A 70-year-old male patient was admitted to a hospital on March 1,2024 due to"muscle soreness in his extremities for over a month".Diagnosis consideration:polymyalgia rheumatica(with a high likelihood,the possi-bility of a tumor needs to be excluded).The patient was treated with methylprednisolone.After discharge from the hospital,the patient's symptoms worsened due to self-withdrawal of medication(methylprednisolone treatment for 20 days),and developed fever and cough.He then revisited the hospital and was confirmed to have Legionella mar-ssiliensis infection through metagenomic sequencing of bronchoalveolar lavage fluid(nucleic acid of all microorga-nisms were extracted from the specimens and compared in the PMDB database to obtain species information of the suspected pathogenic microorganisms).Subsequently,the patient was treated with a combination of 0.75 g levo-floxacin intravenous infusion qd+0.1 g doxycycline enteric-coated capsules orally bid for anti-infective therapy.The patient's symptoms,such as cough and muscle pain,improved significantly after anti-inflammatory and anti-in-fective treatment,and he was discharged on March 18.As the first reported case of Legionella marssiliensis pulmo-nary infection in China,this case highlights that among the multiple species of Legionella,there is another bacte-rium that can infect the human body and cause disease.This case report is beneficial for improving medical staff's understanding on Legionella marssiliensis and providing reference for the diagnosis and treatment of future cases of Legionella marssiliensis infection.

Objective To investigate the effect of ginsenoside Re on angiotensin Ⅱ(Ang Ⅱ)-induced proliferation,migration,and phenotype transformation of vascular smooth muscle cells(VSMCs)by regulating the Ras homologous gene family member A(RhoA)/mitogen activated protein kinase(MAPK)pathway.Methods MOVAS cells were divided into control group,Ang Ⅱ group,ginsenoside Re low dose group,ginsenoside Re medium dose group,ginsenoside Re high dose group,andginsenoside Re high dose+RhoA activator(U46619)group.MOVAS cell proliferation was detected by CCK-8.MOVAS cell migration was detected by scratch assay.Immunocytochemistry was used to detect the positive expression of α-smooth muscle actin(α-SMA)and osteopontin(OPN)proteins in MOVAS cells.qRT-PCR was used to detect the mRNA expression of PCNA,MMP-9,and MMP-2 in MOVAS cells.Western blot was used to detect RhoA,phosphorylated extracellular signal regulated kinase 1/2(p-ERK1/2),phosphorylated stress activated protein kinase 1(p-JNK1),and p-P38 protein in MOVAS cells.Results Compared with the control group,the OD450 value,scratch healing rate,OPN protein positive expression,PCNA,MMP-9,MMP-2 mRNA expression,RhoA,p-ERK1/2,p-JNK1,p-P38 protein expression of MOVAS cells in the Ang II group increased,while the positive expression of α-SMA protein decreased significantly(P<0.05).Compared with the Ang Ⅱ group,the OD450 value,scratch healing rate,OPN protein positive expression,PCNA,MMP-9,MMP-2 mRNA expression,and RhoA,p-ERK1/2,p-JNK1,and p-P38 proteins of MOVAS cells in the low,medium,and high dose groups of ginsenoside Re decreased,while the positive expression of α-SMA protein increased.The trend was most significant in the high dose group of ginsenoside Re(P<0.05).Compared with ginsenoside Re high-dose group,OD450 value,scratch healing rate,OPN protein positive expression,PCNA,MMP-9,MMP-2 mRNA expression and RhoA,p-ERK1/2,p-JNK1,p-P38 protein in ginsenoside Re high-dose+U46619 group increased,the positive expression of α-SMA protein decreased significantly(P<0.05).Conclusion Ginsenoside Re may inhibit the proliferation,migration,and phenotype transformation of Ang Ⅱ in MOVAS cells by suppressing the RhoA/MAPK pathway.

