ObjectiveTo investigate the role of interleukin （IL）-17A in acute inhalational pneumonia induced by the highly drug-resistant and hypervirulent Staphylococcus aureus strain USA300-R in mice. MethodsAn acute inhalational pneumonia model was established in mice using an aerosolized pulmonary delivery technique. RNA sequencing （RNA-seq） and enzyme-linked immunosorbent assay （ELISA） were employed to examine the expression dynamics of Il17a mRNA and IL-17A protein， respectively， in the lungs of infected mice. Il17a knockout （Il17a^-/-） mice were generated using CRISPR/Cas9 gene editing technology. The survival rate， body weight， bacterial load in lung tissue， and histopathological changes were compared between Il17a^-/- and wild-type （WT） mice following inhalational infection with USA300-R. Results12 hours after USA300-R infection， compared to pre-infection， the expression level of Il17a mRNA in lung tissue and the level of IL-17A protein in bronchoalveolar lavage fluid （BALF） increased by approximately 50-fold （P<0.01） and 6-fold （P<0.001）， respectively. Compared to WT mice， Il17a^-/- mice exhibited approximately 10-fold higher bacterial loads in lung tissue at both 12 and 24 hours post-infection （P<0.001， P<0.05）. However， they showed significantly attenuated lung histopathological injury， reduced alveolar wall thickening， markedly decreased neutrophil infiltration， and an approximately 50% improvement in survival rate （P<0.05）. ConclusionIn acute Staphylococcus aureus USA300-R inhalational pneumonia， IL-17A contributes to bacterial clearance by recruiting neutrophils； however， excessive neutrophil infiltration exacerbates pulmonary inflammation and injury， reduces survival rates， and represents a potential therapeutic target.

Objective:To investigate the radiographic changes of calcification of transverse atlantal ligament by clinical case study and improve the understanding of it.Methods:A retrospective analysis was performed to identify the clinical cases of transverse atlantebral ligament calcification. Eleven cases in the orthopedic department of our hospital from January 2015 to December 2022 were identifiled.Results:In this study, a total of 11 patients with calcification of atlas transverse ligament, which showed crowned dens sign (CDSig). Five patients were males and 6 were females, with an average age of 79.9 years (70~89 years). The average follow-up time was 44.7 months (14~89 months), 7 cases had no significant change in calcification, and 4 patients had aggravated calcification. These 11 patients accounted for 28 clinical visits in total, with the primary reasons for consultation as follows: 7 visits were related to cerebrovascular diseases, 6 visits were due to respiratory diseases, 5 visits were for surgical conditions. None of the patients reported a history of "acute neck pain".Conclusion:When patients with CDSig are complicated by acute neck pain, crowned dens syndrome should be considered on the basis of exclusion of malignant diseases such as meningitis. Calcification of the transverse atlanto-vertebral ligament is closely related to age, and calcification develops slowly, and may become worse with age.

Objective:To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of ileocecal valve lipoma.Methods:A retrospective cohort study was performed on data of ileocecal lipoma patients who underwent ESD at the Endoscopy Center of Zhongshan Hospital, Fudan University from December 2013 to June 2023. According to the lesion location, the patients were divided into ileocecal valve group and cecum group. The operation time, operation speed, en bloc resection rate, complications, and follow-up outcomes between the two groups were compared.Results:A total of 59 patients with ileocecal lipoma were enrolled, including 31 patients in the ileocecal valve group and 28 patients in the cecum group.There were no significant differences in gender, age, specimen size, or lesion size between the two groups ( P>0.05). Lipomas in both the ileocecal valve group and the cecum group were successfully resected by ESD. The en bloc resection rates were 100.0% (31/31) and 92.9% (26/28) respectively, and the difference was not statistically significant ( χ2=0.033, P=0.133). Median operative duration significantly differed between the two groups ( ileocecal valve group 26 min VS cecum group 20 min, Z=-0.136, P=0.027), as did resection speed (ileocecal valve group 0.14 cm2/min VS cecum group 0.24 cm2/min, Z=-0.223, P=0.022). Adverse events included one postoperative fever in the ileocecal valve group and one delayed bleeding in the cecum group. During the median follow-up of 38 months (7-106 months), there was no case of residual tumor or recurrence. Conclusion:Despite technical challenges in ESD of ileocecal valve lipoma, it is still a safe, feasible and effective treatment method.

