OBJECTIVE To investigate the improvement effects of azithromycin on bronchopulmonary dysplasia （BPD） in neonatal rats based on hypoxia-inducible factor-1α（HIF-1α）/HIF-2α/vascular endothelial growth factor （VEGF） pathway. METHODS Sixty newborn SD rats were randomly divided into negative control group （NC）， BPD group， azithromycin group and budesonide group （positive control）， with 15 rats in each group. Rats in NC group were given normal breathing air， while rats in other three groups were exposed to high-concentration oxygen for 14 days to establish BPD rat models. After successful modeling， rats in azithromycin group were intraperitoneally injected with azithromycin 200 mg/kg， and rats in budesonide group were atomized with budesonide 1.5 mg/kg once a day for 14 consecutive days， while rats in BPD group and NC group were not treated. Pathological changes of lung tissue， radial alveolar count and mean alveolar intercept of rats were observed in each group. The white blood cell count in bronchoalveolar lavage fluid （BALF） and the levels of tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， IL-1β， superoxide dismutase （SOD）， catalase （CAT） and malondialdehyde （MDA） were detected； mRNA and protein expressions of VEGF， HIF-1α， HIF-2α were also detected. RESULTS Compared with NC group， the lung tissue in BPD group was obviously damaged； the white blood cell count， average alveolar intercept and the levels of TNF-α， IL-6， IL-1β and MDA were significantly increased； the radial alveolar count， SOD and CAT levels， the relative expressions of VEGF， HIF-1α， HIF-2α mRNA and protein were significantly decreased （P＜0.05）. Compared with BPD group， the changes of the above indexes in azithromycin group and budesonide group were significantly reversed （P＜0.05）. CONCLUSIONS Azithromycin can obviously improve the symptoms of BPD in rats， reduce inflammation and oxidative stress， and exert lung protection， the mechanism of which may be realized by activating HIF-1α/HIF-2α/VEGF pathway.

Periodontology is one of the important disciplines in oral clinical medicine, which covers a wide range of subjects and intersects with many basic disciplines. Under the environment of the implementation of modular teaching in Shanghai Jiao Tong University School of Medicine, the assessment method with separate propositions for the teaching and research section is still adopted. There is a mismatch between the assessment mode and the curriculum setting; the basic subject propositions are difficult to be combined with clinical cases; the knowledge point assessment is single, and the students' ability to integrate the knowledge points cannot be assessed. The development and construction of the comprehensive examination database for periodontology was based on curriculum integration, gathering the teaching backbones of various disciplines, focusing on periodontology, radiating all related disciplines, unifying the proposition outline, proposition type, proposition principle, combining with relevant knowledge points of various disciplines based on clinical cases, and tried to apply to clinical students majoring in stomatology. The use of the examination database promotes students' ability to flexibly apply theoretical knowledge to clinical case analysis, further promotes the reform of modular teaching, lays a solid foundation for future clinical work, and meanwhile provides an important basis for directions of the teaching and research section.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective:To explore the value of red blood cell distribution width (RDW) in evaluating the severity of patients infected with novel coronavirus Delta variant.Methods:A total of 28 patients infected with novel coronavirus Delta variant in designated hospital treated by the First Affiliated Hospital of Xi'an Jiaotong University medical team from December 2021 to January 2022 were enrolled (23 cases of common type, 4 severe and 1 critical cases). The detailed clinical data of patients was collected. Then, Pearson's correlation analysis was used to identify the blood examination indexes which affected the arterial partial pressure of oxygen (PaO 2) and arterial partial pressure of carbon dioxide (PaCO 2). According to the median standard deviation of red blood cell distribution width (RDW-SD, 42.5 fL), 28 patients were divided into low RDW-SD group (≤ 42.5 fL, 16 cases) and high RDW-SD group (> 42.5 fL, 12 cases), and the immune related indexes of the two groups were compared. Receiver operator characteristic curve (ROC) was drawn to evaluate the predictive value of RDW-SD on the severity of illness of coronavirus disease 2019 (COVID-19). Results:Correlation analysis showed that RDW-SD was the only index related to PaO 2 and PaCO 2 on the first day of admission, which was negative correlation with PaO 2 ( r = -0.379, P = 0.047) and positive correlation with PaCO 2 ( r = 0.509, P = 0.006). The results of effects of different clinical characteristics on RDW-SD level showed that there was no statistically significant difference in RDW-SD between groups with different clinical characteristics (including male/female, ≥ 65 years old/< 65 years old, having/without hypertension, having/without diabetes, smoking/not smoking, having/without hyperpyrexia, with/without fever for 3 days, with/without respiratory symptoms, with/without digestive symptoms). It was suggested that RDW-SD be relatively stable and not affected by the patient's baseline level. The percentage of B cells in low RDW-SD group was higher than that in high RDW-SD group (23.01±3.01 vs. 15.34±5.34, P < 0.05), immunoglobulin G (IgG) level in low RDW-SD group was lower than that in high RDW-SD group (g/L: 11.43±3.20 vs. 15.42±1.54, P < 0.05). The area under ROC curve (AUC) of RDW-SD in evaluating severe cases was 0.83 [95% confidence interval (95% CI) was 0.59-1.06], which was close to multilobularinltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hyper-tension and age (MuL BSTA score; AUC = 0.82, 95% CI was 0.51-1.12) and better than British Thoracic Society's modified pneumonia score (CURB-65 score; AUC = 0.70, 95% CI was 0.50-0.91). Conclusion:RDW-SD has significant evaluative effect on the severity of COVID-19 patients with Delta variants.

