ObjectiveTo establish a new noninvasive， simple， and convenient clinical predictive model by identifying independent predictive factors for rebleeding after endoscopic therapy in cirrhotic patients with esophagogastric variceal bleeding （EGVB）， and to provide a basis for individualized risk assessment and development of clinical intervention strategies. MethodsCirrhotic patients with EGVB who were diagnosed and treated in The First Affiliated Hospital of Xi’an Medical University from September 2018 to October 2023 were enrolled as subjects， and according to whether the patient experienced rebleeding within 1 year after endoscopic therapy， they were divided into rebleeding group with 93 patients and non-rebleeding group with 84 patients. Clinical data were collected and analyzed. The independent samples t-test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. A Logistic model was established based on the results of the univariate and multivariate analyses， and the receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC） were used to assess the accuracy of the model. R software was used to visualize the model by plotting a nomogram， and the Bootstrap method was used for internal validation of the model. ResultsThe multivariate analysis showed that red blood cell count （RBC）， cholinesterase （ChE）， alkaline phosphatase （ALP）， albumin （Alb）， thrombin time （TT）， portal vein trunk diameter， sequential therapy， and primary prevention were independent predictive factors for rebleeding. Based on the results of the multivariate analysis， a logistic model was established as logit（P）=-0.805-1.978×（RBC）+0.001×（ChE）-0.020×（ALP）-0.314×（Alb）+0.567×（TT）+0.428×（portal vein trunk diameter）-2.303×［sequential therapy （yes=1， no=0）］-2.368×［primary prevention （yes=1， no=0）］. The logistic model （AUC=0.928， 95% confidence interval ［CI］： 0.893—0.964， P<0.001） had a better performance in predicting rebleeding than MELD score （AUC=0.603， 95%CI： 0.520—0.687， P=0.003）， Child-Pugh class （AUC=0.650， 95%CI： 0.578—0.722， P=0.001）， and FIB-4 index （AUC=0.587， 95%CI： 0.503—0.671， P=0.045）. The model had an optimal cut-off value of 0.607， a sensitivity of 0.817， and a specificity of 0.817. Internal validation confirmed that the model had good predictive performance and accuracy. ConclusionSequential therapy， implementation of primary prevention， an increase in RBC， and an increase in Alb are protective factors against rebleeding， while prolonged TT and widened main portal vein diameter are risk factors. The logistic model based on these independent predictive factors can predict rebleeding and thus holds promise for clinical application.

Liver cirrhosis is the terminal stage of various chronic liver diseases， with the main clinical manifestation of portal hypertension， which can lead to spontaneous portosystemic shunt （SPSS）. SPSS is very common in clinical practice and is closely associated with the prognosis of patients. This article summarizes the recent studies in the clinical significance of cirrhotic portal hypertension with SPSS， the controversies in studies， and the current status and future prospects and challenges of treatment， in order to provide a reference for the standardized diagnosis and treatment of portal hypertension.

Objective To observe the clinical features of cognitive function,neuroendocrine and inflammatory cytokines in patients with chronic tension type headache(CTTH)and insomnia.Methods From April 2020 to December 2020,58 patients with CTTH comorbid insomnia in our hospital were selected as the research group,and 58 healthy individuals who underwent physical examinations during the same period were selected as the control group.Pain severity was assessed by the Visual Analog Scale(VAS),sleep quality was evaluated by the Pittsburgh Sleep Quality Index(PSQI),and overall cognitive function was evaluated by the Montreal Cognitive Assessment Scale(MoCA).The serum cortisol(Cor),adrenocorticotropic hormone(ACTH),C-reactive protein(CRP),TNF-α,and IL-6 were measured.Results The VAS and PSQI scores of the research group were significantly higher than those of the control group,while the MoCA score was significantly lower than that of the control group(all P＜0.05).Compared to the control group,the serum levels of Cor,ACTH,CRP,TNF-α,and IL-6 in the research group were significantly increased(all P＜0.05).The VAS,PSQI scores,serum Cor,ACTH,CRP,TNF-α,and IL-6 levels of patients with moderate headache in the research group were significantly higher than those of patients with mild headache,while the MoCA score was significantly lower than that of patients with mild headache(all P＜0.05).The VAS and PSQI scores of the research group showed a significant negative correlation with the MoCA score,and significant positive correlation with the levels of serum Cor,ACTH,CRP,TNF-α,and IL-6,the VAS score showed significant positive correlation with PSQI score(all P＜0.05).Conclusion CTTH comorbidity insomnia has a certain degree of cognitive decline,which may be related to neuroendocrine disorders and overexpression of inflammatory cytokines.

