OBJECTIVE To explore the effects of meropenem exposure and degradation levels on clinical efficacy in patients with purulent meningitis （PM）. METHODS A total of 131 PM patients treated with meropenem at the Affiliated Suzhou Hospital of Nanjing Medical University from January 2022 to June 2025 were prospectively included. Relevant data were collected and divided into a cured group （91 cases） and a non-cured group （40 cases） based on the efficacy. High-performance liquid chromatography-tandem mass spectrometry was used to determine the concentration of meropenem and its open-loop metabolites. Risk factors that affect efficacy were screened， and their predictive power and correlation were evaluated by univariate analysis， and multivariate Logistic regression analysis， receiver operating characteristic （ROC） curves， and correlation analysis. RESULTS Univariate analysis showed that serum creatinine， creatinine clearance rate， minimum inhibitory concentration of meropenem ≥16 μg/mL， cerebrospinal fluid red blood cell count， cerebrospinal fluid white blood cell count， cerebrospinal fluid glucose content， blood trough concentration， blood open-loop metabolite concentration/trough concentration ratio， and intrathecal injection were all correlated with efficacy （P＜0.05）. The results of multiple Logistic regression analysis showed that serum creatinine blood open-loop metabolite concentration/trough concentration ratio， intrathecal injection， and cerebrospinal fluid glucose content were influencing factors for suboptimal anti-infective ltt efficacy （P＜0.05）. ROC curve analysis showed that when the blood open-loop metabolite concentration/trough concentration ratio was greater than 2.854 （AUC＝0.647）， serum creatinine was less than 59.5 μmol/L （AUC＝0.647）， and cerebrospinal fluid glucose content was less than 3.37 mmol/L （AUC＝0.709）， the risk of treatment failure significantly increased （P＜0.05）. Correlation analysis showed that the blood trough concentration of meropenem was positively correlated with the concentration of its open-loop metabolites （R 2＝0.134 5， P＜0.000 1）. CONCLUSIONS Insufficient exposure level and rapid degradation of meropenem are key mechanisms affecting the anti-infective efficacy of PM. Elevated blood open-loop metabolite concentration/ trough concentration ratio， low serum creatinine level， lack of intrathecal injection， and low cerebrospinal fluid glucose content are independent risk factors for poor efficacy.

Objective To analyze the burden and trend of musculoskeletal diseases(including gout,low back pain,neck pain,osteoarthritis,and rheumatoid arthritis)in China from 1990 to 2021,and to provide reference for formulating and adjusting prevention strategies for musculoskeletal diseases.Methods The Global Burden of Disease(GBD)in 2021 database was used to analyze the status and trend of the incidence and disability-adjusted life years(DALYs)rate of musculoskeletal diseases in China.Annual percentage change(EAPC)was used to comprehensively evaluate the trend of the burden of musculoskeletal diseases from 1990 to 2021.Gender and age-specific incidence and DALYs rate of musculoskeletal diseases were analyzed.Results In 2021,the number of cases of gout,low back pain,neck pain,osteoarthritis,and rheumatoid arthritis in China was 3,079,836,43,374,995,10,292,099,11,652,721,and 247,307,respectively.Among the 5 major musculoskeletal conditions,low back pain had the greatest incidence and DALYs rate.From 1990 to 2021,the age-standardized incidence of gout,osteoarthritis,and rheumatoid arthritis showed an upward trend,that of neck pain remained relatively stable,and that of low back pain showed a downward trend.The age-standardized DALYs rates of gout and osteoarthritis showed an increasing trend,that of neck pain and rheumatoid arthritis remained relatively stable,and that of low back pain showed a decreasing trend.The results of the stratified analysis by gender and age indicated that,the age-standardized incidence rate and age-standardized DALYs rate of gout were higher in men than in women,while the age-standardized incidence rate and age-standardized DALYs rate of low back pain,neck pain,osteoarthritis,and rheumatoid arthritis were higher in women than in men.The age groups with the burden of the five major musculoskeletal diseases were relatively consistent,mainly in the 40-75 years old.Conclusion From 1990 to 2021,the disease burden of gout,osteoarthritis,and rheumatoid arthritis increased significantly in China,while the disease burden of neck pain remained relatively stable,while the disease burden of low back pain showed a certain improvement.In addition,the burden of musculoskeletal diseases in China varies greatly by gender and age.Targeted intervention measures should be implemented as soon as possible based on the stratification results by gender and age,and health education and basic healthcare should be improved to effectively reduce the burden of musculoskeletal diseases.

