Objective To investigate the value of integrin subunit αM(ITGAM)and integrin subunit β2(ITGB2)levels in peripheral blood mononuclear cells(PBMC)in the diagnosis and prognosis evaluation for patients with severe acute pancreatitis(SAP)complicated with acute lung injury(ALI).Methods A total of 205 patients with SAP admitted from November 2022 to February 2024 in the hospital were selected,and they were divided into ALI group(103 cases)and non-ALI group(102 cases)according to whether they were com-plicated with ALI.Meanwhile,110 healthy people who underwent the physical examination were selected as the control group.The differences of the levels of ITGAM and ITGB2 in PBMC in different groups were com-pared.Logistic regression was used to analyze the influencing factors for ALI in patients with SAP.The re-ceiver operating characteristic(ROC)curve was used to analyze the diagnostic value of levels of ITGAM and ITGB2 in PBMC for SAP patients complicated with ALI and the predictive value for poor prognosis.Results The levels of ITGAM,ITGB2 in PBMC,and serum amylase and urine amylase levels in ALI group were higher than those in non-ALI group and control group(P＜0.05).Multivariate Logistic regression anal-ysis showed that the increase of ITGAM,ITGB2 and serum amylase levels were risk factors for ALI in pa-tients with SAP(P＜0.05).ROC curve results showed that the area under the curve(AUC)of ITGAM com-bined with ITGB2 in diagnosing ALI in patients with SAP was significantly higher than those of ITGAM and ITGB2 alone(P＜0.05).The levels of ITGAM and ITGB2 in PBMC in the poor prognosis group were higher than those in the good prognosis group(P＜0.05).ROC curve results showed that the AUC of ITGAM com-bined with ITGB2 in predicting poor prognosis in patients with SAP complicated with ALI was significantly higher than those of ITGAM and ITGB2 alone(P＜0.05).Conclusion Increased levels of ITGAM and IT-GB2 in PBMC are risk factors for ALI in patients with SAP.ITGAM combined with ITGB2 has a good predic-tive efficacy for the poor prognosis in patients with SAP complicated with ALI,which has important value in clinical practice and is expected to become potential biomarkers.

This study analyzed the clinical and laboratory data of 3 children diagnosed with mitochondrial disease-associated primary adrenal insufficiency (PAI) at the Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from October 2018 to November 2023.All patients were normal at birth but gradually developed symptoms and were diagnosed with PAI between the ages of 1 year and 1 month and 7 years and 3 months.The children presented typical clinical symptoms of PAI, including skin and mucosal hyperpigmentation (3 cases), electrolyte disturbances (3 cases), and hypoglycemia (2 cases), as well as multisystem abnormalities related to mitochondrial disease, including recurrent infections, growth retardation, cachexia, and hyperlactatemia.Genetic testing revealed significant single deletions in mitochondrial DNA in all patients: Patient 1: m.11219_15954del, Patient 2: m.8483_13459del, and Patient 3: m.8649_16084del.Treatment with Hydrocortisone acetate replacement therapy improved the electrolyte disturbances and hypoglycemia, but issues with recurrent infections, growth retardation, and cachexia persisted.This study suggests that in clinical practice, the possibility of mitochondrial disease should be highly suspected when PAI patients present with multisystem abnormalities, especially in conjunction with hyperlactatemia.

This study analyzed the clinical and laboratory data of 3 children diagnosed with mitochondrial disease-associated primary adrenal insufficiency (PAI) at the Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from October 2018 to November 2023.All patients were normal at birth but gradually developed symptoms and were diagnosed with PAI between the ages of 1 year and 1 month and 7 years and 3 months.The children presented typical clinical symptoms of PAI, including skin and mucosal hyperpigmentation (3 cases), electrolyte disturbances (3 cases), and hypoglycemia (2 cases), as well as multisystem abnormalities related to mitochondrial disease, including recurrent infections, growth retardation, cachexia, and hyperlactatemia.Genetic testing revealed significant single deletions in mitochondrial DNA in all patients: Patient 1: m.11219_15954del, Patient 2: m.8483_13459del, and Patient 3: m.8649_16084del.Treatment with Hydrocortisone acetate replacement therapy improved the electrolyte disturbances and hypoglycemia, but issues with recurrent infections, growth retardation, and cachexia persisted.This study suggests that in clinical practice, the possibility of mitochondrial disease should be highly suspected when PAI patients present with multisystem abnormalities, especially in conjunction with hyperlactatemia.

