Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.

Objective To understand the epidemiological characteristics and trends of postoperative pneumonia(POP)in tertiary general hospitals in Jiangsu Province,and provide theoretical basis for carrying out targeted pre-vention and control measures.Methods Surgery patients from 22 tertiary general hospitals in 12 cities in north,central,and south of Jiangsu Province from January 1,2022 to December 31,2023 were chosen as studied subjects,occurrence of POP was analyzed and compared.Results A total of 848 274 surgical procedures were performed in 22 hospitals,and 3 606 cases of POP occurred,with an incidence of 0.43％.The incidence in 2023 was 0.37％,which was lower than that in 2022(0.49％),with statistically significant difference(P＜0.001).The top three de-partments with high incidence of POP were neurosurgery(6.71％),cardiothoracic surgery(2.91％),and general surgery(0.77％).Among hospitals of different grades,the incidence of POP in tertiary first-class hospitals was 0.44％,which was higher than that in other tertiary hospitals(0.37％).There was no statistically significant difference in the incidence of POP between municipal and district/county hospitals(P＞0.05).The incidence of POP in hospitals with a bed:infection control full-time staff ratio＜200∶1 was lower than that in hospitals with the ratio ≥200∶1(0.39％vs 0.47％,P＜0.001),while the incidence of POP in hospitals with a proportion ≥30％of full-time staff being doctors was higher than that in hospitals with a proportion＜30％(0.45％vs 0.36％,P＜0.001).The incidence of POP in male patients was higher than that in female patients(0.62％vs 0.26％,P＜0.001).The incidence of POP in elderly patients aged≥65 was higher than that in patients aged＜65(0.73％vs 0.26％,P＜0.001).A total of 2 667 strains of infectious pathogens were detected,with the top three being Acine-tobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa,accounting for 28.95％,22.72％,and 15.45％,respectively.The detection rates of carbapenem-resistant Acinetobacter baumannii(CRAB),carba-penem-resistant Klebsiella pneumoniae(CRKP),and carbapenem-resistant Pseudomonas aeruginosa(CRPA)were 60.75％,21.45％,and 32.28％,respectively.The detection rate of CRKP decreased in 2023 compared with 2022,with statistically significant difference(P＜0.05).Conclusion The overall incidence of POP in tertiary general hos-pitals in Jiangsu Province is relatively low,but there are significant differences among different hospitals.There-fore,perioperative prevention and control measures should be carried out based on the epidemiological characteristics of patients.

Objective:To investigate the effect of changes of left ventricular diatolic function immediately after transcatheter aortic valve replacement (TAVR) on the prognosis of TAVR.Methods:A total of 80 patients undergoing TAVR treatment were retrospectively enrolled from October 2017 to February 2023 in the Department of Cardiology of the First Hospital of China Medical University. Demographic data, imaging parameters, laboratory data and operation data were recorded. Patients were followed up at 30 days and 1 year after TAVR through clinic or telephone visits. The changes of diastolic function parameters before and immediately after TAVR were analyzed. When the improvement of left ventricular diastolic function grade≥1 grade was defined as the improvement of diastolic function. Included patients were divided into left ventricular diastolic disfunction (LVDD) improvement group and non-improvement group. The primary endpoint was the composite outcome of 1-year all-cause mortality and cardiovascular rehospitalization. The diffferences of adverse events between two groups were analyzed, and univariate and multivariate Cox regression analysis were used to explore the predictors of the primary adverse events of TAVR.Results:Improvement in LVDD grade was seen in 30 (37.5%) patients immediately after TAVR. Patients with improvement in ≥1 grade of LVDD had less 1-year death/cardiovascular rehospitalization than patients in non-improvement group(6.7% vs 28.0%, P=0.021). Multivariate Cox proportional hazards models showed that improvement in LVDD grade immediately after TAVR was an independent protective factor for 1-year death/cardiovascular rehospitalization ( HR=0.103, 95% CI=0.021-0.502, P=0.005), while diabetes mellitus ( HR=4.035, 95% CI=1.294-12.584, P=0.016), society of thoracic surgeons (STS) score ( HR=1.253, 95% CI=1.015-1.421, P<0.001), intensive care unit (ICU) stay ( HR=1.198, 95% CI=1.012-1.418, P=0.036), and aortic valve area (AVA) ( HR=1.079, 95% CI =1.039-1.121, P<0.001) were independent risk factors for 1-year death/cardiovascular rehospitalization. Conclusions:The improved left ventricular diastolic function is experienced in 37.5% of patients immdiately after TAVR, and patients with improvement in LVDD grade immediately after TAVR has less 1-year death/cardiovascular rehospitalization, which is an independent protective factor for 1-year death/cardiovascular rehospitalization, while diabetes mellitus, STS score, ICU stay and AVA are independent risk factors for 1-year death/cardiovascular rehospitalization.

