Objective To generate mice with whole-body overexpression of human METRNL gene.Methods Based on Cre-loxP system,Dppa3-Cre mice were mated with Rosa26-LSL-METRNL knock-in mice(R26-LSL-METRNL+/-)to generate R26-L-METRNL+/-mice.The genotypes of the offsprings were identified,and tissues of the blood,heart,liver,spleen,lung,kidney,brain,white adipose and muscle were collected.The expression of human METRNL gene in mice was investigated by quantitative real-time PCR,western blot and enzyme linked immunosorbent assay.Results Compared with wild type control mice,human METRNL in R26-L-METRNL+/-mice significantly expressed at both mRNA and protein levels in tissues,with abundant METRNL protein in blood.Conclusion The mouse model overexpressing human METRNL gene(R26-L-METRNL+/-mouse)was successfully constructed.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To evaluate the role of hippocampal prostaglandin-endoperoxide synthase 2 (PTGS2) in baicalin-induced reduction of cognitive dysfunction after cerebral ischemia-reperfusion injury (CIRI) in mice.Methods:Thirty healthy male C57BL/6 mice, aged 16 weeks, weighing 20-25 g, were divided into 5 groups ( n=6 each) using a random number table method: control group (C group), CIRI group, baicalin+ CIRI group (B+ CIRI group), overexpression of PTGS2+ CIRI group (PTGS2+ CIRI group), and overexpression of PTGS2+ baicalin+ CIRI group (PTGS2+ B+ CIRI). In B+ CIRI group and PTGS2+ B+ CIRI group, baicalin-liposome 0.2 ml was injected through the tail vein, and the CIRI model was established 1 week later. In PTGS2+ CIRI group and PTGS2+ B+ CIRI group, PTGS2-overexpressed adeno-associated virus 1.2 μl was injected into the hippocampus, and the CIRI model was established 4 weeks later. CIRI model was established by using the transient (50 min) bilateral common carotid artery occlusion/reperfusion. On the 12th day after developing the model, the spatial learning and memory ability was evaluated using Morris water maze test. The expression of PTGS2 in the hippocampus was detected by Western blot, and the expression of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β), IL-6, Iba-1 and CD68 mRNA in the hippocampus was detected by quantitative real-time polymerase chain reaction. Results:Compared with C group, the escape latency was significantly prolonged, the time spent in the target quadrant was shortened, the number of crossing the original platform was reduced, and the expression of PTGS2 and expression of Iba-1, CD68, TNF-α, IL-1β and IL-6 mRNA in the hippocampus was up-regulated in CIRI group ( P<0.05). Compared with CIRI group, the escape latency was significantly shortened, the time spent in the target quadrant was prolonged, the number of crossing the original platform was increased, and the expression of PTGS2 and expression of Iba-1, CD68, TNF-α, IL-1β and IL-6 mRNA in the hippocampus was down-regulated in B+ CIRI group, and the escape latency was significantly prolonged, the time spent in the target quadrant was shortened, the number of crossing the original platform was reduced, and the expression of PTGS2 and expression of Iba-1, CD68, TNF-α, IL-1β and IL-6 mRNA in the hippocampus was up-regulated in PTGS2+ CIRI group ( P<0.05). Compared with B+ CIRI group, the escape latency was significantly prolonged, the time spent in the target quadrant was shortened, the number of crossing the original platform was reduced, and the expression of PTGS2 and expression of Iba-1, CD68, TNF-α, IL-1β and IL-6 mRNA in the hippocampus was up-regulated in PTGS2+ B+ CIRI group ( P<0.05). Conclusions:The mechanism by which baicalin attenuates cognitive dysfunction after CIRI is related to down-regulation of hippocampal PTGS2 expression and inhibition of neuroinflammation in mice.

