ObjectiveTo explore the clinical characteristics and risk factors for 30-day mortality in hospitalized patients with bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). MethodsData were obtained retrospectively from the electronic medical records of inpatients at a tertiary A-grade hospital in Shanghai from January 2016 to December 2023. The collected variables included age, gender, department, surgical treatment, empirical antibiotic therapy, Pitt Bacteremia score (PBS), Charlson comorbidity index (CCI), INCREMENT-CPE score (ICS), length of hospital stay, the time from CRKP-BSI to discharge and, etc. The follow-up period ended upon discharge, with the follow-up outcomes defined as in-hospital mortality or discharge. The endpoint was defined as death within 30 days (including day 30) caused by CRKP-BSI or infection-related complications. Patients who survived within 30 days after CRKP-BSI were classified into the survival group, while those who died within 30 days were classified into the death group. Independent risk factors for 30-day mortality in patients with CRKP-BSI were analyzed using univariate and multivariate Cox regression analysis. ResultsA total of 71 hospitalized patients with CRKP-BSI, comprising 51 males and 20 females, with an average age of (65.12±18.25) years, were included during the study period. The M (P₂₅, P₇₅) of hospital stay were 37.00 (24.00, 56.00) days, and M (P₂₅, P₇₅) of the duration from CRKP-BSI to discharge or death were 18.00 (7.00, 35.00) days. There were 20 deaths (28.17%) in the death group and 51 survivors (71.83%) in the survival group. The results of multivariate Cox regression analysis showed that the ICS as an independent risk factor for 30-day mortality in CRKP-BSI patients (HR=1.379, 95%CI: 1.137‒1.671, P=0.001). Each 1-point increase in the ICS was associated with a 37.9% increase in the risk of mortality. ConclusionThe ICS is found to be a risk factor for 30-day mortality in patients with CRKP-BSI, which may facilitate the prediction for the risk of 30-day mortality and thereby support clinical decision-making for patients with CRKP-BSI.

Objective:To describe the current status and changes of multisymptom burden during the post-transplant hematopoietic reconstruction period in children with hematopoietic stem cell transplantation, and to provide reference for the precise management of symptoms in post-transplantation children.Methods:Children aged 7-18 years who underwent hematopoietic stem cell transplantation in Shanghai Children′s Medical Centre, Shanghai Jiao Tong University School of Medicine from September 2022 to October 2023 were selected by convenience sampling method. The Pediatric Patient Reported Outcomes version of Common Terminology Criteria for Adverse Events was used to assess multiple symptoms and burden during the reconstruction period on days 0, 7, 14, and 21 after transplantation.Results:Finally, 90 children who underwent hematopoietic stem cell transplantation were investigated, including 61 males and 29 females, aged (9.98 ± 2.96) years old. On days 0, 7, 14, and 21 after transplantation, the number of symptoms, severity of symptoms, degree of symptom interference were 20.00 (14.00), 18.00 (14.50), and 10.00 (9.75), with scores of 0.18 (0.30), 0.14 (0.29), 0.08 (0.13), 0.00 (0.08), and 0.27 (0.42), 0.19 (0.30), 0.09 (0.16), 0.03 (0.11), respectively. The overall differences were statistically significant ( Z=101.69, 93.70, 96.65, all P<0.01). The symptom burden in children showed four different trajectories including higher symptom burden in the early stages and lower in the later stages, consistently high burden, high symptom burden followed by low symptom burden, and consistently low burden. Conclusions:Children after hematopoietic stem cell transplantation are plagued by multiple symptoms during hematopoietic reconstruction, and with the treatment and time, different symptoms show different trajectories of change. Healthcare professionals should accurately assess the symptomatic changes of children after transplantation and provide targeted interventions to reduce the symptomatic burden and promote the recovery of children.