Objective:To investigate the effect of changes of left ventricular diatolic function immediately after transcatheter aortic valve replacement (TAVR) on the prognosis of TAVR.Methods:A total of 80 patients undergoing TAVR treatment were retrospectively enrolled from October 2017 to February 2023 in the Department of Cardiology of the First Hospital of China Medical University. Demographic data, imaging parameters, laboratory data and operation data were recorded. Patients were followed up at 30 days and 1 year after TAVR through clinic or telephone visits. The changes of diastolic function parameters before and immediately after TAVR were analyzed. When the improvement of left ventricular diastolic function grade≥1 grade was defined as the improvement of diastolic function. Included patients were divided into left ventricular diastolic disfunction (LVDD) improvement group and non-improvement group. The primary endpoint was the composite outcome of 1-year all-cause mortality and cardiovascular rehospitalization. The diffferences of adverse events between two groups were analyzed, and univariate and multivariate Cox regression analysis were used to explore the predictors of the primary adverse events of TAVR.Results:Improvement in LVDD grade was seen in 30 (37.5%) patients immediately after TAVR. Patients with improvement in ≥1 grade of LVDD had less 1-year death/cardiovascular rehospitalization than patients in non-improvement group(6.7% vs 28.0%, P=0.021). Multivariate Cox proportional hazards models showed that improvement in LVDD grade immediately after TAVR was an independent protective factor for 1-year death/cardiovascular rehospitalization ( HR=0.103, 95% CI=0.021-0.502, P=0.005), while diabetes mellitus ( HR=4.035, 95% CI=1.294-12.584, P=0.016), society of thoracic surgeons (STS) score ( HR=1.253, 95% CI=1.015-1.421, P<0.001), intensive care unit (ICU) stay ( HR=1.198, 95% CI=1.012-1.418, P=0.036), and aortic valve area (AVA) ( HR=1.079, 95% CI =1.039-1.121, P<0.001) were independent risk factors for 1-year death/cardiovascular rehospitalization. Conclusions:The improved left ventricular diastolic function is experienced in 37.5% of patients immdiately after TAVR, and patients with improvement in LVDD grade immediately after TAVR has less 1-year death/cardiovascular rehospitalization, which is an independent protective factor for 1-year death/cardiovascular rehospitalization, while diabetes mellitus, STS score, ICU stay and AVA are independent risk factors for 1-year death/cardiovascular rehospitalization.

Aiming at the problems of missing important features, inconspicuous details and unclear textures in the fusion of multimodal medical images, this paper proposes a method of computed tomography (CT) image and magnetic resonance imaging (MRI) image fusion using generative adversarial network (GAN) and convolutional neural network (CNN) under image enhancement. The generator aimed at high-frequency feature images and used double discriminators to target the fusion images after inverse transform; Then high-frequency feature images were fused by trained GAN model, and low-frequency feature images were fused by CNN pre-training model based on transfer learning. Experimental results showed that, compared with the current advanced fusion algorithm, the proposed method had more abundant texture details and clearer contour edge information in subjective representation. In the evaluation of objective indicators, Q ^AB/F, information entropy (IE), spatial frequency (SF), structural similarity (SSIM), mutual information (MI) and visual information fidelity for fusion (VIFF) were 2.0%, 6.3%, 7.0%, 5.5%, 9.0% and 3.3% higher than the best test results, respectively. The fused image can be effectively applied to medical diagnosis to further improve the diagnostic efficiency.
Image Processing, Computer-Assisted/methods* ; Neural Networks, Computer ; Tomography, X-Ray Computed ; Magnetic Resonance Imaging/methods* ; Algorithms

