Objective To explore the clinical effect of surgery on treating multi-extensively drug resistant (MDR) and extensively drug resistant pulmonary (XDR) tuberculosis (M/XDR-PTB) in order to provide the new approach for patients with M/XDR-PTB.Methods The information of 75 cases with M/XDRPTB were recorded and they were underwent thoracic surgery at the National Tuberculosis Center in Tbilisi,Georgia from October 2008 to February 2011.Results Of 75 patients,52 cases were MDR and 23 were XDR with PTB underwent adjunctive thoracic surgery.The following surgical procedures were performed including pneumonectomy(10％),lobectomy (51％),segmentectomy (33％).Median age was 30 years and average duration of preoperative M/XDR-PTB medical therapy was 350 days.Mean postoperative follow up period was 372 days.Of 72 patients with complete outcomes information,59 (82％) had favorable outcomes including 90％ of MDR and 68％ of XDR-TB patients.No postoperative death occurred,7 patients (9％) had postoperative complications.Univariate analysis showed that,compared with good treatment outcomes,risk factors of poor treatment outcomes included cavitary disease (62％ vs.27％,P =＞ 0.02),probability of suffering from XDR (62％ vs.27％,P =0.02),positive preoperative sputum culture (77％ vs.14％,P＜ 0.001),acceptance of sensitive drugs(1.9％ vs.2.8％,P =0.03) and major postoperative surgical complication (23％ vs.5％,P =0.03).Conclusion Patients with M/XDR-PTB undergoing adjunctive thoracic surgery show with high rates of favorable outcomes,and no surgical related death as well as the low complications rates.Adjunctive surgery appears to play an important role in the treatment of select patients with M/XDR-PTB.

The study aimed to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for 28-day mortality in patients treated with extracorporeal membrane oxygenation (ECMO). Patients receiving ECMO treatment were selected from the Department of Intensive Care Medicine of Zhejiang Hospital from January 2019 to February 2022. The moment when patients started receiving ECMO treatment was set as the starting point, and death at 28 days was set as the endpoint. The patients were divided into survivors and deaths. Laboratory tests, such as neutrophil, lymphocyte, and platelet counts, using the peripheral blood of all patients were collected within 24 h after ECMO treatment. NLR and PLR were calculated. The risk factors influencing prognosis were analyzed by logistic regression. The correlation between NLR, PLR, acute physiology, and chronic health score Ⅱ (APACHE Ⅱ) was investigated. Receiver operating characteristic (ROC) curve analysis was used to analyze the value of NLR and PLR in predicting the 28-day mortality of patients treated with ECMO. Kaplan-Meier method was used to analyze the cumulative survival of patients at 28 days. The results showed that of 53 patients, 20 survived, and 33 died. The NLR and PLR of the deceased were higher than those of the survivors (NLR: 30.67±14.48 vs. 17.41±7.06;PLR: 303.34±159.23 vs. 191.54±106.03; P<0.001). NLR and PLR were positively correlated with APACHE Ⅱ ( r=0.296, r=0.284, P<0.05). ROC curve analysis showed that the area under the curve (AUC) of NLR and PLR to predict the 28 d death of ECMO-treated patients was 0.805 and 0.714, respectively, and the optimal cutoff values of NLR and PLR were 18.93 and 253.0, respectively. The 28-day fatality rate in patients with NLR≥18.93 was higher than that in patients with NLR<18.93 [86.20%(25/29) vs. 33.33%(8/24), χ2=15.625, P<0.01],that in patients with a PLR≥253.0 was higher than that in patients with PLR<253.0 [82.61%(19/23) vs. 46.67%(14/30), χ2=7.158, P<0.01]. Kaplan-Meier survival curve showed that the 28-day cumulative survival rate of NLR≥18.93 was lower than that of NLR<18.93 [9.00 (2.00, 19.50) d vs. 28.00 (10.75, 28.00) d, Z=-3.124, P<0.01], and that of PLR≥253.0 was lower than that of PLR<253.0 [6.00 (2.00, 19.00) d vs. 28.00 (6.25, 28.00) d, Z=-2.673, P<0.01]. Thus, NLR and PLR have good predictive value for 28-day mortality in patients treated with ECMO.