Objective To explore the factors associated with respiratory syncytial virus(RSV)infection in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and its correlation with serum levels of heat shock protein 70(HSP70),Krüppel-like factor 5(KLF5),and macrophage inflammatory protein-2(MIP-2).Methods A total of 195 AECOPD patients were prospectively enrolled and categorized into an RSV-infected group(n=95)and an uninfected group(n=100)based on RSV infection status.The infected group was further subdivided by disease severity into mild,moderate,and severe subgroups(31 cases,35 cases,29 cases),and by prognosis into poor prognosis(n=51)and good prognosis subgroups(n=44).ELISA method was used to measure the serum levels of HSP70,KLF5,and MIP-2 in each group,and their correlation with relevant clinical indicators was analyzed.Multivariate Cox regression analysis was used to explore risk factors for RSV infection in AECOPD patients.Relative risk analysis was used to explore the impact of high and low levels of HSP70,KLF5,and MIP-2 on the prognosis of AECOPD patients with RSV infection.Kaplan-Meier survival curves analyzed patient survival outcomes.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of serum HSP70,KLF5,and MIP-2 levels for the prognosis of AECOPD patients with RSV infection.Results The infected group had significantly higher proportions of respiratory failure,higher number of exacerbations within one year,and higher levels of CRP,HSP70,KLF5,and MIP-2 compared to the non-infected group(P<0.05),while FEV1%pred were significantly lower(P<0.05).Serum HSP70,KLF5,MIP-2 levels were positively correlated with respiratory failure,number of exacerbations within one year,and CRP levels(P<0.05),and negatively correlated with FEV1%pred(P<0.05).Multivariate Cox regression identified respiratory failure,number of AECOPD exacerbations within one year≥3 times,low FEV1%pred,and high levels of CRP,HSP70,KLF5,and MIP-2 as independent risk factors for RSV infection in AECOPD patients(P<0.05).As the condition worsens,the levels of serum HSP70,KLF5,and MIP-2 gradually increase(P<0.05).The poor prognosis subgroup had prominently higher serum levels than the good prognosis subgroup(P<0.05).Patients with high levels of HSP70,KLF5,and MIP-2 have a greater risk of poor prognosis and a lower 28-day progression-free survival rate(P<0.05).The areas under the ROC curve(AUC)predicted by the combination of the three indicators was significantly better than that predicted by a single indicator(P=0.015).Conclusion Respiratory failure,the number of AECOPD exacerbations within one year≥3 times,low FEV1%pred,high CRP level,and high serum levels of HSP70,KLF5,and MIP-2 are risk factors for RSV infection in AECOPD patients.Serum levels of HSP70,KLF5,MIP-2 are closely related to disease severity and prognosis in AECOPD patients with RSV infection.The combined detection of the three biomarkers has significant predictive value for patient prognosis,which is helpful for early clinical assessment and the formulation of intervention strategies.

Objective To elucidate the mechanism of Polygonatum kingianum water extract(PW)on the proliferation and colonization of Lactobacillus reuteri 1.2838,the differential expression of genes associated with proliferation,the quorum sensing signal molecule autoinducer-2(AI-2),and stress resistance were detected.Method L.reuteri 1.2838 was anaerobically cultured at 37℃in MRS medium supplemented with 0.0126 g·mL-1 PW,and the growth curve was subsequently plotted.The quantification of AI-2 production was conducted using the bioluminescence assay with Vibrio harveyi BB170.Transcriptome sequencing was executed using Illumina HiSeq technology,followed by the identification of differentially expressed genes.The expression profiles of these genes were analyzed,and real-time quantitative PCR was employed for validation.Results Incubation with PW resulted in increased proliferation and AI-2 production capacity of L.reuteri 1.2838.Transcriptome sequencing revealed 425 genes with significant differential expression,comprising 253 upregulated and 172 downregulated genes.Post GO and KEGG annotation analysis,genes related to L.reuteri 1.2838 proliferation,including pdhA,pshB,dlat,dld,genes pertinent to AI-2 production such as luxS,sec,and genes linked to the strain's stress resistance,groEL,groES,gltC,exhibited an upregulated expression pattern.Conclusion PW facilitates the proliferation and colonization of L.reuteri 1.2838 by influencing the tricarboxylic acid cycle,quorum sensing,and the strain's stress resistance,thus offering theoretical support for the development of both Polygonatum kingianum and Lactobacillus reuteri.

