ObjectiveTo investigate the feasibility， safety， and efficacy of surgery-assisted transjugular intrahepatic portosystemic shunt （SA-TIPS） in the treatment of portal hypertension comorbid with complex portal vein thrombosis， including cavernous transformation of the portal vein （CTPV）. MethodsAn analysis was performed for the data of 36 patients with portal hypertension and complex portal vein thrombosis who underwent SA-TIPS in Beijing Shijitan Hospital， Capital Medical University， from November 2023 to January 2025， including general status， technical data of the surgical process （surgical success rate， puncture times， time of operation， the number of stents used， and the length of shunt）， perioperative complications， and surgical recovery. The change in portal pressure gradient （PPG） after shunt was compared， and the rate of reaching the standard for PPG reduction was calculated， as well as stent patency rate within 1 week after surgery. The paired samples t-test was used for comparison of continuous data between two groups. ResultsAmong the 36 patients， 34 （94.4%） underwent SA-TIPS successfully. The incidence rate of perioperative complications was 16.7% （6/36）， including 3 cases of thoraco-abdominal hemorrhage， 2 cases of intraoperative arrhythmia， and 1 case of incision infection. There was a significant reduction in PPG after SA-TIPS （t=19.85， P<0.01）， and the patients achieving a ≥50% reduction in PPG accounted for 76.5% （26/34）. Imaging reexamination within 1 week showed a shunt patency rate of 100%. ConclusionSA-TIPS has a high technical success rate， a favorable safety profile， and good efficacy in the treatment of portal hypertension comorbid with complex portal vein thrombosis （including CTPV）， and therefore， it holds promise for clinical application.

OBJECTIVE To observe the changes of serum proteins in the mice with carbapenem-resistant hyperviru-lent Klebsiella pneumoniae(CR-hvKP)bloodstream infection by using liquid chromatogram-mass spectrometer(LC-MS),find out the differentially expressed proteins and carry out corresponding biological function analysis.METHODS The models of ICR mice with CR-hvKP and classical Klebsiella pneumoniae(cKP)bloodstream infec-tions were established,the serum specimens were collected from the mice at 12 hours of establishment of the in-fection models and were detected by using LC-MS.The result of LC-MS was identified by using Maxquant soft-ware.The corresponding bioinformatics analysis was performed for the differentially expressed proteins.RESULTS As compared with the normal control group,there were 24 upregulated proteins and 20 downregulated proteins in CR-hvKP group.As compared with cKP group,there were 107 upregulated proteins in the CR-hvKP group.The 134 differentially expressed proteins were retrieved one by one from Uniprot database,it was found that the pro-teins were involved in biological regulation,immune process,biological interaction,movement,metabolic process,response to stimulation,signal transduction,inflammatory response,oxidative stress and angiogenesis.The signal pathway analysis involved multiple metabolism-related pathways,including complement and coagula-tion cascades,cholesterol metabolism,bacterial infection,heme clearance,and assembly,remodeling and clear-ance of plasma lipoprotein.In terms of the proteins being attached great importance,the expression levels of kal-likrein B1(KLKB1)and serpin family A(Serpina)1b were downregulated as compared with the normal control group and were upregulated as compared with the cKP group;the expression levels of serum amyloid A protein(SAA)1,SAA2,Vanin-3(VNN3)and hemoglobinβpolypeptide chain b2(HBB-b2)were upregulated as com-pared with both the cKP group and the normal control group.CONCLUSIONS The CR-hvKP bloodstream infection involves the activation and action of multiple proteins.The rise of SAA1,SAA2,VNN3 and HBB-b2 or the de-cline of KLKB1 and Serpina1b may indicate the CR-hvKP bloodstream infection.

