OBJECTIVE To explore the changes of serum Toll-like receptor(TLR)2,TLR4 and 25 hydroxyvitamin D[25(OH)D]in the general anesthesia orthopedic surgery patients with postoperative pulmonary infections and analyze the distribution and drug resistance of pathogens.METHODS A total of 59 general anesthesia orthopedic surgery patients with postoperative pulmonary infections who were treated in Tianjin Fifth Central Hospital from Jul.2019 to Jul.2024 were chosen as the infection group,meanwhile,65 patients who underwent the same surger-y but did not have postoperative pulmonary infection or other acute and chronic infections were chosen as the non-infection group.The etiological characteristics of the postoperative pulmonary infections and the drug re-sistance rates were analyzed.The clinical data and the levels of serum TLR2,TLR4 and 25(OH)D were observed and compared between the two groups of patients.The values of the above indicators in diagnosis of the postopera-tive pulmonary infections in the general anesthesia orthopedic surgery were analyzed.RESULTS Totally 63 strains of pathogens were isolated from the 59 general anesthesia orthopedic surgery patients with postoperative pulmona-ry infections,36(57.14％)of which were gram-negative bacteria.3 of 15 Pseudomonas aeruginosa strains were resistant to meropenem;4 of 12 Klebsiella pneumoniae strians were resistant to meropenem;all of the 11 Staph-ylococcus aureus strains were methicilin-resistant S.aureus.The proportions of patients with age,hypoproteine-mia and diabetes mellitus,the serum TLR2 and TLR4 levels were higher in the infection group than in the non-infection group(P＜0.05),while the 25(OH)D level of the infection group was lower than that of the no in-fection group(P＜0.05).The area under the curves(AUCs)of serum TLR2,TLR4,25(OH)D and the joint de-tection of the above indicators were respectively 0.817,0.801,0.787 and 0.917 in diagnosis of postoperative pul-monary infections in the general anesthesia orthopedic surgery patients,and the AUC of the joint detection of the indicators was greater than that of the single detection(P＜0.05).CONCLUSIONS The general anesthesia or-thopedic surgery patients with postoperative pulmonary infections show high expressions of serum TLR2 and TLR4 and the low expression of 25(OH)D.The joint detection of the above indexes has higher diagnostic value.The gram-negative bacteria are dominant among the pathogens causing the infections.The pathogens vary in the drug resistance.

Pain assessment in children is vital in clinical practice. Accurate evaluation of pain intensity in children is the prerequisite for implementing effective analgesic interventions, it is necessary to chose age-specific assessment tools tailored to developmental stages of children. The degrees of patin reported by children themselves are the gold standard for evaluation, and self-assessment should be prioritized when feasible. In addition, behavioral and physiological assessments also show good reliability and validity. This review summarizes current domestic and international researches on pediatric pain assessment tools and their clinical applications, aiming to provide reference for optimizing pain evaluation in pediatric practice.

Objective:To investigate the plasma level of interleukin(IL)-37 and assess its regulatory effects on monocyte activity in type 1 diabetes mellitus(T1DM) patients.Methods:This prospective study included 57 T1DM patients and 21 healthy controls who were continuously enrolled from December 2022 to January 2024 at Xinxiang Central Hospital. Plasma and peripheral blood mononuclear cells were isolated. IL-37 and soluble interleukin 1 receptor 8(IL-1R8) levels were measured by enzyme-linked immunosorbent assay(ELISA). Levels of IL-37 receptor subunits in monocytes were analyzed via flow cytometry. Purified monocytes were stimulated with recombinant IL-37 and co-cultured with a human pancreatic β-cell line to assess cytotoxicity, measured by target cell death and cytokine levels. Additionally, monocytes were co-cultured with autologous CD4 + T cells to evaluate antigen presentation by measuring interferon-γ(IFN-γ) and IL-17A secretion. Results:Plasma IL-37 level and IL-37 receptor subunit expression in monocytes were significantly lower in T1DM patients compared to controls(both P<0.001). However, there was no significant difference in soluble IL-1R8 levels between the groups( P=0.457). Monocytes from T1DM patients exhibited increased cytotoxicity, as indicated by higher target cell death and elevated levels of granzyme A, granzyme B, granzyme H, IL-1β, IL-6, and tumor necrosis factor-α( P<0.05). Additionally, monocyte-induced secretion of IFN-γ and IL-17A by CD4 + T cells was elevated in T1DM patients(all P<0.05). Stimulation of T1DM monocytes with recombinant IL-37 reduced target cell death and decreased granzyme B secretion compared to unstimulated monocytes(both P<0.05). However, IL-37 stimulation had no significant effect on other cytokine levels or monocyte-induced IFN-γ and IL-17A secretion( P>0.05). Conclusions:Monocytes exhibit enhanced cytotoxicity and antigen-presenting capacity in T1DM patients. IL-37 reduces monocyte cytotoxicity by inhibiting granzyme B secretion, but does not affect antigen presenting function in T1DM.