Objective To summarize the clinical characteristics of children with drug-induced hypersensitivity syndrome(DIHS)complicated with herpesvirus reactivation,and to promote the early and accurate identification,diagnosis,and treatment of DIHS in children.Methods The medication history,clinical manifestations,treatment,and prognosis of 12 children confirmed DIHS complicated with herpesvirus reactivation in Guangzhou Women and Children's Medical Center between January 2018 and March 2023 were retrospectively analyzed.The changes in hematological parameters,inflammatory indexes,and hepatic and renal function within 5 d before the eruption,5 d,and 6-10 d after eruption were compared.Results Of the 12 patients,the male-to-female ratio was 5∶1,with a median age of 27(interquartile range 20.50-34.75)months.Two or more antibiotics were used at least two to six weeks before onset,with a combination of 3 or more antibiotics in 7 children,and a combined or sequential application of 2 antibiotics in 5 children.The antibiotics included cephalosporins(n=12),semisynthetic penicillins(n=5),vancomycin(n=4)and azithromycins(n=7).All 12 patients presented fever,rashes,and multiple organ involvement.The rashes were red maculopapules in the early stage and then gradually developed into massive fusion exceeding 50%of the whole body.Among them,seven children were accompanied by facial edema,and two had purplish-red facial rashes.11 children suffered from exfoliative dermatitis in the later stage.12 children presented obviously enlarged lymph nodes.Liver involvement was the most common(100%,simple increase of transaminase in four children,cholestasis in six children,and hepatic failure in two children),and lung involvement was found in nine children.Laboratory examination showed no significant increase in leukocytes or eosinophils within 5 d before the eruption,but low levels of atypical lymphocytes.After the eruption,leukocytes,eosinophils,and atypical lymphocytes increased progressively.Inflammatory indexes of hypersensitive C-reactive protein(CRP),procalcitonin(PCT)increased dramatically before and after the eruption.All the children received intravenous immunoglobulin(IVIG)and methylprednisolone,two children were given antiviral therapy,and nine children were treated with multiple plasma exchanges.After treatment,nine children were cured,one developed immune reconstitution syndrome,and two died of hepatic failure.Conclusions Antibiotics are common allergenic drugs for DIHS in children.Its clinical manifestations include fever and rashes,accompanied by multiple organ involvement,such as the liver and lung.When leukocytes,eosinophils,and atypical lymphocytes are progressively elevated after the eruption,DIHS should be highly suspected,herpesvirus activation should be monitored,medication history should be traced,and early active immunotherapy and antiviral therapy should be conducted if necessary.

Flos Trollii is a traditional Chinese medicinal herb in China. The 2020 edition of the Chinese Pharmacopoeia （part 1） did not include the medicinal herb， its source is not clear， and there is a lack of relevantly systematic and comprehensive research. By consulting ancient Chinese herbal medicines， medical books and related literature， the textual research of Flos Trollii was conducted to verify the name， origin and producing area， so as to provide a reference for the clinical application and resource development of Flos Trollii. Through textual research， it could be seen that the name “Jinlianhua” was used as the correct name in the mainstream origin of the past dynasties， and there were still multiple synonyms such as Hanjinlian， Jinmeicao and so on， most of which originated from its growth environment and appearance. According to the distribution of varieties， it could be inferred that the mainstream origin of Flos Trollii in the Qing Dynasty and before was Trollius chinensis Bge. According to historical records， Flos Trollii were mostly produced in northern regions such as Hebei， Inner Mongolia， Shanxi， etc.， which was related to the fact that Flos Trollii liked cloudy， humid and cold environments. Based on the textual research results， the author suggested that the mainstream origin of the past dynasties T. chinensis Bge. should be selected for subsequent collection of Flos Trollii.

The syndrome of dampness stagnancy due to spleen deficiency (DSSD) is relatively common globally. Although the pathogenesis of DSSD remains unclear, evidence has suggested that the gut microbiota might play a significant role. Radix Astragali, used as both medicine and food, exerts the effects of tonifying spleen and qi. Astragalus polysaccharide (APS) comprises a macromolecule substance extracted from the dried root of Radix Astragali, which has many pharmacological functions. However, whether APS mitigates the immune disorders underlying the DSSD syndrome via regulating gut microbiota and the relevant mechanism remains unknown. Here, we used DSSD rats induced by high-fat and low-protein (HFLP) diet plus exhaustive swimming, and found that APS of moderate molecular weight increased the body weight gain and immune organ indexes, decreased the levels of interleukin-1β (IL-1β), IL-6, and endotoxin, and suppressed the Toll-like receptor 4/nuclear factor-‍κB (TLR4/NF-‍κB) pathway. Moreover, a total of 27 critical genera were significantly enriched according to the linear discriminant analysis effect size (LEfSe). APS increased the diversity of the gut microbiota and changed its composition, such as reducing the relative abundance of Pseudoflavonifractor and Paraprevotella, and increasing that of Parasutterella, Parabacteroides, Clostridium XIVb, Oscillibacter, Butyricicoccus, and Dorea. APS also elevated the contents of short-chain fatty acids (SCFAs). Furthermore, the correlation analysis indicated that 12 critical bacteria were related to the body weight gain and immune organ indexes. In general, our study demonstrated that APS ameliorated the immune disorders in DSSD rats via modulating their gut microbiota, especially for some bacteria involving immune and inflammatory response and SCFA production, as well as the TLR4/NF-κB pathway. This study provides an insight into the function of APS as a unique potential prebiotic through exerting systemic activities in treating DSSD.
Rats ; Animals ; NF-kappa B/metabolism* ; Spleen ; Gastrointestinal Microbiome ; Toll-Like Receptor 4 ; Polysaccharides/pharmacology* ; Astragalus Plant/metabolism* ; Immune System Diseases/drug therapy* ; Body Weight