Objective:To compare the therapeutic efficacy of the dual anteromedial and anterolateral approaches versus that of the anterior midline approach in the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse.Methods:A retrospective study was conducted to analyze the 21 patients who had been treated for Wahlquist type C medial tibial plateau fractures plus posterior column collapse at The Fourth Orthopedic Ward, The 72nd Group Army Hospital of PLA between January 2019 and August 2023. The cohort included 13 males and 8 females, with an age of (43.3±6.7) years. The left side was involved in 14 fractures and the right side in 7 ones. The patients were divided into 2 groups based on their surgical approaches: a dual-approach group ( n=13) undergoing fixation via the dual anteromedial and anterolateral approaches, and a single-approach group ( n=8) undergoing fixation via the anterior midline approach. Comparative parameters included operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, medial proximal tibial angle (MPTA), incision complications, postoperative bone mass reduction quality (evaluated according to the Rasmussen anatomical criteria for tibial condyle fracture reduction), lateral tibial plateau instability, incidence of genu varum, and post-traumatic arthritis. Functional recovery of the lower limb joints was assessed at the final follow-up using the Merchant criteria. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups preoperatively, indicating comparability ( P>0.05). All patients were followed up for a mean duration of (38.1±11.3) months. The postoperative MPTA in the dual-approach group (86.8°±0.8°) was significantly larger than that in the single-approach group (85.5°±0.9°) ( P<0.05). Genu varum occurred in 1 patient in the dual-approach group and in 4 patients in the single-approach group, while lateral tibial plateau instability was observed in 1 patient in the dual-approach group and in 4 patients in the single-approach group, showing statistically significant differences between the 2 groups ( P<0.05). No statistically significant differences were found between the 2 groups regarding operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, incidence of incision complications, or incidence of post-traumatic arthritis ( P>0.05). At the final follow-up, no statistically significant difference was observed in the functional recovery of the lower limb joints assessed by the Merchant criteria between the 2 groups ( P>0.05). Conclusion:In the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse, compared with the single anterior midline approach, the dual anteromedial and anterolateral approaches can restore more effectively the MPTA, and reduce the incidences of genu varum and lateral tibial plateau instability.

OBJECTIVE To observe the changes of serum proteins in the mice with carbapenem-resistant hyperviru-lent Klebsiella pneumoniae(CR-hvKP)bloodstream infection by using liquid chromatogram-mass spectrometer(LC-MS),find out the differentially expressed proteins and carry out corresponding biological function analysis.METHODS The models of ICR mice with CR-hvKP and classical Klebsiella pneumoniae(cKP)bloodstream infec-tions were established,the serum specimens were collected from the mice at 12 hours of establishment of the in-fection models and were detected by using LC-MS.The result of LC-MS was identified by using Maxquant soft-ware.The corresponding bioinformatics analysis was performed for the differentially expressed proteins.RESULTS As compared with the normal control group,there were 24 upregulated proteins and 20 downregulated proteins in CR-hvKP group.As compared with cKP group,there were 107 upregulated proteins in the CR-hvKP group.The 134 differentially expressed proteins were retrieved one by one from Uniprot database,it was found that the pro-teins were involved in biological regulation,immune process,biological interaction,movement,metabolic process,response to stimulation,signal transduction,inflammatory response,oxidative stress and angiogenesis.The signal pathway analysis involved multiple metabolism-related pathways,including complement and coagula-tion cascades,cholesterol metabolism,bacterial infection,heme clearance,and assembly,remodeling and clear-ance of plasma lipoprotein.In terms of the proteins being attached great importance,the expression levels of kal-likrein B1(KLKB1)and serpin family A(Serpina)1b were downregulated as compared with the normal control group and were upregulated as compared with the cKP group;the expression levels of serum amyloid A protein(SAA)1,SAA2,Vanin-3(VNN3)and hemoglobinβpolypeptide chain b2(HBB-b2)were upregulated as com-pared with both the cKP group and the normal control group.CONCLUSIONS The CR-hvKP bloodstream infection involves the activation and action of multiple proteins.The rise of SAA1,SAA2,VNN3 and HBB-b2 or the de-cline of KLKB1 and Serpina1b may indicate the CR-hvKP bloodstream infection.