Objective:To investigate the pathogen distribution, temporal trends in the rates of antimicrobial resistance, and susceptibility of bloodstream isolates and comparatively explore the epidemiological characteristics of bloodstream infections in hematology departments across 56 healthcare facilities in Guangdong Province from 2020 to 2024.Methods:A multicenter analysis was conducted to evaluate the constituent ratio of different pathogens isolated from clinical isolate data from bloodstream specimens in hematology, respiratory, and intensive care unit (ICU) departments across 56 healthcare facilities in Guangdong Province (2020-2024), and antimicrobial resistance trends in pathogens with high-detection rate over 5 years were assessed. Carbapenem-resistant Gram-negative organisms (CRO) were randomly sampled for carbapenemase gene detection and in vitro antimicrobial susceptibility tests with novel antimicrobial agents.Results:From 2020 to 2024, a total of 8 968, 6 440, and 25 511 bloodstream isolates were identified in the hematology, respiratory, and ICU departments, respectively, across 56 participating facilities in Guangdong Province, with significant differences in the pathogen constituent ratio among departments ( P<0.001). Notably, the hematology department demonstrated a predominance of Escherichia coli (24.1%), Klebsiella pneumoniae (17.5%), Pseudomonas aeruginosa (11.7%), coagulase-negative Staphylococci (15.2%), and Staphylococcus aureus (5.1%). In the resistance analysis, the rates of meropenem resistance of Escherichia coli and Klebsiella pneumonia increased from 6.7% and 5.8% (2020) to 14.0% and 15.8% (2024), respectively. Conversely, Pseudomonas aeruginosa exhibited a declining trend in the rate of meropenem resistance (6.2% to 1.9%) and imipenem (10.2% to 6.1%) during the same period. Acinetobacter baumannii demonstrated a biphasic resistance pattern to common antimicrobial agents, characterized by an initial decline, followed by a rebound. In this study, the susceptibility rates to conventional antimicrobial agents were significantly higher in Staphylococcus aureus versus coagulase-negative Staphylococci, with no glycopeptide- or linezolid-resistant strains detected. Notably, the prevalence of vancomycin-resistant Enterococcus faecium increased from 0 in 2020 to 23.1% in 2024. CRO carbapenemase phenotypes through active surveillance revealed that 80% Escherichia coli isolates were carrying blaNDM, 90% Klebsiella pneumoniae isolates were carrying blaKPC, 10% Pseudomonas aeruginosa isolates were carrying blaVIM, and 100% Acinetobacter baumannii were carrying blaOXA-23. The results of the antimicrobial susceptibility test in CRO revealed that carbapenem-resistant Escherichia coli (CRECO) demonstrated a 0 resistance rate to tigecycline, polymyxin B, and aztreonam/avibactam, whereas carbapenem-resistant Klebsiella pneumoniae exhibited a 0 resistance rate to aztreonam/avibactam, ceftazidime/avibactam, and imipenem/relebactam. Carbapenem-resistant Pseudomonas aeruginosa exhibited a 95.0% susceptibility rate to amikacin and polymyxin B, with a 45.0% resistance rate to ceftazidime/avibactam. In contrast, carbapenem-resistant Acinetobacter baumannii demonstrated complete susceptibility (100.0%) to sulbactam/durlobactam (MIC90=2 μg/ml), whereas eravacycline showed MIC50 and MIC90 values of 1 and 2 μg/ml, respectively. Conclusion:The pathogen constituent ratio of bloodstream isolates differed significantly among hematology, respiratory, and ICU departments. Notably, although CRO exhibited an escalating prevalence, it sustained high susceptibility to novel antimicrobial agents.

