Objective: To explore the protective effect and mechanism of Rhodiola rosea(Rho) bionic nanomedicine in rats with acute pancreatitis. Methods: Erythrocyte membrane vesicles(EMV) were used as biomimetic nanomedicine coating materials to construct Rho biomimetic nanomedicine. Meanwhile, rat models of acute pancreatitis were constructed and divided into acute pancreatitis model(AP) group, Rho group, EMV group and Rhodiola rosea erythrocyte membrane vesicles(R-EMV) group. R-EMV group rats were further treated with NLRP3 activator BMS-986299(R-EMV+BMS-986299 group) and inhibitor MCC950(R-EMV+MCC950 group). The changes of abdominal water volume were observed, and serum levels of interleukin(IL-6), IL-1β, endothelin(ET), diamine oxidase(DAO), malondialdehyde(MDA), superoxide dismutase(SOD) and glutathione(GSH) were detected by enzyme-linked immunosorbent assay(ELISA). Hematoxylin-eosin(HE) staining was used to observe the pathological changes of pancreatic tissue. Immunohistochemistry, reverse transcription-polymerase chain reaction(RT-PCR) and Western blot were used to analyze the expression of NOD-like receptor protein 3(NLRP3) and nuclear transcription factor-Kappa B(NF-κB) in pancreatic tissue. Results: The prepared R-EMVs were nearly circular, the average particle size was(244.61±1.08) nm, and the Zeta potential was-(11.13±1.25) mV. At the same time, the EMV could load(58.67±0.79) μg of Rho. Compared with Sham group, the abdominal water volume of rats in AP group was significantly higher(t=33.79,P<0.01), and the levels of peripheral blood immune indexes IL-1β, IL-6, ET and DAO increased(t=38.25, 42.54, 29.20, 34.92, allP<0.01). In AP group, there were obvious tissue hyperemia and edema, widening of lobular space, infiltration of a large number of inflammatory cells, and increased pancreatic pathological score(t=30.06,P<0.01). Compared with AP group, abdominal water volume, dry-wet weight ratio of pancreas, pathological score, amylase and lipase levels in Rho group decreased(F=1 523.7, 543.3, 839.9, 446.1, 172.2,P<0.05). Compared with other groups, the levels of serum IL-1β, IL-6, ET and DAO in AP group decreased to some extent. Compared with AP group, NF-κB p65 and NLRP3 protein levels and NF-κB and NLRP3 immunohistochemical staining scores decreased in R-EMV group(t=24.54 and 26.91, bothP<0.001). At the same time, the levels of serum IL-1β, IL-6, ET, DAO, MDA, SOD and GSH in R-EMV+MCC950 group were significantly lower than those in AP group, R-EMV group and R-EMV+BMS-986299 group. Conclusion R-EMV has a good pancreatic protection effect in acute pancreatitis, which is related to reducing the activity of NF-κB/NLRP3 pathway and down-regulating the expression of inflammatory factors such as IL-6 and oxidative stress indicators such as MDA.

Objective To investigate the performance of a nomogram model established based on clinical indices and magnetic resonance imaging(MRI)signs in determining the traditional Chinese medicine(TCM)syndrome types of primary liver cancer.Methods A retrospective analysis was performed for the clinical data of 138 patients with primary liver cancer who were hospitalized in The Affiliated Hospital of Shaanxi University of Chinese Medicine from September 2018 to July 2023,and the patients were divided into excess syndrome group with 84 patients and deficiency syndrome group with 54 patients.All patients underwent Gd-EOB-DTPA contrast-enhanced MRI scan before treatment.The independent-samples t test was used for comparison of continuous data between two groups,and the chi-square or the Fisher's exact test was used for comparison of categorical data between groups.A Logistic regression analysis was used to investigate the independent predictive factors for the TCM syndrome type of primary liver cancer,and a nomogram model was established.The patients were randomly divided into training group with 110 patients and validation group with 28 patients at a ratio of 8∶2,and the calibration curve,the receiver operating characteristic(ROC)curve,and the decision curve were used to evaluate the clinical performance of this model.Results There were significant differences between the excess syndrome group and the deficiency syndrome group in neutrophils,lymphocyte count(LYM),platelet count,albumin(Alb),neutrophil-lymphocyte ratio(NLR),prothrombin time(PT),alpha-fetoprotein(AFP),direct bilirubin(DBil),indirect bilirubin,total bilirubin,presence or absence of portal vein invasion,number of tumors,hepatobiliary tumor signal,and apparent diffusion coefficient(ADC)(all P<0.05).The Logistic regression analysis showed that AFP(odds ratio[OR]=0.003,95%confidence interval[CI]:0.000—0.052,P<0.001),PT(OR=0.032,95%CI:0.004—0.286,P=0.002),LYM(OR=0.032,95%CI:0.004—0.286,P=0.002),Alb(OR=0.009,95%CI:0.001—0.163,P=0.001),NLR(OR=0.040,95%CI:0.003—0.457,P=0.010),DBil(OR=0.014,95%CI:0.001—0.198,P=0.002),portal vein cancer thrombus(OR=0.005,95%CI:0.000—0.115,P=0.001),number of tumors(OR=12.740,95%CI:1.212—133.937,P=0.034),and ADC(OR=19.269,95%CI:3.163—117.387,P=0.001)were independent predictive factors for TCM syndrome types of primary liver cancer.In the training group,the model had an area under the ROC curve(AUC)of 0.962,a sensitivity of 84.1%,a specificity of 92.4%,and an accuracy of 89.1%,and in the validation group,the model had an AUC of 0.848,a sensitivity of 63.6%,a specificity of 100.0%,and an accuracy of 85.7%.The calibration curve showed that the nomogram model had good consistency between predicted syndrome types and actual syndrome types in the training group and the validation group,and the decision curve showed that the nomogram model had good net benefits within a relatively wide range of threshold probability.Conclusion The nomogram model based on clinical indices and MRI signs has good clinical efficacy and value in judging the TCM syndrome type of primary liver cancer.