Objective:To compare the therapeutic efficacy of the dual anteromedial and anterolateral approaches versus that of the anterior midline approach in the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse.Methods:A retrospective study was conducted to analyze the 21 patients who had been treated for Wahlquist type C medial tibial plateau fractures plus posterior column collapse at The Fourth Orthopedic Ward, The 72nd Group Army Hospital of PLA between January 2019 and August 2023. The cohort included 13 males and 8 females, with an age of (43.3±6.7) years. The left side was involved in 14 fractures and the right side in 7 ones. The patients were divided into 2 groups based on their surgical approaches: a dual-approach group ( n=13) undergoing fixation via the dual anteromedial and anterolateral approaches, and a single-approach group ( n=8) undergoing fixation via the anterior midline approach. Comparative parameters included operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, medial proximal tibial angle (MPTA), incision complications, postoperative bone mass reduction quality (evaluated according to the Rasmussen anatomical criteria for tibial condyle fracture reduction), lateral tibial plateau instability, incidence of genu varum, and post-traumatic arthritis. Functional recovery of the lower limb joints was assessed at the final follow-up using the Merchant criteria. Results:No statistically significant differences were observed in the baseline characteristics between the 2 groups preoperatively, indicating comparability ( P>0.05). All patients were followed up for a mean duration of (38.1±11.3) months. The postoperative MPTA in the dual-approach group (86.8°±0.8°) was significantly larger than that in the single-approach group (85.5°±0.9°) ( P<0.05). Genu varum occurred in 1 patient in the dual-approach group and in 4 patients in the single-approach group, while lateral tibial plateau instability was observed in 1 patient in the dual-approach group and in 4 patients in the single-approach group, showing statistically significant differences between the 2 groups ( P<0.05). No statistically significant differences were found between the 2 groups regarding operative time, intraoperative blood loss, fracture healing time, quality of fracture reduction, incidence of incision complications, or incidence of post-traumatic arthritis ( P>0.05). At the final follow-up, no statistically significant difference was observed in the functional recovery of the lower limb joints assessed by the Merchant criteria between the 2 groups ( P>0.05). Conclusion:In the treatment of Wahlquist type C medial tibial plateau fractures accompanied by posterior column collapse, compared with the single anterior midline approach, the dual anteromedial and anterolateral approaches can restore more effectively the MPTA, and reduce the incidences of genu varum and lateral tibial plateau instability.

Objective:To construct a recombinant bioluminescent bacteriophage (HT7) targeting Escherichia coli, and evaluate its ability to identify Escherichia coli. Methods:Initially, pCRISPR-sg (1-10) and PFN-1000 plasmid strains were constructed by genetic engineering, and the most efficient small guild RNA (sgRNA) were screened by bilayer plate. By the gene editing technique, which comprised homologous recombination and clustered regularly interspaced short palin dromic repeats (CRISPR)-Cas system, the Nanoluc luciferase gene was integrated into the downstream non-coding region of 10A gene of T7 phage, to constructe the bioluminescent phage HT7 successfully. The difference of biological characteristics between HT7 phage and T7 phage was evaluated by plaque assay and liquid amplification assay. In addition, 51 strains of Escherichia coli, 20 strains of Klebsiella pneumoniae, 14 strains of Staphylococcus aureus, 6 strains of Enterococcus faecium, 5 strains of Enterococcus faecalis, 3 strains of Acinetobacter baumannii and 1 strain of Pseudomonas aeruginosa were collected and isolated to evaluate the limit of detection and specificity of HT7 phage. Results:Among the 10 CRISPR-targeted cleavage systems constructed, sgRNA8 exhibited the highest cleavage efficiency, with a cleavage rate of 0.18. After three rounds of recombination screening using the pCas9/pCRISPR/PFN-1000 triple-plasmid system, PCR validation yielded recombinant phage bands at 2 798 bp, indicating the successful construction of the HT7 phage. The recombinant phage showed significant differences in biological characteristics in terms of lysis efficiency ( P<0.001), one-step growth curve ( P=0.001), and infection multiplicity ( P=0.031). Both lysis burst time and log growth node were extended by 10 min, with the optimal infection multiplicity being 0.1. Clinical sample testing identified lysis of 6 strains of Escherichia coli within 4.5 h, while other strains remained unaffected, with detection of pathogenic bacteria below 10 CFU/ml. Conclusions:The developed pCas9/pCRISPR/PFN-1000 triple-plasmid editing system efficiently edits the bacteriophage genome. The constructed HT7 fluorescent bacteriophage enables the detection of Escherichia coli below 10 CFU/ml within 4.5 hours, demonstrating low detection limits and high detection specificity.