Objective To analyze the prevalence of latent tuberculosis infection(LTBI)among relevant healthcare workers(HCWs)in designated tuberculosis medical institutions(MIs)in Yantai City,and explore its influencing factors.Methods The cluster random sampling method was adopted to select two county-and district-level desig-nated tuberculosis MIs.All HCWs underwent questionnaire survey and creation tuberculin skin test(C-TST)at the same time,and the influencing factors for LTBI were analyzed.Results A total of 215 HCWs from designated tu-berculosis MIs were included for analysis,37 were diagnosed with LTBI,with an infection rate of 17.21％(95％CI:12.42％-22.93％).Multivariate logistic regression analysis showed that clinicians(OR=3.19,95％CI:1.05-9.69),laboratory technician(OR=5.90,95％CI:1.21-28.77),working years≥10 years(OR=3.31,95％CI:1.39-7.90),and tuberculosis history of family members(OR=6.49,95％CI:1.01-41.46)were independent risk factors for LTBI.Conclusion The infection risk of clinicians and laboratory technicians who directly contact with tuberculosis patients or Mycobacterium tuberculosis is higher than that of other HCWs,and is related to the length of working years.It is suggested that healthcare-associated infection control measures should be streng-thened,and tuberculosis active screening should be carried out regularly for HCWs in key departments.

Objective The aim of this study was to analyze the incidence,mortality,and epidemiological trends of malignant tumors in the cancer registration areas of Qinghai Province and provide a reference for the prevention and control strategies and meas-ures of malignant tumors.Methods According to the quality control standards for cancer registration,the data on malignant tumor in-cidence and mortality from 8 national cancer registration areas in Qinghai Province from 2014 to 2021 were collated.The crude inci-dence/mortality,age-standardized incidence/mortality rate by Chinese standard population(ASIRC/ASMRC)and World standard population(ASIRW/ASMRW),the cumulative rates(0-74 years old),and the age-specific incidence/mortality of malignant tumors were calculated for different sexes and regions.The Joinpoint 4.9.0.0 software was used to calculate the average annual percentage change(AAPC)and conduct trend analysis.Results The crude incidence of malignant tumors in the cancer registration areas of Qinghai Province from 2014 to 2021 was 221.25/100,000(243.31/100,000 for males and 198.68/100,000 for females),the ASIRC was 199.48/100,000(229.13/100,000 for males and 173.34/100,000 for females),the ASIRW was 196.38/100,000(228.32/100,000 for males and 167.97/100,000 for females).The cumulative rate for those aged 0-74 years was 21.57％;the crude mortali-ty of malignant tumors was 131.90/100,000(163.86/100,000 for males and 99.20/100,000 for females),the ASMRC was 121.07/100,000(157.33/100,000 for males and 87.45/100,000 for females),the ASMRW was 120.53/100,000(157.54/100,000 for males and 86.31/100,000 for females),and the cumulative rate for those aged 0-74 years was 12.79％.The crude incidence,ASIRC,ASIRW,crude mortality,ASMRC and ASMRW were all higher in males than those in females.Both the crude incidence and mortality of malignant tumors increased with age.The crude incidence rate increased rapidly after age 45,peaked in the 80-84 age group(2,352.29 per 100,000),and declined slightly in the 85+age group.The crude mortality increased rapidly after age 50,peaked in the 85+age group(2,305.44 per 100,000).The crude incidence(AAPC=5.68％,95％CI:3.48％-7.93％,P＜0.05)and erude mortality(AAPC=3.67％,95％CI:2.44％-4.91％,P＜0.05)of malignant tumors showed an overall upward trend from 2014 to 2021.The ASIRC(AAPC=-0.12％,95％CI:-3.70％-3.59％,P＞0.05)remained stable,while the ASMRC(AAPC=-2.81％,95％CI:-3.28％--2.03％,P＜0.05)showed a downward trend.The top five malignant tumors in terms of crude incidence were stom-ach cancer,lung cancer,liver cancer,female breast cancer,and cervical cancer,respectively;the top five malignant tumors in terms of crude mortality were stomach cancer,lung cancer,liver cancer,esophagus cancer,and colorectal cancer,respectively.Conclusion From 2014 to 2021,the incidence and mortality of malignant tumors in the Qinghai Province cancerregistration areas showed an in-creasing trend,with higher rates in males than those in females.It is recommended that targeted prevention and control measures should be implemented for people aged 45 and older,with stomach cancer,liver cancer,and cervical cancer as key cancers.

