Emergency Department,Peace Hospital,Changzhi Medical College
Abstract：
Objective To study the levels of serum enkephalinogen A 119-159(penKid) and insulin-like growth factor binding protein 7(IGFBP7) in patients with severe burns and the predictive value of acute kidney injury(AKI).Method Ninety-eight patients with severe burns admitted to the Emergency Department of Peace Hospital affiliated to Changzhi Medical College from April 2019 to April 2022 were selected as the burn group, and they were divided into AKI subgroups according to whether AKI occurred(n=30) and non-AKI subgroups(n=68), and 60 cases of healthy people who had medical checkups in the hospital at the same time were used as the healthy control group. Enzyme-linked immunosorbent assay(ELISA) was used to detect the levels of serum penKid and IGFBP7 in patients within 24 h after injury; multifactorial logistic regression was used to analyze the influencing factors on the occurrence of AKI in patients with severe burns; and the value of the working characteristic curve of subjects to evaluate the prediction of the occurrence of AKI in patients with severe burns by serum penKid, IGFBP7 and the combination of the two was evaluated.Results The serum penKid and IGFBP7 levels were higher in the burn group than in the control group(t/P=36.873/<0.001, 35.841/<0.001). Acute Physiology and Chronic Health Status Evaluation II scores, sequential organ failure scores, blood creatinine, penKid, and IGFBP7 were higher in the AKI subgroup than in the non-AKI subgroup within 24 h of admission(t/P=4.405/<0.001, 14.070/<0.001, 12.055/<0.001, 8.939/<0.001, 7.827/<0.001). Serum penKid and IGFBP7 were sequentially increased with increasing AKI stage in patients with severe burns(F/P=11.922/<0.001, 17.381/<0.001). SOFA score, APACHE II score, blood creatinine, serum penKid, and IGFBP7 were independent risk factors affecting the development of AKI in patients with severe burns [OR(95% Cl)=1.605(1.168-2.205), 1.765(1.233-2.526), 1.859(1.317-2.625), 1.602(1.268-2.022), 1.594(1.252-2.028)]. The area under the curve(AUC) of serum penKid, IGFBP7 and the combination of the two in predicting the occurrence of AKI in severe burns were 0.804, 0.840, 0.890, respectively, and the AUC of the two in combination in predicting the occurrence of AKI in patients with severe burns was higher than that of the single test(Z=4.348, 3.847,Pall<0.001).Conclusion Elevated levels of serum penKid and IGFBP7 in patients with severe burns are independent influences on the occurrence of AKI, and the combination of the two has a high predictive value for the occurrence of AKI in patients with severe burns.

目的 分析血清纤维蛋白样因子1(FGL1)、长链非编码RNA SChLAP1(LncSChLAP1)评估接受免疫治疗的晚期非小细胞肺癌(NSCLC)患者疗效及预后的价值。方法 选取2019年4月—2022年12月南京市胸科医院呼吸内科诊治晚期NSCLC患者98例为NSCLC组，均接受免疫检查点抑制剂治疗，根据疗效分为有效亚组74例和无效亚组24例，以同期医院健康体检者50例为健康对照组。酶联免疫吸附实验检测NSCLC患者血清FGL1水平，实时荧光定量PCR检测血清LncSChLAP1水平；多因素Logistic回归分析影响晚期NSCLC患者化疗疗效的因素；受试者工作特征曲线分析血清FGL1、LncSChLAP1对晚期NSCLC患者免疫治疗疗效的预测价值；Kaplan-Meier曲线分析血清FGL1、LncSChLAP1对晚期NSCLC患者生存预后的影响。结果 血清FGL1、LncSChLAP1水平比较，NSCLC组高于健康对照组(t/P=57.365/<0.001、28.443/<0.001)。无效亚组TNM分期Ⅳ期比例、血清FGL1、LncSChLAP1水平高于有效亚组(χ2/P=15.375/<0.001,t/P=35.077/<0.001、35.127/<0.001)。血清FGL1、LncSChLAP1高是影响晚期NSCLC患者免疫治疗疗效的独立危险因素[OR(95%CI)=1.327(1.104～1.596)、1.415(1.094～1.829)];血清FGL1、LncSChLAP1及两项联合的AUC分别为0.856、0.792、0.905,两者联合优于各自单独预测效能(Z/P=4.258/0.007、5.119/<0.001)。FGL1高、低表达组1年总体生存率分别为22.92%(11/48)、60.00%(30/50),LncSChLAP1高、低表达组1年总体生存率分别为27.66%(13/47)、54.90%(28/51),FGL1高表达组、LncSChLAP1高表达组晚期NSCLC患者1年累积生存率分别低于FGL1低表达组、LncSChLAP1低表达组(χ2/P=14.180/<0.001、17.553/<0.001)。结论 晚期NSCLC患者血清FGL1、LncSChLAP1升高，是新的评估晚期NSCLC患者免疫治疗疗效及生存预后的血清标志物。

