Objective To summarize and analyze the clinical efficacy of negative pressure suction bell in the treatment of young children (≤6 years) with pectus excavatum. Methods The relevant clinical medical records of the children with pectus excavatum who received negative pressure suction bell treatment in the Outpatient Department of Children’s Hospital of Chongqing Medical University from May 2019 to January 2023 were collected. The age, sex, type, severity, depth of depression, duration of use and prognosis of children with pectus excavatum were retrospectively analyzed. Results A total of 100 pediatric patients were ultimately included in the study, comprising 74 males and 26 females. The age distribution was 57 patients aged 0-3 years and 43 patients aged 3-6 years. All patients were prescribed and used a negative pressure suction device for at least 3 months, after which they returned to our department's outpatient clinic for follow-up. The treatment demonstrated clinical effectiveness in 99 patients, yielding an efficacy rate of 99.00%. The excellent/good rate was 52.00%, and the complication rate was 8.00%. After treatment, the Haller index and the depth of sternal depression were reduced compared with those before treatment (P<0.001), and there was no statistical difference in the effective rate and excellent/good rate between different genders, different ages, different types of pectus excavatum, or different severity (P＞0.05). Conclusion Negative pressure suction bell is safe and effective in the treatment of young children (≤6 years) with pectus excavatum, and the correction effect has nothing to do with gender, type and severity.

Objective:To explore the safety and efficacy of transesophageal echocardiography(TEE)-guided percutaneous patent foramen ovale(PFO)closure in treating migraine.Methods:A total of 78 patients with migraine who underwent TEE-guided percutaneous PFO closure at The Third Hospital of Mianyang between March 2021 and August 2023 were included in the study.The impact of headache on daily life was assessed using the Headache Impact Test(HIT-6)score.Preoperatively conventional examination included TEE,right heart acoustic imaging,and contrast transcranial Doppler(c-TCD)were conducted to assess the situation of foramen ovale and right-to-left shunt(RLS).PFO closure was completed under TEE monitoring in surgery,and TEE examination was immediately implemented after surgery so as to evaluate the effect of closure.The transthoracic TTE,right heart acoustic imaging and c-TCD were adopted to conduct follow-up for the form and position of occluder,and the situation of residual shunt at the 1st,3rd and 6th month after surgery.HIT-6 score was used to assess whether the headache of patients was improved.Results:Transesophageal echocardiography(TEE)-guided PFO closure was successfully performed in 75 patients(success rate was 96%),while 3 cases was failure in closure.There was not major surgical complications in all patients.During follow-up,TTE demonstrated the position and form of occluder were well,and there was not pericardial effusion.The results of right heart acoustic imaging and c-TCD showed the RLS obviously reduced or even disappeared after closure.HIT-6 scores showed the number of patients,whose scores were less than 50 scores,increased at the 1st,3rd and 6th after closure,which were respectively 44 cases,49 cases and 64 cases,and the differences of them were significant(x2=49.912,82.041,96.189,P＜0.05).Conclusion:The single TEE-guided percutaneous PFO closure is safe,which short-term outcomes is favorable for migraine.This technique is worth in clinical application.

Objective:To report the nationwide surveillance results of pathogenic profiles and antimicrobial resistance patterns of Gram-positive bloodstream infections in China in 2023.Methods:The clinical isolates of Gram-posttive bacteria from blood cultures were collected in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）during January to December 2023. Antimicrobial susceptibility testing was performed using the dilution method recommended by the Clinical and Laboratory Standards Institute（CLSI）. Statistical analyses were conducted using WHONET 5.6 and SPSS 25.0 software.Results:A total of 4 385 Gram-positive bacterial isolates were obtained from 60 participating center. The top five pathogens were Staphylococcus aureus（ n=1 544，35.2%），coagulase-negative Staphylococci（ n=1 441，32.9%）， Enterococcus faecium（ n=574，13.1%）， Enterococcus faecalis（ n=385，8.8%），and α-hemolytic Streptococci（ n=187，4.3%）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）was 26.2%（405/1 544）and 69.8%（1 006/1 441），respectively. Notably，all Staphylococci remained susceptible to glycopeptide or daptomycin. Staphylococcus aureus demonstrated excellent susceptibility（>97.0%）to cephalobiol，rifampicin，trimethoprim-sulfamethoxazole，linezolid，minocycline，tigecycline，and eravacycline. No Enterococcus exhibiting resistance to linezolid were detected. Glycopeptide resistance was uncommon but more frequent in Enterococcus faecium（resistance to vancomycin and teicoplanin：both 1.7%）compared to Enterococcus faecalis（both 0.3%）. The detection rates of MRSA and MRCNS exhibited significant regional variations across the country（ χ2=17.674 and 148.650，respectively，both P<0.001）. No vancomycin-resistant Enterococci were detected in central China. Institutional comparison demonstrated higher prevalence of MRSA（ χ2=14.111， P<0.001）and MRCNS（ χ2=4.828， P=0.028）in provincial hospitals than that in municipal hospitals. Socioeconomic analysis identified elevated detection rates of both MRSA（ χ2=18.986， P<0.001）and MRCNS（ χ2=4.477， P=0.034）in less developed regions（per capita GDP

