Multidrug efflux pump is the main reason for bacterial multidrug resistance, and it’s a chal- lenge for the treatment of infectious diseases. Analysis of multidrug efflux pump offers us the mecha- nism and treatment ideas of bacterial multidrug resistance. New advances have been made in the study of Escherichia coli AcrAB-TolC efflux pump structure and its regulation, which provides data for the multidrug resistance research in pathogenic bacterium. Progress in this area is reviewed here.

Objective: To find out the pathomechanism of low back and leg pain related to intervertebral disc. Methods: The nucleus pulposus of coccygeal vertebral was transplanted to the cavum epidurale of rats to establish the non-compressive model with transplanted nucleus pulposus. The evoke potentials and morphology of nerve roots were observed. Results: Even without mechanical compression, rats transplanted with nucleus pulposus resulted in significant harm to evoked potential and morphology of cauda equina. Conclusion: The biomechanical and/or immunologic inflammatory effect of nucleus pulposus can result in nerve roots injury and is an important factor in the pathogenesis of low back and leg pain.

Objective:To study the role of phospholipase A 2 in the pathomechanism of low back and leg pain. Methods:Phospholipase A 2 was injected into rats′ cavum epidurale, then the pathologic changes of cauda equina was viewed under light microscopy and electronic microscopy. The substance P(SP) in the dorsal root ganglia(DRG) and spinal cord was determined by immunohistochemistry. Results:After phospholipase A 2 injection, the nerve fibers of cauda equina displayed significant degeneration and demyelination. In L 4 to L 6 segment, the number and area of SP positive neurons in the DRG increased significantly. The relative density of positive nerve endings in the dorsal horn of spinal cord was also increased significantly. There were significant difference compared to the normal solution control group by statistic analysis. Conclusion:Phospholipase A 2 is a nocuous substance to cauda equina. It may play an important role in the pathomechanisms of low back and leg pain related to lumbar disc herniation.

Objective To systematically evaluate the efficacy of high-flow nasal cannulae oxygen (HFNC) in patients with respiratory failure.Methods Computerized PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP, Wanfang Database up to March 31st, 2017, all published available randomized controlled trials (RCTs) or cohort studies about HFNC therapy for patients with respiratory failure were searched. The control group was treated with face mask oxygen therapy (FM) or non-invasive positive pressure ventilation (NIPPV), while the experimental group was treated with HFNC. The main outcomemeasurements included endotracheal intubation rate, patient comfort, and the secondary outcome was in-hospital mortality. The quality of the literature was completed by two professionally trained evidence-based medical students, and meta-analysis was performed on quality-compliant literature. Funnel plot was used to analyze the publication bias.Results A total of 17 articles were enrolled including 15 RCTs and 2 cohort studies. There were 3909 patients enrolled, 1907 patients in HFNC group, and 2002 in control group (1068 patients with FM, and 934 with NIPPV). Meta-analysis showed that HFNC had a significant advantage over FM in reducing the tracheal intubation rate of patients with respiratory failure [odds ratio (OR) = 0.51, 95% confidence interval (95%CI) = 0.29-0.89,P = 0.02], but there was no significant difference as compared with that of NIPPV (OR = 0.80, 95%CI = 0.54-1.17,P = 0.25). It was shown by pooled analysis of two subgroups that compared with FM/NIPPV, HFNC had a significant advantage in reducing tracheal intubation rate in patients with respiratory failure (pooledOR = 0.66, 95%CI = 0.47-0.94, P = 0.02). Compared with FM, patients with respiratory failure were more likely to receive HFNC for comfort [standardized mean difference (SMD) = -0.41, 95%CI = -0.56 to -0.26,P < 0.00001]. There was no significant difference in hospital mortality between HFNC and FM (OR = 0.82, 95%CI = 0.55-1.24,P = 0.35) or NIPPV (OR = 0.66, 95%CI = 0.37-1.17, P = 0.16). The results of pooled analysis of two subgroups were still unchanged (pooledOR = 0.75, 95%CI = 0.54-1.05, P = 0.09). It was shown by the funnel analysis that there was a bias in the study of tracheal intubation rate in the literature, while the bias of patient comfort and hospital mortality was low.Conclusions Compared with FM, HFNC could reduce the rate of tracheal intubation in patients with respiratory failure, but no difference was found as compared with NIPPV. Compared with FM, HFNC made patients more comfortable, and it was easier to be accepted and tolerated. However, there was no difference in hospital mortality among FM, NIPPV, and HFNC.

To observe the relationship between positive rate of β1-adrenergic and AT1 receptors autoantibodies with serum concentration of cystatin C in 371 patients with diabetic nephropathy patients,107 patients with type 2 diabetes,and 47 subjects as healthy control.In patients with diabetic nephropathy,the positive rates of the β1 and AT1 receptors autoantibodies were significantly higher than those in patients with type 2 diabetes and normal controls.The titers of β1 and AT1 receptors autoantibodies in diabetic nephropathy patients with abnormal cystatin C were significantly higher than those with normal cystatin C concentration.These findings suggested that β1 and AT1 receptors autoantibodie may play important roles in the pathogenesis of diabetic nephropathy.

Objective:To explore the possible related factors of Beh?et's disease complicated with tendinitis, in order to better understand the etiology and development mechanism so to guide clinical diagnosis and treatment.Methods:The clinical data of patients with Beh?et's disease complicated with tendonitis treated at Department of Rheumatology and Immunology of Lanzhou University Second Hospital from October 2018 to September 2019 were retrospectively reviewed and related literature were reviewed.Results:Two patients were diagnosed as Beh?et's disease. Foot pain occurred during the treatment. Ultrasound showed tendonitis, and the corresponding treatment relieved the symptoms.Conclusion:Tendons may be involved and presents as a chronic change in patients with Beh?et's disease. In patients with rheumatic diseases, attention should be paid to the correlation between the disease and tendonitis. Aggressive treatment can prevent adverse consequences.