Objective: To explore the psychological responses and related factors of college students in Shaan’xi during the outbreak of COVID-19, in order to provide reference for the psychological intervention for college students. Methods: A self-designed general data questionnaire and Psychological Questionnaires for Emergent Events of Public Health(PQEEPH) were sent out to students in public university aged 18 to 28 years by Wechat APP from February 7th to 9th, 2020. Univariate and Logistic analysis were used to analyze the influencing factors associated with NCP. Results: The scores of the five factors on the PQEEPH scale were (0.29±0.48) for depression, (0.27±0.46) for neurasthenia, (0.92±0.60) for fear, (0.15±0.34) for obsessive-anxiety, and (0.26±0.44) for hypochondria，The score of fear factors were the highest. And 15.4% had depressive emotional deviation, accounting for the highest proportion of emotional deviation, and the proportion of compulsive anxiety emotional disorder was highest, which accounting for 6.4%. Logistic regression analysis showed that the higher grades were risk factors for depression (OR=1.61, 95%CI=1.05-2.47), obsessive anxiety (OR=1.56, 95%CI=1.05-2.31) and hypochondria (OR=2.01, 95%CI=1.16-3.47) disorders, Non-medical specialties is risk factor for fear disorders (OR=2.16, 95%CI=1.18-3.95)，not believing oneself to be in danger in the face of the epidemic was a protective factor for five types of mood disorders (OR=0.17-0.51), and residence in towns and villages was a protective factor for neurasticity disorders (OR=0.58, 95%CI=0.38-0.87), the gender of female was the protective factor of hypochondria emotional disorder (OR=0.34, 95%CI=0.19-0.62)(P<0.05). Conclusion During outbreak of COVID-19, psychological intervention counselling and health education of college students should be strengthened. Moreover, psychological problems need be screened in time for intervention, so as to reduce panic and other adverse psychological conditions of students.

