Objective To evaluate the clinical application of computer-aided electromagnetic imaging navigation in nasal endoscopic surgery.Methods Twenty-two cases of nasal endoscopic surgery with intraoperative imaging navigation were retrospectively reviewed,including 16 cases of sinusitis with or without polyp;5 cases of nasal inverting papilloma; 1 case of maxillary capillary hemangioma.All cases were operated with computer-aided electromagentic imaging navigation and nasal endoscope.Results The preoperative preparing time would take 4-10 minutes.In 22 cases,the localization accuracy between 3-D image landmarks of navigation system and actual anatomical landmarks was less than 1 mm.The optic nerve and other anatomical landmarks could be orientated accurately in intraoperative procedures.No complication occurred.Conclusions Nasal endoscope combined with computer-aided electromagnetic imaging navigation provides accurate anatomical localization of nasal cavity,sinuses and anterior skull base.It could improve the effectiveness and decrease surgical complications,especially in complicated cases.

Objective To observe the effect of Puerarin on the level of tau phosphorylation in the olfactory bulb of Alzheimer's disease rat brain, and explore the underlying molecular mechanism.Methods ① Twenty-two male SD rats were randomly divided into the normal control group, model control group and Puerain-treated group.The levels of tau-1, PS396 and tau-5 in the olfactory bulb were detected by Western blotting.② Twenty male SD rats were randomly divided into model control group, low-dose Puerarin (40 mg·kg-1·d-1), medium-dose puerarin (80 mg·kg-1·d-1) and high-dose puerarin (160 mg·kg-1·d-1) groups.The levels of tau-1 and PS396 phosphorylation in the olfactory bulb were detected by Western blotting.③ The level of GSK-3β phosphorylation in the olfactory bulb of the normal control group, model control group A and puerain-treated group was detected by Western blotting.Results ① It was shown by Western blotting that the relative expression of tau-1 was significantly decreased in the olfactory bulb of the model group A(0.49±0.07)rat brain compared with the normal control group(0.85±0.03)(P<0.01), and the level of tau-1 was obviously higher in the puerarin-treated group(0.58±0.03)compared with that of the model group A(P<0.05).The differences of the levels of tau-5 and PS396 in the olfactory bulb were insignificant among the 3 groups.②Compared with the model group B, the expression of tau-1 in the olfactory bulb was significantly enhanced in the low-, medium-and high-dose of puerarin group: (0.39±0.09)vs(0.69±0.11),(0.55±0.11),(0.70±0.04);and the level of PS396 was significantly decreased in the olfactory bulb of low-dose puerarin group(0.36±0.07) compared with the model group B(0.55±0.05)(P<0.01).③Compared with the normal control group(0.96±0.07), the ratio of pS9-GSK-3β/tGSK-3β was obviously decreased in the olfactory bulb of the model group A(0.51±0.12),while that was significantly increased in the puerarin group(0.62±0.03) compared with the model group A(P<0.01).Conclusion Puerarin can attenuate AD-like tau hyperphosphorylation in the olfactory bulb of Alzheimer's disease rat brains, and decreased activity of GSK-3β might be involved in the effects of puerarin on tau hyperphosphorylation.

Objective To explore the safety and efficacy of laparoscopic cholecystectomy in different time points after endoscopic retrograde cholangiopancreatography in elderly patients with cholecystolithiasis and choledocholithiasis. Methods 99 elderly patients （≥60 years old）with cholecystolithiasis and choledocholithiasis treated by sequential LC after ERCP in the Department of Hepatobiliary and Pancreatic surgery in our hospital from January 2015 to June 2020 were analyzed. Aocording to different time points after ERCP, LC was divided into experimental group (within 1 day after ERCP) and control group (within 2-7 days after ERCP). The complications were followed up by telephone within 3 months after operation. Results After analysis，the difference between the experimental group and the control group in the total length of hospitalization [(13.0±4.6)d vs ( 15.1±4.4)d] and total hospitalization expenses (38 172.5±12 448.9) vs ( 42 535.4±8 814.6)] was statistically significant (P<0.05). However, there was no significant difference in the conversion rate of LC to laparotomy, the total postoperative complications , the length of hospital stay after LC，the amount of blood loss during LC and the time of LC operation between the two groups(P>0.05). Conclusion For elderly patients with cholecystolithiasis and choledocholithiasis, LC within 1 day after ERCP does not increase the difficulty of operation and postoperative complications，but shortens the hospitalization time, and it is economical and safe at the same time.