Objective: To explore aspirin resistance (AR) phenomenon in patients with coronary artery disease (CAD) for secondary prevention and to study the relationships between AR and COX1, COX2, TBXA2R gene polymorphisms. Methods: A total of 2881 CAD patients taken aspirin (100 mg/day) in 7 consecutive days were enrolled. Among them, 2 groups were established as AR group, n=166 and Control group, n=200 aspirin sensitive patients. Platelet aggregation function was induced by arachidonic acid (AA), COX1, COX2 and TBXA2R gene polymorphisms were examined by polymerase chain reaction-restricted fragment length polymorphisms (PCR-RFLP) method. Results: The occurrence rate of AR was 5.76% (166/2881). There were 8 tagSNPs locus in 3 genes as in COX1:(rs3842788), (rs4273915), (rs7866582); in: COX2 (rs3218625); in TBXA2R: (rs2238630), (rs2238631), (rs2238633), (rs3786989). The frequencies of wild type, heterozygous genotype and homozygous genotype were similar between 2 groups. Conclusion: The incidence rate of AR is not high in CHD patients with regular aspirin medication; single nucleotide gene polymorphisms of COX1, COX2 and TBXA2R have no obvious correlation to AR.

Objective:To observe the efficacy of cytokine-induced killer (CIK) cells on patients with advanced lung cancer. Methods:A total of 90 patients with advanced lung cancer were identified from January 2011 to December 2013. CIK therapy was given to 41 pa-tients in the observation group, whereas the other 49 patients in the control group received the best support treatments without che-motherapy or radiotherapy within one month of inclusion. Following up was conducted for the patients in the two groups, and KPS scores, median survival, and adverse reactions compared. Results:The KPS score in the observation group was higher than that of the control group after treatment (P=0.034). The median survival period of the observation group was eight months, which was one month longer than that of the control group (P=0.044). Major adverse reactions included fever, joint pain, and insomnia, which were recorded 51.22%, 36.58%, and 29.27%of occurrence, respectively. Conclusion:CIK cell therapy improved the quality of life and pro-longed the survival of advanced lung cancer patients with tolerable adverse reactions.

Aim To establish the rat model of Spleen-Qi deficiency, analyse the metabolic pathways and investigate the connection between the changed urinary metabolites and Spleen-Qi deficiency, in order to explore the potential mechanisms of Spleen-Qi deficiency.Methods With the binding methods of diarrhea induced by bitter and cold, abnormal of starvation and excessive tiredness, the rat Spleen-Qi deficiency model was established.Then the activity of creatine phosphokinase(CPK) was detected.The endogenous metabolites in the urine were detected by NMR, and the data were analyzed with multivariate and statistical methods.Then the metabolites were selected that could be clearly distinct in the two groups with the fold change value(>1.2) and the P<0.05 of Student′s t-test.Both the pathway analysis and enrichment analysis were performed with Metabo Analyst 3.0.Results Compared with the normal rats, the activity of CPK decreased significantly in model rats(P<0.05).A significant separation appeared in the principal components analysis(PCA) score plot when the control group and the model group were compared, indicating that the Spleen-Qi deficiency model was successfully duplicated.The 33 differential metabolites, which mainly involved in the metabolic pathways, were distinguished from the comparision of Spleen-Qi deficiency model group and control group.The metabolic pathways was related to energy metabolism, amino acid metabolism, nucleotide metabolism and disturbance of gut microbes.Conclusions The main energy metabolic pathways (tricarboxylic acid cycle, glycolysis and liquid oxidation) may be disturbed in Spleen-Qi deficiency rats.The energy supply function is suppressed, which leads to the fatigue and weight loss in rats.