Objective:Interpret the key differences between the China Health-care Security Diagnosis Related Groups(CHS-DRG)2.0 and CHS-DRG 1.1,and provide reference for optimizing management strategies in medical institutions.Methods:Text analysis was used to import the CHS-DRG 2.0 and 1.1 grouping scheme dictionary data into the SQL database in a structured table format using SQL Server 2014.The key differences between the two schemes in grouping structure,grouping rules,grouping results,and other aspects were identified.Results:CHS-DRG 2.0 version added 26 groups,deleted 3 groups,and refined 10 groups into 20 groups for 14 clinical specialties at the ADRG level compared to CHS-DRG 1.1.Some group codes,names,and grouping rules were adjusted;Adjusted some grouping conditions and grouping results at the DRG level.Conclusion:CHS-DRG 2.0 version has improved grouping efficiency compared to CHS-DRG 1.1,solved some clinical bottleneck problems,and standardized the role of clinical diagnosis in grouping from the perspective of resource consumption.However,it has not completely solved the grouping problems of multi disease co treatment,multi disease treatment,and combined surgery.The adjustment of DRG weights and rates,the follow-up of related supporting policy reforms,and the negative effects of DRG will still pose challenges for medical institutions.

BACKGROUND:Neuroinflammation is a major cause of exacerbation after spinal cord injury.In recent years,pyroptosis has received much attention due to its remarkable pro-inflammatory features.Some of these natural products can significantly inhibit the inflammatory response and improve the damaged nerve function by regulating the level of pyroptosis after spinal cord injury,which provides a new therapeutic idea for spinal cord injury.OBJECTIVE:To summarize the mechanism of action of natural products in regulating pyroptosis for the treatment of spinal cord injury,with a view to providing lessons and references for future research on the treatment of spinal cord injury.METHODS:The search terms"spinal cord injury,pyroptosis,inflammasome,natural products,natural compounds,traditional Chinese medicine"in Chinese and English were used to search for relevant literature since the establishment of the database up to September 2024 in the databases of PubMed,Web of Science,WanFang,and CNKI.According to the inclusion and exclusion criteria,75 relevant articles were finally obtained.RESULTS AND CONCLUSION:(1)Pyroptosis is an important pro-inflammatory pathway in spinal cord injury,and controlling pyroptosis is an effective way to improve damaged nerve function.(2)Some natural products can regulate pyroptosis via the NLRP3/Caspase-1 classical pyroptosis pathway,the NF-κB-related pathway,other upstream pathways such as Nrf2/HO-1,and autophagy,thereby affecting the level of tissue inflammation and accelerating neurological recovery after spinal cord injury.(3)The anti-pyroptosis effects of these natural products are mostly dependent on the NLRP3 classical pyroptosis pathway,and there is a lack of studies on other pyroptosis pathways.(4)There are still many problems in this field,such as the fact that these natural products are not currently supported by evidence from appropriate clinical studies.(5)The natural product has great potential in regulating pyroptosis and is expected to be a powerful weapon in the treatment of spinal cord injury.