OBJECTIVE To observe the epidemiological characteristics,virulence and drug resistance genes in Kleb-siella oxytoca complex(KOX)strains isolated from the children in Suzhou so as to provide theoretical bases for clinical prevention and control.METHODS The clinical distribution and drug resistance of 101 strains of KOX that were isolated from Children's Hospital of Soochow University from Jan.2021 to Mar.2024 were retrospectively analyzed.Fifty strains were randomly selected to detect the expressions of 18 types of virulence genes and 12 types of drug resistance genes.RESULTS Of the 97 strains of KOX isolated from hospitalized children,32.67％from i-solated from sputum,27.72％from stools and 24.74％from urine;45.54％were isolated from hematology de-partment,18.81％from neonatology department and 10.89％from ICU.The strains expressed a variety of viru-lence genes,among which the ironophore-related genes entB(82.00％),irp-1(64.00％),irp-2(64.00％),ybtS(64.00％)and fyuA(64.00％)were dominant.Carbapenem-sensitive KOX(CS-KOX)strains were susceptible to most of the antibiotics,while the drug resistance rates of the CR-KOX strains to most of the antibiotics were relatively high.The detection rates of extended-spectrum β-lactamase gene CTX(56.52％)and carbapenemase gene NDM(78.26％)were relatively high among the CR-KOX strains;38.89％(7/18)of the strains expressed NDM gene and meanwhile expressed other carbapenemase genes.CONCLUSIONS The KOX strains isolated from the hospitalized children in Suzhou carry a variety of virulence and drug resistance genes,and there is risk of trans-mission of CR-KOX in the hospital.Therefore,it is necessary to attach great importance to the surveillance of drug-resistant strains for the long-term hospitalized children and raise the awareness of infection control so as to prevent the transmission of such bacteria.

Objective:To investigate the utility of a computational pathology-based tumor microenvironment(TME)score derived from whole slide images(WSIs)in predicting the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs)in patients with EGFR mutation-positive non-small cell lung cancer(NSCLC).Methods:This retrospective study collected 240 EGFR-mutant NSCLC pa-tients treated with EGFR-TKIs at The First Affiliated Hospital of Wannan Medical College and analyzed hematoxylin-eosin(H&E)-stained WSIs of biopsy specimens,along with clinical and imaging data.The patients were randomly assigned into a training cohort(n=160)and an inde-pendent validation cohort(n=80)in a 2:1 ratio.Treatment response was assessed based on CT findings at 3 months after EGFR-TKIs initi-ation.Computational pathology was employed to automatically quantify the proportions of four TME components(tumor epithelium,stroma,lymphocytes,and vasculature)within the tumor regions of WSIs.Multivariate Logistic regression in the training cohort identified TME components independently predictive of treatment response(P<0.05),which were then integrated into a TME-score.The predictive performance was evaluated using receiver operating characteristic(ROC)curve analysis and area under the curve(AUC).The TME-score model was compared with a clinical-feature-based model and a combined model(TME-score+clinical features).Finally,the models were val-idated in the independent cohort.Results:In the training cohort,the TME-score,incorporating epithelial and stromal proportions,achieved an AUC of 0.827(95%CI:0.749-0.892)for predicting treatment response,while the validation cohort yielded an AUC of 0.845(95%CI:0.735-0.937).Both outperformed the clinical model(AUCs=0.730[95%CI:0.645-0.804]and 0.712[95%CI:0.586-0.824],respectively).The combined model(TME-score+clinical features,including cytokeratin 19 fragment and non-contrast CT values)further improved predictive performance(AUCs=0.884[95%CI:0.827-0.932]and 0.882[95%CI:0.798-0.950],respectively).Delong's test for pairwise model comparis-ons showed significant differences(all P<0.05)except TME-score and the combined model in the validation cohort(P=0.289).Conclusions:TME-score outperformed clinical models in predicting EGFR-TKIs efficacy in EGFR mutation-positive NSCLC patients and may serve as a novel tool for identifying patients likely to benefit from targeted therapy.

Mandibular retrusion is a common dentofacial deformity of maxillofacial region in clinical practice,which seriously af-fects facial appearance and oral function.Severe mandibular retrusion can lead to systemic diseases,and even lead to sleep apnea,which is life-threatening.The etiology of mandibular retrusion is not clear,but heredity,bad habits and endocrine dysfunction are related to its occurrence and development.At present,functional appliance treatment,camouflage treatment,combined orthodontic and orthognathic treatment are the main ways to treat mandibular retrusion.This article discusses the pathogenesis,clinical manifes-tations,and treatment strategies of class Ⅱ malocclusion with mandibular retrusion.