Objective To explore the effect and mechanism of Sechang Zhixie Powder(SCZXS)on mice with acute diarrhea caused by castor oil.Methods The mice were randomly divided into blank control group,model control group,montmorillonite powder group(1.4 g·kg-1),SCZXS-L group(0.9 g·kg-1),SCZXS-M group(1.8 g·kg-1)and SCZXS-H group(3.6 g·kg-1),10 mice in each group.After continuous administration of 7 days,the acute diarrhea model of mice was prepared by oral administration of castor oil(0.01 mL·g-1).The diarrhea of mice was observed within 4 hours of castor oil administration,and the rate of loose stool,degree of loose stool,and diarrhea index were calculated;the levels of DAO,D-LDH,VIP,and SS in the colon were determined by enzyme-linked immunosorbent assay;The morphological changes in the colon tissue of mice were observed after HE staining and the thicknesses of the mucosal and muscular layers of the colon were quantified;AB-PAS staining was performed to observe the effect on mucin in the colon;and the expression of AQP3,Occludin,and ZO-1 in the colon were quantified by immunohistochemistry.Results Compared with the model control group,the rate of loose stool,degree of loose stool,and diarrhea index of the mice in the SCZXS groups tended to decrease,but the difference was not statistically significant.Compared with the model control group,the flat luminal surface of the mice in the SCZXS-M and SCZXS-H group were significantly thickened(P<0.01),and the amount of VIP in the colon was significantly decreased(P<0.05,P<0.01),and that of DAO in the colon was significantly decreased(P<0.01),Occludin and ZO-1 expression were significantly increased(P<0.01),the mucin area ratio was significantly increased(P<0.05)in the SCZXS-M group,and AQP3 expression was significantly increased(P<0.05)in the SCZXS groups.Conclusions SCZXS can improve acute diarrhea induced by castor oil in mice.and its mechanism may be related to the regulation of gastrointestinal hormones and AQP3.In addition,SCZXS improves intestinal damage caused by diarrhea and protects the intestinal barrier.

Objective To analyze the risk factors of fluconazole resistance in Candida tropicalis(C.tropicalis)urinary tract infection(UTI),and evaluate the efficacy of different treatment regimens.Methods Patients with C.tropicalis UTI at Xiangya Hospital of Central South University from January 2021 to December 2023 were in-cluded for single center retrospective study.The minimum inhibitory concentration(MIC)of fluconazole was deter-mined by microbroth dilution.Patients were divided into a fluconazole-resistant group and a fluconazole-sensitive group based on fluconazole resistance.Risk factors for fluconazole resistance were analyzed based on clinical data,and therapeutic efficacy in patients in fluconazole-resistant group was analyzed.Results A total of 198 patients were included in the study.133(67.2％)C.tropicalis strains were detected to be sensitive to fluconazole,while 65(32.8％)strains were resistant,and 63.1％(n=41)had MIC values ≥128 μg/mL.Compared with fluconazole-sensitive group,fluconazole-resistant group had a higher proportion of pulmonary infection(P=0.019).Pulmonary infection(OR=3.282)was a risk factor for fluconazole resistance in C.tropicalis UTI,while urinary system ob-struction(OR=0.269)was a protective factor for fluconazole resistance in C.tropicalis UTI.There was no statis-tically significant difference in the usage rate of different antimicrobial agent types between the two groups(all P＞0.05).The therapeutic efficacy analysis showed that the effective rates of treatment with fluconazole dosage regi-mens of ≤200 mg/d,≥400 mg/d,and fluconazole monotherapy against fluconazole-resistant strains were 66.7％(6/9),83.3％(5/6),and 100％(6/6),respectively.For patients treated with monotherapy using other drugs or with multidrug sequential treatment regimens,the treatment effective rate was 60.0％(3/5).The proportion of pa-tients in the effective treatment group who removed their urinary catheters after detecting C.tropicalis was higher than that in the ineffective treatment group(P＜0.001).Conclusion The fluconazole resistance of C.tropicalis is related to urinary tract obstruction and concurrent pulmonary infection.When treating UTI caused by fluconazole-resistant strains,the catheter should be removed as early as possible.In addition to increasing the dosage of flucon-azole,other antifungal drugs such as flucytosine alone or sequential treatment with multiple drugs can also be con-sidered.