Clinical data of 655 patients with acute ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) in Luoyang Central Hospital during January 2017 to March 2020 were analyzed retrospectively. There were 425 cases who first visited PCI-capable hospital (PCI hospital group) and 230 cases who were transferred to PCI-capable hospital (transfer group). Compared with PCI hospital group, STEMI patients in the transfer group had a shorter first diagnosis time [2.0 (0.8, 4.2)h vs. 2.5(1.2, 4.1)h, Z=3.66, P<0.01], longer time from first medical contact to the balloon through (FMC2B) [175 (113, 344) min vs. 75 (57, 112) min, Z=-8.92, P<0.01], longer total ischemic time [5.4 (3.5, 9.8) h vs. 3.9 (2.4, 6.0) h, Z=-5.43, P<0.01]. There was no significant difference in the time from PCI hospital entry to balloon passage (DTB) between the two groups [43(29, 103) min vs. 46 (61, 94) min, Z=-0.56, P=0.573]. The compliance rate of FMC2B time<120 min in the transfer group was only 25.9% (50/193). However, the different first-visit hospital had no significant effect on the risk of heart failure ( OR=0.54, 95 %CI:0.16-1.79, P=0.311) and risk of death ( OR=1.14, 95 %CI:0.20-6.36, P=0.885). The results suggest that STEMI patients referred to PCI hospitals have considerable time delay, and the rate of compliance with FMC2B time<120 min is low.

Objective:To investigate the safety and effectiveness of Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.Methods:A retrospective analysis was performed. Six patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection admitted to the 3 hospitals from May 2016 to December 2019 were chosen; their clinical data were collected. The surgical processes and complications were concluded, and the prognoses were evaluated by modified Rankin scale (mRS).Results:One patient was treated with intraoperative simple tamponade compression for hemostasis, and died for massive intracranial hemorrhage 2 weeks after surgery. Five patients were occluded by Willis covered stents; the occluded success rate was 100% but ophthalmic arteries were blocked in all. During the perioperative period, diabetes insipidus occurred in one patient and incomplete oculomotor paralysis occurred in one patient; 5 patients were followed up for 3-12 months: MRI indicated subtotal resection of tumor in 4 patients and total resection in one patient, no new bleeding or ischemic stroke events occurred in these 5 patients, and the prognosis was good.Conclusion:Willis covered stent is safe and effective in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.

Purpose: Caspase recruitment domain containing protein 9 (CARD9) has been demonstrated to be a pro-tumor factor in various cancers. However, our previous study found a significant decrease of CARD9 in malignant pleural effusion compared with benign pleural effusion. So we investigated the role of CARD9 in non-small cell lung cancer (NSCLC) and its working mechanism. Materials and Methods: Immunohistochemistry, western blot, and quantitative real-time polymerase chain reaction were used to detect the expression of CARD9 in specimens of NSCLC patients. The Cancer Genome Atlas (TCGA) databasewas also used to analyze the expression of CARD9 in NSCLC and its predicting value for prognosis. Immunofluorescence was used for CARD9 cellular location. Cell growth assay, clonal formation assay, wound healing assay, matrigel invasion assay, and flow cytometry were used to test cell proliferation, migration, invasion, apoptosis, and cycle progression of NSCLC cells with CARD9 knockdown or CARD9 overexpression. Co-immunoprecipitation was used to identify the interaction between CARD9 and B-cell lymphoma 10 (BCL10). SB203580 was used to inhibit p38 activation. Results: CARD9 was decreased in NSCLC tissues compared with normal tissues; low CARD9 expression was associated with poor survival. CARD9 was expressed both in tumor cells and macrophages. Downregulation of CARD9 in NSCLC cells enhanced the abilities of proliferation, invasion and migration via activated MAPK/p38 signaling, while overexpression of CARD9 presented antitumor effects. BCL10 was identified to interact with CARD9. Conclusion We demonstrate that CARD9 is an independent prognostic factor in NSCLC patients and inhibits proliferation, migration, and invasion by suppressing MAPK/p38 pathway in NSCLC cells.