Objective To investigate the regulatory effect of BBR on the intestinal flora of mice with polycystic ovary syndrome(PCOS) and its therapeutic mechanism.Methods In June 2021-June 2022, experiments were carried out in the Experimental Animal Center of Shanghai Fifth People's Hospital Affiliated to Fudan University, 24 clean-grade healthy female C57BL/6J mice, 6 mice were randomly selected as the normal control group, and the remaining 18 mice were used to prepare the PCOS model by letrozole gavage. After successful modeling, the modeled mice were randomly divided into the model(PCOS) group, the positive drug daunin-35(0.2 mg·kg-1·d-1) group and the BBR(100·kg-1·d-1) groups, 6 mice in each group, were given the corresponding drugs for 14 d. Feces were collected from the colon of the mice, and 16S rDNA sequencing was used to detect intestinal flora; mice were weighed, and morphological changes of vaginal exfoliated cells were observed; serum sex hormone and insulin levels were detected; HE staining was used to observe the pathological structure of the ovary; immunohistochemistry was used to detect the expression of Claudin-1 and Occludin in the colon of mice; and Western-blot was used to detect the expression of proteins related to the PI3K/AKT pathway in the ovary tissues. Results The 16S rDNA sequencing showed that the diversity of intestinal flora in the PCOS group was changed compared with that in the normal control group. At the genus level, the abundance of harmful bacteria such as Blautia, Fusobacterium spp., Coccidioides immitis, Coccidioides twins and Clostridium spp. was increased in the PCOS group compared with the normal control group, while the disordered state of the intestinal flora of the mice was improved by BBR, and the abundance of beneficial bacteria, such as Lactobacillus spp., was increased. Compared with the normal control group, mice in the PCOS group had reduced levels of estradiol(E2), follicle-stimulating hormone(FSH), and insulin sensitivity index(ISI)(t/P=2.847/0.017,3.079/0.012, 3.541/0.005), body mass and testosterone(T), luteinizing hormone(LH), LH/FSH, fasting glucose(FPG), fasting insulin(FINS), and insulin resistance index(HOMA-IR) levels were elevated(t/P=4.782/0.013,4.626/0.001,5.703/<0.001, and 2.578/0.028, 4.156/0.002, 3.255/0.009, 7.439/<0.001), disturbances in the motility cycle, light microscopic ovarian structures consistent with PCOS pathology, and decreased expression of Claudin-1, Occludin, p-PI3K/PI3K, and p-AKT/AKT(t/P=3.806/0.003, 3.795/0.004, 13.474/<0.001, 17.285/<0.001). Compared with the PCOS group, E2, FSH, and ISI levels were elevated(t/P=2.389/0.038,3.354/0.007, 3.198/0.010), and body mass and T, LH, LH/FSH, FINS, and HOMA-IR levels were decreased in the darbepoetin-35 group(t/P=3.133/0.011, 3.416/0.007,4.596/0.001,2.327/0.042, 2.908/0.016, 6.096/<0.001), improved motility cycle and ovarian structure, Claudin-1, Occludin, p-PI3K/PI3K and p-AKT/AKT expression was elevated(t/P=2.390/0.038, 2.247/0.048, 7.323/<0.001,7.564/<0.001); BBR group ISI levels were elevated(t/P=3.198/0.010), and body mass and T, LH, LH/FSH, FPG, FINS, HOMA-IR levels were decreased(t/P=3.668/0.004, 4.602/0.001, 6.101/<0.001, 2.535/0.030, 5.950/<0.001, 2.914/0.015, 7.630/<0.001), improved motility cycle and ovarian structure, improved levels of Claudin-1, Occludin, p-PI3K/PI3K and p-AKT/AKT expression was elevated(t/P=3.799/0.003,3.185/0.010, 7.473/<0.001, 8.187/<0.001).Conclusion Letrozole-induced PCOS mice have dysbiosis, BBR may help to activate the PI3K/AKT pathway and improve the intestinal barrier function by regulating the distribution of intestinal flora to achieve the therapeutic purpose of PCOS.

Objective To investigate the role of cGAS interferon gene stimulating protein(STING) pathway regulation of nuclear receptor co activator 4(NCOA4) mediated iron autophagy in hypoxia reoxygenation injury of mouse hippocampal neurons(HT22). Methods From September 2020 to December 2022, experiments were conducted in the Central Laboratory of People's Hospital of Wuhan University. HT22 cell lines were randomly divided into four groups: control group(Ctrl group), hypoxia reoxygenation group(HR group), hypoxia reoxygenation+cGAS inhibitor(RU.521) group(HR+RU group), and hypoxia reoxygenation+RU.521+NCOA4 overexpression group(HR+RU+NCOA4 group). The HR group was cultured for 6 hours under sugar free hypoxia conditions and then re cultured for 24 hours to construct a hypoxia reoxygenation model. The HR+RU group and HR+RU+NCOA4 group were given 3.0 in advance μ After 24 hours of treatment with RU.521 at a concentration of mol/L, a hypoxia reoxygenation model was constructed. The HR+RU+NCOA4 group was transfected with NCOA4 lentivirus 5 days before hypoxia reoxygenation, while the control group was cultured routinely. Immunofluorescence was used to detect ROS in each group, ELISA was used to detect CCK8, LDH, SOD, MDA, and ferrous ions, Western blot was used to detect cGAS, STING, NCOA4, LC3B, and ferritin. Results Compared with the Ctrl group, the cell viability CCK8 and SOD in the HR group decreased, while LDH, ROS, MDA, cGAS, STING, NCOA4, LC3B, ferritin, and ferrous ions increased(P<0.05); Compared with the HR group, the HR+RU group showed an increase in cell viability CCK8, SOD, and ferritin, while LDH, ROS, MDA, cGAS, STING, NCOA4, LC3B, and ferrous ions decreased(P<0.05); Compared with the HR+RU group, the cell viability CCK8, SOD, and ferritin in the HR+RU+NCOA4 group decreased(P<0.05), while="" and="" ferrous="" ions="" increased.="" there="" was="" no="" statistically="" significant="" difference="" in="" cgas="" p="">0.05). Conclusion After hypoxia and reoxygenation, the cGAS STING pathway is upregulated, and NCOA4 mediated excessive activation of iron autophagy exacerbates cell damage.

We report the clinical data of a patient with Schimke's immune-osteodysplasia and conduct a review of the literature.