Objective:To investigate the relationship between bone mineral density (BMD) and metabolic syndrome (MS) and its components in men.Methods:The cross-sectional study method was used. The subjects were male physical examination population who were examined in the Health Examination Center of the Affiliated Hospital of Hebei University from January 2021 to December 2021. According to the MS diagnostic criteria, they were divided into MS and non MS groups. The BMD of femur was measured by dual energy X-ray bone density analyzer. The prevalence rate and bone mineral density of osteopenia, osteoporosis, metabolic syndrome in different age groups, and the differences of metabolic indicators between MS and non MS groups and the impact of MS on BMD were analyzed. Multivariate linear stepwise regression was used to analyze the risk factors of male bone mineral density.Results:6 191 subjects were included in the study. The prevalence of osteoporosis (OP) was 9.50%(588/6 191) and the prevalence of MS was 31.64%(1959/6 191) in healthy men. The prevalence of age, body mass index (BMI), fasting plasma glucose (FPG), total glyceride (TG), total cholesterol (TC), uric acid, diastolic blood pressure, systolic blood pressure and fatty liver in MS group were higher than those in non-MS group, with statistically significant difference (all P<0.05). The high density lipoprotein cholesterol (HDL-C) in MS group was lower than that in non-MS group, with statistically significant difference (all P<0.05). There were no significant difference in the prevalence of OP and BMD between the MS group and the non-MS group (all P>0.05). There was no statistically significant difference in BMD values among different MS groups, but after adjusting BMI, when the MS group score increased from 0 to 4, the BMD value decreased gradually, and the difference was statistically significant ( P<0.05). Multiple linear regression analysis showed that BMD was positively correlated with BMI and diastolic blood pressure, but negatively correlated with age, systolic blood pressure and prevalence of fatty liver disease (all P<0.05). Conclusions:With the increase of the number of MS components, BMD in men decreased gradually. BMD in men was positively correlated with BMI and diastolic blood pressure, but negatively correlated with age, systolic blood pressure and prevalence of fatty liver disease.

Objective:To analyze the research status of umbrella review by bibliometric methods.Methods:The citation search was performed via Web of Science Core Collection database to obtain studies on umbrella review from inception to December 31, 2021. VOSviewer1.6.16 was used to extract the included authors, countries, institutions and keywords, and generate the cooperative network graph of high-productivity authors, countries, institutions, and clustering graph of high-frequency keywords. CiteSpace5.7.R5W was used to detect burst terms.Results:A total of 755 articles or reviews were included. The quantity of studies had been increasing over time. The United Kingdom was the country with the most published papers (297), and the University of College London was the institution with the most published papers (77). A total of 3 863 authors participated in the umbrella review research, of which Solmi M had the largest number of papers with 28 papers published. The main authors formed three groups, with little cooperation between the groups. Research hotspots focused on chronic diseases such as cardiovascular disease, diabetes, cancer, mental health and its health management. Besides, diabetes, heart failure and Mediterranean diet were the frontier fields.Conclusions:Umbrella review is in the development stage, and the amount of studies is increasing. The United Kingdom is in a leading position in this field. The members of each team work closely together, but there is a lack of cross-team cooperation. Chronic diseases and their management are currently research hotspots and key research contents.

Objective:To evaluate the efficacy and safety of perioperative rehabilitation approaches based on the concept of Enhanced Recovery After Surgery (ERAS) for pelvic fractures.Methods:A prospective randomized control trial was conducted to include 114 emergency patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for surgical treatment of pelvic fractures from June 2019 to December 2020. Of them, 57 were assigned into an intervention group according to a random digits table. They were 42 males and 15 females, aged from 18 to 77 years and subjected to management of pelvic fractures with tentative perioperative ERAS approaches which were adjusted at different stages. The other random 57 patients were assigned into a control group. They were 40 males and 17 females, aged from 17 to 70 years and subjected to management of pelvic fractures with conventional rehabilitation approaches which included postoperative in-hospital consultation and guidance by rehabilitation physicians. The 2 groups were compared in terms of Majeed pelvis scores and Barthel indexes at postoperative 2, 6, 12 and 24 weeks, and visual analogue scale (VAS) pain scores and SF36 scores at postoperative 12 and 24 weeks.Results:A total of 105 patients (55 in the intervention group and 50 in the control group) were completely followed up for 151 to 254 d (mean, 177 d). The 2 groups were comparable due to no significant difference between them in the preoperative general data ( P>0.05). The Majeed scores (44±13, 67±16, 86±14 and 98±7) and Barthel indexes (57±13, 79±16, 95±8 and 100±2) at postoperative 2, 6, 12 and 24 weeks in the intervention group were significantly higher than those in the control group [(35±16, 51±16, 73±14 and 91±12) and (45±19, 67±18, 86±12 and 98±4)] (all P<0.05). At postoperative 12 and 24 weeks, the SF-36 scores (129±15 and 141±6) in the intervention group were significantly higher than those in the control group (114±15 and 131±12) ( P<0.05). There was no significant difference in the pain degree between the 2 groups ( P>0.05). Conclusion:In management of pelvic fractures, compared with conventional perioperative rehabilitation approaches, the perioperative ERAS rehabilitation approaches may improve early functional outcomes and thus help the patients restore their activities of daily living earlier.