Objective To observe the clinical features of cognitive function,neuroendocrine and inflammatory cytokines in patients with chronic tension type headache(CTTH)and insomnia.Methods From April 2020 to December 2020,58 patients with CTTH comorbid insomnia in our hospital were selected as the research group,and 58 healthy individuals who underwent physical examinations during the same period were selected as the control group.Pain severity was assessed by the Visual Analog Scale(VAS),sleep quality was evaluated by the Pittsburgh Sleep Quality Index(PSQI),and overall cognitive function was evaluated by the Montreal Cognitive Assessment Scale(MoCA).The serum cortisol(Cor),adrenocorticotropic hormone(ACTH),C-reactive protein(CRP),TNF-α,and IL-6 were measured.Results The VAS and PSQI scores of the research group were significantly higher than those of the control group,while the MoCA score was significantly lower than that of the control group(all P＜0.05).Compared to the control group,the serum levels of Cor,ACTH,CRP,TNF-α,and IL-6 in the research group were significantly increased(all P＜0.05).The VAS,PSQI scores,serum Cor,ACTH,CRP,TNF-α,and IL-6 levels of patients with moderate headache in the research group were significantly higher than those of patients with mild headache,while the MoCA score was significantly lower than that of patients with mild headache(all P＜0.05).The VAS and PSQI scores of the research group showed a significant negative correlation with the MoCA score,and significant positive correlation with the levels of serum Cor,ACTH,CRP,TNF-α,and IL-6,the VAS score showed significant positive correlation with PSQI score(all P＜0.05).Conclusion CTTH comorbidity insomnia has a certain degree of cognitive decline,which may be related to neuroendocrine disorders and overexpression of inflammatory cytokines.

A deep learning based microwave imaging model which can directly map the scattered electric field to the dielectric property distribution image of the target object is developed,and its potential for medical applications is explored.The two-dimensional time-domain finite difference method is used for numerical simulation to obtain a dataset of scattered electric fields;a deep convolutional autoencoder based imaging model is constructed to perform imaging studies on two types of target objects;the imaging results are quantitatively evaluated using relative error,and the model's ability to distinguish different types of strokes is also analyzed.The results show that the imaging network based on deep convolutional autoencoder exhibits excellent imaging performance when processing both numerical models.For simple objects,the model can accurately locate and preliminarily reconstruct the shape of the object,with an average relative error of 0.3012,while for the stroke models,it can effectively reconstruct the location and shape of the stroke area,and preliminarily reconstruct other brain tissues,with an average relative error of 0.077 8.The microwave imaging network based on deep convolutional autoencoder has great promise for fast and accurate image reconstruction,and the numerical example of stroke detection demonstrates its significant application potential in biomedical imaging.