BACKGROUND: The area of myocardial infarction is the determinative factor of acute myocardial infarction prognosis. Amelioration of blood transportation and replacement therapy can reduce infarction area. Bone marrow mesenchymal stem cells can differentiate into cardiovascular tissue and are easy to obtain. After cultured and expanded in vitro, they can become the ideal cells for cardiovascular replacement therapy.OBJECTIVE: To evaluate the therapeutic effect of intracoronary transplantation of bone marrow mesenchymal stem cells in the treatment of myocardial infarction. DESIGN: Self-control observation taking the patients as subjects.SETTING: Department of Cardiology, Department of Nuclear Medicine,Echocardiogram Room, Nanjing First Hospital Affiliated to Nanjing Medical University.PARTICIPANTS: Totally 20 patients with acute myocardial infarction who received the therapy of bone marrow mesenchymal stem cells transplantation in the Department of Cardiology, Nanjing First Hospital Affiliated to Nanjing Medical University during March 2003 to March 2004 were recurited. Informed consents were obtained from the patients, and the complete postoperative follow up was over 3 months. The patients include 15 male and 5 female, and they were aged (64±10) years.METHODS: All the patients underwent percutaneous coronary intervention (PCI) to treat infarction-related blood vessel. Autologous bone marrow was taken from the patients, then stem cells were extracted to be performed in vitro induction, differentiation and proliferation, and transplanted infarction-related blood vessel through coronary artery at the mean number of (21.7±30.14)× 107 within 2 weeks. Before and 3 months after transplantation of stem cells, patients underwent gated dual-isotopic myocardial perfusion/metabolic imaging (18-fluoro-2-deoxy-glucose, 18F-FDG) examination. Survived and necrotic myocardia were predicted and infarction area was obtained. At the same time, wall motion and heart function index were evaluated with ultrasound cardiography (UCG)examination, and they were re-checked 3 months after operation to evaluate the amelioration of wall motion and heart function index. A 5-point scale was used in the evaluation of gated dual-isotopic myocardial perfusion/metabolic imaging (18F-FDG) examination: point 0: normal, 1: sparse, 2:obviously sparse, 3: defected. Evaluative standard of UCG: point 1: normal,2: reduced, 3: obviously reduced, 4: no ventricular wall motion or paradoxical motion; Wall motion with 2 points or more than 2 points suggests it is improved.MAIN OUTCOME MEASURES: ① Results of gated dual-isotopic myocardial perfusion/ metabolic imaging (18F-FDG-SPECT); ②Infarctionrelated myocardial segment score and heart function index before and after stem cell transplantation of patients in ECG follow-up observation.RESULTS: All the 20 patients participated in the result analysis.Results of gated dual-isotopic myocardial perrusion/metabolic imaging (18F-FDG-SPECT): The myocardial perfusion defect area of 20 patients was significantly reduced after therapy than before therapy [(33±15)%,-(44±18)% ,P ＜ 0.05]; Metabolie defect area was significantly reduced after therapy than before therapy [(33±17)%, (43±21)% ,P ＜ 0.05];Before therapy, there were 199 segments, in which blood flow reperfusion was matched to glycometabolism defect, and they were determined as necrotic myocardium. After therapy, blood flow perfusion metabolism was improved in 79 segments, but blood flow perfusion and glycometabolism were not improved significantly in 120 segments (P ＜ 0.05). Results of UCG: ejection fraction of patients was significantly larger after therapy than before therapy [(53±8)%, (42±7)% ,P ＜ 0.05].CONCLUSION: Intracoronary transplantation of human bone marrow mesenchymal stem cells for treating myocardial infarction is simple to operate. After therapy, the infarction area is obviously reduced, myocardial blood flow perfusion and metabolism of necrotic area improve, myocardial segments without survival determined before operation reduce sigrificantly and the heart function of patients improve.

ObjectiveTo investigate the risk factors for open pancreatic necrosectomy (OPN), an effective treatment method for severe acute pancreatitis (SAP) after the failure of percutaneous catheter drainage (PCD), in patients with SAP. MethodsA retrospective analysis was performed for 156 patients with SAP who underwent surgical intervention based on the step-up approach in The Affiliated Hospital of Zunyi Medical University from January 1, 2010 to June 30, 2018, and according to whether OPN was performed, the patients were divided into PCD group with 126 patients and PCD+OPN group with 30 patients. Related clinical data were collected, including age, sex, etiology, blood calcium on admission, white blood cell count on admission, whether CTSI score was ＞7, APACHE-Ⅱ score, Ranson score, presence or absence of peripancreatic fluid accumulation, presence or absence of infection, presence or absence of multiple organ failure (MOF), and whether PCD was performed at more than 1 week after admission. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; a multivariate logistic regression analysis was used to determine the independent predictive factors for OPN. ResultsThe probability of OPN was 19.2% for SAP patients in the later stage. Compared with the PCD+OPN group, the PCD group had a significantly lower proportion of patients with MOF on admission ［27.0% (34/126) vs 70.0% (21/30), χ2=19.642, P＜0.01］ and a significantly higher proportion of patients undergoing PCD at less than 1 week after admission ［61.9% (78/126) vs 20.0% (6/30), χ2=17.121, P＜0.01］. MOF on admission (odds ratio ［OR］=5.343, 95% confidence interval ［CI］: 1.832-15.583, P＜0.05), initial PCD performed at more than 1 week after admission (OR= 5.518, 95% CI: 1.742-17.477, P＜0.05), and infection on admission (OR=5.016, 95% CI: 1.322-19.378, P＜0.05) were independent risk factors for subsequent OPN in SAP patients. ConclusionSAP with MOF on admission, initial PCD performed at more than 1 week after admission, and SAP with infection on admission are independent risk factors for subsequent OPN in SAP patients undergoing PCD in the early stage based on the step-up approach. Timely identification of related risk factors helps to grasp the timing of OPN in clinical practice and improve the clinical prognosis of SAP patients.

