Acute lung injury (ALI) is a significant complication of sepsis, characterized by high morbidity, mortality, and poor prognosis. Neutrophils, as critical intrinsic immune cells in the lung, play a fundamental role in the development and progression of ALI. During ALI, neutrophils generate neutrophil extracellular traps (NETs), and excessive NETs can intensify inflammatory injury. Research indicates that Taohe Chengqi decoction (THCQD) can ameliorate sepsis-induced lung inflammation and modulate immune function. This study aimed to investigate the mechanisms by which THCQD improves ALI and its relationship with NETs in sepsis patients, seeking to provide novel perspectives and interventions for clinical treatment. The findings demonstrate that THCQD enhanced survival rates and reduced lung injury in the cecum ligation and puncture (CLP)-induced ALI mouse model. Furthermore, THCQD diminished neutrophil and macrophage infiltration, inflammatory responses, and the production of pro-inflammatory cytokines, including interleukin-1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α). Notably, subsequent experiments confirmed that THCQD inhibits NET formation both in vivo and in vitro. Moreover, THCQD significantly decreased the expression of peptidyl arginine deiminase 4 (PAD4) protein, and molecular docking predicted that certain active compounds in THCQD could bind tightly to PAD4. PAD4 overexpression partially reversed THCQD's inhibitory effects on PAD4. These findings strongly indicate that THCQD mitigates CLP-induced ALI by inhibiting PAD4-mediated NETs.
Extracellular Traps/immunology* ; Acute Lung Injury/immunology* ; Animals ; Sepsis/immunology* ; Drugs, Chinese Herbal/pharmacology* ; Mice ; Neutrophils/immunology* ; Male ; Protein-Arginine Deiminase Type 4/genetics* ; Mice, Inbred C57BL ; Humans ; Disease Models, Animal ; Cytokines/metabolism*

Objective: To investigate the potential efficacy and safety of Lutai Danshen Baishao granules (LDBG) for treating female melasma associated with kidney deficiency and blood stasis patterns. Methods: A randomized, double-blind, placebo-controlled trial was conducted at the Third Central Hospital of Tianjin, China from March to December 2023. A total of 110 female patients with melasma linked to kidney deficiency and blood stasis were enrolled and treated with either LDBG or a placebo twice daily for 60 days. Efficacy was assessed through measures such as the total melasma area, reduced melasma area, reduction rate of melasma area, melasma color score, Melasma Area and Severity Index (MASI) score, and traditional Chinese medicine (TCM) symptom score scale. Safety assessments included routine blood and biochemical tests. Results: Participants in both groups were aged 52–63 years, with no significant differences. After the 2-month intervention, the total melasma area decreased in both groups; however, a greater reduction was observed in the test group [462.50 mm2 (12.81%) vs. 100.00 mm2 (3.11%), P < .001]. Moreover, LDBG treatment significantly reduced the MASI and melasma color scores in the test group (P < .05). The total TCM symptom evaluation score significantly decreased (test group: 6.00 vs. placebo group: 7.00, P = .001), with significant relief in symptoms such as improvement in dark lips, nails, and waist soreness in the test group, compared with that in the placebo group (P < .05). Within-group comparisons revealed that TCM syndrome was significantly alleviated in the test group (P < .05). Conclusion LDBG intervention shows promising effectiveness in reducing female melasma and alleviating TCM syndromes.

We report a family with multiple endocrine neoplasia type 1(MEN1), in which the proband presented with primary amenorrhea and was diagnosed with both a pituitary prolactinoma and an ACTH-secreting adenoma. Genetic testing identified a heterozygous MEN1 gene c. 1449_1476del mutation in the proband, as well as in six additional family members, who exhibited variable clinical phenotypes. Following initial transsphenoidal pituitary surgery, the proband's symptoms and biochemical abnormalities persisted, with elevated ACTH and cortisol levels. Functional imaging using [ 68Ga]-DOTA-TATE PET/CT confirmed residual pituitary tumor tissue, and a second surgery resulted in biochemical remission.