OBJECTIVE To investigate the roles and mechanisms of γ-bungarotoxin(γ-BGT)in inducing respiratory distress in mice.METHODS Six male Kunming mice were selected and anesthe-tized before tracheal intubation and respiratory recording.After stabilizing respiration,the mice were intraperitoneally injected with γ-BGT at a dose of 6 mg·kg-1.Once a decrease in respiratory frequency was observed,the mice were intravenously injected with nikethamide at a dose of 12.5 mg·kg-1.Respi-ratory frequency was monitored using the BL420 signal acquisition and processing system.Male Kunming mice were randomly divided into the normal control group(saline,ip),γ-BGT group(6 mg·kg-1,ip),and γ-BGT+nikethamide group(γ-BGT 6 mg·kg-1,ip,followed by nikethamide 12.5 mg·kg-1,ip,when shal-low breathing and enhanced abdominal respiration were observed).The levels of Glu and GABA in the medulla oblongata were measured using ELISA.The protein expression levels of GAD65 and GAD67 in the medulla oblongata were determined by Western blotting.Primary mouse medullary neurons were cultured in vitro and divided into the following groups:cell control group,γ-BGT group,carbachol group,gallamine group,γ-BGT+H-89 group,and γ-BGT+Y-27632 group.The γ-BGT group,carbachol group,and gallamine group were incubated with γ-BGT(40 mg·L-1),carbachol(100 mmol·L-1),and gallamine(100 mmol·L-1),respectively,for 4 h.The γ-BGT+H-89 and γ-BGT+Y-27632 groups were pretreated with γ-BGT(40 mg·L-1)for 4 h,followed by incubation with the protein kinase A(PKA)inhibitor H-89(50 mmol·L-1)and the Ca2+channel inhibitor Y-27632(50 mmol·L-1)for another 2 h,respectively.ELISA was used to measure the levels of Glu,GABA,cAMP,and calpain in the primary mouse medul-lary neurons.Western blotting was employed to assess the protein expression levels of GAD65 and GAD67,and PKA phosphorylation levels.Fluo-4 fluorescent probe was used to detect the intracellular Ca2+level.RESULTS The respiratory rate of mice significantly decreased after iv administration of γ-BGT(γ-BGT group)(P<0.05).After treatment with nikethamide(nikethamide group),the respiratory rate significantly recovered(P<0.05).Compared with the normal control group,the γ-BGT group exhib-ited a significant decrease in Glu content(P<0.05),a significant increase in GABA content(P<0.05),and a significant decrease in the Glu/GABA ratio.Additionally,the protein expression levels of GAD65 and GAD67 were significantly elevated(P<0.05).Compared with the γ-BGT group,the γ-BGT+niketh-amide group showed a significant increase in Glu content(P<0.05),a significant decrease in GABA content(P<0.05),a significant increase in the Glu/GABA ratio,and a significant reduction in GAD65 and GAD67 protein expression levels(P<0.05).Compared to the cell control group,the γ-BGT group demonstrated a significant decrease in Glu content(P<0.05),a significant increase in GABA content(P<0.05),and a significant reduction in the Glu/GABA ratio.Furthermore,the protein expression levels of GAD65 and GAD67 were significantly elevated(P<0.05).Additionally,cAMP content,PKA phosphor-ylation levels,Ca2+levels,and calpain activity were all significantly increased(all P<0.05).Glu,GABA,Glu/GABA ratio,and GAD expression levels in the γ-BGT group changed in the same way as in the gallamine group;In the γ-BGT+Y-27632 group,calpain activity and expression levels of GAD65 and GAD67 were all significantly decreased(all P<0.05).In the γ-BGT+H-89 group,Ca2+levels and calpain activity were significantly reduced(all P<0.05).CONCLUSION γ-BGT-induced poisoning can lead to respiratory distress in mice,possibly through the antagonism of M2 muscarinic acetylcholine receptors in medullary neurons,activation of the cAMP/PKA signaling pathway,elevation of intracellular Ca2+levels,and increased expression and activity of GAD,resulting in an imbalance of Glu and GABA in the medulla.

Objective: This study aims to investigate the anatomical relationship among the nerve roots, intervertebral space, pedicles, and intradural rootlets of the cervical spine for improving operative outcomes and exploring neuroventral decompression approach in posterior endoscopic cervical discectomy (PECD). Methods: Cervical computed tomography myelography imaging data from January 2021 to May 2023 were collected, and the RadiAnt DICOM Viewer Software was employed to conduct multiplane reconstruction. The following parameters were recorded: width of nerve root (WN), nerve root-superior pedicle distance (NSPD), nerve root-inferior pedicle distance (NIPD), and the relationship between the intervertebral space and the nerve root (shoulder, anterior, and axillary). Additionally, the descending angles between the spinal cord and the ventral (VRA) and dorsal (DRA) rootlets were measured. Results: The WN showed a gradual increase from C4 to C7, with measurements notably larger in men compared to women. The NSPD decreased gradually from the C2–3 to the C5–6 levels. However, the NIPD showed an opposite level-related change, notably larger than the NSPD at the C4–5, C5–6, and C7–T1 levels. Furthermore, significant differences in NIPD were observed between different age groups and genders. The incidence of the anterior type exhibited a gradual decrease from the C2–3 to the C5–6 levels. Conversely, the axillary type exhibited an opposite level-related change. Additionally, the VRA and DRA decreased as the level descended, with measurements significantly larger in females. Conclusion A prediction of the positional relationship between the intervertebral space and the nerve root is essential for the direct neuroventral decompression in PECD to avoid damaging the neural structures. The axillary route of the nerve root offers a safer and more effective pathway for performing direct neuroventral decompression compared to the shoulder approach.