This paper reported a type 1 diabetes patient who had severe diabetic nephropathy, retinopathy, hypertension, and hypothyroidism before pregnancy. The patient's blood glucose control was poor before pregnancy, and the complications were not properly treated. This was an unintended pregnancy, with a pre-pregnancy glycated hemoglobin A1c of 7.8% and early pregnancy urine protein of 3.81-4.53 g/24 h. Considering the patient's poor blood glucose control before pregnancy and the lack of proper treatment for multiple complications including nephropathy, a multidisciplinary consultation at an external hospital recommended termination of the pregnancy. However, the patient was determined to continue the pregnancy and was referred to Peking University First Hospital. Through strict blood glucose control, monitoring and evaluation of complications, and comprehensive management, the patient's blood glucose and blood pressure were well controlled during pregnancy. Regular monitoring of urine protein, renal function, and ocular fundus was conducted. At 31 weeks and 4 days of gestation, the patient's 24-hour urine protein significantly increased. After promoting fetal lung maturity, a cesarean section was performed at 34 weeks and 1 day of gestation, resulting in a successful delivery with good maternal and neonatal outcomes. At the 42-day postpartum follow-up, the patient's blood glucose and blood pressure were stable, urine protein returned to pre-pregnancy levels, and the infant was in good general condition.

Objective:To explore the relationship between anxiety symptoms and dispositional mindfulness and analyze the role of psychological resilience and interpersonal sensitivity in their relationship.Methods:A total of 478 college students were selected and assessed with the Depression Anxiety Stress Scale-Anxiety subscale(DASS-A),Mindful Attention Awareness Scale(MAAS),Brief Resilience Scale(BRS)and Symptom Checklist 90-Interpersonal Sensitivity Scale(IPS).SPSS macro program PROCESS3.5 was used to test the mediating role.Results:The DASS-A scores were negatively correlated with the MAAS and BRS scores(r=-0.38,-0.33,Ps＜0.01),and positively correlated with the IPS scores(r=0.40,P＜0.01).The MAAS scores were positively correlated with the BRS scores(r=0.40,P＜0.01),and negatively with the IPS scores(r=-0.39,P＜0.01).The BRS scores were negatively correlated with the IPS scores(r=-0.42,P＜0.01).Psychological resilience and interpersonal sensitivity acted as mediators and chain mediators between dispositional mindfulness and anxiety symptoms,with effect sizes of-0.06,-0.07,-0.03,accounting for 15.79％,18.42％,7.89％of the total effect,respectively.Conclusion:It suggests that anxiety symptoms are related to dispositional mindfulness in college students,and psychological resilience and interpersonal sensitivity play a chain mediating role between them.

Objective: To explore the differential lipid metabolites in the plasma of mice with idiopathic pulmonary fibrosis(IPF). Methods : Thirty SPF C57BL/6 male mice were randomly divided into 2 groups with 15 mice in each group. The experimental groups were divided into control group and bleomycin(BLM) group. The model of idiopathic pulmonary fibrosis was induced by one-time intratracheal infusion of BLM(1 mg/kg). Hematoxylin-eosin(HE) staining was used to observe the lung histopathology. The collagen fiber deposition in lung tissue was observed by Sirius red staining. The differential lipid metabolites in plasma of IPF mice were screened and enriched by lipidomics. Results : HE staining showed that the pulmonary tissue structure was disordered, alveolar septum was broken and alveolar wall was destroyed in BLM group. Sirius red staining showed a large amount of collagen fiber deposition in the lung interstitium of BLM group. The results of lipidomics analysis showed that the lipid metabolism profile of BLM group changed, 15 differential lipid metabolites were screened out, of which 11 differential lipid metabolites were up-regulated, and 4 differential lipid metabolites were down-regulated, mainly concentrated in glycerophosphoglycerophosphates, glycerophosphocholines, steroid lactones, etc. Conclusion The lipid metabolism profile of BLM group mice changes, differential lipid metabolites such as phosphoglycolate phosphatase(PGP)(18:0/18:0), PGP(i-12:0/i-24:0), PGP(i-13:0/a-25:0), and phosphatidylcholine(PC)(18:0/14:0), PC(18:3/16:0), lysophosphatidylcholine(LPC)(16:1), and LPC(18:3) may play an important role in the progression of IPF. These findings provide a new reference for further study of the molecular mechanism of IPF, and also provide a potential new target for clinical treatment.