Objective To explore the effect and mechanism of Sechang Zhixie Powder(SCZXS)on mice with acute diarrhea caused by castor oil.Methods The mice were randomly divided into blank control group,model control group,montmorillonite powder group(1.4 g·kg-1),SCZXS-L group(0.9 g·kg-1),SCZXS-M group(1.8 g·kg-1)and SCZXS-H group(3.6 g·kg-1),10 mice in each group.After continuous administration of 7 days,the acute diarrhea model of mice was prepared by oral administration of castor oil(0.01 mL·g-1).The diarrhea of mice was observed within 4 hours of castor oil administration,and the rate of loose stool,degree of loose stool,and diarrhea index were calculated;the levels of DAO,D-LDH,VIP,and SS in the colon were determined by enzyme-linked immunosorbent assay;The morphological changes in the colon tissue of mice were observed after HE staining and the thicknesses of the mucosal and muscular layers of the colon were quantified;AB-PAS staining was performed to observe the effect on mucin in the colon;and the expression of AQP3,Occludin,and ZO-1 in the colon were quantified by immunohistochemistry.Results Compared with the model control group,the rate of loose stool,degree of loose stool,and diarrhea index of the mice in the SCZXS groups tended to decrease,but the difference was not statistically significant.Compared with the model control group,the flat luminal surface of the mice in the SCZXS-M and SCZXS-H group were significantly thickened(P<0.01),and the amount of VIP in the colon was significantly decreased(P<0.05,P<0.01),and that of DAO in the colon was significantly decreased(P<0.01),Occludin and ZO-1 expression were significantly increased(P<0.01),the mucin area ratio was significantly increased(P<0.05)in the SCZXS-M group,and AQP3 expression was significantly increased(P<0.05)in the SCZXS groups.Conclusions SCZXS can improve acute diarrhea induced by castor oil in mice.and its mechanism may be related to the regulation of gastrointestinal hormones and AQP3.In addition,SCZXS improves intestinal damage caused by diarrhea and protects the intestinal barrier.

Objective To analyze the risk factors of fluconazole resistance in Candida tropicalis(C.tropicalis)urinary tract infection(UTI),and evaluate the efficacy of different treatment regimens.Methods Patients with C.tropicalis UTI at Xiangya Hospital of Central South University from January 2021 to December 2023 were in-cluded for single center retrospective study.The minimum inhibitory concentration(MIC)of fluconazole was deter-mined by microbroth dilution.Patients were divided into a fluconazole-resistant group and a fluconazole-sensitive group based on fluconazole resistance.Risk factors for fluconazole resistance were analyzed based on clinical data,and therapeutic efficacy in patients in fluconazole-resistant group was analyzed.Results A total of 198 patients were included in the study.133(67.2％)C.tropicalis strains were detected to be sensitive to fluconazole,while 65(32.8％)strains were resistant,and 63.1％(n=41)had MIC values ≥128 μg/mL.Compared with fluconazole-sensitive group,fluconazole-resistant group had a higher proportion of pulmonary infection(P=0.019).Pulmonary infection(OR=3.282)was a risk factor for fluconazole resistance in C.tropicalis UTI,while urinary system ob-struction(OR=0.269)was a protective factor for fluconazole resistance in C.tropicalis UTI.There was no statis-tically significant difference in the usage rate of different antimicrobial agent types between the two groups(all P＞0.05).The therapeutic efficacy analysis showed that the effective rates of treatment with fluconazole dosage regi-mens of ≤200 mg/d,≥400 mg/d,and fluconazole monotherapy against fluconazole-resistant strains were 66.7％(6/9),83.3％(5/6),and 100％(6/6),respectively.For patients treated with monotherapy using other drugs or with multidrug sequential treatment regimens,the treatment effective rate was 60.0％(3/5).The proportion of pa-tients in the effective treatment group who removed their urinary catheters after detecting C.tropicalis was higher than that in the ineffective treatment group(P＜0.001).Conclusion The fluconazole resistance of C.tropicalis is related to urinary tract obstruction and concurrent pulmonary infection.When treating UTI caused by fluconazole-resistant strains,the catheter should be removed as early as possible.In addition to increasing the dosage of flucon-azole,other antifungal drugs such as flucytosine alone or sequential treatment with multiple drugs can also be con-sidered.