BACKGROUND:Slow bone repair and poor bone formation quality are still problems during masquelet technique in the treatment of large segment bone defects.H-type vessels can induce osteogenesis,enhance the local angiogenesis and osteogenesis coupling,and promote bone repair.However,there are few reports on the role of H-type blood vessels in the bone induced membrane.OBJECTIVE:To construct a large segment bone defect model of SD rat tibia,observe the expression characteristics of H-type blood vessels in the bone induced membrane,then to identify the expression peak point of H-type blood vessels in the bone induced membrane and determine the optimal period of bone grafting.METHODS:Sixty SD rats were randomly divided into a control group(n=30)and a model group(n=30)by random number table method.The two groups were further divided into three subgroups at 4,6,and 8 weeks after bone cement implantation,with 10 rats in each group.A 4 mm bone defect model of the right tibia was constructed in both the control and the model groups.Polymethyl methacrylate bone cement was implanted in the model group to induce bone biomembrane formation,while bone cement was not implanted in the control group.At 4,6,and 8 weeks after bone cement implantation,6 rats were randomly selected at each time point.The bone induction membrane tissue was cut from the model group,and the non-bone soft tissue of the corresponding part was cut from the control group.The dynamic expressions of H-type blood vessels in the bone induced membrane were identified by immunofluorescence.The morphological changes of the bone induced membrane were observed by hematoxylin-eosin staining.The formation of blood vessels in the bone induced membrane was observed by angiography.The expression levels of osteoblast-specific transcription factor in the bone induced membrane were detected by immunohistochemistry.Four rats remained at each time point.In the model group,the bone induced membrane was cut open and the bone cement was removed and autologous coccyx was implanted.In the control group,autologous coccyx was implanted in the bone defect area.Micro-CT evaluation of the tibial defect was performed 8 weeks after bone grafting.RESULTS AND CONCLUSION:(1)Immunofluorescence staining showed that the expression of H-type vessels in the model group was most obvious 6 weeks after bone cement implantation,and the expression of H-type vessels in the model group at each time point after bone cement implantation was higher than that in the control group(P＜0.05).(2)Hematoxylin-eosin staining and angiography showed that the number and volume of new blood vessels at each time point after bone cement implantation in the model group were greater than those in the control group(P＜0.05).The order of the number and volume of new blood vessels in the model group was:8 weeks after bone cement implantation＞6 weeks after bone cement implantation＞4 weeks after bone cement implantation.(3)Immunohistochemical staining showed that the positive expression of osteoblast-specific transcription factors at each time point after bone cement implantation in the model group was higher than that in the control group(P＜0.05),and the positive expression of osteoblast-specific transcription factors in the model group was most obvious 6 weeks after bone cement implantation.(4)Micro-CT detection showed that the bone repair effect of the three subgroups in the model group was significantly better than that of the corresponding subgroups in the control group,and the bone repair effect of the subgroup in the model group 6 weeks after bone cement implantation was better than that of the subgroups 4 and 8 weeks after bone cement implantation.The results indicate that H-type blood vessels are dynamically expressed in the bone induced membrane and reached a peak 6 weeks after bone cement implantation.Good bone repair effects can be obtained by the bone induced membrane bone grafting 6 weeks after bone cement implantation.

Objective To compare the effect of moderate-intensity continuous training(MICT)and high-intensity interval training(HIIT)on gait and balance for stroke patients.Methods From December,2023 to December,2024,96 patients with post-stroke gait and balance dysfunction were se-lected from the First Affiliated Hospital of Bengbu Medical University,and randomly divided into control group(n=32),MICT group(n=32)and HIIT group(n=32).The control group received routine comprehensive reha-bilitation therapy,while MICT and HIIT groups received additional respective training,for four weeks.They were measured with symmetry indexes(SI)of mean pressure and footprint area during eyes-open and eyes-closed condition,as well as anterior-posterior and medial-lateral displacement of the center of mass,before and after treatment;while they were assessed with Berg Balance Scale(BBS),distance of 6-minute walk test(6MWT),time of Timed Up&Go test(TUGT)and 10-meter walk test(10MWT),and Fugl-Meyer Assessment-Lower Extremities(FMA-LE).Results The main effects of time(F>351.683,P<0.001)and groups(F>4.945,P<0.05),and the interaction effects(F>16.919,P<0.001)were significant for BBS scores,distance of 6MWT,time of TUGT and 10MWT,and FMA-LE scores;and all the indicators were better in MICT group and HIIT group than in the control group(P<0.05)after treatment,and they were better in HIIT group than in MICT group(P<0.05)except BBS score.Un-der eyes-open condition,the main effects of time(F>64.684,P<0.001)and groups(F>9.472,P<0.001),and the interaction effects(F>10.562,P<0.001)were significant for SI of mean pressure and footprint area,and an-terior-posterior and medial-lateral displacement of the center of mass;and all the indicators were better in MICT group and HIIT group than in the control group(P<0.001)after treatment,and they were better in HIIT group than in MICT group(P<0.05).Under eyes-closed condition,the main effects of time(F>107.730,P<0.001)and groups(F>4.275,P<0.05),and the interaction effects(F>7.985,P<0.05)were significant for SI of mean pressure and footprint area,and anterior-posterior and medial-lateral displacement of the center of mass;and SI of mean pressure was better in HIIT group than in MICT group(P<0.05),the other indicators were better in MICT group and HIIT group than in the control group(P<0.001)after treatment.Conclusion Both HIIT and MICT can improve gait and balance for stroke patients,and HIIT is more effective on gait and static balance with eyes open,but similar on static balance with eyes closed.