Objective: To understand and explore the fear-related emotional disorder and its influencing factors among college students during the prevalence of coronavirus disease 2019 （COVID-19）, in order to provide reference for the further health education and psychological intervention. Methods: A self-designed questionnaire for general data and Psychological Questionnaires for Emergent Events of Public Health （PQEEPH） were typed in www.wjx.cn and sent out to the students of four univerties in Xi'an by WeChat from February 7th to 9th,2020. The status and influencing factors of fear-related emotional disorder in response to COVID-19 were analyzed. Results: Totally 1 546 valid questionnaire were collected. The average age of the students was （20.24±1.60）years old. There were 761 males（49.22%）and 785（50.78%）females;499 medical students （32.27%）and 1 047 non-medical students（67.72%）. The average score of fear dimension was 0.90±0.59,which was the highest in PQEEPH. Moreover, 280 students had fear-related emotional deviance,accounting for 18.11%,and 57 students had fear-related emotional disorder,accounting for 3.69%. The rate of fear-related emotional disorder was significantly higher in non-medical students（4.58%）than in medical students（1.80%,P<0.05）. The rate of fear-related emotional disorder was significantly higher in the students who considered themselves close to COVID-19（4.22%）and at risk of COVID-19（5.45%） than in the students who did not（1.94% and 0.98%,both P<0.05）. Conclusions Totally 3.69% of the students from universities in Xi'an suffer from fear-related emotional disorder in response to COVID-19. The students who do not major in medicine are prone to developing fear-related emotional disorder.

Objective: To investigate the clinical value of plasma brain natriuretic peptide (BNP) levels in predicting the severity of hand, foot and mouth disease (HFMD) in children with coxsackie virus A6 (CV-A6) infection. Methods: A total of 305 children with CV-A6 type HFMD admitted to Xi′an Children′s Hospital from January 2017 to December 2018 were divided into general group (200 cases) and severe group (105 cases) according to the severity of the disease.The receiver operating characteristic curve was used to calculate the value of plasma BNP levels to predict the severe CV-A6 HFMD.Multivariate logistic regression analysis was used to analyze the correlation between the related factors and the severity of CV-A6 HFMD. Results: Compared with the normal group, children in the severe group had statistically significant differences in WBC level, BNP level, neurological symptoms, circulatory disorders, and blood glucose levels(all P<0.05). The optimal cut-off value of the receiver operating characteristic curve for BNP level to predict severe HFMD was 294.85 ng/L.Multivariate logistic regression analysis found that WBC>15×10⁹/L, blood glucose> 8.3 mmol/L, and BNP>294.85 ng/L were related to the severity of CV-A6 HFMD(OR=2.275, P=0.013; OR=6.057, P=0.028; OR=1.008, P<0.001). Conclusion BNP>294.85 ng/L is closely related to the severity of CV-A6 HFMD and has predictive value.It is an early warning factor for the severity of CV-A6 HFMD.

Objective: To understand the etiological and clinical characteristics of children with severe hand, foot and mouth disease (HFMD) in Xi′an in 2018, and to provide the evidence for clinical diagnosis and treatment. Methods: The children with severe HFMD admitted at Xi′an Children′s Hospital from January to December 2018 were selected as the research objects.Clinical data were collected, and the anal swab were detected by adopting real time(RT)-polymerase chain reaction(PCR). Results: Ninety-five cases of HFMD were treated in Xi′an Children′s Hospital in 2018, of which 92 cases were severe and 3 cases were critical.Eighty-seven cases were positive for enterovirus nucleic acid, 30 cases were enterovirus 71(EV71)(31.6%), 39 cases were coxsackievirus A6(CA6) (41.0%), 3 cases were CA16(3.2%), 2 cases were CA10(2.1%) and 13 cases were other enteroviruses (13.7%). Among 95 patients, the ratio of male to female was 1.1∶1.0; the peak period of incidence of HFMD was from May to July, and the main age of onset of severe HFMD was under 3 years old.The main clinical manifestations were mental retardation, vomiting, irritability, lethargy and convulsion.Severe cases of CA6 are prone to convulsion.The main form of rash in CA6 cases was bullous rash, and demethylation may occur in recovery period.The rash in EV71 cases was small, thick, hard and few.After active treatment, only one child with EV71 infection died because of severe cerebral dysfunction, frequent convulsions and neurogenic pulmonary edema.The other child was discharged with hemiplegia and language dysfunction.The other severe children were cured and discharged from hospital. Conclusions In 2018, CA6 was the main pathogen of severe HFMD in Xi′an, with bullae was the main manifestation of skin rash, and nail removal could occur during convalescence.Critical and death cases were still caused by EV71.