A 70-year-old male patient was admitted to a hospital on March 1,2024 due to"muscle soreness in his extremities for over a month".Diagnosis consideration:polymyalgia rheumatica(with a high likelihood,the possi-bility of a tumor needs to be excluded).The patient was treated with methylprednisolone.After discharge from the hospital,the patient's symptoms worsened due to self-withdrawal of medication(methylprednisolone treatment for 20 days),and developed fever and cough.He then revisited the hospital and was confirmed to have Legionella mar-ssiliensis infection through metagenomic sequencing of bronchoalveolar lavage fluid(nucleic acid of all microorga-nisms were extracted from the specimens and compared in the PMDB database to obtain species information of the suspected pathogenic microorganisms).Subsequently,the patient was treated with a combination of 0.75 g levo-floxacin intravenous infusion qd+0.1 g doxycycline enteric-coated capsules orally bid for anti-infective therapy.The patient's symptoms,such as cough and muscle pain,improved significantly after anti-inflammatory and anti-in-fective treatment,and he was discharged on March 18.As the first reported case of Legionella marssiliensis pulmo-nary infection in China,this case highlights that among the multiple species of Legionella,there is another bacte-rium that can infect the human body and cause disease.This case report is beneficial for improving medical staff's understanding on Legionella marssiliensis and providing reference for the diagnosis and treatment of future cases of Legionella marssiliensis infection.

Objective To investigate the effect of ginsenoside Re on angiotensin Ⅱ(Ang Ⅱ)-induced proliferation,migration,and phenotype transformation of vascular smooth muscle cells(VSMCs)by regulating the Ras homologous gene family member A(RhoA)/mitogen activated protein kinase(MAPK)pathway.Methods MOVAS cells were divided into control group,Ang Ⅱ group,ginsenoside Re low dose group,ginsenoside Re medium dose group,ginsenoside Re high dose group,andginsenoside Re high dose+RhoA activator(U46619)group.MOVAS cell proliferation was detected by CCK-8.MOVAS cell migration was detected by scratch assay.Immunocytochemistry was used to detect the positive expression of α-smooth muscle actin(α-SMA)and osteopontin(OPN)proteins in MOVAS cells.qRT-PCR was used to detect the mRNA expression of PCNA,MMP-9,and MMP-2 in MOVAS cells.Western blot was used to detect RhoA,phosphorylated extracellular signal regulated kinase 1/2(p-ERK1/2),phosphorylated stress activated protein kinase 1(p-JNK1),and p-P38 protein in MOVAS cells.Results Compared with the control group,the OD450 value,scratch healing rate,OPN protein positive expression,PCNA,MMP-9,MMP-2 mRNA expression,RhoA,p-ERK1/2,p-JNK1,p-P38 protein expression of MOVAS cells in the Ang II group increased,while the positive expression of α-SMA protein decreased significantly(P<0.05).Compared with the Ang Ⅱ group,the OD450 value,scratch healing rate,OPN protein positive expression,PCNA,MMP-9,MMP-2 mRNA expression,and RhoA,p-ERK1/2,p-JNK1,and p-P38 proteins of MOVAS cells in the low,medium,and high dose groups of ginsenoside Re decreased,while the positive expression of α-SMA protein increased.The trend was most significant in the high dose group of ginsenoside Re(P<0.05).Compared with ginsenoside Re high-dose group,OD450 value,scratch healing rate,OPN protein positive expression,PCNA,MMP-9,MMP-2 mRNA expression and RhoA,p-ERK1/2,p-JNK1,p-P38 protein in ginsenoside Re high-dose+U46619 group increased,the positive expression of α-SMA protein decreased significantly(P<0.05).Conclusion Ginsenoside Re may inhibit the proliferation,migration,and phenotype transformation of Ang Ⅱ in MOVAS cells by suppressing the RhoA/MAPK pathway.