Objective To investigate the effect of continuous theta burst stimulation-intermittent theta burst stimulation(cTBS-iT-BS)priming protocols with different time intervals on the plasticity of primary motor cortex(M1).Methods A total of 39 healthy young adults were recruited from Changzhou De'an Hospital from March to August,2024.Participants received cTBS-iTBS priming protocols with intervals of 5 minutes,10 minutes and 15 minutes using a randomized crossover design.Motor-evoked potential(MEP)amplitudes in M1 were recorded at baseline(before intervention)and 0 minute,10 minutes,20 minutes and 30 minutes after intervention.Results The main effects of stimulation protocol(F=19.761,P<0.001)and measurement time(F=10.224,P<0.001)were significant.At each time point after intervention,the MEP amplitude was significantly higher under the 10-minute interval than under the 5-minute and 15-minute intervals(t>3.010,P<0.05).Conclusion The 10-minute interval of cTBS-iTBS is more effective on M1 plasticity.

Objective:To compare the dose-response effects of single-fraction ultra-high dose rate (FLASH) and conventional dose rate (CONV) whole abdominal irradiation (WAI) with X-rays on acute radiation-induced intestinal injury in mice, in order to identify optimal dose parameters and potential mechanisms.Methods:A total of 186 male C57BL/6J mice were randomly assigned to a non-irradiation group ( n=6), FLASH irradiation groups ( n=90), and CONV irradiation groups ( n=90). Acute radiation-induced intestinal injury models were established using single-fraction WAI with 11, 12, 13, 14, and 15 Gy X-rays (200 Gy/s for FLASH and 4 Gy/min for CONV). Changes in body weight, stool characteristics, and disease activity index (DAI) scores were assessed at 9 d post-irradiation. At 7 d post-irradiation at 11, 12, and 13 Gy, the intestines were collected for macroscopic examination and length measurement. The small intestine was selected for HE staining and quantitative analysis of intestinal crypt number and mucosal epithelial thickness. The survival of mice was assessed at 15 d post-WAI across all dose groups. Results:After single-fraction WAI at 11, 12, and 13 Gy, the body weight was higher in the FLASH group than that in the CONV group ( t=10.17, 12.65, 10.16, P<0.05). The DAI scores for the FLASH group were 1.00±1.10, 3.17±0.75, and 2.83±1.17, respectively, which were lower than those of the CONV group (4.33±0.52, 7.00±0.00, 8.60±0.55; t=8.70, 11.71, 14.99, P<0.05). However, after WAI at 14 Gy and 15 Gy, there were no significant differences in body weight and DAI between the FLASH group and the CONV group ( P>0.05). At 7 d after single-fraction WAI at 11, 12, and 13 Gy, mice in the FLASH group exhibited less intestinal congestion, edema, and shortening compared with the CONV group. The difference between the FLASH and CONV groups were statistically significant in small intestine length at 11 and 13 Gy ( t=4.42, 3.78, P<0.05), and in colorectal length at 11 and 12 Gy ( t=3.97, 3.12, P<0.05). Small intestine HE staining revealed superior preservation of intestinal architecture in the FLASH group compared with the CONV group, characterized by longer villi, increased crypt numbers, thicker mucosal epithelium, and enhanced structural integrity. The differences in crypt number and mucosal epithelial thickness were statistically significant ( tcrypt=13.10, 23.80, 11.90; tmucosal=5.75, 2.64, 7.74; P<0.05). At 15 d post-irradiation, the survival rate in the 15 Gy FLASH group was higher than that in the CONV group (50% vs. 10%, χ2=5.39, P<0.05), with a median survival extension of 6 d ( HR=0.340, 95% CI: 0.115 4-0.999 9). No significant survival differences were observed between the FLASH group and the CONV group at 11, 12, 13, and 14 Gy ( P>0.05). Conclusions:FLASH irradiation significantly alleviated acute radiation-induced intestinal injury from medium single-fraction WAI with 11, 12, and 13 Gy X-rays compared with CONV irradiation, and showed potential to improve mouse survival after single-fraction WAI at 15 Gy. This effect is likely associated with the preservation of intestinal crypts and exhibits a dose-dependent relationship.

