Objective To investigate levels of IL-17 and IL-22 mRNA in the blood of type 2 diabetes(T2DM)patients with the different stages of kidney injury and explore the relationship between the gene expression levels of IL-17,IL-22 and renal lesions in patients with diabetic nephropathy(DM).Methods Subjects included 60 T2DM patients with or without kidney injury and 20 normal controls(NC,n=20).Diabetes patients were divided into 3 groups by level of urinary albumin to creati-nine ratio (ACR):no proteinuria group (NA,ACR<30 mg/g,n=22),microalb uminuria group (MA,30 mg/g>ACR>300 mg/g,n=18)and diabetic nephropathy group (DN,ACR>300 mg/g,n=20).Quantitative Real-Time RT-PCR was used to detect IL-17 and IL-22 mRNA levels.Analysis differences of IL-17 and IL-22 mRNA levels among NA,MA,DN and NC groups.Results The levels of IL-17 and IL-22 mRNA were significantly higher in DN group than that in MA,NA and NC group (P <0.01,respectively),However,there were not significant difference among MA,NA and NC group (P >0.05,re-spectively).Conclusion Levels IL-17 and IL-22 mRNA were increased in blood of T2DM patients with nephropathy.IL-17 and IL-22 may play role in the pathogenicity of diabetic nephropathy.

Abstract: To report a case of Aspergillus salwaensis-induced spinal infection and its laboratory detection. The inflammatory granulation and necrotic tissue samples of a patient with spinal infection were collected from, the Affiliated Hospital of Chengde Medical College on June 17, 2020 for direct smear microscopy and culture, and the isolated strain was identified by microscopy by smear staining, matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF-MS), molecular identification and in vitro antifungal susceptibility test. The patient was 62 years old female and presented with recurrent chest and back pain with no obvious cause. The initial diagnosis was spinal infection, after 7 days of treatment with levofloxacin, the effect was not good. Surgery was then performed remove the lesion via posterior thoracic debridement, and fungal hypha was observed under microscope in tissue specimens. The isolated strains had no typical structure, MALDI-TOF-MS was used for identification for many times, but there was no identification result. After 7 days of fluconazole treatment, the patient's condition improved, and her chest and back pain were alleviated compared to before surgery. The patient was discharged and followed up in the outpatient department, the fungus was later identified as Aspergillus salwaensis by sequence analysis of the internal transcribed spacer (ITS) gene sequencing, and the patient's antifungal medication was changed to voriconazole after with the attending physician. The patient consciously recovered well with no pain in the operative area and normal spinal activity at 1 year follow-up. The possibility of spinal fungal infection should be considered in patients with back pain without a clear cause and poor response to routine antibiotic treatment. Direct smear report of microscopic results are very important for guiding clinical antibiotic selection for rare filament fungi with atypical colony and microscopic morphology and unsuccessful MALDI-TOF-MS identification, molecular biological methods such as ITS sequence analysis can be helpful for early identification of the fungal species, improving identification speed.

Objective Evaluate the clinical value of nerve growth factor (NGF) in patients with interstitial cystitis for diagnosis and predicting the prognostic.Methods From January 2013 to January 2017,22 cases of interstitial cystitis patients,including 20 female cases and 2 male cases,were collected.Their mean age was (48.5 ± 12.8) years old.The average frequency of urination was 25.4 ±4.6 before treatment.The average frequency of nocturia was 4.6 ± 0.5.The average maximal bladder volume was (223.4 ± 39.5)ml.Their IPSS and QOL scores were 17.3 ± 1.2,12.7 ± 1.7,respectively.Meanwhile,22 healthy volunteers,including 18 female cases and 4 male cases,were collected.Their mean age was (40.2 ± 8.7) years old.The average frequency of urination was 4.2 ± 2.6 before treatment.The average frequency of nocturia was 1.1 ± 0.4.Urine NGF of these patients were collected before and after sodium hyaluronate bladder perfusion treatment,and the levels of NGF were detected by ELISA method.The correlationship between NGF and the severity of the symptoms were evaluated before and after treatment.Results After 1,3 and 6 months' treatment,the levels of NGF were dropped from (243.5 ±37.8) ng/L to (187.3 ±28.7) ng/L,(141.5 ± 21.3) ng/L and (123.1 ± 15.9) ng/L,which was positively associated with the degree of clinical symptom.The number of urination droppted from 25.4 ± 4.6 to 21.7 ± 5.2,17.2 ± 3.9 and 14.6 ± 3.8.The number of nocturia was dropped from 4.6 ± 0.5 to 3.8 ± 0.6,3.0 ± 0.8 and 1.7 ± 1.1.The maximum volume of bladder increased from (223.4 ± 39.5) ml to (258.7 ± 40.2) ml,(289.6 ± 37.1) ml and (305.2±40.4) ml.The IPSS scores dropped from 17.3 ± 1.2 to 15.1 ±2.4,12.4 ± 1.82and 9.8 ± 1.4.The QOL scores dropped from 12.7 ± 1.7 to 10.6 ± 1.2,8.5 ± 1.5 and 7.1 ± 1.3 (P ＜ 0.05).The logistic regression analysis showed the level of NGF in IC patients has positive relationship with frequency of urination,nocturia,QOL scores,IPSS scores and maximal bladder volume (P ＜ 0.05).Conclusions The level of NGF in urine is associated with IC symptom severity and NGF has the potential to be used as a marker for the diagnosis of IC.