Objective: To compare the safety and efficacy of the retrograde and the antegrade techniques in laparoscopic left hemihepatectomy. Methods: Of the 65 patients who underwent laparoscopic left hemihepatectomy between January 2016 to June 2018 at the Ningbo Li Huili Hospital of Medical Center, retrograde left hemihepatectomy was carried out in 31 patients, and antegrade left hemihepatectomy in 34 patients. The perioperative data, duration of operation, intraoperative blood loss, postoperative complications (including major bleeding, abdominal abscess and bile leakage), and post-operative hospital stay were retrospectively compared between the two groups. Results: There were no significant differences in the perioperative general status between the two groups (P>0.05). Both the duration of operation [(121.5±22.1) min vs. (190.9±48.9) min, P<0.05] and the amount of blood loss [(118.9±84.1) ml vs. (195.2±85.4) ml, P<0.05] were significantly less in the retrograde than the antegrade group. There were no statistical differences in the incidences of major complications such as post-hepatectomy hemorrhage, abdominal abscess, or bile leakage, and in the postoperative hospital stay [(10.0±2.8) d vs. (12.2±3.4) d, P>0.05]. Conclusions Occlusion of hepatic vascular inflow and outflow combined with retrograde left hemihepatectomy was safe and feasibly. The retrograde approach was superior to the antegrade approach in laparoscopic left hemihepatectomy.

Objective To observe and analyze the expression of programmed cell death 4 (PDCD4) gene and apoptosis inhibitor Livin in triple negative breast cancer (TNBC) tissues and its relationship with prognosis.Methods One hundred cases of TNBC tumor tissue,50 cases of adjacent carcinoma tissue,50 cases of normal breast tissue were selected as the research data.The immunohistochemical technique was applied to detect and compare the expression positive rates of PDCD4 and Livin protein in three kinds of tissues.The patients were followed up.The overall survival (OS) and the progression free survival (PFS) were observed and compared.Results The expression positive rate of PDCD4 in TNBC tissue was significantly lower than that in adjacent carcinoma tissue or normal breast tissue,the differences were statistically significant (x2=26.613,32.000,P＜0.05).The expression was correlated with the clinical pathological features of tumor size,lymph node metastasis,clinical stage,axillary lymph node metastasis and cancer embolus (x2=26.936,13.210,22.774,27.463,5.803,P＜0.05);the expression positive rate of Livin protein in TNBC tissue was significantly higher than that in adjacent carcinoma tissue or normal breast tissue and the expression positive rate of Livin protein in adjacent carcinoma tissue was significantly higher than that in normal breast tissue,the differences were statistically significant (x2 =14.614,57.353,19.048,P＜0.05).The expression was correlated with the clinical pathological features of lymph node metastasis,clinical stage,axillary lymph node metastasis and cancer embolus (x2 =10.788,6.160,27.350,8.914,P＜0.05);OS,PFS in the patients with PDCD4 negative expression were significantly lower than those in the patients with PDCD4positive expression.OS,PFS in the patients with Livin positive expression were significantly lower than those in the patients with Livin negative expression,the above differences were statistically significant (x2 =23.931,19.163,22.649,17.213,P＜0.05).OS in the TNBC patients was correlated with age (RR=1.405),clinical stage (RR =2.897),tumor diameter (RR=2.722),axillary lymph node metastasis (RR=2.516),vascular invasion (RR=3.020),PDCD4 Expression (RR=1.752) and Livin expression (RR=2.051) (P＜0.05).PFS in the patients was correlated with clinical stage (RR =2.756),axillary lymph node metastasis (RR =2.437),PDCD4 expression (RR =1.649) and Livin expression (RR=1.804) (P＜0.05).Conclusion The PDCD4 low expression and Livin protein over-expression exist in TNBC tissues.Their abnormal expressions are correlated with the clinicopathological features of tumor and the prognosis of patient,and could be used as the auxiliary indexes in evaluation of progression and prognosis of TNBC.