Objective:To explore the clinical value of synovial fluid calprotectin for the diagnosis of periprosthetic joint infection (PJI).Methods:Based on prospective cohort study design, a total of 82 patients suspected of PJI after hip and knee arthroplasty in the First Medical Center of the PLA General Hospital from July 2021 to June 2022 were selected. Patients were divided into infection group (PJI, n=39) and non-infection group (non-PJI, n=43) according to the diagnostic criteria proposed by the Second International Consensus Conference in 2018. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used for double-blind detection of calprotectin and internal reference standard (IRS) in synovial fluid of patients. The peaks of target protein and IRS were recorded for further analysis. Mann-Whitney U test was used to compare the concentrations of S100A8 and S100A9 between the two groups, and receiver operating characteristic curve (ROC) was used to analyze the diagnostic efficacy of S100A8 and S100A9 for PJI. Results:Calprotectin was detected as monomers S100A8 and S100A9. Synovial fluid S100A8 was significantly higher in the PJI group than that in the non-PJI group [1.57 (0.48, 4.17) vs 0.00 (0.00, 0.05), Z=?7.221, P<0.05]. Synovial fluid S100A9 was also significantly higher in the PJI group than that in the non-PJI group [0.74 (0.29, 1.70) vs 0.06 (0.00, 0.10), Z=?6.255, P<0.05]. When using S100A8 and S100A9 to diagnose PJI, the sensitivity were 97.4% and 87.2%, the specificity were 86.0% and 88.4%, and the area under the ROC were 0.964 (95% CI 0.929-0.998) and 0.902 (95% CI 0.924-0.996), respectively. Conclusion:The detection of synovial fluid S100A8 and S100A9 by MALDI-TOF MS can make a satisfactory diagnosis for PJI.

Objective:To investigate the clinical efficacy of proximal gastrectomy and total gastrectomy in the treatment of Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG).Methods:The retrospective cohort study was conducted. The clinicopathological data of 170 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to Guangdong Provincial People′s Hospital from January 2010 to December 2018 were collected. There were 125 males and 45 females, aged from 30 to 85 years, with a median age of 64 years. Of the 170 patients, 82 cases undergoing proximal gastrectomy were allocated into the proximal gastrectomy group and 88 cases undergoing total gastrectomy were allocated into the total gastrectomy group. Observation indica-tors: (1) surgical and postoperative situations; (2) follow-up and survival; (3) analysis of prognostic factors. Follow-up was conducted using telephone interview and outpatient examination to detect survival of patients up to December 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measure-ment data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Kaplan-Meier method was used to draw survival curves, and Log-Rank test was used for survival analysis. COX proportional hazard model was used for univariate and multivariate analyses. Variables with P<0.1 in univariate analysis were included for multivariate analysis. Results:(1) Surgical and postoperative situations. Cases with surgical approach as transthoracic or thoraco-abdominal approach, transabdominal approach, the operation time, cases with volume of intra-operative blood loss ≤100 mL or >100 mL, cases with length of proximal margin ≤1.5 cm or >1.5 cm, cases with radical surgery outcome as R 0, R 1, R 2, the number of lymph nodes harvest, cases with anastomotic leakage, cases with anastomotic stricture, cases with incision infection, cases with pleural infection or effusion, cases with abdominal infection or ascites were 61, 21, (211±18)minutes, 46, 36, 44, 38, 73, 6, 3, 15(9,22), 5, 2, 2, 4, 2 in the proximal gastrectomy group, respec-tively. The above indicators were 12, 76, (263±15)minutes, 27, 61, 45, 43, 82, 4, 2, 23(18,32), 4, 1, 3, 1, 4 in the total gastrectomy group, respectively. There were significant differences in the surgical approach, operation time, volume of intraoperative blood loss and the number of lymph nodes harvest between the two groups ( χ2=63.94, t=-25.50, χ2=11.19, Z=-5.62, P<0.05). There was no significant difference in the length of proximal margin or radical surgery outcome between the two groups ( χ2=0.11, Z=-0.95, P>0.05) and there was no significant difference in the anastomotic leakage, anastomotic stricture, incision infection, pleural infection or effusion, abdominal infection or ascites between the two groups ( P>0.05). (2) Follow-up and survival. All the 170 patients were followed up for 89(64,106)months. Of the 170 patients, the 5-year overall survival rates were 43.8% and 35.5% of the Siewert type Ⅱ and Ⅲ AEG patients, respectively, showing no significant difference between them ( χ2=0.87, P>0.05). Of the patients with Siewert type Ⅱ AEG, the 5-year overall survival rates were 41.7% and 54.3% in the patients with proximal gastrectomy and the total gastrectomy, respectively, showing no significant difference between them ( χ2=1.05, P>0.05). Of the patients with Siewert type Ⅲ AEG, the 5-year overall survival rates were 31.3% and 37.5% in the patients with proximal gastrectomy and the total gastrectomy, respectively, showing no significant difference between them ( χ2=0.33, P>0.05). The 5-year overall survival rates were 39.0% and 44.2% in the proximal gastrectomy group and the total gastrectomy group, respectively, showing no significant difference between the two groups ( χ2=0.63, P>0.05). Of the patients in TNM stage Ⅰ, stage Ⅱ, stage Ⅲ, the 5-year overall survival rates were 65.3%, 36.3%, 27.1% in the proximal gastrectomy group, versus 83.3%, 48.0%, 39.7% in the total gastrectomy group, showing no signifi-cant difference between the two groups ( χ2=0.02, 1.50, 1.21, P>0.05). (3) Analysis of prognostic factors. Results of univariate analysis showed that pathological N staging, degree of tumor differen-tiation and radical surgery outcome were related factors influencing prognosis of AEG patients ( hazard ratio=1.71, 1.70, 2.85, 95% confidence interval as 1.16-2.60, 1.15-2.50, 1.58-5.14, P<0.05). Results of multivariate analysis showed that pathological N staging and radical surgery outcome were independent factors influencing prognosis of AEG patients ( hazard ratio=1.55, 2.18, 95% confidence interval as 1.05-2.31, 1.18-4.02, P<0.05). Conclusions:There is no significant difference in the prognosis of Siewert type Ⅱ and Ⅲ AEG patients undergoing proximal gastrectomy or total gastrectomy. Proximal gastrectomy can be used for the treatment of advanced Siewert type Ⅱ and Ⅲ AEG.