Objective To elucidate the mechanism of Polygonatum kingianum water extract(PW)on the proliferation and colonization of Lactobacillus reuteri 1.2838,the differential expression of genes associated with proliferation,the quorum sensing signal molecule autoinducer-2(AI-2),and stress resistance were detected.Method L.reuteri 1.2838 was anaerobically cultured at 37℃in MRS medium supplemented with 0.0126 g·mL-1 PW,and the growth curve was subsequently plotted.The quantification of AI-2 production was conducted using the bioluminescence assay with Vibrio harveyi BB170.Transcriptome sequencing was executed using Illumina HiSeq technology,followed by the identification of differentially expressed genes.The expression profiles of these genes were analyzed,and real-time quantitative PCR was employed for validation.Results Incubation with PW resulted in increased proliferation and AI-2 production capacity of L.reuteri 1.2838.Transcriptome sequencing revealed 425 genes with significant differential expression,comprising 253 upregulated and 172 downregulated genes.Post GO and KEGG annotation analysis,genes related to L.reuteri 1.2838 proliferation,including pdhA,pshB,dlat,dld,genes pertinent to AI-2 production such as luxS,sec,and genes linked to the strain's stress resistance,groEL,groES,gltC,exhibited an upregulated expression pattern.Conclusion PW facilitates the proliferation and colonization of L.reuteri 1.2838 by influencing the tricarboxylic acid cycle,quorum sensing,and the strain's stress resistance,thus offering theoretical support for the development of both Polygonatum kingianum and Lactobacillus reuteri.

Objective To investigate the risk factors for short-term prognosis in patients with HBV-related acute-on-chronic liver failure (ACLF). Methods A retrospective analysis was performed for the clinical data of 119 patients with HBV-related ACLF who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from October 2019 to October 2020, and according to their survival status on day 90, they were divided into death group and survival group. The patients were given antiviral therapy with entecavir or tenofovir. Related clinical data were collected, including alanine aminotransferase (ALT), aspartate aminotransferase, cholinesterase (ChE), albumin (Alb), cholesterol, alpha-fetoprotein, and HBV DNA at baseline, as well as the incidence rate of important complications. Model for End-Stage Liver Disease (MELD) score was also calculated. The t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-squared test was used for comparison of categorical data between two groups; a logistic regression analysis was used to investigate the influencing factors for the 90-day prognosis of patients with HBV-related ACLF and establish a new predictive model; the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of the new model in predicting the prognosis of HBV-related ACLF. Results Of all patients, 33 died within 90 days, resulting in a mortality rate of 27.7%. There were significant differences between the survival group and the death group in age, ALT, Alb, ChE, MELD score, and incidence rates of hepatic encephalopathy, primary peritonitis, and hepatorenal syndrome (all P < 0.05). The logistic regression analysis showed that baseline hepatic encephalopathy (odds ratio [ OR ]=10.404, 95% confidence interval [ CI ]: 2.522-42.926, P =0.001), serum Alb at baseline ( OR =0.853, 95% CI : 0.764-0.952, P =0.005), and MELD score at baseline ( OR =1.143, 95% CI : 1.036-1.261, P =0.008) were independent predictive factors for the short-term prognosis of patients with HBV-related ACLF. A new predictive model was established based on the combination of these three indices, and the ROC curve analysis showed that this new model had an area under the curve of 0.833, while MELD score had an area under the ROC curve of 0.672. Conclusion As for the evaluation of the 90-day prognosis of patients with HBV-related ACLF, the new prognostic model established based on hepatic encephalopathy, Alb, and MELD score has a better predictive value than MELD score alone.

Objective:To investigate the expression levels and internal relations of matrix metalloproteinase-9(MMP-9), interleukin(IL)-1β and tissue inhibitor of metalloproteinase-1(TIMP-1) within 24 h after cerebral hypoxia and ischemia(HI) in neonatal rats.Methods:SD rats aged 7 days were randomly divided into HI group( n=40), and sham operation group(sham group, n=40). The HI models were established and divided into 5 subgroups with those at 8 cases in each group at 5 postoperative time points(0, 4, 8, 12, 24 h). Pathological changes of cerebral cortex were observed by HE staining, and the expressions of MMP-9, IL-1β and TIMP-1 were detected by Western blot and RT-PCR.In addition, the hypoxia models of mouse hippocampal neuron HT22 cells were established.With adding MMP-9 inhibitor and MMP-9 agonist, the relations among MMP-9, IL-1β and TIMP-1 were further confirmed. Results:Slight nuclear abnormalities and cell body swelling occurred in cerebral cortex at 4 h after HI, and neuronal eosinophilic changes were most obvious at 12 h. Compared with those at 8 h and 12 h, the expressions of MMP-9 and IL-1β at protein and mRNA level significantly increased at 24 h after HI( P<0.01). While MMP-9 inhibitor was added to HT22 cells under hypoxia at 4 h, IL-1β mRNA expression was down-regulated. Conclusion:In the early stage of hypoxic ischemic encephalopathy in newborn rats, the expressions of MMP-9 and TIMP-1 are time-dependent.Inhibition of MMP-9 expression could reduce the level of Interleukin-1β.

