Acute respimtory distress syndrome(ARDS)is an acute diffuse inflammatory lung injury caused by various internal and external lung injury factors.It has complex pathogenesis,rapid onset and high mortality,which seriously endangers human life and health.Pulmonary fibrosis is one of the important pathologic processes of ARDS occurrence and development,and it is also an important cause of death in ARDS patients.To a certain extent,the severity of pulmonary fibrosis in ARDS is determined by the dynamic balance of macrophage-fibroblast interactions.Therefore,this article aims to review the interaction mechanism of macrophage-fibroblasts in the pro-cess of ARDS pulmonary fibrosis,and provide new methods and ideas for the diagnosis and treatment of ARDS pul-monary fibrosis.

Objective To explore the factors influencing enteral nutrition intolerance in critically ill patients and to develop a risk prediction model to provide medical staff with a tool for early identification of patient intolerance.Methods Domestic and international databases such as CNKI,PubMed and Web of Science were searched and supplemented by searching references and grey literature.The search period was from inception to November 2022.Data were independently screened and extracted by 2 systematically trained researchers,and the quality of the literature was evaluated.Meta-analysis was performed using Review Manager 5.4 software.The OR value of the comprehensive effect of the factors was taken as the coefficient of each factor in the formula,and the natural logarithm of the ratio of intolerance incidence and non-incidence was the constant term of the formula.From December 2022 to June 2023,360 patients who met the inclusion and exclusion criteria in the ICU of a tertiary hospital were collected as a model verification group by convenient sampling method,and the collected clinical data were substituted into the formula to evaluate the discrimination and calibration of the model.Results A total of 13 articles were included.7 influencing factors with more than 3 times of reports and statistically significant results were obtained.For age[OR=0.97,95％CI(0.94,0.99),P=0.010],Acute Physiology and Chronic Health Evaluation scoreⅡ[OR=1.17,95％CI(1.01,1.36),P=0.040],comorbidity with diabetes[OR=1.21,95％CI(1.05,1.40),P=0.008],comor-bidity with neurological diseases[OR=0.85,95％CI(0.74,0.98),P=0.020],mechanical ventilation[OR=3.21,95％CI(1.82,5.66),P＜0.001],using sedative analgesics[OR=2.27,95％CI(1.66,3.10),P＜0.001],using gastric motility drugs[OR=0.23,95％CI(0.15,0.36),P＜0.001].The incidence of enteral nutrition intolerance was 35.00％.The risk prediction model for enteral nutrition intolerance in critically ill patients was logit(P)=-0.619-0.031×age+0.157 × APACHE Ⅱ+0.191 ×comorbidity with diabetes-0.163 ×comorbidity with neurosurgery+0.820 ×using sedatives and analgesics+1.166×mechanical ventilation-1.470×using gastric dynamic drugs.The area under the receiver operating characteristic curve of the model was 0.864.The maximum Youden index was 0.589.The sensitivity was 0.922.The specificity was 0.667.The corresponding clinical diagnostic threshold was 0.536.Hosmer-Leme-show test x2=13.410,P=0.098.Brier score was 0.195.Conclusion The risk prediction model of enteral nutrition intolerance in critically ill patients based on large sample evidence-based medicine is universal,scientific and practical.It provides a tool for medical staff to identify patients with enteral nutrition feeding intolerance in ICU.

Autism spectrum disorder（ASD）is a heterogeneous group of neurodevelopmental disorders.The prevalence of ASD increases year by year.Sleep disorder is the common comorbidity of ASD.The pathogenesis is still unknown.The imbalance of excitation / inhibition（E/I）and neuroplasticity changes are the possible pathogenesis of ASD.Early childhood sleep is an important factor affecting E/I balance and neuroplasticity.ASD and sleep disorder may share common pathogenesis.Various genetic variants（such as Shank3，SynGAP，et al）and related chromosomal disease（such as 16p11.2 deletion）and their associated syndromes such as Rett syndrome，Smith-Magenis syndrome，and Angelman syndrome，ect，all manifest both ASD and sleep disorder phenotypes.In addition，melatonin，oxytocin，hypothalamic hormone，serotonin，etc，may participate in the neural pathways of sleep disorder，ASD pathology and neuroplasticity，promoting the incidence of ASD and sleep disorder.Some treatments such as supplementing with melatonin，oxytocin，zinc，iron，and dietary supplements can improve the clinical symptoms of ASD while treating sleep disorder in children with ASD.This article reviews the mechanism of comorbid sleep disorder in children with ASD to improve clinical diagnosis and treatment.