Objective To systematically evaluate the effects of left ventricular global longitudinal strain (GLS) determined by two dimensional speckle tracking imaging technology (2D-STI) and left ventricular ejection fraction (LVEF) on the prognosis of patients with sepsis/septic shock.Methods Databases such as the National Library of Medicine PubMed database, Dutch medical abstracts Embase, Cochrane Library, Netherlands Elsevier, Springer and China biomedical literature database (CBMdisc), China National Knowledge Internet (CNKI), Wanfang database, China science and technology journal full-text database, Vip Chinese biomedical journal database were searched from the establishment of literature database to April 2018 to study GLS, LVEF and their relationships with mortality of septic/septic shock patients. The literatures screening and data collecting were independently conducted by two researchers, and the quality of the included literature was evaluated. The sensitivity and heterogeneity analysis were performed with RevMan 5.3 software, and the combined effects were calculated. Funnel plot was used to evaluate publication bias.Results A total of 6 articles including 5 English articles and 1 Chinese article were enrolled. There were 503 patients, 333 in the survival group and 170 in the death group. The quality of the literature was high, and the Newcastle-Ottawa scale (NOS) score was 8-9. Meta-analysis showed that short-term mortality was associated with higher GLS in patients with sepsis/septic shock [standardized mean difference (SMD) = -0.47, 95％ confidence interval (95％CI) = -0.76 to -0.18, Z = 3.16,P = 0.002], and there was no significant difference in LVEF between the survival group and the death group (SMD = 0.18, 95％CI = -0.03-0.39,Z = 1.64, P = 0.10). Sensitivity analysis was carried out for each effect index by removing each document one by one, and the results showed that there was no significant change in the combined effect before and after each document, indicating that the results were stable. The funnel plot showed that the effect points of each literature were roughly in the form of "inverted funnels" with a large symmetric distribution centered on the combined effect, but the number of studies included in this study was too small, so the publication bias could not be completely excluded.Conclusion Compared with LVEF, GLS might be a more sensitive indicator for detecting myocardial dysfunction in patients with sepsis/septic shock and might have important predictive value for short-term mortality.

Objective:To analyze the expression levels of urinary interleukin-6 (IL-6), signal transducer and activator of transcription 3 (STAT3) and heparin-binding protein (HBP) in urinary tract infection and its correlation with infection prognosis.Methods:The clinical data of 100 patients with urinary tract infection (urinary tract infection group) from January 2021 to December 2022 in the Affiliated Hospital of Jining Medical College were retrospectively analyzed. Among them, simple urinary tract infection was in 62 cases, and complex urinary tract infection was in 38 cases; after treatment, 25 cases were not cured, and 75 cases were cured. Another 50 healthy examinees were selected as the health control group. The level of urine IL-6 was detected by luminescence assay method, the level of urine STAT3 was detected by