Objective:To report the results of bacterial resistant investigation collaborative system（BRICS）on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2023，and provide reference for clinical tretment of bloodstream infections and prevention and control of bacterial resistance.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of BRICS were collected during January 2023 to December 2023. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 were used to analyze the data.Results:During the study period，11 492 strains of Gram-negative bacteria were collected from 60 hospitals，of which 10 098（87.9%）were Enterobacterales and 1 394（12.1%）were non-fermentative bacteria. The top 5 bacterial species were Escherichia coli（50.0%）， Klebsiella pneumoniae（26.1%）， Pseudomonas aeruginosa（5.1%）， Acinetobacter baumannii complex（5.0%）and Enterobacter cloacae complex（4.1%）. The ESBL-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus mirablilis were 46.8%（2 685/5 741），18.3%（549/2 999）and 44.0%（77/175），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（76/5 741）and 15.0%（450/2 999）；32.9%（25/76）and 78.0%（351/450）of CREC and CRKP were sensitive to ceftazidime/avibactam combination，respectively. 94.7%（72/76）and 90.2%（406/450）of CREC and CRKP were sensitive to aztreonam/avibactam combination. Furthermore，57.9%（44/76）and 79.1%（356/450）were sensitive to imipenem/relebactam combination. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 64.6%（370/573），while more than 80.0% of CRAB complex was sensitive to tigecycline，eravacycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 17.0%（99/581）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of important Gram-negative bacteria resistance among different regions in China，with statistically significant differences in the prevalence of CREC，CRKP，CRPA and CRAB complex（ χ2=10.6，28.6，10.8 and 19.3， P<0.05）. The prevalence of ESBL-producing Escherichia coli， CREC，CRAB complex and CRKP were higher in provincial hospitals than those in municipal hospitals（ χ2=12.5，9.8，12.7 and 57.8，all P<0.01）. Conclusions:Gram-negative bacteria are the main pathogens causing bloodstream infections in China，and Escherichia coli is ranked in the top，while the trend of Klebsiella pneumoniae increases continuously with time. CRKP infection shows a slow upward trend，CREC infecton maintains a low prevalence level，and CRAB complex infection continues to exhibit a high prevalence rate. The composition and resistance patterns of pathogens causing bloodstream infections vary to some extent across different regions and levels of hospitals in China.

Objective:To investigate immunotherapy effects and mechanism of BCG and recombinant BCG(rBCG)with c-di-AMP as adjuvant on melanoma in mice model.Methods:Melanoma mice model was established by B16F10 cell subcutaneous injec-tion in groin,and treated with 1×106 CFU of BCG and rBCG by adjacent injection of subcutaneous tumor for 3 times,respectively.Survival of melanotic mice,tumor growth and metastasis were observed.Tumor tissues of mice were isolated to prepare cell suspen-sion,and proportion of immune cells were detected by flow cytometry.Transcriptional levels of immune-related genes in tumor tissues were detected by qRT-PCR.Results:Both BCG and rBCG immunotherapy could significantly inhibit growth in melanoma mice and prolong survival time of mice.rBCG showed better inhibition on metastasis than BCG.Both strains significantly reduced proportion of M2-type macrophages and myeloid-derived suppressor cell associated with tumor growth and metastasis.Both two strains promoted infiltration of lymphocytes in tumor tissues,and rBCG significantly increased proportion of B cells in tumor.BCG immunotherapy upregulated transcription levels of metastasis-related cytokines,while rBCG therapy had no effects on transcriptions of these genes.Conclusion:Both BCG and rBCG have immunotherapeutic effects on melanotic mice,and rBCG with c-di-AMP as adjuvant shows better inhibition on tumor metastasis than BCG,which mechanism was related to regulation of immune response in tumor tissues.