【Objective】 To compare the effect of different combinations of filter membranes on the removal of IgA by component Ⅱ solution. 【Methods】 The dissolved solution of component Ⅱ was filtered with different combinations of filter membranes, and the turbidity, IgA residue, molecular size distribution and purity were compared. 【Results】 After filtering through the combination of NA-16+ Millpore 0.5μ, NA-16+ EmphazeTMAEX HP, and ZetaPlus™ + Emphaze™AEX HP filter membranes, the turbidity of the filtrate decreased by 35.5%(22.4/63.1), 39.2%(24.8/63.3) and 59.8%(37.4/62.5), the IgA residue decreased by 5.8%(14.77/253.70), 20.0%(50.90/254.00) and 44.3%(112.13/253.33), respectively.Molecular size distribution was 99.60%, 99.85% and 100%, and the purity was 100%, 100% and 100%, respectively. 【Conclusion】 The combination of ZetaPlus™ + Emphaze™AEX HP filter membrane can not only effectively remove IgA in the dissolution solution of component Ⅱ with other quality indicators remaining high-level, which can be used in IVIG large-scale production process.

OBJECTIVE: To assess the effect of ergonomic factor load on work-related musculoskeletal disorders(WMSDs) in shipyard workers. METHODS: A total of 751 shipyard workers were selected as the research subjects using judgment sampling method. The exposure level of adverse ergonomic factors was assessed using the Quick Exposure Check method. The prevalence of WMSDs was investigated using the revised Musculoskeletal Disorders Investigating Questionnaire of our research group, and the relationship between them was analyzed. RESULTS: The proportions of high or very high level of work load exposure to the neck, back, shoulder and hand in shipyard workers from high to low were 66.4%, 63.5%, 59.8% and 43.7%(P<0.01) respectively. The proportions of occupational stress, driving, vibration and working rhythm at high or very high exposure level were 20.0%, 4.1%, 22.9% and 3.2%, respectively. The prevalence of WMSDs in four body parts of shipyard workers from high to low was the back, neck, hand and shoulder(the prevalence were 44.2%, 31.2%, 26.9% and 26.6%, respectively, P<0.01). After excluding the influence of confounding factors, multiple logistic regression analysis showed that the higher the labor load exposure level and longer of the vibration tool using, the higher the risk of shoulder WMSDs [odds ratio(OR) and 95% confidence interval(CI) were 1.25(1.04-1.51) and 1.33(1.05-1.69), respectively, P<0.05]. The higher the level of occupational stress, the higher the risk of back and neck WMSDs [OR(95%CI) was 1.29(1.05-1.58) and 1.42(1.15-1.77), respectively, P<0.05]. CONCLUSION: There was a dose-effect relationship between the exposure level of shoulder load, the time of using vibration tools and the shoulder WMSDs, and there was a dose-effect relationship between the occupational stress level and the WMSDs in the back and neck.