AIM:To evaluate the clinical efficacy of 0.05% cyclosporine eye drops(Ⅱ)combined with sodium hyaluronate eye drops in treating patients with type 2 diabetes mellitus(T2DM)and moderate-to-severe dry eye.METHODS:A total of 120 T2DM patients(120 eyes)with moderate-to-severe dry eye, treated at the endocrinology and ophthalmology departments at the Affiliated Hospital of Xuzhou Medical University from January 2024 to September 2024, were enrolled in the study. The patients were randomly divided into two groups: combination group [0.05% cyclosporine eye drops(Ⅱ)+ sodium hyaluronate eye drops] and control group(sodium hyaluronate eye drops alone), with 60 cases(60 eyes)in each group. Assessments were conducted at baseline and at 1, 2, and 3 mo post-treatment, including the ocular surface disease index(OSDI), non-contact tear meniscus height(NITMH), first non-invasive tear breakup time(NIBUTf), meibomian gland loss score, lipid layer thickness grade, conjunctival hyperemia grade, and corneal fluorescein staining(FL)score. At 3 mo after treatment, changes in tear inflammatory factors were observed, and corneal subbasal nerve plexus(SBN)morphology/density were analyzed using in vivo confocal microscopy(IVCM).RESULTS:At 1, 2, and 3 mo post-treatment, both groups showed statistically significant increases in NITMH and NIBUTf compared to baseline(all P<0.05), with greater improvement observed in the combination group(both P<0.05). OSDI and FL scores significantly decreased from baseline(all P<0.05), with more pronounced reductions in the combination group(both P<0.05). Meibomian gland loss scores showed no significant improvement in either group(all P>0.05). At 3 mo after treatment, tear levels of interleukin 6(IL-6)and matrix metalloproteinase-9(MMP-9)significantly decreased in both groups(all P<0.001), with a greater reduction noted in the combination group(both P<0.001). The combination group displayed increased corneal nerve branch density and nerve fiber density, along with decreased nerve tortuosity and dendritic cell(DC)density compared to baseline(all P<0.001), while the control group did not show significant changes(all P>0.05).CONCLUSION: The combination of 0.05% cyclosporine eye drops(Ⅱ)and sodium hyaluronate eye drops significantly improves clinical outcomes in T2DM patients with moderate-to-severe dry eye. This treatment effectively alleviates ocular surface inflammation, restores corneal nerve morphology and density, and demonstrates a favorable safety profile.

AIM: To explore the risk factors associated with diabetic retinopathy(DR)based on ultra-widefield swept-source optical coherence tomography angiography(UWF-SS-OCTA), and to establish a clinical prediction model.METHODS:A total of 235 patients(235 eyes)with type 2 diabetes mellitus who were treated in the Affiliated Hospital of Xuzhou Medical University from July to November 2024 were selected as the research objects. According to the presence or absence of DR, they were divided into 120 cases(120 eyes)in non-DR group(NDR group)and 115 cases(115 eyes)in non-proliferative DR group(NPDR group). Data on general characteristics, laboratory tests, and OCTA results were collected for both groups. Univariate analysis was employed to identify DR-related risk factors. Logistic regression analysis was conducted to analyze these risk factors and to establish a DR prediction model. The efficacy of the model was evaluated using the receiver operating characteristic(ROC)curve, calibration curve, and decision curve analysis(DCA).RESULTS: The duration of diabetes, fasting blood glucose, blood urea nitrogen(BUN), history of hypertension, and the choroidal vascular index(CVI)were found to be statistically significant in the model(all P<0.05). Specifically, the duration of diabetes, fasting blood glucose, BUN, and history of hypertension were identified as risk factors for DR among diabetic patients, while CVI was recognized as a protective factor. The area under the curve for the model predicting the probability of DR was 0.898(0.859-0.938), with a diagnostic threshold of 0.438. The corresponding sensitivity and specificity were 87.8% and 78.3%, respectively, indicating that the model possesses high predictive value for the occurrence of DR.CONCLUSION: The duration of diabetes, fasting blood glucose, BUN, history of hypertension, and CVI are significantly correlated with DR. The established prediction model demonstrates a substantial screening capability for DR.