Objective To analyze the main epidemiological characteristics of fungal infection in this hospital in the past 7 years,and to provide reference for clinical treatment and prevention and control strategies of fun-gal infection.Methods The fungal data and clinical data of related patients isolated from clinical samples in Peking Union Medical College Hospital from early January 2018 to the end of May 2024 were selected,and the main epidemiological characteristics of fungal infection in this hospital were identified and described through multi-angle statistical analysis.Results A total of 4 479 patients with filamentous fungal infection were en-rolled.The proportion of male patients[57.5％(2 576/4 479)]was higher than that of female patients[42.5％(1 903/4 143)],mainly distributed in internal medicine,Intensive Care Unit(ICU)and emergency de-partment,among which internal medicine accounted for the highest proportion[50.0％(2 241/4 479)].About 90.0％of the specimens were from the lower respiratory tract,in addition to specimens from skin and soft tis-sue,tissue,ear and blood culture.In terms of seasonal distribution,there are more patients in winter.The fun-gi were mainly composed of Aspergillus,Mucor,Cerdosporium,Fusarium and Penicillium,among which As-pergillus was the most abundant,accounting for 74.6％of the total.Aspergillus fumigatus was the most a-bundant Aspergillus,accounting for 42.5％of the total Aspergillus(1 418/3 340).Among the related infec-tions caused by mold,Aspergillus was the most common in the lower respiratory tract,accounting for 76.8％.Among them,Aspergillus fumigatus accounted for the highest proportion(33.6％).98.6％of the molds infected the ear were Aspergillus,of which Aspergillus niger and Aspergillus terreus were the most common.Skin infections are mainly caused by Sporothrix schenckii,Trichophyton rubrum,Microsporum ca-nis.The results of in vitro drug sensitivity test showed that the four common Aspergillus isolated in this hos-pital were sensitive to voriconazole,and amphotericin B had better antifungal activity against Mucorales in vitro.Conclusion Based on the main epidemiological characteristics of fungal infections in this hospital,it is recommended that special attention be paid to the admission of patients in the respiratory department during the peak infection period in autumn and winter.In the treatment of fungal infections in different regions and on different body parts,attention should be paid to the differences in the distribution of bacterial species.

Objective To explore the effects of family functioning,peer victimization and school connectedness on nonsuicidal self-injury in adolescents,as well as the mediating effect of psychache in these relationships.Methods A total of 525 junior high school students in Foshan City were surveyed using the brief Family Function Scale,Peer Victimization Scale,School Connectedness Scale,Psychache Scale,and Nonsuicidal Self-injury Scale.Descriptive statistics and correlation analyses were performed using SPSS 23.0,and mediation analysis was conducted using Mplus 7.4.Results ① Family functioning could directly predict adolescent non-suicidal self-injury(β=-0.20,P＜0.01),but did not exert an indirect effect through psychache(P=0.123).② Peer victimization could not directly predict adolescent non-suicidal self-injury(β=0.10,P=0.133),but had an indirect effect through psychache,with an indirect effect value of 0.142(P＜0.001).③ School connectedness could not directly predict adolescent non-suicidal self-injury(β=0.13,P=0.053),but had an indirect effect through psychache,with an indirect effect value of-0.128(P＜0.001).Conclusion Psychache fully mediates the relationship between peer victimization,school connectedness,and non-suicidal self-injury in adolescents,but it does not mediate the relationship between family functioning and adolescent non-suicidal self-injury.

