In recent years,the microorganisms residues in endoscopes have frequently resulted in cross transmis-sion or even the outbreak of hospital-associated infections.It is of great importance to carry out standardized bio-logical surveillance of endoscopes,find out the high-risk links of cleaning and disinfection,and take targeted inter-vention measures to reduce the incidence of endoscopy-related infection.Based on the related guidelines in China and abroad as well as the latest clinical practice researches,the biological surveillance sampling and culture for en-doscopes were summarized in the article so as to enhance the surveillance quality,ensure the reprocessing effect and guarantee the endoscopy-related quality and safety.

OBJECTIVE To explore the distribution and drug resistance of the pathogens causing the abdominal(pelvic)soft tissue infections in secondary or above medical institutions of Suzhou so as to provide bases for pre-vention and control of the infections.METHODS The surveillance data of abdominal(pelvic)soft tissue infections that were reported regularly from 58 member institutions of Suzhou from Jan.2020 to Dec.2023 were collected from the regional nosocomial infection surveillance platform by Suzhou nosocomial infection management and qual-ity control center.Totally 26 tertiary hospitals and 32 secondary hospitals were involved.RESULTS Most of the 1178 strains of pathogens were isolated from the tertiary hospitals,the proportion of gram-negative bacteria was the highest;Escherichia coli,Klebsiella pneumoniae and Enterococcus faecium ranked the top 3 species.The constituent ratio of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains the was highest among the mul-tidrug-resistant organisms.The K.pneumoniae and CRKP strains were sensitive to tigecycline;the E.coli strains were highly sensitive to carbapenems,minocycline and piperacillin-tazobactam;Stenotrophomonas maltophilia strains were highly resistant to most of the antibiotics;Enterobacter cloacae strains were highly resistant to ampi-cillin-sulbactam but were highly sensitive to carbapenems;the drug resistance rate of the A.baumannii strains to tigecycline was less than 5％;the drug resistance rate of Pseudomonas aeruginosa strains to ticarcillin-clavulanic acid was highest.CONCLUSIONS The abdominal(pelvic)soft tissue infection is always mixed infections.The pathogens show severe drug resistance.It is necessary to strengthen the surveillance of etiological spectrum and drug resistance and conduct targeted guidance for clinical practice of diagnosis and treatment.

Objective:To explore the clinical and genetic characteristics and follow-up status of pediatric patients with hepatic glycogen storage disease in order to further improve the prognosis.Methods:The clinical data of hospitalized children diagnosed with hepatic glycogen storage disease in the Department of Gastroenterology at the Children's Hospital of Capital Institute of Pediatrics from January 2010 to April 2023 were collected and retrospectively analyzed. The results of laboratory examination and gene sequencing were analyzed, and the number of cases that exceeded three (n) were grouped according to the genetic results: Group 1 was type Ⅰ ( n=8), Group 2 was type Ⅲ ( n=5), and Group 3 was type Ⅸa ( n=8).The growth, development and prognosis of the children were followed up. The related clinical characteristics of pediatric hepatic glycogen storage disease were summarized. Results:Twenty-five pediatric patients with hepatic glycogen storage disease were enrolled in this study, with fifteen males and ten females. The mean age of diagnosis was (29.1±13.5) months. There were twelve cases (48%) accompanied with varying degrees of hypoglycemia, and two cases (8%) with severe hypoglycemia.There were nineteen cases with stature retardation (76%), four cases with anemia (16%), three cases with proteinuria (12%), and one case with cholestasis (4%).The genetic results showed that there were four cases of type Ⅰa (16%), four cases of type Ⅰb (16%), one case of type Ⅱ (4%), five cases of type Ⅲ (20%), two cases of type Ⅳ (8%), one case of type Ⅵ (4%), and eight cases of type Ⅸ (32%).The three subgroups analysis showed that there were significant statistical differences in uric acid and triglycerides among the three groups ( P<0.05), while there were no statistical significant differences in transaminase levels, fasting blood glucose, lactate, cholesterol, and low-density lipoprotein levels ( P>0.05). The height-for-age Z scores of the three groups were -2.86±1.62, -1.46±1.06, and -1.83±0.98, respectively. The growth and development of groups 2 and 3 were significantly improved compared with group 1 ( P<0.05), with Z scores of -2.28±1.07, 0.20±1.54, and 0.10±1.44 after at least one year of follow-up. All pediatric patients with type Ⅸa had discontinued using raw corn starch after more than one year of follow-up and their transaminases had returned to normal. Four pediatric patients with type Ia were orally administered raw corn starch on a regular basis, and the aminotransferases, uric acid, and lactate were normal, with hypoglycemia being monitored. Among the four cases with type Ⅰb, one had recurrent respiratory tract and intestinal infections, two were combined with Crohn's disease, and one was monitored for hypoglycemia. In four cases of type Ⅲ, raw corn starch was discontinued, and a high-protein, low-carbohydrate diet was adopted, with the exception of the presence of high creatine kinase and normal aminotransferase. Liver failure resulted in the death of one type Ⅵ case, while two were type Ⅳ cases; one died, and one case recently had slightly elevated aminotransferase. Conclusion:When pediatric patients exhibit manifestations such as hepatomegaly, elevated transaminases, fasting hypoglycemia, and delayed growth and development, it is necessary to be alert to hepatic glycogen storage disease. Clinical manifestations and biochemical indicators combined with genetic testing are helpful for the diagnosis of hepatic glycogen storage disease. Simultaneously, targeted nutritional management should be carried out according to the metabolic characteristics of different subtypes, with attention on growth and development status.