Objective:To conduct the clinical effect achieved by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis.Methods:From June 2021 to December 2022, a study was conducted on patients with bilateral bromhidrosis in the Department of Plastic Surgery, Jining First People’s Hospital. The study used a self-control method, with one side undergoing axillary flap trimming combined with scraping through small axillary incisions (designated as Group A), while the other side underwent direct axillary flap trimming through central axillary incisions (designated as Group B). Randomization was achieved using a number table method for both sides. In Group A, two short incision lines of 0.5-1.0 cm were designed on both sides of the armpit. These incisions separated all layers of the skin, and excised the sweat glands and fat tissue. Additionally, two drainage openings were left in the surgical area to maintain two drainage tubes through the surgical incision. In Group B, the incision lines of 2-3 cm were designed in the central axillary area. After incision and dissection, four drainage tubes were retained in the operation area. The efficacy evaluation consisted of three aspects: the surgical outcome one month post-operation, categorized as cure, effective, or ineffective; the recurrence of bromhidrosis six months post-operation; and the occurrence of surgical complications. SPSS 25.0 software was used for data analysis, and chi-square test was applied for the comparisons between the two groups in terms of response rate, recurrence rate, and complication rate. A statistically significant difference was determined at the P<0.05 level. Results:A study was conducted on 62 patients, aged between 16 and 35 years, with bilateral bromhidrosis, including 38 males and 24 females. In Group A, 55 patients achieved complete cure, while 7 patients experienced significant improvement, resulting in an overall effectiveness rate of 100%. However, 5 cases of recurrence were observed, with a recurrence rate of 8.1%. Additionally, there were 1 case of subflap hematoma, 2 cases of flap erosion, and 1 case of scar hypertrophy, resulting in a complication rate of 6.5%. In Group B, 58 patients achieved complete cure, while 4 patients experienced improvement, resulting in an overall effectiveness rate of 100%. Three cases of recurrence were reported within 6 months, with a recurrence rate of 4.8%. Furthermore, there were 4 cases of subflap hematoma, 4 cases of flap erosion, 2 cases of flap necrosis, and 4 cases of scar hypertrophy, resulting in a complication rate of 22.6%. Statistical analysis showed no significant difference in treatment response rate ( χ2=0.34, P=0.559) or postoperative recurrence rate ( χ2=0.53, P=1.000) between the two groups. However, the complication rate in Group A was significantly lower than that in Group B ( χ2=6.50, P=0.011). Conclusion:The clinical outcome is satisfactory, achieving a high rate of effectiveness by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis. And the complications are fewer compared to the direct axillary flap trimming through central axillary incisions.