Objective:To explore the related influencing factors of interstitial pneumonia (IP) in B-cell non-Hodgkin lymphoma (B-NHL) patients treated with R-CHOP-like chemotherapy regimen.Methods:The clinical data of 377 CD20 + B-NHL patients in Minhang Branch of Fudan University Shanghai Cancer Hospital from January 2014 to June 2019 were retrospectively analyzed. According to whether rituximab was used, patients were divided into R-CHOP-like chemotherapy group (275 cases) and CHOP-like chemotherapy group (102 cases). The incidence of IP in patients stratified according to different clinical factors was analyzed, and logistic multivariate regression was used to analyze the risk factors of IP. Results:Thirty-eight out of 377 patients (10.08%) developed IP; the incidence rates of IP in the R-CHOP-like chemotherapy group and the CHOP-like chemotherapy group were 13.09% (36/275) and 1.96% (2/102), respectively, and the difference was statistically significant (χ 2 = 10.169, P < 0.01). There were statistical differences in the incidence rates of IP between patients with or without rituximab, with or without liposomal doxorubicin in the regimen, and with or without grade Ⅳ neutropenia occurred during the treatment [13.09% (36/275) vs. 1.96% (2/102), 18.18% (22/ 121) vs. 6.25% (16/256), 15.43% (27/175) vs. 5.45% (11/202), all P < 0.01]. Logistic regression analysis showed that the application of rituximab ( OR = 6.761, 95% CI 1.369-33.711, P = 0.020) and grade Ⅳ neutropenia ( OR = 7.443, 95% CI 2.132-8.199, P = 0.001) were independent risk factors for the occurrence of IP. Conclusions:R-CHOP-like chemotherapy regimen increases the occurrence of IP in patients with B-NHL. The use of rituximab and grade Ⅳ neutropenia are independent risk factors for the occurrence of IP.

Objective: To investigate the diagnosis, treatment and prognosis of nonodontogenic periapical lesions and to provide a reference for clinical diagnosis and treatment. Methods: A case of a patient with right upper molar pulp with apical penetration and local occlusion admitted to the West China Stomatological Hospital of Sichuan University was retrospectively analyzed, and the curative effect of microapical surgery and pith preservation was also analyzed. Results : The imaging features of tooth 16 showed periradicular radiolucency combined with local radiopaque lesions around the distal buccal apical area. Endodontic microsurgery was performed under local anesthesia. Soft tissue coverage was observed in the distal buccal apical area during the surgery, and no radiopaque tissue was detected. The distal buccal root apex was cut by 3 mm, and mineral trioxide aggregate was used for root-end backfilling. The postoperative pathological results revealed fibrous connective tissue. One-week recall X-ray examination showed tight root-end backfilling and no periradicular radiolucency; an electrical test of pulp vitality showed positive results. The four-year follow-up showed that there was no discoloration in tooth 16 and no significant difference in thermal and electrical tests of pulp vitality compared with control teeth. Combining the clinical manifestations, imaging features, surgical exploration results and pathological reports, the case was most likely to be cemental hypoplasia. Through the literature review, the treatment and healthy pulp preservation of such cases by endodontic microsurgery under the premise of preserving teeth has not been reported. Conclusion For maxillary posterior teeth with periapical lesions but healthy pulp, accurate estimation of pulp status, endodontic microsurgical exploration and application of bioactive materials can achieve vital pulp preservation while removing the lesions.