Objective:To develop a novel fibroblast activation protein (FAP) cyclic peptide imaging agent, Al 18F-FAP-NOX, evaluate its in vitro and in vivo properties, and explore its feasibility of PET/CT imaging in tumors with FAP positive expression. Methods:Al 18F-FAP-NOX was manually synthesized. The in vitro stability of Al 18F-FAP-NOX was determined using radio high performance liquid chromatography (HPLC). The lipid water partition coefficient log P, in vitro cell uptake experiments, microPET/CT imaging and biodistribution in 293T-FAP tumor-bearing mice were conducted to preliminarily evaluate the pharmacokinetics and biological efficacy of Al 18F-FAP-NOX. Afterwards, a patient (male, 65 years old) with lung cancer underwent Al 18F-FAP-NOX PET/CT imaging. Results:Al 18F-FAP-NOX was successfully synthesized with a yield of (26.28±2.31)% without attenuation correction ( n=4), and the radiochemical purity was more than 95%. Al 18F-FAP-NOX exhibited good stability and hydrophilicity (log P=-3.02±0.08, n=5). In cell assays, the uptake of Al 18F-FAP-NOX in HT1080-FAP cells reached the plateau phase at 15 min ((7.31±0.53) percentage activity of injection dose per million cells (%ID/mio cells)), exhibiting high cellular uptake. The uptake of Al 18F-FAP-NOX could be significantly inhibited by 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (DOTA)-FAP-2286. The microPET/CT results of 293T-FAP tumor-bearing mice in vivo showed that Al 18F-FAP-NOX was highly uptaken in FAP-positive tumor tissues (60 min: (12.47±1.66) percentage activity of injection dose per gram of tissue (%ID/g)), while the uptake was very low in FAP-negative tumors. The biodistribution results were similar to the microPET/CT imaging results of tumor-bearing mice. The human clinical imaging showed an abnormal increase in Al 18F-FAP-NOX uptake (SUV max 5.5) of the lung cancer lesions. Conclusions:A novel cyclic peptide radiopharmaceutical, Al 18F-FAP-NOX, demonstrates good stability and hydrophilicity. It can be quickly distributed to tumor tissue in vivo. The human clinical PET/CT imaging shows certain diagnostic ability of Al 18F-FAP-NOX for lung cancer lesions. It is a promising cyclic peptide agent for PET imaging.