Objective: To investigate the effect and mechanism of G protein coupled receptor 119 (GPR119) in regulating lipid metabolism. Methods: (1) Macrophage THP-1 was induced by oxidized low density lipoprotein (oxLDL) to the formation of lipid foam cells, protein expression of GPR119, hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) were detected by Western blotting. (2) Constructing GPR119 over-expressed and low-expressed plasmids, the plasmids were transfected into THP-1 cells which induced by oxLDL. The lipid content in macrophages was observed by oil red O staining. Cholesterol efflux was detected by liquid scintillation counter. The mRNA and protein expressions of HIF-1α, VEGF were detected by reverse transcription PCR and Western blotting. (3) Constructing GPR119, HIF-1α, and VEGF over-expressed plasmids, then co-transfection of GPR119 and HIF-1α/VEGF plasmids. The lipid content in macrophages was observed by oil red O staining. Cholesterol efflux was detected by liquid scintillation counter. Results: Compared with the control group, the lipid droplets were densely distributed in macrophages, with a large number and volume. The protein expression of GPR119 was significantly decreased and HIF-1α, VEGF were significantly increased in macrophages induced by oxLDL (P<0.05). After over-expression of GPR119, the lipid droplets were sparsely distributed and the number was significantly reduced in macrophages, the lipid droplets were mostly located in the area around the cells. The cholesterol efflux was significantly increased (P<0.01). The mRNA and protein expressions of HIF-1α and VEGF were significantly decreased (P<0.01). On the contrary, in the GPR119 inhibition group, the lipid droplets were densely distributed in macrophages, with a large number and volume. The lipid droplets even covered the nuclei. The cholesterol efflux was significantly reduced (P<0.05). The mRNA and protein expression of HIF-1α, VEGF were significantly increased (P<0.05). After GPR119 were co-expressed with HIF-1α and VEGF, the number of lipid droplets was increased, lipid droplets were dense and bulky in oxLDL-induce macrophages. The cholesterol efflux was inhibited. Conclusion GPR119 can regulate lipid metabolism and possibly by down-regulating the expression of HIF-1α and VEGF.

Objective To explore the safe and effective intravenous anesthetic regimen for intemperants' painless endoscopy.Methods 120 cases of intemperants,aged 25-65 years old,ASA grade Ⅰ or Ⅱ,were randomly divided into 3 groups (n =40):sulfentanyl group (group S),midazolam and sulfentanyl group(group MS),ketamine and sulfentanyl group (group KS).Group S were intravenous injected with sufentanil 0.1 μg/kg,propofol 1-2 mg/kg,etomidate 0.1 mg/kg.Group MS and group KS were additional intravenous injected with midazolam 0.01 mg/kg and ketamine 0.1 mg/kg on the basis of Group S respectively.The occurrence of hypoxia,cough,body movement and blood pressure were recorded,the use of vasoactive drugs and the recovery time were also recorded.Results There are no statistical significant difference of age,gender,and testing time among the three groups (P ＞0.05).Compared with the group S,the total dose of propofol,the incidence of hypoxemia and hypotension,the incidence of body movement and cough reaction in group MS and group KS were all lower (P ＜ 0.01).And compared with the group MS,the patients have lower incidence of hypoxemia and hypotension in group KS (P ＜ 0.05).All the patients were awake well (P ＞ 0.05).Conclusions Small doses of midazolam or ketamine combined with sulfentanyl,propofol and etomidate are safe and effective in the process of anesthesia during endoscopic diagnosis and treatment of intemperants.