Objective:To evaluate the efficacy and safety of oliceridine for treatment of moderate to severe pain after surgery with general anesthesia in patients.Methods:The patients with moderate to severe pain (numeric pain rating scale ≥4) after abdominal surgery with general anesthesia from 14 hospitals between July 6, 2021 and November 9, 2021 were included in this study. The patients were assigned to either experiment group or control group using a random number table method. Experiment group received oliceridine, while control group received morphine, and both groups were treated with a loading dose plus patient-controlled analgesia and supplemental doses for 24 h. The primary efficacy endpoint was the drug response rate within 24 h after giving the loading dose. Secondary efficacy endpoints included early (within 1 h after giving the loading dose) drug response rates and use of rescue medication. Safety endpoints encompassed the development of respiratory depression and other adverse reactions during treatment.Results:After randomization, both the full analysis set and safety analysis set comprised 180 cases, with 92 in experiment group and 88 in control group. The per-protocol set included 170 cases, with 86 in experiment group and 84 in control group. There were no statistically significant differences between the two groups in 24-h drug response rates, rescue analgesia rates, respiratory depression, and incidence of other adverse reactions ( P>0.05). The analysis of full analysis set showed that the experiment group had a higher drug response rate at 5-30 min after giving the loading dose compared to control group ( P<0.05). The per-protocol set analysis indicated that experiment group had a higher drug response rate at 5-15 min after giving the loading dose than control group ( P<0.05). Conclusions:When used for treatment of moderate to severe pain after surgery with general anesthesia in patients, oliceridine provides comparable analgesic efficacy to morphine, with a faster onset.

Objective To explore the relationship between serum levels of decorin,soluble Axl(sAxl),cy-tokine-like protein 1(CYTL1)and Kellgren-Lawrence(K-L)grading in patients with knee osteoarthritis.Methods From August 2021 to May 2023,328 patients with knee osteoarthritis admitted to the hospital were selected as the research group,and 328 healthy controls during the same period were selected as the control group.Serum Decorin,sAxl and CYTL1 levels were detected by enzyme-linked immunosorbent assay.Western Ontario and McMaster University Osteoarthritis Questionnaire(WOMAC)was used to assess patients'clini-cal symptoms.Spearman method was used to analyze the correlation between serum Decorin,sAxl,CYTL1 and K-L grading,as well as WOMAC score.Logistic regression was used to analyze the influencing factors of knee osteoarthritis.ROC curve was drawn to analyze the diagnostic value of serum Decorin,sAxl and CYTL1 in grade Ⅰ to Ⅱ and Ⅲ to Ⅳ of knee osteoarthritis.Results Serum Decorin and sAxl levels in the study group were significantly higher than those in the control group(P＜0.05),and CYTL1 levels were signifi-cantly lower than those in the control group,with statistical significance(P＜0.05).The levels of serum Decorin,sAxl and WOMAC scores in K-L grades Ⅰ,Ⅱ,Ⅲ and Ⅳ were increased successively(P＜0.05),while the levels of CYTL1 were decreased successively(P＜0.05).Spearman correlation analysis showed that serum Decorin and sAxl were positively correlated with K-L grading and WOMAC score(P＜0.05),and CYTL1 was negatively correlated with K-L grading and WOMAC score(P＜0.05).High level of Decorin,sAxl and low level of CYTL1 were risk factors for knee osteoarthritis(P＜O.05).The levels of serum Decor-in,sAxl and CYTL1 had certain diagnostic value for grade Ⅰ to Ⅱ and grade Ⅲ to Ⅳ of knee osteoarthritis.Conclusion Serum Decorin,sAxl and CYTL1 levels are closely related to K-L grade of knee osteoarthritis,and can be used for auxiliary diagnosis of grade Ⅰ to Ⅱ and grade Ⅲ to Ⅳ of knee osteoarthritis.