Objective To analyze the burden and trend of musculoskeletal diseases(including gout,low back pain,neck pain,osteoarthritis,and rheumatoid arthritis)in China from 1990 to 2021,and to provide reference for formulating and adjusting prevention strategies for musculoskeletal diseases.Methods The Global Burden of Disease(GBD)in 2021 database was used to analyze the status and trend of the incidence and disability-adjusted life years(DALYs)rate of musculoskeletal diseases in China.Annual percentage change(EAPC)was used to comprehensively evaluate the trend of the burden of musculoskeletal diseases from 1990 to 2021.Gender and age-specific incidence and DALYs rate of musculoskeletal diseases were analyzed.Results In 2021,the number of cases of gout,low back pain,neck pain,osteoarthritis,and rheumatoid arthritis in China was 3,079,836,43,374,995,10,292,099,11,652,721,and 247,307,respectively.Among the 5 major musculoskeletal conditions,low back pain had the greatest incidence and DALYs rate.From 1990 to 2021,the age-standardized incidence of gout,osteoarthritis,and rheumatoid arthritis showed an upward trend,that of neck pain remained relatively stable,and that of low back pain showed a downward trend.The age-standardized DALYs rates of gout and osteoarthritis showed an increasing trend,that of neck pain and rheumatoid arthritis remained relatively stable,and that of low back pain showed a decreasing trend.The results of the stratified analysis by gender and age indicated that,the age-standardized incidence rate and age-standardized DALYs rate of gout were higher in men than in women,while the age-standardized incidence rate and age-standardized DALYs rate of low back pain,neck pain,osteoarthritis,and rheumatoid arthritis were higher in women than in men.The age groups with the burden of the five major musculoskeletal diseases were relatively consistent,mainly in the 40-75 years old.Conclusion From 1990 to 2021,the disease burden of gout,osteoarthritis,and rheumatoid arthritis increased significantly in China,while the disease burden of neck pain remained relatively stable,while the disease burden of low back pain showed a certain improvement.In addition,the burden of musculoskeletal diseases in China varies greatly by gender and age.Targeted intervention measures should be implemented as soon as possible based on the stratification results by gender and age,and health education and basic healthcare should be improved to effectively reduce the burden of musculoskeletal diseases.

Objective:To compare surgery-related indicators, patient recovery status, perioperative complications and risk factors affecting the occurrence of postoperative grade Ⅲ or higher complications in patients undergoing laparoscopic gastric mesenchymal tumor surgery with different visceral fat areas.Methods:Clinical data of 116 patients with gastric interstitial tumor in Shaanxi Provincial People′s Hospital from April 2014 to June 2020 were retrospectively analyzed, including 44 male patients and 72 female patients, with patient aged from 25 to 88 years old and the mean age was (61.8±10.7) years, including 54 patients in the high VFA group and 62 patients in the low VFA group. SPSS 23.0 was used for statistical analysis, and t-test and χ2 test were applied to compare and analyze the patients′ surgery-related indexes, postoperative recovery status, complications within 30 d after surgery and differences in Clavien-Dindo classification of complications, while univariate and multifactorial analyses were used to study the factors affecting the occurrence of postoperative grade Ⅲ or higher complications. Results:Patients in the high VFA group had a higher body mass index than in the low VFA group, and the difference was statistically significant ( t=4.48, P<0.001); patients in the high VFA group had longer operative time ( t=2.88, P=0.005), more intraoperative bleeding ( t=2.17, P=0.032), longer period of fasting ( t=2.73, P=0.008), longer time for defecation ( t=4.46, P<0.001) and bowel movement ( t=4.62, P<0.001), and longer postoperative hospital stay ( t=3.43) compared with those in the low VFA group ( t=2.73, P=0.001), prolonged defecation ( t=4.46), prolonged bowel movement ( t=4.62), and prolonged postoperative hospitalization ( t=3.43), with statistically significant differences ( P<0.05); the incidence of postoperative complications was significantly higher in the high VFA group (31.4%) compared with the low VFA group (14.5%) ( χ2=4.78, P=0.029); among them, the incidence of postoperative pulmonary infection was significantly higher in patients in the high VFA group (12.9%) compared with those in the low VFA group (1.6%), and the difference between them was statistically significant ( χ2=4.16, P<0.05); while the differences in postoperative incision-related complications, anastomotic fistula, lower limb venous thrombosis, and intestinal obstruction were not statistically significant ( P>0.05). The incidence of postoperative complications above grade Ⅲ of the Clavien-Dindo complication classification was significantly higher in patients in the high VFA group (16.7%) compared with those in the low VFA group (4.8%), and the difference between the two was statistically significant ( χ2=4.35, P<0.05); univariate analysis revealed that operative time ≥300 min and increased VFA were the risk factors for postoperative grade Ⅲ or higher complications, while VFA was not an independent risk factor. Conclusion:Larger visceral fat area increases the difficulty of laparoscopic gastric mesenchymal tumor surgery operation, and also affects patients′ postoperative recovery, leading to increased postoperative complications, but VFA is not an independent risk factor affecting the occurrence of postoperative grade Ⅲ or higher complications in patients with gastric mesenchymal tumor.