Objective:To develop and validate a perioperative oral care protocol for patients undergoing oral vestibular approach endoscopic thyroid cancer radical surgery, providing practical guidance for clinical nursing.Methods:The protocol was constructed through literature analysis and Delphi expert consultation. A prospective non-randomized controlled study was conducted using convenience sampling, enrolling 60 patients who underwent oral vestibular approach endoscopic thyroid cancer radical surgery at the First Affiliated Hospital with Nanjing Medical University Thyroid Center between August 2023 and May 2024. Participants were divided into control group (from August to December, 2023) and experimental group (from January to May, 2024) based on admission dates with 30 cases in each group. The control group received routine care, while the experimental group received the developed oral care protocolin on the basis of the control group. Postoperative pain scores, mouth-opening difficulties, and oral cleanliness were compared on days 1, 3, and 7 after surgery.Results:The final protocol comprised 7 first-level indicators (team collaboration, health education, preoperative oral assessment, preoperative management, intraoperative management, postoperative management, and discharge follow-up), 17 second-level indicators, and 49 third-level indicators. The control group had 4 males and 26 females, with an age of (29.57 ± 5.34) years; the experimental group had 6 males and 24 females, with an age of (29.87 ± 6.25) years. On postoperative days 1, 3, and 7, the pain scores were 3.87 ± 1.01, 3.30 ± 0.92, and 2.53 ± 0.68 in the control group and 3.20 ± 0.87, 2.10 ± 0.76, and 1.50 ± 0.51 in the experimental group, respectively. The differences between the two groups were statistically significant ( t = 2.89, 5.12, 6.34, all P<0.05). For mouth-opening difficulties, the control group had 6, 13, and 15 patients with grade I on postoperativedays 1, 3, and 7, respectively, while the experimental group had 10, 20, and 25 patients with gradeⅠ. The control group had 20, 14, and 14 patients with gradeⅡonpostoperative days 1, 3, and 7, respectively, while the experimental group had 17, 10, and 5 patients with gradeⅡ. The control group had 4, 3, and 1 patients with grade Ⅲ on postoperative days 1, 3, and 7, respectively, while the experimental group had 3, 0, and 0 patients with grade Ⅲ. There were 0 cases in both groups with grade Ⅳ. The differences between the two groups on postoperative days 3, and 7 were statistically significant ( χ2 = 10.45, 18.67, both P<0.05). For oral cleanliness, the control group had 3, 4, and 5 patients with excellent cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 11, 16, and 19 patients with excellent cleanliness. The control group had 20, 22, and 23 patients with good cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 18, 13, and 10 patients with good cleanliness. The control group had 7 (23.33%), 4 (13.33%), and 2 (6.67%) patients with poor cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 1 (3.33%), 1 (3.33%), and 1 (3.33%) patients with poor cleanliness. The differences between the two groups were statistically significant ( χ2 = 9.19, 11.32, 16.68, all P<0.05). Conclusions:The developed perioperative oral care protocol is scientifically sound, feasible, and practical. Following the intervention, significant decreases in pain scores, alleviation of trismus symptoms, and marked improvements in oral cleanliness were observed in patients compared to pre-intervention assessments, and worth further clinical application.

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 develop and validate a perioperative oral care protocol for patients undergoing oral vestibular approach endoscopic thyroid cancer radical surgery, providing practical guidance for clinical nursing.Methods:The protocol was constructed through literature analysis and Delphi expert consultation. A prospective non-randomized controlled study was conducted using convenience sampling, enrolling 60 patients who underwent oral vestibular approach endoscopic thyroid cancer radical surgery at the First Affiliated Hospital with Nanjing Medical University Thyroid Center between August 2023 and May 2024. Participants were divided into control group (from August to December, 2023) and experimental group (from January to May, 2024) based on admission dates with 30 cases in each group. The control group received routine care, while the experimental group received the developed oral care protocolin on the basis of the control group. Postoperative pain scores, mouth-opening difficulties, and oral cleanliness were compared on days 1, 3, and 7 after surgery.Results:The final protocol comprised 7 first-level indicators (team collaboration, health education, preoperative oral assessment, preoperative management, intraoperative management, postoperative management, and discharge follow-up), 17 second-level indicators, and 49 third-level indicators. The control group had 4 males and 26 females, with an age of (29.57 ± 5.34) years; the experimental group had 6 males and 24 females, with an age of (29.87 ± 6.25) years. On postoperative days 1, 3, and 7, the pain scores were 3.87 ± 1.01, 3.30 ± 0.92, and 2.53 ± 0.68 in the control group and 3.20 ± 0.87, 2.10 ± 0.76, and 1.50 ± 0.51 in the experimental group, respectively. The differences between the two groups were statistically significant ( t = 2.89, 5.12, 6.34, all P<0.05). For mouth-opening difficulties, the control group had 6, 13, and 15 patients with grade I on postoperativedays 1, 3, and 7, respectively, while the experimental group had 10, 20, and 25 patients with gradeⅠ. The control group had 20, 14, and 14 patients with gradeⅡonpostoperative days 1, 3, and 7, respectively, while the experimental group had 17, 10, and 5 patients with gradeⅡ. The control group had 4, 3, and 1 patients with grade Ⅲ on postoperative days 1, 3, and 7, respectively, while the experimental group had 3, 0, and 0 patients with grade Ⅲ. There were 0 cases in both groups with grade Ⅳ. The differences between the two groups on postoperative days 3, and 7 were statistically significant ( χ2 = 10.45, 18.67, both P<0.05). For oral cleanliness, the control group had 3, 4, and 5 patients with excellent cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 11, 16, and 19 patients with excellent cleanliness. The control group had 20, 22, and 23 patients with good cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 18, 13, and 10 patients with good cleanliness. The control group had 7 (23.33%), 4 (13.33%), and 2 (6.67%) patients with poor cleanliness on postoperative days 1, 3, and 7, respectively, while the experimental group had 1 (3.33%), 1 (3.33%), and 1 (3.33%) patients with poor cleanliness. The differences between the two groups were statistically significant ( χ2 = 9.19, 11.32, 16.68, all P<0.05). Conclusions:The developed perioperative oral care protocol is scientifically sound, feasible, and practical. Following the intervention, significant decreases in pain scores, alleviation of trismus symptoms, and marked improvements in oral cleanliness were observed in patients compared to pre-intervention assessments, and worth further clinical application.