Objective:To conduct the clinical effect achieved by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis.Methods:From June 2021 to December 2022, a study was conducted on patients with bilateral bromhidrosis in the Department of Plastic Surgery, Jining First People’s Hospital. The study used a self-control method, with one side undergoing axillary flap trimming combined with scraping through small axillary incisions (designated as Group A), while the other side underwent direct axillary flap trimming through central axillary incisions (designated as Group B). Randomization was achieved using a number table method for both sides. In Group A, two short incision lines of 0.5-1.0 cm were designed on both sides of the armpit. These incisions separated all layers of the skin, and excised the sweat glands and fat tissue. Additionally, two drainage openings were left in the surgical area to maintain two drainage tubes through the surgical incision. In Group B, the incision lines of 2-3 cm were designed in the central axillary area. After incision and dissection, four drainage tubes were retained in the operation area. The efficacy evaluation consisted of three aspects: the surgical outcome one month post-operation, categorized as cure, effective, or ineffective; the recurrence of bromhidrosis six months post-operation; and the occurrence of surgical complications. SPSS 25.0 software was used for data analysis, and chi-square test was applied for the comparisons between the two groups in terms of response rate, recurrence rate, and complication rate. A statistically significant difference was determined at the P<0.05 level. Results:A study was conducted on 62 patients, aged between 16 and 35 years, with bilateral bromhidrosis, including 38 males and 24 females. In Group A, 55 patients achieved complete cure, while 7 patients experienced significant improvement, resulting in an overall effectiveness rate of 100%. However, 5 cases of recurrence were observed, with a recurrence rate of 8.1%. Additionally, there were 1 case of subflap hematoma, 2 cases of flap erosion, and 1 case of scar hypertrophy, resulting in a complication rate of 6.5%. In Group B, 58 patients achieved complete cure, while 4 patients experienced improvement, resulting in an overall effectiveness rate of 100%. Three cases of recurrence were reported within 6 months, with a recurrence rate of 4.8%. Furthermore, there were 4 cases of subflap hematoma, 4 cases of flap erosion, 2 cases of flap necrosis, and 4 cases of scar hypertrophy, resulting in a complication rate of 22.6%. Statistical analysis showed no significant difference in treatment response rate ( χ2=0.34, P=0.559) or postoperative recurrence rate ( χ2=0.53, P=1.000) between the two groups. However, the complication rate in Group A was significantly lower than that in Group B ( χ2=6.50, P=0.011). Conclusion:The clinical outcome is satisfactory, achieving a high rate of effectiveness by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis. And the complications are fewer compared to the direct axillary flap trimming through central axillary incisions.

Objective:To study the clinical features and treatment strategy of neonatal ureaplasma meningitis.Methods:During 2021, the clinical data of 2 neonates with ureaplasma meningitis treated in Children's Hospital of Hunan Province were retrospectively analyzed. Literature on this subject were searched in the following databases: CNKI, Wanfang Database, Chinese Medical Journal Full-Text Database, CQVIP database, SinoMed, PubMed, Embase and Web of Science (up to March 2022). The key words included “infant”, “neonate”, “newborn”, “ureaplasma”, “mycoplasma urealytium”, “meningitis”, “central nervous system infection”, “brain”. The clinical data, treatment and prognosis of patients from the literature were summarized.Results:Case 1, female, gestational age(GA) 33 +3 weeks, intracranial hemorrhage (ICH) and ventricular dilatation were found on 2 d after birth. The cerebrospinal fluid (CSF) routine and biochemistry tests indicated meningitis, but the CSF culture was negative. No improvement after antibiotic treatment. CSF metagenomic next-generation sequencing (mNGS) and 23S rRNA showed Ureaplasma urealyticum on 30 d after birth. The patient was treated with doxycycline (DOX) for 21 d until mNGS turned negative and DOX was discontinued. However, the disease recurred 23 d later and erythromycin was added with DOX as combined therapy. The patient was followed up until 6 months without neurodevelopmental disabilities. Case 2, male, GA 26 weeks, ICH and ventricular dilatation were found on 10 d after birth. The CSF routine and biochemistry tests indicated meningitis, but the CSF culture was negative. No improvement after antibiotic treatment. CSF mNGS and 23S rRNA showed Ureaplasma parvum. The patient received erythromycin therapy for 32 d and had normal neurodevelopment at 5 months. According to the literature, 43 cases were reported including the 2 cases descirbed above, 17 cases were full-term infants and 26 cases were preterm infants. The median CSF leukocytes, glucose and proteins were 566 cells/mm 3, 0.2 mmol/L and 2.2 g/L. 27 cases were diagnosed based on CSF culture, 6 cases using mNGS, 4 cases with both CSF culture and PCR method and 6 cases with other methods. Macrolides alone were used in 14 cases, macrolides combined with another antibiotic were used in 8 cases, non-macrolide antibiotics were used in 9 cases and 12 cases didn't receive any anti-ureaplasma therapy. All 17 term infants survived, however, 8 cases with hydrocephalus. Among the 26 preterm infants, 8 patients died, 18 patients had periventricular-intraventricular hemorrhage and 15 patients had hydrocephalus. Conclusions:Neonatal ureaplasma meningitis has significantly lower CSF glucose level with hydrocephalus as the common complication. For intracranial infections of unknown etiology and no response to treatment, mNGS is helpful in determining the pathogen.Neonatal ureaplasma meningitis should be treated with macrolides alone or as add-on therapy.