Objective:To assess the diagnostic performance of serum anti-toxocara immunoglobulin G (anti-T-IgG) in ocular toxocariasis (OT) patients.Methods:A diagnostic tests. A total of 109 patients (109 eyes) with clinically-suspected OT who treated in Department of Ophthalmology of Xuzhou First People’s Hospital from June 2015 to December 2022 were included. Patients were divided into two groups, 76 with OT and 33 with non-OT, according to the clinical manifestations and Goldmann-Witmer coefficient. Paired serum and intraocular fluid samples from each patient were collected and analyzed for specific anti-T-IgG using enzyme linked immunosorbent assay. Mann-Whitney test was performed for comparison between groups. The area under the receiver operating characteristic curve (ROC) was used to assess the diagnostic performance of serum anti-T-IgG. Kappa analysis was performed to examine the consistency of serum or intraocular fluid anti-T-IgG positive rate with OT diagnostic result. Spearman’s rank correlation test was performed to assess the association.Results:Compared with the non-OT group, the proportions of children and history of exposure to cats and dogs ( χ2=9.785, 12.026) were significantly higher in OT group, and the differences were statistically significant ( P<0.01). The positive rate ( χ2=24.551) and U value ( Z=-4.379) of serum anti-T-IgG in OT group were higher than those in non-OT group, and the differences were statistically significant ( P<0.000 1). The recommended serum anti-T-IgG cut-off value of 11 U had 0.72 sensitivity, 0.79 specificity, 0.89 positive predictive value, 0.55 negative predictive value, and 0.77 area under the ROC with 95% confidence interval ( CI) 0.669-0.860. Correlation analysis showed that serum anti-T-IgG was positively correlated with intraocular fluid anti-T-IgG ( r s=0.520, 95% CI 0.363-0.648, P<0.000 1). The Kappa values of serum and intraocular fluid anti-T-IgG positive rate with OT diagnosis were 0.457 (95% CI 0.292-0.622) and 0.711 (95% CI 0.582-0.840), respectively. The Kappa value of serum anti-T-IgG positive rate with OT diagnosis was lower than that of intraocular fluid. Conclusion:The sensitivity and specificity of serum anti-T-IgG and the consistency between serum anti-T-IgG positive rate and OT diagnosis are low, suggesting that serum anti-T-IgG level cannot be used as a basis for OT diagnosis.

Objective: First-line bevacizumab plus carboplatin and paclitaxel (CP) is approved for stage III/IV ovarian cancer treatment following initial surgical resection, based on global phase III GOG-0218 and ICON7 trials. This study evaluated the efficacy and safety of bevacizumab + CP as first-line ovarian cancer therapy in Chinese patients. Methods: Patients with newly diagnosed, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV epithelial ovarian, fallopian tube, or primary peritoneal cancer post-primary surgery were randomized 1:1 to receive 6 cycles of CP with bevacizumab/ placebo, followed by bevacizumab/placebo maintenance until unacceptable toxicity or disease progression. Primary endpoint was investigator-assessed progression-free survival (PFS). Stratification factors were FIGO stage and debulking status (stage III optimally debulked vs stage III suboptimally debulked vs stage IV) and Eastern Cooperative Oncology Group performance status (0 vs 1 or 2). Results: Of randomized patients, 51 received bevacizumab + CP and 49 received placebo + CP. Median PFS was 22.6 months with bevacizumab + CP (95% confidence interval [CI]=18.6, not estimable) and 12.3 months (95% CI=9.5, 15.0) with placebo + CP (stratified hazard ratio=0.30; 95% CI=0.17, 0.53). Treatment-related grade 3/4 adverse events occurred in 46 of 49 (94%) patients receiving bevacizumab + CP, and 34 of 50 (68%) receiving placebo + CP. Conclusion Bevacizumab + CP showed clinically meaningful improvement in PFS vs placebo + CP, consistent with GOG-0218 results. Safety data were aligned with the known bevacizumab safety profile. These results support first-line bevacizumab + CP therapy in Chinese patients with ovarian cancer.