Hepatic ischemia-reperfusion injury (HIRI) is the main cause of liver damage and even multiple organ failure after complex liver surgery.When liver ischemia reperfusion occurs,the non-coding RNAs in the liver tissue is dysregulated and part of the non-coding RNAs with abnormal expression is involved in HIRI regulation.Non-coding RNAs to may be the intervention target for reducing HIRI.This article summarized the types and related functions of non-coding RNAs,the role of different non-coding RNAs in HIRI,and the interconnections between various non-coding RNAs in HIRI.

Robot-assisted laparoscopy hepatectomy (RALH) is a new technique for surgical operation. Compared with conventional laparoscopic hepatectomy, RALH is more frequently used in complex liver tumor and liver tumor with special locations, but this technique is still under development and is limited by the burden of high costs and surgical devices. Meanwhile, there is a lack of generally accepted and confirmed clinical data, and therefore, the role of RALH is still under debate. This article reviews the surgical indication, learning curve, advantages, and limitations of RALH.

Objective To investigate the changing distribution and antibiotic resistance profiles of clinical isolates of Staphylococcus in hospitals across China from 2015 to 2021.Methods Antimicrobial susceptibility testing was conducted for the clinical isolates of Staphylococcus according to the unified protocol of CHINET(China Antimicrobial Surveillance Network)using disk diffusion method and commercial automated systems.The CHINET antimicrobial resistance surveillance data from 2015 to 2021 were interpreted according to the 2021 CLSI breakpoints and analyzed using WHONET 5.6.Results During the period from 2015 to 2021,a total of 204,771 nonduplicate strains of Staphylococcus were isolated,including 136,731(66.8％)strains of Staphylococcus aureus and 68,040(33.2％)strains of coagulase-negative Staphylococcus(CNS).The proportions of S.aureus isolates and CNS isolates did not show significant change.S.aureus strains were mainly isolated from respiratory specimens(38.9±5.1)％,wound,pus and secretions(33.6±4.2)％,and blood(11.9±1.5)％.The CNS strains were predominantly isolated from blood(73.6±4.2)％,cerebrospinal fluid(12.1±2.5)％,and pleural effusion and ascites(8.4±2.1)％.S.aureus strains were mainly isolated from the patients in ICU(17.0±7.3)％,outpatient and emergency(11.6±1.7)％,and department of surgery(11.2±0.9)％,whereas CNS strains were primarily isolated from the patients in ICU(32.2±9.7)％,outpatient and emergency(12.8±4.7)％,and department of internal medicine(11.2±1.9)％.The prevalence of methicillin-resistant strains was 32.9％in S.aureus(MRSA)and 74.1％in CNS(MRCNS).Over the 7-year period,the prevalence of MRSA decreased from 42.1％to 29.2％,and the prevalence of MRCNS decreased from 82.1％to 68.2％.MRSA showed higher resistance rates to all the antimicrobial agents tested except trimethoprim-sulfamethoxazole than methicillin-susceptible S.aureus(MSSA).Over the 7-year period,MRSA strains showed decreasing resistance rates to gentamicin,rifampicin,and levofloxacin,MRCNS showed decreasing resistance rates to gentamicin,erythromycin,rifampicin,and trimethoprim-sulfamethoxazole,but increasing resistance rate to levofloxacin.No vancomycin-resistant strains were detected.The prevalence of linezolid-resistant MRCNS increased from 0.2％to 2.3％over the 7-year period.Conclusions Staphylococcus remains the major pathogen among gram-positive bacteria.MRSA and MRCNS were still the principal antibiotic-resistant gram-positive bacteria.No S.aureus isolates were found resistant to vancomycin or linezolid,but linezolid-resistant strains have been detected in MRCNS isolates,which is an issue of concern.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.