Objective:To study the risk factors and prognosis of pulmonary hypertension(PH) associated with bronchopulmonary dysplasia (BPD) in extremely preterm infants(EPIs).Methods:From January 2020 to December 2021, EPIs [gestational age (GA) <32 w] with BPD admitted to NICU of our hospital were retrospectively assigned into two groups: BPD with late-onset PH(PH group) and BPD without late-onset PH(non-PH group). Their general condition, treatment and prognosis were compared and the risk factors of late-onset PH were analyzed.Results:A total of 229 EPIs with BPD were enrolled, including 24(10.5%) in the PH group and 205(89.5%) in the non-PH group. The PH group had significantly smaller GA [(27.9±2.3) w vs. (28.7±1.8) w], longer mechanical ventilation [42.0(16.0, 84.0) d vs. 9.0(2.0, 23.0) d], longer hospital stay [100.5(86.3, 142.0) d vs. 77.0(56.5, 96.5)d],higher incidence of early-onset PH(54.2% vs. 9.3%) and higher mortality rate(33.3% vs. 9.8%) than the non-PH group ( P<0.05). Multivariate logistic regression analysis showed prolonged mechanical ventilation ( OR=1.046, 95% CI 1.011~1.064), early-onset PH ( OR=5.414, 95% CI 1.796~16.323) were independent risk factors for BPD with late-onset PH. 8(33.3%) patients in the PH group died, including 2 with grade Ⅱ BPD and 6 grade Ⅲ BPD. Conclusions:Prolonged mechanical ventilation and early-onset PH are independent risk factors for late-onset PH in BPD infants. BPD infants with late-onset PH have longer hospital stay, higher mortality and worse prognosis.

Objective:To summarize the situation of dead newborns and their parents after parents gave up treatment, and analyze the reasons and emotional needs of parents who gave up treatment, so as to provide reference for reducing neonatal mortality and negative emotions of parents.Methods:A retrospective study was conducted to collect the data of neonates and mothers who died after giving up treatment reported in Hunan Children′s Hospital from January 2019 to December 2021. The general information, perinatal risk factors, and the incidence of in-hospital diseases were analyzed. Then, semi-structured interviews were conducted with parents of newborns who died after giving up treatment from February to December 2021. Understand why parents give up treatment and their emotional needs.Results:A total of 172 newborns died after giving up were included in the analysis, including 103 males (59.88%) and 74 premature infants (43.02%); Umbilical cord, placenta and amniotic fluid abnormalities were 21 cases (12.21%), 39 cases (22.67%) and 25 cases (14.53%), respectively. Birth asphyxia was 31 cases (18.02%), including severe asphyxia in 18 cases (10.46%); There were 21 (12.21%), 35 (20.35%) and 30 (17.44%) cases of maternal infection in the third trimester, hypertension in pregnancy and diabetes in pregnancy, respectively. The top three causes of death were septicemia (18.02%), congenital malformation (16.86%) and severe pneumonia (10.47%). The main reason why parents give up treatment was that the child′s disease was critical and irreversible, and parents had strong emotional needs for hospice care in their hearts.Conclusions:There are many high risk factors of perinatal death of newborns after giving up treatment. Sepsis is the primary cause of death, and strengthening perinatal health care is fundamental. Parents have a strong demand for hospice care, so it is of practical significance to implement family-centered hospice care model for such special newborns.

