterial pressure and bronchoscopy-related complications were recorded before and 1 hour, 2 hours and 24 hours after bronchoscopy. Results:A total of 51 children were collected, all of whom suffered from endobronchitis.More secretions were observed in the airways of 36 patients in the lavage group, and only a little or no secretions were observed in 15 patients in the non-lavage group.P/F value and PCO 2 at 2 hours, 24 hours and 48 hours after treatment in the lavage group were improved comparing to those before treatment and were superior to those in the non-lavage group( P<0.05). P/F values at 24 hours and 48 hours after treatment in the non-lavage group increased and PCO 2 decreased at 48 hours after treatment( P<0.05). The thermal duration, time to resolution of moist rales in the lungs in the lavage group were shorter than those in the non-lavage group( P<0.05). The mortality rate in the lavage group was lower than that in the non-lavage group[2.8%(1/36) vs.26.7%(4/15), P<0.05]. The positive rate of pathogen detection in lavage group was higher than that in non-lavage group[55.6%(20/36) vs. 20.0%(3/15), P<0.05]. There was no significant difference in heart rate, respiratory rate, and mean arterial pressure at each time point before and after bronchoscopic treatment( P>0.05). Associated complications were 11 cases of intraoperative transient hypoxemia, four cases of bronchial mucosal bleeding, and one case each of postoperative hypoxemia, intraoperative hypertension and hypotension.There was no significant difference in the incidence of complications between the two groups( P>0.05). Conclusion:Bronchoscopic lavage, in treating children with severe adenovirus pneumonia, may improve clinical symptoms, respiratory function, and rate of pathogen detection, reduce mortality, and is effective and safe.

Objectives To determine the risk factors of ventilator-associated pneumonia (VAP) in the pediatric intensive care unit and to explore effective strategies to reduce the morbidity of VAP. Methods A retrospective analysis was conducted on 455 children admitted into the PICU of Hunan Children's Hospital from June 2014 to June 2017. The 455 children were divided into VAP group (n=43) and non-VAP group (n=412). The incidence of VAP was identified and risk factors were compared using the logistic regression analysis via SPSS 19.0 software.Results There were 311 males and 144 females with a median age of 11 months old (29 days to 9 years and 4 months). The incidence of VAP was 9.45% (43/455). Congenital laryngeal and trachea malformation with pulmonary infection was the first reason for the occurrence of VAP (23.3%), followed by congenital heart diseases with pulmonary infection (18.6%). Via univariate analysis, types of endotracheal intubation (χ2=45.33, P<0.001), duration of mechanical ventilation (Z=1.21, P=0.034), re-intubation (χ2=20.22, P=0.004), early usage of antibiotics (χ2=4.98, P=0.026),and methods of nutritional support(χ2=10.15,P=0.006)were identified as risk factors of VAP in the pediatric intensive care unit patients (P<0.05). Based on the multivariate logistic regression analysis, the followings were all independent predictor for VAP:types of endotracheal intubation(OR=1.87,95%CI:1.48~9.75),duration of mechanical ventilation(OR=1.14, 95%CI:1.08~2.35), re-intubation (OR=3.42, 95%CI:1.26~5.57), early usage of antibiotics (OR=4.55, 95%CI:2.21~8.77). Conclusions Many risk factors were found related with the occurrence of VAP. A comprehensive analysis of the host factors and iatrogenic factors should be conducted. Rational use of antibiotics and daily assessment of extubation might help reduce the incidence of VAP.

Objective To investigate the prevalence of pulmonary fungal infection and drug resist-ance of the pathogenic fungi among children with severe diseases in pediatric intensive care unit(PICU). Methods From July 2013 to June 2017,the complete clinical data,results of fungal culture and drug sensi-tivity of bronchoalveolar lavage fluid in 112 critically ill children with pulmonary fungus infection of PICU hospitalization in our hospital were collected. Samples of peripheral venous blood were collected meantime, including blood routine examination,C reactive protein,G test and GM test. Results One hundred and twen-ty-six fungi were isolated from sputum samples in 112 critically ill children. Severe pulmonary infection (30. 36%,34/112) was the most common form of the primary diseases, the next were severe sepsis (16. 07%,18/112)and severe malnutrition(15. 18%,17/112). Classified based on age difference,the first one was ＜1 year old (43. 75%,49/112),the second one was 1 to 3 years old(29. 46%,33/112). The fun-gal strains were predominantly Candida albicans (61. 90%) and Candida tropicalis (16. 67%),among the infectious cases 14 were diagnosed as mixed infection. Two cases of 3 cryptococcal infectious children were HIV infection,another one was malignant tumor,Cryptococcus was cultured in both sputum,pleural effusion and cerebrospinal fluid. The drug resistance rate of fluconazol in 126 strains of fungi was 12. 70%,the rate of itraconazole was 7. 14%. Generally,the fungi cultured were with very low resistance to 5-fluorocytosine,vori-conazole and amphotericin B. However,the strains of Aspergillus fumigates,Candida kruse,Candida parapsi-losis and Cryptococcus were highly resistant to fluconazol and itraconazole,but with very low resistance to 5-fluorocytosine and amphotericin B. Conclusion Candida albicans is the main pathogenic fungus of pulmo-nary fungal infection among children in PICU,and we could choose voriconazole and amphotericin B as treat-ment of critically ill children with pulmonaty fungal infection.

