Acute-on-chronic liver failure （ACLF） is a dangerous disease with severe conditions， rapid progression， and high short-term mortality. Intestinal flora and metabolites are closely associated with the development， progression， and pathogenesis of ACLF. During the development of ACLF， the destruction of intestinal integrity and the dysregulation of intestinal microecology and its metabolites mediate immune disturbance and thus aggravate systemic inflammatory response. This article elaborates on the role of intestinal flora and metabolites in the development and progression of ACLF and related therapeutic strategies.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective:To evaluate the incidence of malnutrition in hospitalized patients with liver cirrhosis using the Global Leadership Initiative on Malnutrition (GLIM) criteria, and to identify the risk factors of malnutrition.Methods:A total of 305 inpatients with liver cirrhosis were included from the Department of Gastroenterology of the People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture between January 1, 2023 to September 30, 2023. The patient characteristics, clinical indicators, complications, unplanned readmission within 90 days and death outcomes were collected. Malnutrition was diagnosed according to the GLIM criteria, the differences in various indicators were compared between the malnutrition group and the well-nourished group, and the influencing factors of malnutrition were analyzed. The relationship between malnutrition and short-term prognosis was also discussed.Results:Among the enrolled patients, 188 (61.6%) were diagnosed with malnutrition per GLIM criteria, of whom 18 were with Child-Turcotte-Pugh (CTP) Grade A liver function, 108 Grade B, and 62 Grade C. Compared with the well-nourished group, the malnutrition group showed prolonged length of hospital stay ( P<0.001), lower body mass index P=0.003), lower levels of red blood cell count, hemoglobin, serum albumin, serum albumin/globulin ratio, and serum calcium ( P<0.001), higher level of aspartate aminotransferase ( P=0.025), and increased levels of C-reactive protein, total bilirubin, international normalized ratio, plasma prothrombin time and model for end-stage liver disease score ( P<0.001). The proportion of patients with ascites, esophageal gastric varices, upper gastrointestinal bleeding, hepatic encephalopathy and unplanned readmission within 90 days were significantly increased ( P<0.001) in malnutrition group, and the mortality within 90 days was also higher ( P=0.042). Logistic regression analysis identified lower body mass index level ( OR=0.910, P=0.038), ascites ( OR=0.065, P<0.001) and upper gastrointestinal bleeding ( OR=0.184, P=0.001) as the influencing factors of malnutrition in liver cirrhosis patients. Conclusions:The prevalent malnutrition in patients with liver cirrhosis may affect the short-term prognosis. Lower body mass index, ascites and upper gastrointestinal bleeding are influencing factors for malnutrition in liver cirrhosis patients. Therefore, patients with liver cirrhosis should be screened for malnutrition to allow timely nutritional intervention measures.

Objective:To evaluate the relationship between glutathione S-transferase μ1 (GSTM1) and the apoptosis signal-regulating kinase 1 (ASK1)-c-Jun N-terminal kinase (JNK)/p38 mitogen-activated protein kinase (MAPK) signaling pathway during therapeutic hypothermia-induced reduction of cerebral ischemia-reperfusion injury (CIRI) in rats.Methods:One hundred clean-grade healthy male Sprague-Dawley rats, aged 8 weeks, weighing 260-280 g, were divided into 5 groups ( n=20 each) using a random number table method: sham operation group (S group), cerebral ischemia-reperfusion group (I/R group), therapeutic hypothermia group (H group), GSTM1 inhibitor+ therapeutic hypothermia group (IH group), and GSTM1 inhibitor + ASK1 inhibitor + therapeutic hypothermia group (IAH group). CIRI model was developed by occlusion of the left middle cerebral artery for 2 h, followed by restoration of the blood flow. A nylon thread was inserted into the internal carotid artery and advanced cephalad until resistance was met. The brain temperature was maintained at 36-37 ℃ during surgery. In H group, the head and neck were wiped with 75% alcohol immediately after reperfusion, and the brain temperature was maintained at 32-33℃ for 3 h, and the rest procedures were the same as those previously described in I/R group. In IH group, GSTM1 inhibitor itaconic acid 8.6 mg/kg was intraperitoneally injected at 24 and 1 h before developing the model, and the rest procedures were the same as those previously described in H group. In IAH group, ASK1 inhibitor selonsertib 10 mg/kg was given orally once a day for 4 consecutive days starting from 4 days before developing the model, and the rest procedures were the same as those previously described in IH group. Modified Neurological Severity Score (mNSS) was assessed at 24 h of reperfusion, then the rats were sacrificed and brains were harvested for microscopic examination of brain infarction, neuronal morphology (using HE staining) and for determination of the expression of GSTM1, ASK1, phosphorylated ASK1 (p-ASK1), JNK, phosphorylated JNK (p-JNK), p-38 MAPK and phosphorylated p-38 MAPK (p-p38 MAPK) (by Western blot) and neuronal apoptosis (by TUNEL assay). The percentage of the infarct size was calculated using TTC staining. The apoptosis rate was calculated. Results:Compared with S group, the mNSS, apoptosis rate of neurons, percentage of the cerebral infarct size, p-ASK1/ASK1 ratio, p-JNK/JNK ratio and p-p38 MAPK/p38 MAPK ratio were significantly increased, and the expression of GSTM1 was down-regulated in I/R group ( P<0.05). Compared with I/R group and IH group, the mNSS, apoptosis rate of neurons, percentage of the cerebral infarct size, p-ASK1/ASK1 ratio, p-JNK/JNK ratio and p-p38 MAPK/p38 MAPK ratio were significantly decreased, the expression of GSTM1 was up-regulated ( P<0.05), and the neuronal injury was significantly attenuated in H group. Compared with IH group, the mNSS, apoptosis rate of neurons, percentage of the cerebral infarct size, p-ASK1/ASK1 ratio, p-JNK/JNK ratio and p-p38 MAPK/p38 MAPK ratio were significantly decreased ( P<0.05), no significant change was found in GSTM1 expression ( P>0.05), and the neuronal damage was significantly attenuated in IAH group. Conclusions:The mechanism by which therapeutic hypothermia alleviates CIRI is related to up-regulating the expression of GSTM1 and inhibiting the activation of the ASK1-JNK-p38 MAPK signaling pathway in rats.