Objective: First-line bevacizumab plus carboplatin and paclitaxel (CP) is approved for stage III/IV ovarian cancer treatment following initial surgical resection, based on global phase III GOG-0218 and ICON7 trials. This study evaluated the efficacy and safety of bevacizumab + CP as first-line ovarian cancer therapy in Chinese patients. Methods: Patients with newly diagnosed, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV epithelial ovarian, fallopian tube, or primary peritoneal cancer post-primary surgery were randomized 1:1 to receive 6 cycles of CP with bevacizumab/ placebo, followed by bevacizumab/placebo maintenance until unacceptable toxicity or disease progression. Primary endpoint was investigator-assessed progression-free survival (PFS). Stratification factors were FIGO stage and debulking status (stage III optimally debulked vs stage III suboptimally debulked vs stage IV) and Eastern Cooperative Oncology Group performance status (0 vs 1 or 2). Results: Of randomized patients, 51 received bevacizumab + CP and 49 received placebo + CP. Median PFS was 22.6 months with bevacizumab + CP (95% confidence interval [CI]=18.6, not estimable) and 12.3 months (95% CI=9.5, 15.0) with placebo + CP (stratified hazard ratio=0.30; 95% CI=0.17, 0.53). Treatment-related grade 3/4 adverse events occurred in 46 of 49 (94%) patients receiving bevacizumab + CP, and 34 of 50 (68%) receiving placebo + CP. Conclusion Bevacizumab + CP showed clinically meaningful improvement in PFS vs placebo + CP, consistent with GOG-0218 results. Safety data were aligned with the known bevacizumab safety profile. These results support first-line bevacizumab + CP therapy in Chinese patients with ovarian cancer.

Objective: First-line bevacizumab plus carboplatin and paclitaxel (CP) is approved for stage III/IV ovarian cancer treatment following initial surgical resection, based on global phase III GOG-0218 and ICON7 trials. This study evaluated the efficacy and safety of bevacizumab + CP as first-line ovarian cancer therapy in Chinese patients. Methods: Patients with newly diagnosed, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV epithelial ovarian, fallopian tube, or primary peritoneal cancer post-primary surgery were randomized 1:1 to receive 6 cycles of CP with bevacizumab/ placebo, followed by bevacizumab/placebo maintenance until unacceptable toxicity or disease progression. Primary endpoint was investigator-assessed progression-free survival (PFS). Stratification factors were FIGO stage and debulking status (stage III optimally debulked vs stage III suboptimally debulked vs stage IV) and Eastern Cooperative Oncology Group performance status (0 vs 1 or 2). Results: Of randomized patients, 51 received bevacizumab + CP and 49 received placebo + CP. Median PFS was 22.6 months with bevacizumab + CP (95% confidence interval [CI]=18.6, not estimable) and 12.3 months (95% CI=9.5, 15.0) with placebo + CP (stratified hazard ratio=0.30; 95% CI=0.17, 0.53). Treatment-related grade 3/4 adverse events occurred in 46 of 49 (94%) patients receiving bevacizumab + CP, and 34 of 50 (68%) receiving placebo + CP. Conclusion Bevacizumab + CP showed clinically meaningful improvement in PFS vs placebo + CP, consistent with GOG-0218 results. Safety data were aligned with the known bevacizumab safety profile. These results support first-line bevacizumab + CP therapy in Chinese patients with ovarian cancer.

Objective To explore the clinical curative effect of azithromycin combined with high-dose vitamin C (VC) in children with Mycoplasma pneumoniae pneumonia (MPP)and its influences on peripheral blood T lymphocyte subsets, serum interleukin (IL)-17, high-sensitivity C-reactive protein (hs-CRP), E2-associated factor 2 (Nrf2) in peripheral blood mononuclear cells and P1 proteins in throat swab. Methods A total of 240 children with MPP confirmed in the hospital were enrolled as observation objects between June 2020 and June 2023. They were randomly divided into high-dose VC group, low-dose VC group and control group, with 80 cases in each group. The control group was treated with azithromycin, low-dose VC group was treated with azithromycin plus low-dose VC, and high-dose VC group was treated with azithromycin plus high-dose VC, the three groups all treated for 2 weeks. The clinical curative effect and duration of clinical symptoms in the three groups were recorded. Before and after treatment, fasting venous blood and throat swabs were collected in the three groups. T lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺) in peripheral blood were detected by flow cytometry. The levels of serum IL-17, hs-CRP and VC were detected by enzyme-linked immunosorbent assay (ELISA). The mRNA levels of Nrf2 protein in peripheral blood mononuclear cells and P1 protein in throat swabs were detected by real-time fluorescence quantitative polymerase chain reaction (qRT-PCR). The adverse reactions during treatment in the three groups were recorded and compared. Results After treatment, time of fever, cough, expectoration and lung moist rale, and length of hospital stay were shorten in high-dose VC group and low-dose VC group when compared with those in the control group (P < 0.05), and were shorten in the high-dose VC group when compared with those in the low-dose VC group (P < 0.05). After treatment, levels of peripheral blood T lymphocyte subsets (CD3⁺, CD4⁺, CD4⁺/CD8⁺) were increased when compared with those before treatment in the three groups (P < 0.05). The levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in the high-dose VC group were higher than those in the low-dose VC group and control group (P < 0.05), and CD4⁺ level in the low-dose VC group was higher than that in the control group (P < 0.05). After treatment, levels of serum IL-17 and hs-CRP were decreased as compared with those before treatment in the three groups (P < 0.05). The levels of serum IL-17 and hs-CRP in the high-dose VC group were lower than those in the low-dose VC and control group, but there was no difference between low-dose VC group and control group (P>0.05). After treatment, levels of serum VC were increased as compared with that before treatment in high-dose VC group and low-dose VC group, and it was higher in the high-dose VC group than low-dose VC group (P < 0.05). There were no differences in IL-17 and hs-CRP between low-dose VC group and control group (P>0.05). After treatment, mRNA levels of Nrf2 protein in peripheral blood mononuclear cells and P1 protein in throat swabs were decreased compared with those before treatment in the three groups (P < 0.05). The expression level of Nrf2 mRNA in the high-dose VC group was higher than that in the low-dose VC group and control group (P < 0.05), but there was no significant difference in mRNA expression of PI protein among the three groups (P>0.05). There were no obvious adverse reactions in any group during treatment. Conclusion Azithromycin combined with high-dose VC can effectively improve clinical symptoms, enhance immunity, reduce IL-17 and hs-CRP levels, maintain Nrf2 mRNA level and improve clinical curative effect in MPP children, and has higher safety.