Objective To conduct a cross-sectional study on the relationship between the serum uric acid(sUA)to high density lipoprotein-cholesterol(HDL-C)ratio(UHR)and female infertility.Methods We analyzed data from the National Health and Nutrition Examination Survey(NHANES)2013-2018 cycle,examining 2,963 women aged 18 to 45 years.A multivariable Logistic regression model was used to assess the association between UHR and infertility,adjusting for various confounding factors.The study also explored interactions and dose-response relationships through subgroup analyses and restricted cubic spline(RCS)models,and evaluated the predictive value of UHR for infertility by using receiver operating characteristic(ROC)curve analysis.Results The results showed that the prevalence of infertility was significantly higher among women with elevated UHR.Baseline characteristics revealed that the mean UHR in women with infertility(9.68±4.23)was significantly higher than in those without infertility(8.7±3.81,P<0.001).Multivariable Logistic regression analysis indicated that women in the highest quartile(Q4)of UHR had a significantly increased likelihood of infertility compared to those in the lowest quartile(Q1),with adjusted odds ratios(ORs)ranging from 1.61(95% CI:1.14-2.28)to 1.98(95% CI:1.42-2.78)across different models(P for trend<0.001).Subgroup analyses demonstrated that these associations were consistent across different age groups,body mass index(BMI)categories,and racial groups.The RCS model showed a significant linear dose-response relationship between UHR and infertility risk(nonlinear P=0.03,overall association P<0.001).Additionally,ROC analysis indicated that UHR had a moderate ability to discriminate infertility status,with an area under the curve(AUC)of 0.570.Conclusion A higher UHR is significantly associated with an increased risk of female infertility,and UHR has the potential to serve as a predictive biomarker for the risk of female infertility.

This study assessed the role and mechanism of the recombinant Bacillus Calmette-Gue?rin vaccine(rBCG)with c-di-AMP adjuvant in regulating metabolism and immunity in epididymal white adipose(eWAT)in mice.Male C57BL/6 mice were intravenously immunized with BCG and rBCG,and their body weights were monitored.eWAT was isolated from the mice,and the stromal vascular fractions(SVFs)cell number was counted with a hemocytometer.Sections of mouse adipose tissue were prepared,and the size,number,and morphology of eWAT adipocytes and crown-like structure(CLS)formation were compared under a microscope after HE staining.The transcription levels of lipid metabolism-associated factors,cytokines and aging-associated genes in each group were determined with qRT-PCR.The body weights of mice gradually increased after immunization with BCG and rBCG.The proportions of eWAT increased,and the SVFs cell number decreased,in rBCG immunized mice.HE staining indicated that BCG immunization promoted hyperplasia,whereas rBCG immunization promoted hypertrophy of eWAT adipocytes;moreover,both BCG and rBCG immunization induced CLS formation in eWAT.The qRT-PCR results indicated that rBCG immunization inhibited the expression of genes associated with lipolysis and energy expenditure in eWAT.BCG immunization had little effect on cytokine transcription,whereas rBCG significantly induced the transcription of IFN-γ and IL-1Ra,and inhibited that of IL-15 and IL-2,but did not induce the expression of aging-associated genes.Thus,rBCG immunization induced eWAT adipocyte hypertrophy,which was associated with the inhibition of eWAT lipolysis and the regulation of cytokine expression.

Objective To construct YOLOv10 based artificial intelligence(AI)models for the automatic detection in small bowel capsule endoscopy(SBCE)images.Methods SBCE data from two centers was collected,including 23 115 images and 35 412 annotated labels covering 11 categories of small bowel lesions.The images were annotated using the LabelMe tool and converted into the YOLO format required for deep learning model development.The pre-trained YOLOv10 and YOLOv8 models were used for transfer learning training on the constructed dataset.Model performance was comprehensively evaluated using metrics such as precision,accuracy,sensitivity,specificity,false-positive rate,and detection speed.Finally,the models were deployed on local computers for real-time detection of SBCE images and videos.Results Six different versions of YOLO object detection models were developed,namely YOLOv8n,YOLOv8s,YOLOv8m,YOLOv10n,YOLOv10s,and YOLOv10m.On the validation set,YOLOv10s model achieved the best mAP50(0.795);although its inference latency was not the fastest(4.803 ms/img),it met the requirements for clinical application.On the test set,YOLOv10s performed well,with an accuracy of 92.69%,a sensitivity of 89.23%,and a false-positive rate of 4.78%.Especially,in category-specific inference,the highest sensitivity was for"bleeding"at 96.41%,while the lowest was for"narrowing"at 82.29%.Conclusion The model constructed based on YOLOv10 neural network can rapidly and accurately detect and classify various small bowel lesions,exhibiting significant clinical application potential.