Objective To investigate the relationship between peripheral blood thyroxine levels and cardiac function in elderly patients with chronic heart failure.Methods Seventy patients with chronic heart failure admitted into our hospital from January 2016 to December 2017 were enrolled as the study group,and 70 healthy subjects were collected as the control group.Left ventricular ejection fraction(LVEF)and serum thyroxine levels were measured in both groups.Results LVEF,serum levels of total triiodothyronine(TT3)and total thyroxine(TT4)were lower in the study group than in the control group[(37.3±2.4)％ vs.(58.5 ± 5.3) ％,(87.4 ± 8.7) mmol/L vs.(120.8±10.4) mmol/L,(8.6±1.7)mmol/L vs.(10.1 ± 1.3)mmol/L,t =30.486,20.609 and 5.864,P =0.000].LVEF,TT3 and TT4 in patients with grade lⅡ 、grade Ⅲ and grade Ⅳ Cardiac insufficiency were [(42.3±2.2)％、(37.9± 1.0)％ and(31.8±1.5)％,(104.2± 15.4) mmol/L、(89.7±4.6) mmol/L and(72.0±7.2)mmol/L,(9.3± 1.8)mmol/L、(8.8± 1.3) mmol/L and (8.1 ± 0.9) mmol/L]respectively.Serum levels of TT3 and TT4 and LVEF steadily declined as cardiac dysfunction grew more severe in patients with chronic heart failure(P =0.000).Conclusions Patients with chronic cardiac insufficiency are often combined with euthyroid sick syndrome,and serum levels of TT3 and TT4 can indicate the degree of abnormal cardiac systolic function.Therefore,low serum levels of T3 and T4 can be used as indicators for poor prognosis in patients with chronic heart failure.

Objective To investigate the application of plasma creatine kinase isoenzyme (CK-MB) ,N-ter-minal pro-brain natriuretic peptide(NT-proBNP)and myocardial nutrient-1(CT-1)in the diagnosis of neonatal asphyxia complicating myocardial injury .Methods Eighty cases of neonatal asphyxia in the hospital from Jan-uary to December 2016 were selected ,including 28 cases in the asphyxia non-myocardial injury group ,32 cases in the mild asphyxia myocardial injury group and 20 cases in the severe asphyxia myocardial injury group .Oth-er 80 healthy neonates were selected as the control group .The levels of plasma CK-MB ,NT-proBNP and CT-1 on 1 ,3 ,5 d after birth were measured by adopting the ELISA method .The relationship between plasma CK-MB ,NT-proBNP and CT-1 levels with prognosis in neonatal asphyxia was analyzed .Then the application value of plasma CK-MB ,NT-proBNP and CT-1 in the prognosis evaluation of neonatal asphyxia complicating myo-cardial injury was analyzed by using the receiver operating characteristic (ROC) curve .Results Plasma NT-proBNP ,CK-MB and CT-1 levels in the control group had no statistically significant difference among 1 ,2 ,3 d after birth (P>0 .05) ,but plasma CK-MB ,NT-proBNP and CT-1 levels on postnatal 3 d in the neonatal as-phyxia group reached the peak value ,plasma CK-MB ,NT-proBNP and CT-1 level on postnatal 1 ,3 d in the se-vere asphyxia myocardial injury group and mild asphyxia myocardial injury group were significantly higher than those in the non-myocardial injury group and control group ,and w hich in the non-myocardial injury group were higher than those in the control group ,the differences were statistically significant (P<0 .05) .Plasma NT-proBNP ,CK-MB and CT-1 levels on postnatal 5 d in the non-myocardial injury group and mild asphyxia myocardial injury group returned to normal levels ,w hile w hich in the severe asphyxia myocardial injury group were still higher than those in the other groups ,the differences were statistically significant (P<0 .05) .The levels of plasma CK-MB ,NT-proBNP and CT-1 in the death neonates with neonatal asphyxia were higher than those in the survival neonates ,and the difference was statistically significant (P<0 .05) .The sensitivity and specificity of combined detection of plasma CK-MB ,NT-proBNP and CT-1 for the prognosis diagnosis in neo-nates with asphyxia complicating myocardial injury were higher than that of single index .Conclusion The early determination of plasma CK-MB ,NT-proBNP and CT-1 levels will be helpful to effectively evaluate the myocardial injury severity and prognosis in asphyxia neonates and has an important clinical value .