Objective:To systematically evaluate the safety and efficacy of the novel fibroblast activation protein (FAP)-targeted tracer 64Cu-FAP inhibitor (FAPI)-XT117 in patients with malignant solid tumors, and to compare with 18F-FDG. Methods:This self-controlled study was conducted on fifteen patients (8 males, 7 females; age (60 ±9) years) with malignant solid tumors from the First Affiliated Hospital of Guangzhou Medical University between July 2023 and December 2023. Each subject underwent 64Cu-FAPI-XT117 PET/CT at 30, 60, and 120min post-injection and was assigned to three dose cohorts (111MBq, 148MBq, and 185MBq; 5 patients in each cohort), and safety assessments were conducted within 24h after injection. In addition, all patients underwent 18F-FDG PET/CT at 60min post-injection. Time-activity curves were generated for 64Cu-FAPI-XT117, and the dosimetry was calculated. Image quality was evaluated using a 5-point Likert scale, and the optimal injected activity and imaging time point were determined. The paired t test was used to compare differences of the lesion detection count and SUV max between 64Cu-FAPI-XT117 and 18F-FDG PET/CT. Results:64Cu-FAPI-XT117 was well tolerated, with no adverse events reported. Time-activity curves of 68Ga-FAPI-XT117 revealed prominent uptake in the uterus, while the background activity in other organs remained low, with the whole-body effective dose of (0.0084±0.0021)mSv/MBq. The optimal imaging time point for 64Cu-FAPI-XT117 PET/CT was 60min post-injection, with an optimal administered activity of 111MBq. Compared with 18F-FDG, 64Cu-FAPI-XT117 demonstrated significantly higher uptake and more lesions in lymph-node metastases (SUV max: 8.6±3.8 vs 15.3±6.8, t=2.33, P=0.048; number of lesions: 8.3±5.4 vs 15.0±6.4; t=4.21, P=0.003) and distant metastases (SUV max: 11.8±3.7 vs 20.9±7.2, t=3.66, P=0.022; number of lesions: 7.0±3.2 vs 12.4±3.7, t=2.86, P=0.046). Conclusions:64Cu-FAPI-XT117 PET/CT is well tolerated in patients with solid tumors, with a controllable radiation risk. Moreover, it outperforms 18F-FDG PET/CT in the assessment of metastases.

Megestrol acetate is widely used in clinical practice and offers benefits to patients. However, it carries potential adverse effects, such as hypoadrenocorticism, which is often overlooked due to its atypical clinical manifestations. This report describes two cases of megestrol acetate-induced hypoadrenocorticism. Through a review of relevant literature, the mechanisms, clinical characteristics, and treatment strategies are summarized to enhance clinicians′ awareness of this potential complication.

Objective:To identify the influencing factors for acute kidney injury (AKI) in patients undergoing interventional embolization of intracranial aneurysms under general anesthesia and develop a predictive model.Methods:In this retrospective study, the clinical data from patients who underwent elective interventional embolization of intracranial aneurysms at Hospital Affiliated to Nanjing Medical University from January 2019 to December 2023 were collected. All the patients were divided into AKI group and non-AKI group based on whether AKI occurred postoperatively. The general data, preoperative laboratory parameters, and intraoperative parameters of the patients were obtained through the electronic medical record system and operation-anesthesia management system. The variables screened using LASSO regression were included in the multivariate logistic regression analysis to identify the risk factors for AKI following embolization of cerebrovascular aneurysms. Based on the results, a predictive model was established and evaluated.Results:A total of 428 patients were collected, with 73 in AKI group and 355 in non-AKI group. LASSO regression for variable selection and multivariate logistic regression analysis showed that serum creatinine concentration, duration of surgery and age were independent risk factors, and the glomerular filtration rate and hemoglobin concentration were protective factors for AKI after interventional embolization of intracranial aneurysms ( P<0.05). The area under the receiver operating characteristic curve of the prediction model was 0.860 (95% confidence interval 0.815 to 0.905), with a sensitivity of 0.880 and a specificity of 0.718. The calibration curve showed a mean absolute error of 0.014. The Hosmer-Lemeshow goodness-of-fit test indicated that there was no statistically significant difference between the predicted and observed values of the model ( χ2=3.29, P=0.915). The clinical decision curve demonstrated that the net benefit rate for patients was higher when the threshold probability ranged from 0 to 0.83. Conclusions:The glomerular filtration rate, serum creatinine concentration, hemoglobin concentration, duration of surgery and age are influencing factors for AKI following interventional embolization of intracranial aneurysms, and the prediction model established based on these factors demonstrates good predictive performance.