Objective To evaluate the effect of remifentanil preconditioning ( RP ) on intestinal is?chemia?reperfusion ( I∕R) injury in rats and its relationship with opioid receptors. Methods Seventy?two Sprague?Dawley rats, aged 6-7 weeks, weighing 250-280 g, were randomly divided to 9 groups ( n=8 each): sham operation group (S), intestinal I∕R group (group I∕R), RP group, different opioid receptor antagonists groups (N, BNI and CTOP groups), and opioid receptor antagonists + RP groups (N+RP, BNI+RP and CTOP+RP groups) . Intestinal I∕R was produced by clamping the superior mesenteric artery for 1 h followed by 2 h reperfusion in all the groups except group S. RP was induced by 3 cycles of 5 min infusion of remifentanil 0?2 μg·kg-1 ·min -1 followed by 5 min infusion of normal saline before ischemia. Naltrindole (δ?receptor antagonist, 5 mg∕kg) , nor?binaltorphimine (κ?receptor antagonist, 5 mg∕kg) and CTOP (μ?receptor antagonist, 1 mg∕kg) were administered before RP. At 2 h of reperfusion, blood sam?ples were collected from the cardiac apex for determination of serum diamine oxidase ( DAO) activity. Intes? tinal tissues were then removed for microscopic examination. Intestinal damage was assessed and scored ac?cording to Chiu. Apoptosis in intestinal mucosal epithelial cells was detected using TUNEL assay, and ap?optosis index was calculated. The expression of activated caspase?3 in intestinal mucosal epithelial cells was measured by Western blot. Results Compared with group S, the serum DAO activity, Chiu′s score, and apoptosis index were significantly increased, and the expression of activated caspase?3 was up?regulated in I∕R and RP groups ( P<0?05) . Compared with group I∕R, the serum DAO activity, Chiu′s score, and ap?optosis index were significantly decreased, and the expression of activated caspase?3 was down?regulated in RP, BNI+RP and CTOP groups (P<0?05), and no significant change was found in the parameters men?tioned above in N, N+RP, BNI and CTOP+RP groups (P>0?05). Compared with group RP, the serum DAO activity, Chiu′s score, and apoptosis index were significantly increased, and the expression of activa?ted caspase?3 was up?regulated in N+RP and CTOP+RP groups ( P<0?05) , and no significant change was found in the parameters mentioned above in group BNI+RP ( P>0?05) . Conclusion RP can mitigate in?testinal I∕R injury in rats, and the mechanism is related to the anti?apoptotic effect mediated by activation ofδ?and μ?opioid receptors, but not κ?opioid receptors.

Objective To investigate the influence of electrocardiogram(ECG)-controlled dose modulation on exposure dosage and image quality of cardiac CT imaging in a cardiac phantom with simulated fluctuant heart rate.Methods The basal heart rate of the cardiac pulsating phantom was set as 60 bpm.the experimental situations were divided as 6 groups according to different heart rates.The cardiac imaging was performed on the cardiac phantom when the ECG-controlled dose modulation was firstly turned off.The exposure dosage of each scan sequence was documented.The standard deviation of the CT values of the phantom was measured on the central slice after coronal reformation of the raw data.The quality of 2D and 3D images were scored.Thell cardiac imaging was performed when ECG modulation was on and set as four groups according to different modulation parameters.All the data were documented as before.The results from the five groups with and without ECG modulation current were analyzed bv F test and comparative rank sum test using the statistical software SPSS 10.0.Results Statistical analysis showed no significant difference(P＞0.05)between the SNR of images(SD value was 27.78 and 26.30)from the groups that full mA output at wide reconstruction phase(69%～99%)when the heart rate was fluctuant(≥7.5 bpm).There was also no significant difference(P＞0.05)between the quality of the 2D and 3D images.But there was a significant difference(P＜0.01)between the SNR of images(SD value was 26.78 and 29.90)that full mA was only used at 85%reconstruction phase when the heart rate Was fluctuant(≥7.5 bpm).The exposure dosage was remarkably reduced when the ECG modulated current was on than when it Was off under fluctuant heart rate.Furthermore.there were significant difierence(P＜0.01)among the difierent ECG modulated current parameter groups.The exposure dosage can be reduced by 44.7%under the situation that the heart rate was fluctuant.Whell the fluctuation of the heart rate was≤12.5 bpm,there wag no obvious relationship between the fluctuation of the heart rate and the exposure dosage (the variation was from 0.1 to 1.1 mSv),but if the heart rate fluctuation was＞12.5 bpm,the exposure dosage would increase obviously (from 0.6 to 1.7 mSv).Conclusion For cardiac imaging with 16-slice row CT,the application of ECG modulated current can effectively reduce the exposure dosage without compromising the image quality even if heart rate was fluctuant.