Objective To dynamically supervise medical insurance diagnosis and treatment behaviors through informa-tion technology,prevent compliance risks,and improve the efficiency of hospital medical insurance fund management.Methods Taking Gansu Provincial Hospital of Traditional Chinese Medicine as the research object,a hierarchical medical insurance in-telligent audit system was constructed,and core functional modules were designed to achieve full-process supervision.Based on system operation data,the audit efficiency,standardization of diagnosis and treatment behaviors,and cost control effects were compared and analyzed.Results After the system was launched,the time required for a single audit decreased from 5 minutes to 0.6 minutes,with an 88％improvement in processing efficiency.The average hospitalization cost for provincial residents de-creased by 16.33％year-on-year,and overall expenditures decreased by 16.34％.Billing loopholes and unreasonable charging behaviors were corrected.Conclusion The medical insurance intelligent audit system can effectively enhance supervision effi-ciency,standardize diagnosis and treatment behaviors,and control unreasonable cost growth.Additionally,it is recommended to further improve the intelligent supervision system through multi-dimensional policy education,deep integration with clinical sys-tems,and algorithm optimization.

Objective:To evaluate the efficacy and safety of nebulized inhalation of recombinant human interferon (IFN) α1b injection in the treatment of respiratory syncytial virus (RSV) associated lower respiratory tract infections (pneumonia and bronchiolitis) in children.Methods:A randomized, double-blind, parallel, placebo-controlled add-on design was used.Children with pneumonia or bronchiolitis aged 2 months to 5 years who tested positive for RSV antigen within 72 hours of onset from 30 clinical trial sites including Beijing Children′s Hospital, Capital Medical University between February 2021 and December 2022 were included in this study and randomly divided into 2 groups at a ratio of 1∶1 based on a stratified-block method.Both groups received basic treatments such as cough control, asthma relieving, expectorant treatment, fever reduction, oxygen therapy, etc.The experimental group received additional nebulized inhalation of IFN α1b injection at a dose of 2.0 μg/(kg·time), twice a day.The control group received nebulized inhalation of placebo twice a day.Clinical efficacy was evaluated based on indicators such as the duration of clinical symptoms and signs, and the Kaplan-Meier method was used to calculate the median and 95% CI of the duration of clinical symptoms and signs.The Log-rank test was used to compared data between groups.Safety was assessed through the incidence of adverse reactions and laboratory tests, and the Chi-square test was used to analyze the difference between groups. Results:There were 123 children in the experimental group and 122 children in the control group.The median durations of all the 5 clinical symptoms and signs [including shortness of breath, wheezing, dyspnea (visible retractions), decreased transcutaneous oxygen saturation, and abnormal mental state] in the experimental group after treatment were slightly shortened than those in the control group [2.7 d(95% CI: 1.9-3.0 d)] vs.[2.9 d(95% CI: 2.6-3.6 d), P=0.027].The improvement in dyspnea (retractions) was especially pronounced in the experimental group, with a relief rate of 50.0% (0, 100%) on the first day of administration[compared with 0 (0, 50.0%) in the control group ( Z=2.002, P=0.025)].The median duration of dyspnea in the experimental group was nearly 1 day shorter than that in the control group [1.0 d(95% CI: 0.7-1.7 d) vs.1.8 d(95% CI: 1.0-2.5 d), P=0.046].There were no significant difference in hospital stay [6.0(5.0, 8.0) d vs.6.5(5.0, 8.0) d, Z=0.675, P=0.500], oxygen therapy duration [32.0(14.0, 96.3) h vs.39.0 (24.0, 83.2) h, Z=0.094, P=0.925], the recovery rate from clinical symptoms during treatment [(105/106, 99.1%) vs.(96/101, 95.0%)], and recurrence rate [(0/106, 0) vs.(2/101, 2.0%)] between the 2 groups (all P>0.05).However, the above-mentioned four indicators in the experimental group showed a trend of clinical benefits.The quantitative virus detection results showed that the RSV viral load in both groups decreased after treatment compared to before treatment.After 2 days of treatment, the decline rate of RSV viral load from the baseline was 0.90 lg copies/(mL·d) in the experimental group and 0.25 lg copies/(mL·d)in the control group, with a statistically significant difference ( P<0.05).Furthermore, there was no statistically significant difference in the incidence of adverse reactions between the 2 groups ( P>0.05).Importantly, no drug-related serious adverse reactions occurred in both groups. Conclusions:The nebulized inhalation therapy of IFN α1b demonstrates efficacy and safety in treating pediatric RSV associated lower respiratory tract infections.It particularly offers outstanding clinical therapeutic value for severe children.