Objective:To develop a risk prediction model for early cardiac arrest in emergency sepsis utilizing a machine learning algorithm to enhance the quality and efficiency of patient treatment.Methods:This study focused on patients with sepsis who received treatment at the emergency room of the First Medical Center of Chinese PLA General Hospital from January 1, 2020 to June 1, 2023. The basic clinical characteristics such as vital signs and laboratory results were collected. Patients who fulfilled the specified inclusion criteria were allocated randomly into a training group and a testing group with a ratio of 8:2. A CatBoost model was constructed using Python software, and the prediction efficiency of the model was assessed by calculating the area under the receiver operating characteristic curve (AUC). Furthermore, the performance of the model was compared to that of other widely employed clinical scores.Results:This study included a cohort of 2 131 patients diagnosed with sepsis, among whom 449 experienced cardiac arrest. The CatBoost model demonstrated an AUC of 0.760, surpassing other scores. Notably, the top 10 predictors in the model were identified as age, lactate, interleukin -6, oxygen saturation, albumin, N-terminal pro-B-type natriuretic peptide, potassium, sodium, creatinine, and platelets.Conclusions:The utilization of this machine learning algorithm-based prediction model offers a more precise basis for predicting cardiac arrest in emergency sepsis patients, thereby potentially improving the treatment efficacy for this disease.

Objective:To understand the willingness to accept peer-referral strategies for promoting HIV testing and related factors in men who have sex with men (MSM) in Shijiazhuang.Methods:A total of 544 MSM were recruited using convenient sampling and sharing two-dimensional code of online questionnaire througth MSM social organizations in Shijiazhuang from August to September in 2018. The anonymous online survey were taken by login through the website "jinshuju.com" ( https://im.jinshuju.com/users/sign_in). The information collected included: the demographic and behavioral characteristics, the attitude to HIV testing for partners, and the willingness to accept peer-referral strategies for promoting HIV testing. The socio-demographic characteristics were analyzed by χ 2 test. Univariate and multivariate logistic regression analyses were conducted to identify the related factors associated with willingness. The SAS 9.4 software was used for statistical analysis. Results:A total of 521 MSM completed the survey. Among them 59.50% (310/521) were willing to advise their partners to receive HIV testing, and 90.02% (469/521) were willing to accept the partners' advice of HIV testing. Higher HIV testing frequency for once a year (a OR=2.72,95% CI:1.42-5.20); for once a half year (a OR=5.72, 95% CI:2.97-11.02); for ≥1 time a quarter (a OR=8.76,95% CI:4.56-16.83), enquiring their partners' HIV status (a OR=1.94, 95% CI: 1.15-3.28) and STD history of their partners (a OR=1.83, 95% CI:1.06-3.14) before having sex were the factors positively associated with the willingness to advise partners to receive HIV testing. Discussing HIV testing with partners (a OR=4.43,95% CI:1.87-10.54) was the factor positively associated with the desire to accept the advice of HIV testing from partners, but feeling emotional hurt by the suggestion of HIV testing (a OR=0.35,95% CI:0.15-0.82) was the factor negatively associated with the willingness to accept the advice of HIV testing from partners. Conclusion:To improve the willingess of MSM to advise their partners to receive HIV testing and strengthen self-protection awareness and equal communication skills are essential for the success of peer-referral strategies for promoting HIV testing among MSM.