Objective To investigate the effect of Shenqi Yizhi Granules on brain structure and function in prodromal Alzheimer disease（pAD） under hypoxic conditions based on MRI. Methods A total of 77 female Han Chinese patients， aged 50‒85 years， who had at least 6 years of education and long-term residence in Qinghai region and met the inclusion criteria for pAD were enrolled as subjects. They were randomly divided into drug group （39 patients receiving Shenqi Yizhi Granules） and control group （38 patients receiving placebo） for 24 weeks of clinical observation. Related data were collected from all subjects， including clinical information， cognitive and neuropsychological assessments， diffusion tensor imaging （DTI） data， and rs-fMRI data. Results Cognitive and neuropsychological assessments showed that after treatment， the drug group had significant increases in MoCA， AVTL， SDMT， and CFT-copy scores and significant reductions in ADAS-cog and GDS scores（P<0.05）， while the control group had a significantly increase in ADAS-cog score （P<0.001）； compared with the control group after treatment， the drug group had significantly higher MoCA and AVTL scores （P<0.05） and a significantly lower ADAS-cog score （P<0.01）. DTI results showed that the drug group had significant increases in axial diffusivity （AD） values of multiple brain regions after treatment （P<0.05）. The results of rs-fMRI showed that after treatment， the drug group had significant increases in the amplitude of low-frequency fluctuation （ALFF） in the right temporal middle gyrus， the triangular part of the inferior frontal gyrus， and the medial cingulate gyrus and paracingulate gyrus and significant reductions in ALFF in the left cerebellar hemisphere Crus1 lobule， superior occipital gyrus， and supramarginal gyrus， and compared with the control group， the drug group had a significant increase in ALFF in the right dorsolateral superior frontal gyrus （P<0.05）. After treatment， the drug group had significant increases in the regional homogeneity （ReHo） values of the left triangular part of the inferior frontal gyrus and the inferior occipital gyrus and a significant reduction in the ReHo value of the left cerebellar hemisphere Crus1 lobule （P<0.05）， and compared with the control group， the drug group had a significant increase in the ReHo value of the left inferior parietal gyrus（P<0.05）. Conclusion Shenqi Yizhi Granules can effectively improve overall cognition and the function of multiple cognitive domains in pAD patients living in plateau regions by modulating the microstructure of white matter and spontaneous neuronal activity in cognitive-related brain regions.

Objective:To construct a perioperative activity program for patients with minimally invasive esophageal cancer under enhanced recovery after surgery (ERAS) concept through literature review and Delphi method.Methods:This was a single-center and interview study. Databases and websites including PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Medive and other databases and websites were searched systematically for articles related to esophageal cancer and upper digestive tract cancer patients′ activities from January 1, 2002 to January 31, 2022. In this single-center and interview study, literature review and group discussion were conducted to form a preliminary activity program, and then Delphi method was used to further demonstrate the practicability and feasibility of the activity program.Results:The overall program and specific intervention methods of perioperative activity program for minimally invasive esophageal cancer patients under ERAS concept were constructed, including 3 first-level indicators, 9 second-level indicators and 35 third-level indicators.Conclusions:Perioperative activity program of patients with minimally invasive esophageal cancer is scientific and reasonable, which can provide reference for medical staff and patients.