Objective:To observe the impact of ultra early neurorehabilitation combined with cognitive intervention training on the psychological state,neurological function,and quality of life of stroke patients.Methods:89 stroke patients who were admitted to our hospital from April 2023 to May 2024 were divided into control group(conventional rehabilitation intervention combined with cognitive intervention training,44 cases)and study group(control group combined with ultra early neurological rehabilitation,45 cases)by using random number table method.The neurological function,daily self-care ability,psychological state,quality of life,and satisfaction between two groups were compared.Results:14 d after intervention,the study group had lower scores on the national institutes of health stroke scale(NIHSS),self rating anxiety scale(SAS),and self rating depression Scale(SDS)compared to the control group,had higher scores of the comprehensive quality of life evaluation questionnaire-74(CQOLI-74)and the modified barthel index(MBI)(P＜0.05).The overall satisfaction rate of the study group was higher than that of the control group(P＜0.05).Conclusion:Ultra early neurorehabilitation combined with cognitive intervention training can effectively improve the neurological function and daily self-care ability of stroke patients,reduce anxiety and depression,improve their quality of life,and achieve good patient satisfaction.

Objective To explore the molecular mechanism of circular RNA(circ)VAPA promoting the Hippo pathway to inhibit liver regeneration through the miR-101a-3p/TEAD3 axis.Methods A mouse model of 70％partial hepatectomy-induced liver regeneration was constructed,and the expressions of circVA-PA,miR-101a-3p,and TEAD3 were analyzed.Mouse embryonic hepatocyte BNL CL.2 cells were transfected with siRNA or overexpression plasmids and divided into the VAPA-NC group,the VAPA-NC+miR-101a-3p mimic group,the VAPA-NC+miR-101a-3p mimic-NC group,the VAPA-OE group,the VAPA-OE+miR-101a-3p mimic group and the VAPA-OE+miR-101a-3p mimic-NC group.CCK-8 method and flow cytometry were used to analyze the proliferation,apoptosis,and cell cycle changes of hepatocytes.Immunofluorescence staining was used to analyze the nuclear translocation of YAP1.Quantitative Reverse Transcription Real-Time PCR(qRT-PCR)was used to analyze the expressions of key genes in the Hippo pathway.The dual-lu-ciferase reporter gene assay was used to verify the targeting relationships between circVAPA and miR-101a-3p,as well as between miR-101a-3p and TEAD3.Results The level of circVAPA gradually increased during liver regeneration(P＜0.05),while the level of miR-101a-3p first increased and then decreased(P＜0.05).When miR-101a-3p was overexpressed alone,the cell proliferation rate was the highest(P＜0.05),but it had no effect on the cell apoptosis rate(P＞0.05).When circVAPA was overexpressed alone,it had no effect both on the cell proliferation rate and apoptosis(P＞0.05).After co-overexpression of circVAPA and miR-101a-3p,the cell proliferation rate significantly decreased,and the cell apoptosis significantly increased(P＜0.05).When miR-101a-3p was overexpressed alone,a large number of cells entered into the S phase.After co-overex-pression of circVAPA and miR-101a-3p,a large number of cells were blocked in the G2/M phase.The phos-phorylation level of the Hippo upstream gene YAP1 significantly increased at 6 hours after liver regeneration(P＜0.05)and then rapidly decreased.However,co-overexpression of circVAPA and miR-101a-3p did not af-fect the level of p-YAP1 and the nuclear translocation of YAP1(P＞0.05).The expression levels of the Hip-po downstream gene CTGF and the transcription factor TEAD3 first increased and then decreased during liver regeneration(P＜0.05),and there was no significant change in CYR61(P＞0.05).After co-overexpression of circVAPA and miR-101a-3p,the expression level of CTGF increased(P＜0.05).Knocking down or overex-pressing circVAPA did not affect the expression of TEAD3(P＞0.05),while overexpressing miR-101a-3p could significantly inhibit the expression level of TEAD3(P＜0.05).The dual-luciferase reporter gene assay confirmed the targeting relationships between circVAPA and miR-101a-3p,as well as between miR-101a-3p and TEAD3.Conclusion circVAPA promotes the Hippo pathway to inhibit liver regeneration through the miR-101a-3p/TEAD3 axis.