Objective:To analyze the characteristics of infectious pathogens in burn patients with sepsis based on metagenomic next-generation sequencing (mNGS) technology.Methods:This study was a retrospective observational study. From July 2021 to December 2023, 109 burn patients with sepsis who met the inclusion criteria were admitted to the Department of Burns of the First People's Hospital of Zhengzhou, including 68 males aged 57 to 92 years and 41 females aged 48 to 83 years. Blood, bronchoalveolar lavage fluid, cerebrospinal fluid, sputum, or other fluid specimens were collected from the patients during their hospital stay for microbiological culture (86 patients) and mNGS technology detection (109 patients). The types of specimens and pathogens detected by mNGS technology were counted. Patients were divided into intensive care unit (ICU) group (78 cases) who were admitted to the ICU and non-ICU group (31 cases) who were not admitted to the ICU, and the pathogens for infection in the two groups of patients were analyzed. In addition, the detection of pathogens in the specimens of 86 patients who underwent both mNGS technology detection and microbiological culture detection was analyzed.Results:Among the 109 specimens detected by mNGS technology, there were 42 blood specimens, 17 bronchoalveolar lavage fluid specimens, 4 sputum specimens, 6 cerebrospinal fluid specimens, 16 pus specimens, and 24 tissue fluid specimens; a total of 39 pathogens were detected, including 13 bacteria, 12 fungi, 10 viruses, 2 parasites, and 2 mycoplasmas. The overall positive rate of pathogen detection was 88.99% (97/109). Ranked by the detection rate, the top three Gram-negative bacteria were Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas spp, the top three Gram-positive bacteria were Streptococcus pneumoniae, Staphylococcus aureus, and Enterococcus faecalis; the top three viruses were human herpesvirus, cytomegalovirus, and circovirus; the top three fungi were Aspergillus fumigatus, Candida albicans, and Aspergillus flavus. Twenty-seven patients were infected with one pathogen, 45 patients with two pathogens, and 25 patients with three or more pathogens. Compared with those in non-ICU group, the proportions of Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas spp, Streptococcus pneumoniae, Aspergillus fumigatus, and cytomegalovirus detected in the patients in ICU group were significantly higher (with χ2 values of 8.62, 7.93, 3.93, 5.48, 4.28, and 5.58, respectively, P<0.05). In the pathogens detected by mNGS technology and microbiological culture method, the most common bacteria were Klebsiellapneumoniaeand Acinetobacter baumannii, and the most common fungi were strains of Aspergillus and Candida. There were 19 pathogens those could only be detected by mNGS technology, such as Lichtheimia ramosa, Pneumocystis jirovecii, Mycobacterium tuberculosis, viruses, etc.; there were no pathogens detected by microbiological culture method that couldn't be detected by mNGS technology. Compared with those detected by microbiological culture method, the overall positive rate, bacterial positive rate, and fungal positive rate detected by mNGS technology were significantly increased (with χ2 values of 45.52, 5.88, and 4.94, respectively, P<0.05). The 27.91% (24/86) of patients were detected positive by both methods, and 72.09% (62/86) of the patients were detected positive by mNGS technology but negative by microbiological culture method. The consistency test of the results obtained by the two detection methods showed that the difference was not statistically significant ( κ=0.02, P>0.05). Conclusions:The positive rate of pathogen detection in specimens using mNGS technology is higher than that detected by using conventional microbiological culture method, and it can detect pathogens those cannot be detected by the latter, such as Lichtheimia ramosa, Pneumocystis jirovidii, Mycobacterium tuberculosis, viruses, etc. Detection using mNGS technology can help clarify the types of infectious pathogens in burns patients with sepsis, and provide basis and guidance for clinical medication.