Objective:To evaluate and improve the performance of the newborn screening program for primary carnitine deficiency (PCD) based on tandem mass spectrometry and to investigate the incidence of PCD and molecular characteristics of SLC22A5 gene in Guangzhou.Methods:A total of 200 180 neonates born in Guangzhou from 2015 to 2019 were enrolled into the newborn screening program for PCD by tandem mass spectrometry at Guangzhou Newborn Screening Center. The positive results of screening for PCD was defined as free carnitine (C0) less than 10 μmol/L with decreased acylcarnitine species in dried blood spots of three to seven days after birth. Screen-positive newborns and their mothers were recalled for another blood spot sample. The diagnosis was confirmed based on decreased levels of C0 and acylcarnitine species in recalled blood spots and genetic analysis in SLC22A5 gene sequencing. The utility of using the sum of propionylcarnitine and palmitoylcarnitine (C3+C16) as a biomarker for acylcarnitine species in newborn screening was retrospectively evaluated. The levels of C0 and (C3+C16) at first screening were compared between newborns with PCD and newborns born to mothers with PCD by independent t test. The variant spectrum and known pathogenic variants carrier rate of SLC22A5 in 2 395 healthy children in Guangzhou Women and Children′s Medical Center through whole exon sequencing were analyzed. Results:Among 200 180 neonates, 239 (0.12%) cases were screen-positive for PCD. A total of 37 patients including 15 newborns and 22 mothers had confirmed PCD. The incidence of PCD was 1/13 345 in newborns and 1/9 099 in mothers, respectively. The positive predictive value of this program was 15.5%. Taking cutoff values of C0<8.5 μmol/L or C0 8.5~9.9 μmol/L with (C3+C16)<2 μmol/L, the number of screen-positive cases would be reduced from 810 to 224 without additional false negative case, when compared with cutoff value C0<10 μmol/L only. Both levels of C0 and (C3+C16) at first screening were not significant difference between newborns with PCD and newborns born to mothers with PCD ((6.2±2.4) vs. (5.0±1.8) μmol/L, (1.4±0.4) vs. (1.2±0.5) μmol/L, t=3.826, 0.326; P=0.058, 0.572). Seven PCD mothers experienced moderate fatigue and dizziness in the morning. One of them presented with cardiomyopathy in pregnancy. Genetic analysis of the SLC22A5 gene showed that p.S467C, p.F17L, p.R254X were the three most common variants in newborns with PCD. In PCD mothers and healthy children, the p.S467C, p.F17L and R399W were the three most common whereas the severe variant p.R254X was rare. The population carrier rate for pathogenic variants was 1 in 65 and the estimated incidence of PCD was about 1/16 500. Conclusions:Newborn screening can detect PCD both in newborns and mothers. Adding a quantitative biomarker (C3+C16) <2 μmol/L into the newborn screening program can improve the PCD screen performance. The severe variant p.R253X was common in PCD newborns but rare in PCD mothers and healthy children, indicating that the current screening program maybe failed to detect all PCD newborns and under-estimated the incidence rate of PCD in Guangzhou.

Objective:To evaluate the current status of knowledge and behavior in breast milk collection and storage among nurses in the Neonatal Intensive Care Unit (NICU) , and to explore the factors influencing knowledge and behavior of nurses.Methods:By adopting the convenient sampling method, a total of 175 NICU nurses from ClassⅢ Grade A hospitals in Henan province were selected as the research objects in April 2019. A cross-sectional survey of NICU nurses was conducted using the knowledge and behavior questionnaire on breast milk collection and storage of NICU nurses. A total of 175 questionnaires were issued and 175 were recovered, with a recovery rate of 100%.Results:The total score of knowledge and behavior standards of breast milk collection and storage of 175 NICU nurses was (59.69±8.24) , which was at a low level. Among which, the score of knowledge dimension standard was (43.11±9.74) , and the score of behavior dimension standard was (33.58±5.14) . 85.1% (149/175) NICU nurses had not received special training in breast milk collection and storage, and there were great individual differences in the perception of the working environment of breast milk collection and storage among NICU nurses. The results of multivariate analysis showed that age, working environmentperception score of breast milk collection and storage and training of breast milk collection and storage were the main influencing factors of breast milk collection and storage knowledge behavior of NICU nurses ( P<0.05) . Conclusions:The knowledge and behavior of NICU nurses in breast milk collection and storage need to be improved, especially in breast milk thawing, storage temperature and other issues. Nursing managers should formulate objective and unified breast milk collection and storage systems and procedures and strengthen relevant training for nurses to improve nurses' perception of the working environment of breast milk collection and storage, strengthen relevant knowledge and improve breast milk collection and storage behavior.