Objective:To explore the potential genetic causes of unexplained neonatal encephalopathy.Methods:This retrospective study enrolled 113 infants diagnosed with unexplained neonatal encephalopathy and underwent genetic testing in the Children's Hospital of Hunan Province from January 2019 to May 2021. Perinatal data, clinical manifestations, electroencephalograph, brain MRI findings, genetic information, and prognosis of those patients were analyzed. T-test or Chi-square test were used for data analysis. Results:Of the 113 infants enrolled, 74 (65.5%) were males. The gestational age at birth was (38.6±1.5) weeks, and the birth weight was (2 957±561) g. The most common clinical manifestation was the disturbance of consciousness (83/113, 73.5%), followed by seizures (39/113, 34.5%). There were 38.2% (34/89) of the patients with abnormal brain MRI, and 80.4% (74/92) presented abnormal electroencephalography. Among the 113 infants, 60 (53.1%) had genetic abnormalities, including 48 with single nucleotide variations, eight with copy number variations, and four with chromosome abnormalities. Single nucleotide variations in the 48 patients were classified into syndromic ( n=18, 37.5%), metabolic ( n=16, 33.3%), epileptic ( n=11, 22.9%) and mitochondrial-related genes ( n=3, 6.3%), of which 14 were not included in any database. Among the 103 cases which were successfully followed up until December 31, 2021, 75 (72.8%) had a poor prognosis, including 52 (50.5%) death cases and 23 (22.3%) cases of development retardation. Birth weight and the incidence of seizures in the poor prognosis group were both lower than those in the non-poor prognosis group [(2 876±536) vs (3 254±554) g, t=3.15; 29.3% (22/75) vs 53.6% (15/28), χ2=5.20; both P<0.05], while the incidence of disturbance of consciousness was higher [80.0% (60/75) vs 53.6% (15/28), χ2=7.19, P<0.05]. The proportion of infants with genetic abnormalities in the poor prognosis group was higher than that in the non-poor prognosis group, but the difference was not statistically significant [53.3% (40/75) vs 46.4% (13/28), χ2=0.39, P=0.533]. Conclusions:Genetic abnormality is one of the leading causes of unexplained neonatal encephalopathy. Nucleotide variation is the most common genetic type. Syndromic, metabolic, and epileptic variants are frequently detected in these patients.

Objective:To analyze the accuracy of lung ultrasound and chest X-ray in the diagnosis of neonatal pulmonary disease.Methods:We prospectively collected newborns that needed chest X-ray examination to diagnose pulmonary disease from twelve neonatal intensive care units across the country between June 2019 and April 2020.Each newborn was examined by lung ultrasound within two hours after chest X-ray examination.All chest X-ray and lung ultrasound images were independently read by a radiologist and a sonographer.When there was a disagreement, a panel of two experienced physicians made a final diagnosis based on the clinical history, chest X-ray and lung ultrasound images.Results:A total of 1 100 newborns were enrolled in our study.The diagnostic agreement between chest X-ray and lung ultrasound(Cohen′s kappa coefficient=0.347) was fair.Lung ultrasound(area under the curve=0.778; 95% CI 0.753-0.803) performed significantly better than chest X-ray(area under the curve=0.513; 95% CI 0.483-0.543) in the diagnosis of transient tachypnea of the newborn( P<0.001). The accuracy of lung ultrasound in diagnosing neonatal respiratory distress syndrome, meconium aspiration syndrome, pneumonia and neonatal pulmonary atelectasis was similar to that of chest X-ray. Conclusion:Lung ultrasound, as a low-cost, simple and radiation-free auxiliary examination method, has a diagnostic accuracy close to or even better than that of chest X-ray, which may replace chest X-ray in the diagnosis of some neonatal lung diseases.It should be noted that both chest X-ray and lung ultrasound can only be used as auxiliary means for the diagnosis of lung diseases, and it is necessary to combine imaging with the clinical history and presentation.

Cutinase can degrade aliphatic and aromatic polyesters, as well as polyethylene terephthalate. Lack of commercially available cutinase calls for development of cost-effective production of efficient cutinase. In this study, eight cutinase genes were cloned from Sclerotinia sclerotiorum. The most active gene SsCut-52 was obtained by PCR combined with RT-PCR, expressed in Escherichia coli BL21 and purified by Ni-NTA affinity chromatography to study its characteristics and pathogenicity. Sscut-52 had a total length of 768 bp and 17 signal peptides at the N terminals. Phylogenetic analysis showed that its amino acid sequence had the highest homology with Botrytis keratinase cutinase and was closely related to Rutstroemia cutinase. Sscut-52 was highly expressed during the process of infecting plants by Sclerotinia sclerotiorum. Moreover, the expression level of Sscut-52 was higher than those of other cutinase genes in the process of sclerotia formation from mycelium. The heterologously expressed cutinase existed in the form of inclusion body. The renatured SsCut-52 was active at pH 4.0-10.0, and mostly active at pH 6.0, with a specific activity of 3.45 U/mg achieved. The optimum temperature of SsCut-52 was 20-30 ℃, and less than 60% of the activity could be retained at temperatures higher than 50 ℃. Plant leaf infection showed that SsCut-52 may promote the infection of Banlangen leaves by Sclerotinia sclerotiorum.
Ascomycota/genetics* ; Carboxylic Ester Hydrolases ; Cloning, Molecular ; Phylogeny