With the advancement of information technology,China has entered the era of multimedia.The"Internet plus"mode and technology have also accelerated medical,health,science popularization,and other information,making it an important channel for people to access such information.It has also emerged as the primary platform for hospital ideological work.Taking the ideological communication of the official account of a tertiary general hospital as an example,this study analyzed the current situation and challenges of the network ideology work of public hospitals in the context of the"Internet plus"and explores the construction of the network ideology work path based on this analysis.

In this paper,a case of a hyperdivergent and bimaxillary protrusion with individual teeth cross bite in the anterior region treated by invisible orthodontic appliances was reported.At the end of the treatment,the teeth were aligned,the face profile of the patient was im-proved and the overbite and overjet were normal.

Macrophages play an important role in the development of inflammation,the core mechanism of athero-sclerosis.In recent years,nanotechnology has provided a new perspective for the diagnosis and treatment of atherosclerosis with its unique characteristics of biological compatibility and precise targeting.In this paper,the patholog-ical mechanism of atherosclerosis,the realization of atherosclerosis imaging by targeting macrophages with nanomaterials and the application of macrophage cell membrane biomimetic nanoparticles in anti-atherosclerosis were reviewed.

Objective:To explore the clinical application value of multimodal"one-stop"CT in assessing acute ischemic stroke(AIS).Methods:A total of 98 patients who were diagnosed as AIS and underwent the treatment of intravenous thrombolysis in Department of Neurology of Huainan Chaoyang Hospital from December 2019 to July 2023 were selected.In them,the degree of vascular stenosis of 49 patients was<30%(mild stenosis),and that of 39 patients was 30%～69%(moderate stenosis),and that of 10 patients was 70%～99%(severe stenosis)and 100%occlusion(severe group).All subjects underwent multimodal"one-stop"CT scan,and the changes of perfusion parameters included time to peak(TTP),mean transit time(MTT),cerebral blood flow(rCBF)and cerebral blood volume(rCBV)of them were analyzed.Results:All 98 patients existed stenosis at different locations and degrees,and CT examination showed existed respectively 5 cases of suspicious low density foci in frontal lobe and parietal lobe.Post-processing pseudo-color map showed that all 98 cases had abnormal hypoperfusion.The responsible vessel of 25 cases with occlusion and 20 cases with stenosis was the cerebral middle artery,and that of 3 cases with occlusion and 7 cases with stenosis was posterior artery,and that of 7 cases was internal carotid artery,and that of 3 cases with occlusion and 5 cases with stenosis was basilar artery,and that of 7 cases with occlusion and 18 cases with stenosis was vertebrobasilar artery.In addition,3 cases existed arteriosclerosis.There were significant differences in the average levels of rCBF,rCBV,MTT and TTP among patients with different degrees of stenosis,and the differences were all statistically significant(F=66.689,46.751,3.401,41.565,P<0.05),respectively.The area under curve(AUC)values of the receiver operating characteristic(ROC)curves of rCBF,rCBV,MTT and TTP were all>0.5 in assessing AIS,and the AUC value of the combined examination of above indicators was higher than the AUC value of each single indicator of the above indicators.Conclusion:Brilliance iCT multimodal"one-stop"CT scan can comprehensively understand the vascular morphology and stenosis location of the head and neck,and effectively assess responsible vessels,and provide perfusion parameters of whole brain.This technique can improve the accuracy of diagnosis and treatment decision,which has important impact in improving the efficacy of cerebral stroke.It can provide the basis for the selection of subsequent treatment plan and the prognosis judgment.

Objective To study the stress change characteristics of the cervical disc after removing different ranges of the uncinate process by establishing a three⁃dimensional finite element model of the C