enzyme-linked immunosorbent assay method, and the level of urine HBP was detected by fluorescence immunochromatography method. The blood routine was detected by fully automated blood cell analyzer, and the blood cell count was recorded. The levels of serum C-reactive protein (CRP) and procalcitonin (PCT) were detected by radioimmunoassay. The correlation between urine IL-6, STAT3, HBP and blood routine inflammatory response markers was analyzed by Pearson method. The receiver operating characteristic (ROC) curve was used to evaluate the predictive effectiveness of urine IL-6, STAT3, HBP and blood routine inflammatory response markers in infection prognosis.Results:The urine IL-6, STAT3, HBP, and blood CRP, PCT, white blood cell count in urinary tract infection group were significantly higher than those in healthy control group: (33.19 ± 11.02) μg/L vs. (16.84 ± 3.57) μg/L, (66.77 ± 19.58) μg/L vs. (38.69 ± 11.04) μg/L, (151.98 ± 42.00) μg/L vs. (28.55 ± 9.16) μg/L, (12.57 ± 4.19) mg/L vs. (5.23 ± 1.80) mg/L, (0.58 ± 0.19) μg/L vs. (0.22 ± 0.07) μg/L and (9.86 ± 3.20) × 10 9/L vs. (6.44 ± 2.13) ×10 9/L, and there were statistical differences ( P<0.01). The urine IL-6, STAT3, HBP, and blood CRP, PCT, white blood cell count in patients with complex urinary tract infection were significantly higher than those in patients with simple urinary tract infection: (40.25 ± 10.34) μg/L vs. (28.87 ± 8.55) μg/L, (79.50 ± 17.92) μg/L vs. (58.96 ± 13.43) μg/L, (186.51 ± 35.92) μg/L vs. (130.82 ± 39.74) μg/L, (14.09 ± 4.18) mg/L vs. (11.64 ± 3.55) mg/L, (0.64 ± 0.20) μg/L vs. (0.55 ± 0.13) μg/L and (11.27 ± 3.08) × 10 9/L vs. (8.99 ± 2.36) × 10 9/L, and there were statistical differences ( P<0.01). The urine IL-6, STAT3, HBP, and blood CRP, PCT, white blood cell count in patients with untreated urinary tract infection were significantly higher than those in patients with cured urinary tract infection: (42.97 ± 11.51) μg/L vs. (29.93 ± 8.66) μg/L, (86.81 ± 20.35) μg/L vs. (60.09 ± 17.43) μg/L, (264.27 ± 28.76) μg/L vs. (114.55 ± 21.38) μg/L, (19.11 ± 3.28) mg/L vs. (10.39 ± 2.40) mg/L, (0.85 ± 0.14) μg/L vs. (0.49 ± 0.11) μg/L and (12.26 ± 2.77) × 10 9/L vs. (9.06 ± 2.34) ×10 9/L, and there were statistical differences ( P<0.01). Pearson correlation analysis result showed that urine IL-6, STAT3, HBP were positively correlated with blood CRP, PCT, white blood cell count ( P<0.01). The ROC curve analysis result showed that the area under curve (AUC) of urine IL-6, STAT3 and HBP in predicting the infection prognosis in patients with urinary tract infection was greater than that of blood CRP, PCT and white blood cell count; moreover, the AUC and sensitivity of the combined of urine IL-6, STAT3 and HBP in predicting the infection prognosis in patients with urinary tract infection were significantly higher than the combined of blood CRP, PCT and white blood cell count (0.937 vs. 0.898 and 96.00% vs. 76.00%), but with lower specificity (81.33% vs. 98.67%). Conclusions:Urinary tract infections can cause elevated urine IL-6, STAT3 and HBP, and the degree of elevation is related to the types of simple or complicated infection and the infection prognosis. The combined detection of the urine IL-6, STAT3 and HBP is expected to be a method to predict the infection prognosis, and it provides reference information for clinical diagnosis and treatment.