Objective To evaluate the performance of the detection of Mycobacterium tuberculosis(MTB)nucleic acids on the CFX Opus 96 Dx real-time fluorescence PCR(RT-PCR)analyzer to determine its clinical applicability.Methods 20 clinical sputum samples were collected,and MTB bacterial suspensions were serially diluted to prepare the samples.After extraction of nucleic acids using thermal lysis,MTB DNA was amplified by real-time fluorescent PCR(RT-PCR)using the MTB nucleic acid detection reagent on the CFX Opus 96 Dx real-time fluorescence PCR analyzer to evaluate the performance of the method,including the limit of detection(LOD),precision,cross-reactivity,anti-interference ability,personnel and inter-instrument comparison,and methodological compliance rate.Results The minimum detection limit of the CFX Opus 96 Dx real-time fluorescence PCR analyzer for detecting MTB DNA was 1×102 bacteria/ml,which aligns with the requirements of the reagent specification.The intra-batch coefficient of variation(CV)was 1.04%,1.61%and 1.29%for 3 repetitions of 5×102 bacteria/ml samples.The intra-batch CVs were 0.92%,0.74%and 0.59%for 3 repetitions of 5×103 bacteria/ml samples,which were all<5%.Common respiratory pathogens such as Staphylococcus aureus,Staphylococcus epidermidis,Pseudomonas aeruginosa,Klebsiella pneumoniae,Nocardia,Proteus mirabilis,Legionella pneumophila,Pneumocystis japonicus,Influenza A virus,Influenza B virus,Mycoplasma pneumoniae and SARS-CoV-2 do not cross-react with MTB.There was no statistically significant difference in the change in cycle threshold(Ct)values before and after the addition of the interfering substances Hemoglobin,Mucin,Rifampicin,Isoniazid,Amoxicillin and Levofloxacin to the MTB-positive specimens(all P>0.05).Comparison CVs between the two operators and all three PCR instruments were less than 5 percent.The positive compliance rate,negative compliance rate and total compliance rate of MTB DNA detected by the ABI 7500 real-time PCR analyzer and the CFXOpus 96 Dx real-time PCR analyzer were 100%.Conclusion The LoD,precision,cross-reactivity,anti-interference ability,personnel and inter-instrument comparison,and methodological compliance rate of the CFX Opus 96 Dx real-time fluorescence PCR analyzer for the detection of MTB DNA are all in line with the requirements of clinical molecular biology testing,which can provide a reliable basis for clinical testing.

Objective To investigate the effects of aerobic exercise and different exercise habits on skeletal muscle function and the possible molecular mechanisms in colorectal cancer-loaded mice.Methods Thirty-five 5-week-old BABL/c male mice were acclimatized to feeding for 1 week and then divided randomly into the following groups:control(D),tumor(M),exercise preconditioning(QAM),lifetime exercise(AM),and exercise(HAM)groups(n=7 mice per group).Mice in the QAM and AM groups underwent aerobic exercise regimen 1 from weeks 2～6.At week 7,mice in the experimental groups received 0.2 mL of CT26 colon cancer cell suspension subcutaneously in the dorsal aspect of the left hind limb,while control mice received 0.2 mL of saline at the corresponding site.Mice in the AM and HAM groups were subjected to aerobic exercise regimen 2 for weeks 7～9.The general status and skeletal muscle mass and function were monitored in all mice throughout the experiments.After completion of the experiment,samples were collected and the cross-sectional area of gastrocnemius muscle fibers(CSA)was measured by hematoxylin and eosin staining and expression levels of proteins related to synthesis and catabolism of the gastrocnemius muscle were analyzed by Western Blot.Results(1)The weight ratio of the gastrocnemius muscle was significantly lower in mice in the M,QAM,and HAM groups compared with group D,and was significantly higher in AM mice compared with M,QAM,and HAM mice.(2)Grip strength,endurance,skeletal muscle circumference,and CSA were significantly lower in group D mice compared with the other groups,and was most enhanced in group HAM.Endurance and CSA were consistently enhanced in groups QAM,AM,and HAM.(3)Muscle RING-finger protein-1(MuRF1)expression levels were significantly lower in groups M,QAM,AM,and HAM than in group D,significantly lower in groups AM and HAM than in group M,and significantly lower in group HAM than in group QAM.(4)Fibronectin type Ⅲ domain-containing protein 5(FNDC5)expression levels were significantly lower in group M than in groups D and QAM.(5)Peroxisome proliferator-activated receptor gamma coactivator 1-alpha expression levels were significantly lower in the QAM and HAM groups compared with group M.(6)Expression levels of phospho(p)-AMP-activated protein kinase(AMPK)/AMPK and p-AMPK were significantly higher in group QAM than in groups D and M,p-AMPK expression significantly lower in groups AM and HAM was than in group QAM,and AMPK expression was significantly lower in groups QAM,AM,and HAM than in group D.Conclusions Exercise preconditioning and continuous aerobic exercise can improve skeletal muscle mass and function in CT26 colon cancer-loaded mice by activating AMPK phosphorylation to stimulate skeletal muscle secretion of FNDC5,thereby regulating the expression of MuRF1 protein.