Objective To explore the measurement of(1,3)-β-D glucan in plasma for the diagnosis of pulmonary fungal infections in pulmonary tuberculosis patients. Methods 40 pulmonary tuberculosis patients with pulmonary fungal infections in Guangzhou chest hospital from January 2015 to December 2015 were enrolled as a test group,among which 35 were confirmed and 5 were suspected pulmonary fungal infections. 52 pulmonary tuber-culosis patients without fungal infections were selected as a control group.(1,3)-β-D glucan content(G test)in this 92 patients plasma were detected. The results of G tests were compared with those from etiological diagnosis to assess the performance of G test. Results 13 strains of candida albicans,13 strains of aspergillus,2 strains of candida tropicalis,2 strains of candida glabrata and 6 strains of other yeast were obtained from patients of test group,but no fungal identified from those of control group. The median of G test in test group and in control group was 126.1 and 29.56 pg/mL,respectively,the level in test group was significantly higher than that in control group (P<0.001). 35 cases were identified as positive and 5 were negative in test group by G test ,while 41 cases were identified as negative and 11 were positive in control group. The sensitivity,specificity,positive predictive value, negative predictive value ,concordance and Youden index of G test were 87.5%,78.85%,76.09%,89.13%, 82.6%and 0.663,respectively. Conclusions Candida albicans and aspergillus are more common pathogens than the other fungi isolated from pulmonary tuberculosis patients with pulmonary fungal infection. G test ,used in pul-monary tuberculosis with pulmonary fungal infections diagnosis,is reliable and fast,and has a higher sensitivity, specificity and accuracy.

Objective To explore the role and effectiveness of flexible fiberoptic brochoscopy ( FFB) in critically ill children with continuous invasive respiratory support. Methods From July 2014 to June 2017,135 critically ill children with severe pneumonia had received continuous invasive respiratory sup-port and undergone FFB in the pediatric intensive care unit( PICU) of our hospital. These patients were en-rolled into the therapy group. Another 104 severe pneumonia patients who had not received FFB were enrolled into the control group. Clinical characteristics of both groups were collected and compared. Results No sig-nificant differences were detected in patients′gender, age, PCIS, usage of antibiotics, and the levels of CRP and PCT assayed at the time of admission to PICU between the therapy group and control group(P>0. 05). The positive rate of bacteria culture of the bronchoscopic lavage was 78. 52％( 106 cases ) in the therapy group,and it was significantly higher than that in the control group(60. 58％,63 cases) (χ2 =5. 681,P <0. 005). For 106 cases in the therapy group,117 bacteria strains were identified,while there were 72 bacteria strains found in 63 cases with positive bacteria culture in the control group. Gram negative bacteria were the most common type,followed by Gram positive bacteria. The third most common pathogenic microbes were fungi,with a significantly higher frequency in the therapy group. No significant differences were found in PaO2 and oxygenation index between both groups before FFB. However,in a half hour after FFB,the PaO2 and oxygenation index significantly increased in the therapy group,and higher than those in the control group (P<0. 005). The levels of CRP and PCT assayed before and the first day after FFB were not significantly changed(P>0. 05). But the levels of CRP and PCT in the therapy group significantly decreased in the third day after FFB,and more than those in the control group. Furthermore,duration of invasive respiratory sup-port,and the stay of PICU were significantly shorter in the therapy group(P<0. 005). Conclusion FFB can play an important role in the collection of pathogenic microbes. It also achieves better results in the treatment of severe pneumonia for children in PICU. Therefore,it is worthwhile to be recommended as a safe and feasi-ble intervention in PICU.