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.

We report a family with multiple endocrine neoplasia type 1(MEN1), in which the proband presented with primary amenorrhea and was diagnosed with both a pituitary prolactinoma and an ACTH-secreting adenoma. Genetic testing identified a heterozygous MEN1 gene c. 1449_1476del mutation in the proband, as well as in six additional family members, who exhibited variable clinical phenotypes. Following initial transsphenoidal pituitary surgery, the proband's symptoms and biochemical abnormalities persisted, with elevated ACTH and cortisol levels. Functional imaging using [ 68Ga]-DOTA-TATE PET/CT confirmed residual pituitary tumor tissue, and a second surgery resulted in biochemical remission.

Objective:To examine the effect of short-term regular aerobic exercise on physical fitness of children with pulmonary with atresia ventricular septal defect after radical biventricular treatment.Methods:This was a prospective self pre-and post-control observation study. The subjects performed regular aerobic exercise for 10 days according to the exercise prescription. Body composition measurement and cardiopulmonary exercise test[lung ventilation function, maximum oxygen uptake(VO 2max), maximum oxygen pulse(O 2/HR max), ventilation oxygen uptake efficiency(OUES), exercise load time], 6 min walking distance(6MWD), sports psychometric test, motor function screening test and fitness test, were collected. The changes of test parameters and scale scoring before and after exercise were analyzed and compared. Results:A total of 7 children with PA/VSD after biventricular surgery were enrolled. The age ranged 8.2-16.2 years old, and there were 2 males and 5 females. VO 2max[(1 196.71±395.31)ml/min vs.(1 297.43±425.73)ml/min, P=0.031], O 2/HRmax[(82.43±7.53)ml/beat vs.(91.57±6.95)ml/beat, P<0.001]increased after exercise. The exercise load time was significantly increased compared with that before intervention[(476.43±35.73)s vs.(531.43±45.76)s, P=0.002]. Resting heart rate before exercise( P=0.013) and peak respiration exchange ratio(PeakRER, P=0.021) were significantly lower. Body composition tests suggest weight, intracellular water, protein and muscle content of lower limb were higher( P<0.05). The motor function score was higher than before( P=0.015); the score of sports fear was lower than before( P=0.009). There was no significant difference in lung capacity and 6-minute walking distance before and after exercise( P>0.05). There were no cardiovascular events during the study period. Conclusion:Short-term regular aerobic exercise for children with PA/VSD after biventricular surgery can improve exercise tolerance, increase lower limb muscle content, improve exercise fear and exercise function, and has good safety and feasibility.

Objective To investigate the clinical manifestations,molecular genetics and gonadal pathol-ogy characteristics of patients with disorders of sex development(DSD),and to summarize the clinical experi-ence of identifying rare diseases from common symptoms.Methods The clinical data of 416 patients with DSD diagnosed and treated in the multidisciplinary center of DSD of Guangzhou Women and Children's Medical Cen-ter from May 2018 to August 2023 were retrospectively analyzed,summarized and discussed.Results Accord-ing to chromosome karyotype,416 cases of DSD were classified into three types:92 cases(22.1％)of abnormal sex chromosome karyotype,285 cases(68.5％)of 46,XY karyotype and 39 cases(9.4％)of 46,XX karyotype.Among the 92 patients with abnormal sex chromosome karyotype,59 cases were raised as males,18 cases(30.5％)complained of short penis with hypospadias and cryptorchidism.The most common karyotype was 45,X/46,XY(58 cases,63.0％).Among the 285 patients with 46,XY karyotype,238 cases were raised as males,and 63 cases(26.5％)complained of short penis and hypospadias;47 cases were raised as females,and 13 ca-ses(27.7％)complained of inguinal mass.A total of 216 patients with 46,XY karyotype were subjected to whole exome gene detection,and 155 cases(71.8％)were found to have molecular pathogenesis with the clinical phe-notype.Among the 39 patients with 46,XX karyotype,19 cases were raised as males,and 8 cases(42.1％)com-plained of short penis and hypospadias.In the 18 cases of gonad biopsy,17 cases showed testicular tissue in go-nads.Whole exome sequencing was performed in 14 cases.NR5A1 gene heterozygous mutation,SRY gene muta-tion and SOX3 gene mutation were found in 2 cases,respectively(14.3％).Twenty cases were raised as females,and 14 cases(70.0％)complained of clitoral hypertrophy.Gonad biopsy was performed in 8 cases,with 7 cases of ovotestis(87.5％)and 1 case of NR5A1 gene heterozygous mutation(14.3％).Conclusions The etiologies of DSD are complex and diverse,and the clinical manifestations are various,which can be manifested as hypospa-dias,micropenis,cryptorchidism and other common symptoms of the urinary system.Different etiologies have dif-ferent treatment options.Therefore,chromosome karyotype,molecular genetic testing and gonadal pathology can be used to clarify the cause of disease,especially for rare diseases,improve the detection rate,reduce the rate of missed diagnosis,and ensure reasonable treatment,especially sex selection.