Purpose To explore the relationship between regulatory T cells(Treg cells)and natural killer(NK)cells with tumor occurrence and development in papillary thyroid carcinoma(PTC).Methods Hematoxylin and eosin(HE)staining was performed on pathological tissue sections from patients with nodular goiter and PTC to evaluate im-mune cell infiltration.Flow cytometry was used to detect the percentage and absolute count of Treg cells and NK cells in peripheral blood from healthy controls(HCs)and PTC patients.Treg cells phenotypes(ICOS、PD-1、Lag3)and their IL-10 secretion ability were analayzed,along with functional molecules(TNF-α、IFN-γ、Granzyme B、Perforin)ex-pressed by NK cells.A cytometric bead array was used to measure serum cytokine IL-10 concentration.Changes in Treg and NK cells and their correlations were analyzed.Results Immune cell infiltration in PTC tissues is higher than in nodular goiter tissue.Compared with healthy controls,PTC patients exhibited a significant increase in the percentage[(6.86±3.10)％]and absolute count[(4.97±2.82 × 106 cells/mL)]of circulating Treg cells,with an enhanced IL-10 secretion capacity[(7.18±3.57)％],which is related to lymph node metastasis and vascular invasion.Con-versely,NK cell percentage[(16.56±8.44)％]and absolute count[(3.29±3.12 × 106 cells/mL)]were reduced,with impaired effector functions.The NK-to-Treg cell ratio(2.49±1.60)significantly declined,and a negative corre-lation was observed between the percentage of the two groups cell types(P=0.04,r=-0.625).Serum IL-10 levels in PTC patients were elevated[(1.30±1.09)pg/mL],correlating with tumor size and lymph node metastasis.After treatment with 1,25-(OH)2-D3,PTC patients showed a reduction in the percentage[(7.01±2.13)％]and absolute count(4.27±1.62 × 106 cells/mL)of circulating CD4+CD25+CD127low Treg cells,and a decrease in serum cytokine IL-10 levels[(1.27±0.09)pg/mL].Circulating NK cells percentages[(20.6±6.72)％]and absolute counts[(5.63±2.93)× 106 cells/mL]partially recovered.Conclusion PTC patients exhibit a pronounced immunosup-pressive state.Dysregulated numbers and functions of Treg and NK cells are closely associated with the occurrence,de-velopment,and prognosis of PTC,highlighting their potential importance in tumor immunotherapy.