Objective:To investigate the indoor radon concentrations and to analyze their seasonal variations in urban and rural residential dwellings in Ningxia province.Methods:From March 2022 to March 2023, based on the administrative region division and population distribution in Ningxia, a total of 143 typical residential dwellings, including 82 urban houses and 61 rural houses, were selected to measure indoor radon concentration by CR-39 solid nuclear track detectors for 1 year in Ningxia, with detectors changed every 3 months.Results:The annual average indoor radon concentration in Ningxia was 88 Bq/m 3, range 39-226 Bq/m 3. The annual average indoor radon concentration was below 100 Bq/m 3 for 69.9% of the measured dwellings, and below 300 Bq/m 3 for all of surveyed dwellings. Indoor radon concentrations in rural areas were much higher than those in urban areas ( Z=5.85, P<0.05). Indoor radon concentration varied significantly with the seasons, higher in autumn and winter, but lower in spring and summer, in total ( χ2=63.97, P<0.05), urban ( χ2=24.74, P<0.05), and rural ( χ2=43.15, P<0.05). Conclusion:The annual average indoor radon concentrations in all the measured dwellings are below the reference level of 300 Bq/m 3 recommended by Indoor Air Quality Standard (GB/T 18883-2022) in China.

Objective:To analyze the clinical features of patients with invasive Klebsiella pneumoniae liver abscess syndrome (IKLAS). Methods:The clinical data of 12 patients diagnosed as IKLAS in Zhuzhou Central Hospital from January 2020 to January 2023 were retrospectively analyzed.Results:Among 12 patients there were 6 males and 6 females with an mean age of 65.3±12.2 years (49-90). Nine patients were complicated with type 2 diabetes. The main clinical manifestations were fever ( n=9), chill ( n=6), shiver ( n=4), nausea and vomiting ( n=2), upper abdominal pain ( n=2), fatigue and anepithymia ( n=2), cough and expectoration ( n=1), disturbance of consciousness ( n=1) and hemoptysis ( n=1). The leukocyte count was increased in 8 cases, lymphocyte count decreased in 10 cases, and platelets count decreased in 3 cases. C-reactive protein and procalcitonin levels were elevated, while serum albumin levels were lowered in all patients. The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased in 7 cases each. Liver abscess was located in the right lobe in 8 cases, in the left lobe in 1 cases, and in both lobes in 3 cases. There were 7 patients with single abscess, and 5 patients with multiple abscesses. The etiology was confirmed by liver pus culture ( n=10) and blood culture ( n=5), respectively. The main sites of invasion were lung and blood stream ( n=10 and n=5, respectively). The majority of Klebsiella pneumoniae isolates were antibiotic sensitive strains and the overall drug resistance rate was relatively low. All patients were given antibiotics, and 10 of them also received liver abscess puncture drainage. After treatment, 11 patients were discharged, and 1 died of septic shock. Conclusions:Patients with IKLAS exhibit diverse clinical symptoms, most patients are complicated with diabetes, and the main sites of invasion are in the lungs and blood stream. Timely diagnosis, active screening of extrahepatic infection sites, effective drainage of abscess and appropriate antibiotic treatment can improve the survival of patients.

Objective To primarily investigate the indoor radon concentrations in the urban and rural dwellings in Yinchuan, China, and to estimate the effective dose. Methods A total of 67 dwellings, which included 49 urban households and 18 rural households in Yinchuan, were selected to cumulatively measure the indoor radon concentrations for more than 3 months using solid state nuclear track detection. Results The arithmetic mean, geometric mean, median, and range of indoor radon concentrations in urban and rural areas in Yinchuan were 64 Bq/m³, 59 Bq/m³, 57 Bq/m³, and 25-172 Bq/m³, respectively. Surveillance sites with an indoor radon concentration higher than 100 Bq/m³ accounted for 7.5%. Indoor radon concentrations in rural areas were higher than those in urban areas. Indoor radon concentrations were highest in winter and lowest in summer. The effective dose of indoor radon exposure among residents in Yinchuan was 1.86 mSv/a. Conclusion The results of indoor radon concentrations measured in this investigation in Yinchuan are significantly higher than those measured in the 1990s. The annual effective dose is higher than the mean levels in the world and China.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.