Improper control of depth of anesthesia is not only detrimental to the rapid and stable recovery of anesthesia, but also affects the postoperative outcome of patients. Therefore, accurate control of anesthesia depth is an urgent clinical and scientific problem in the field of anesthesiology. At present, different algorithm models derived from electroencephalogram (EEG) signals are used to monitor the depth of anesthesia, but they cannot meet the requirements of anesthesiologists to accurately evaluate the depth of anesthesia. In recent years, the research on the mechanism and modulation of anesthesia-related neural network suggests that it has potential value as a method to monitor depth of anesthesia. Anesthesia-related neural networks mainly include sleep-wake circuit, thalamic-cortical circuit and corticocortical network. A thorough understanding of the neural network involved in the loss of consciousness caused by anesthesia will guide the depth of anesthesia monitoring more accurately and provide possibility for improving the quality of clinical anesthesia resuscitation.

Objective To investigate the effect of exposure to lead oxide nanoparticles (PbO NPs) on the polarization of microglia in mouse hippocampus. Methods i) Specific pathogen-free male C57 mice were randomly divided into control group, low-, medium- and high-dose groups, with 10 mice in each group. Mice in these three dose groups were intraperitoneally injected with PbO NPs suspension at doses of 5, 10 and 20 mg/kg per day, respectively, and mice in the control group were intraperitoneally injected with the same volume of 0.9% sodium chloride solution, five days per week for four weeks. ii) BV-2 cells were treated with PbO NPs at doses of 0.0, 2.5, 5.0 and 10.0 mg/L for 24 hours. iii) BV-2 cells were randomly divided into control group, PbO NPs group and triggering receptor expressed on myeloid cells 2 (TREM2) high expression + PbO NPs group. The cells in the control group received no treatment. The cells in PbO NPs group were exposed to 10.0 mg/L PbO NPs suspension for 24 hours. Cells in TREM2 high expression + PbO NPs group were transfected with Trem2 high expression plasmid, and then exposed to 10.0 mg/L PbO NPs suspension for 24 hours. iv) The mRNA expression of M1 markers ［nitric oxide synthase (iNos), cyclooxygenase 2 (Cox2), chemokine receptor 7 (Ccr7)］, M2 markers ［arginin-1 (Arg-1), transforming growth factor-β (Tgf-β), chemokine receptor 2 (Ccr2)］ and Trem2 of microglia was detected by real-time fluorescent quantitative polymerase chain reaction. The protein expression of iNOS, ARG-1 and TREM2 was detected by Western blotting. Results i) During the experiment, there was no significant difference in body weight of mice among these four groups (P>0.05). The relative expression of Cox2 and Ccr7 mRNA in the hippocampus of the mice increased in the low-dose group and the iNos, Cox2 and Ccr7 mRNA increased in the medium- and high-dose groups, compared with the control group (all P<0.05). The relative mRNA expression of Tgf-β in the hippocampus of the mice of low-dose group and Arg-1, Tgf-β and Ccr2 in the medium- and high-dose groups was decreased compared with the control group (all P<0.05). The mRNA relative expression of iNos, Cox2 and Ccr7 was increased (all P<0.05), while the mRNA relative expression of Arg-1, Tgf-β and Ccr2 was decreased (all P<0.05) in the hippocampus of the mice of high-dose group compared with the low-dose group. The relative expression of Trem2 mRNA and TREM2 protein in the hippocampus of mice of the medium- and high-dose groups was lower than those in the control group (all P<0.05). The relative expression of Trem2 mRNA and TREM2 protein in the hippocampus of mice of the high dose group was lower than those in the low- and the medium-dose groups (all P<0.05). With the increase of PbO NPs exposure dose, the relative expression of iNOS protein in hippocampus tissues of mice increased (P<0.01), and the relative expression of ARG-1 protein decreased (P<0.01). ii) With the increase of PbO NPs exposure dose, the relative expression of iNOS protein increased (P<0.01), and the relative expression of ARG-1 protein decreased (P<0.01) in BV-2 cells. The relative expression of iNOS protein in BV-2 cells of PbO NPs group and TREM2 high expression + PbO NPs group was increased (all P<0.05), and the relative expression of ARG-1 protein decreased (all P<0.05) compared with the control group. The relative expression of iNOS protein decreased (P<0.05), and the relative expression of ARG-1 protein increased (P<0.05) in BV-2 cells of TREM2 high expression + PbO NPs group compared with the PbO NPs group. Conclusion Exposure to PbO NPs could increase the M1 polarization and decrease the M2 polarization of microglia, with a dose-effect relationship. The M1 polarization of microglia decreased and M2 polarization increased after overexpression of Trem2 gene. The regulation of microglia polarization by TREM2 may be involved in the neurotoxic effects of PbO NPs.

Objective:To compare the difference in measurement results and nursing time between wireless body temperature pulse measuring system and the traditional mercury thermometer combined with hand diagnostic method for measuring body temperature and pulse, to provide a reference for clinical selection of accurate and efficient vital sign measuring tools.Methods:A total of 74 patients hospitalized in the Orthopedics Department of the First Medical Center of the PLA General Hospital from March to August 2022 were selected using a randouized coutrolled study. The body temperature and pulse data of every patients were collected by mercury thermometer + manual diagnosis and wireless body temperature pulse measuring system at the same time, and the measurement results and nursing time of the two methods were compared.Results:The temperature and pulse measured by the wireless body temperature pulse measuring system were (36.31 ± 0.52) ℃ and (78.27 ± 14.06) times/min, which were no significant different than (36.34 ± 0.51) ℃ and (78.57 ± 13.79) times/min by the mercury thermometer + manual diagnosis ( t = -1.54, 1.88, both P>0.05), and the two groups of data were significantly correlated, ( r = 0.940 and 0.995, both P<0.01). The daily nursing work time of the wireless body temperature pulse measuring system was (67.29 ± 5.15) min, which was significantly lower than (131.57 ± 6.58) min by the mercury thermometer + manual diagnosis ( t = 20.35, P<0.01). Conclusions:The wireless body temperature pulse measurement system is accurate in data collection, easy to operate, safe to use, less time-consuming in nursing work and worthy of clinical promotion.