Objective:This study aimed to identify key genes in endothelial cell (EC) associated with the pathogenesis and progression of human venous malformations (VMs) through bioinformatics analysis, providing potential biomarkers for early screening and targeted therapy of VMs.Methods:A case-control study was conducted using surgically resected tissue specimens from VMs patients at the Third Affiliated Hospital of Zhengzhou University (from September 2021 to September 2023), with malformed venous tissues as the experimental group and distal normal venous tissues as controls. Single-nucleus RNA sequencing (snRNA-seq) was performed on paired experimental and control samples from four VM patients. High-dimensional weighted gene co-expression network analysis (hdWGCNA), combined with gene ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG), and protein-protein interaction (PPI) network analysis, identified critical genes. Validation experiments included 15 additional VM cases and controls using reverse transcription quantitative polymerase chain reaction (RT-qPCR), immunohistochemistry (IHC), and Western blot.Results:A total of 55 430 nuclei were captured using snRNA-seq, with 30 391 nuclei from the experimental group and 25 039 nuclei from the control group. Cluster analysis identified 22 distinct cell populations, which were annotated into 8 cell types. hdWGCNA revealed four modules associated with invasion, which were enriched in angiogenesis, integrin signaling, and cell adhesion according to GO analysis. KEGG pathway analysis indicated that the PI3K-AKT signaling pathway and focal adhesion are key regulatory mechanisms. PPI network analysis combined with cytoscape identified EGFL7, TEK, and FLT1 as key genes. RT-qPCR results demonstrated that the relative mRNA expression levels of these three genes in the experimental group (6.66±2.31, 1.86±0.62, 3.49±0.58) were significantly higher than those in the control group (1.05±0.14, 1.00±0.14, 1.06±0.25), with statistically significant differences ( t=9.37, 4.27, 11.20, P<0.05). Immunohistochemical analysis showed that the relative protein expression levels of these three genes in the cytoplasm of the experimental group (0.84±0.15, 0.68±0.14, 0.85±0.12) were also significantly higher than those in the control group (0.19±0.05, 0.23±0.06, 0.30±0.05), with statistically significant differences ( t=16.62, 5.93, 11.68, P<0.05). Western blot analysis confirmed that the relative protein expression levels of these three genes in the experimental group (0.35±0.04, 0.36±0.09, 0.31±0.04) were significantly higher than those in the control group (0.19±0.01, 0.13±0.02, 0.14±0.04), with statistically significant differences ( t=7.05, 4.61, 5.93, P<0.05). Conclusion:EGFL7, FLT1, and TEK in EC may play crucial roles in the occurrence and invasion of VMs.

To evaluate the clinical application value of magnetic bead sorting technology (MBS) using the T-cell select kit combined with an automatic cell sorter for isolating peripheral blood mononuclear cells (PBMCs) to realize automated specimen pre-processing and process optimization in T-SPOT.TB assay. A cross-sectional study was conducted involving 300 patients recruited from the first affiliated hospital of Air Force Medical University from March 2023 to July 2024. Among them, there were 167 males and 133 females. The age range of the patients was 18 to 65 years, with a median age of 49.0 (33.3, 59.0) years and a mean age of (46.4±13.9) years. 4 ml of anticoagulated whole blood samples in duplicate were collected from each patient. One fresh sample (0-4 h) was processed immediately using density gradient centrifugation (DGC) for PBMC isolation, while the other was processed using MBS method at either 0-4 h or 34-54 h post-collection. The cycles for cell enrichment step of the automatic cell sorter were adjusted from the conventional 4 cycles to 2 cycles. Statistical analysis was performed using Cohen′s Kappa test to evaluate the concordance of T-SPOT.TB results across all processing groups. The results showed that for fresh samples (0-4 h), the T-SPOT.TB results for samples processed with 4-cycle and 2-cycle MBS enrichment steps demonstrated positive concordance rates of 91.7% and 93.1%, negative concordance rates of 100% for both, overall concordance rates of 98.0% and 97.9%, and Kappa values of 0.94 and 0.95, respectively, compared with the reference results for paired samples processed using DGC. Correspondingly, the results for samples processed with the 4-cycle and 2-cycle MBS methods at 34-54 h post-collection yielded positive concordance rates of 90.0% and 81.3%, negative concordance rates of 95.1% and 100%, overall concordance rates of 93.0% and 82.9%, and Kappa values of 0.86 and 0.43, respectively, compared with the reference results for fresh samples processed using DGC. In conclusion,for 0-4 h samples, the T-SPOT.TB results from both 4-cycle and 2-cycle MBS enrichment protocols were highly consistent with the reference results from conventional DGC methods. However, for 34-54 h stored samples, results from the 4-cycle MBS method rather than the 2-cycle protocol exhibited significantly superior concordance with the reference results. The MBS method using T-Cell Select kit achieves automated sample pre-processing for T-SPOT.TB assay, reduces hands-on time, and provides a viable alternative with reliable results for long-stored specimens.