Objective To analyze the effect of diltiazem on blood concentration of tacrolimus(TAC)retrospectively,and to provide reference for individual administration of tacrolimus in patients with nephrotic syndrome(NS).Methods The patients with NS who were treated in the outpatient/inpatient department of our hospital from January 2018 to December 2022 were collected,and the general information,combined drug use,blood drug concentration and other information of the patients were recorded.The patients were divided into two groups according to whether diltiazem was used or not:TAC group alone and TAC group combined with diltiazem.The effect of diltiazem on tacrolimus concentration was analyzed.Results A total of 45 patients with NS were included in this study,and 21 patients in the TAC group were treated with TAC alone.The mean blood concentration of TAC after medication was(5.77±2.87)ng·mL-1,which reached the effective therapeutic concentration range.The average blood concentration of TAC+Diltiazem group in the 24 patients was(2.90±1.29)ng·mL-1 before combined treatment,and increased to(5.74±2.46)ng·mL-1 after combined with diltiazem,with a growth rate of(127.34±119.57)％.The increase range was from 10％to 288％,and there was significant difference(P＜0.05).According to the observation within 6 months after the combination of the two drugs,the average blood concentration of TAC continued to increase,especially in the 5th month after the administration of TAC,and the concentration tended to be stable after 5 months.By compare with the effect of diltiazem dosage on the blood concentration of TAC,90 mg·d-1 and 180 mg·d-1 had little difference in improving the blood concentration of TAC.At the same time,the combination of the two drugs did not cause adverse reactions.Conclusion A daily dose of 90 mg of Diltiazem can significantly increase the TAC blood concentration in patients with NS who cannot reach the effective therapeutic concentration with conventional doses.It can reach the effective clinical therapeutic concentration without increasing the dose of tacrolimus.The combination of the two drugs were generally safe and effective.

Objective:To investigate levels of endothelin-1(ET-1)and Apclin in patients with hypertrophic car-diomyopathy(HCM)and diagnostic value of their combination with ECG for HCM,and their association with prognosis.Methods:A total of 150 HCM patients admitted in the Second Affiliated Hospital of Xi'an Medical Uni-versity between June 2020 and June 2022 were selected as observation group.According to death during follow-up,the observation group was divided into survival group(n=64)and death group(n=86),and another 100 healthy volunteers who underwent physical examination in our hospital simultaneously were selected as control group.ET-1,Apelin and ECG indexes were compared between above-mentioned groups.Diagnostic value of ET-1,Apelin and ECG combined detection for HCM was analyzed by receiver operating characteristic(ROC)curve.Multivariate Logistic regression was used to analyze influencing factors of death within 6-month follow-up in HCM patients,and nomogram model was established.Results:Compared with participants in control group,those in the observa-tion group had significant higher ET-1[(0.64±0.15)pmol/L vs.(0.39±0.07)pmol/L],QRS wave group(∑QRS)[(23.60±3.96)mm vs.(14.02±1.78)mm],Cornell voltage index(SV3+RaVL)[(2.12±0.40)mV vs.(1.05±0.20)mV]and S-wave on V1 lead+R-wave on V5 lead(SV1+RV5)[(3.88±0.73)mV vs.(2.24±0.34)mV],and significant lower Apelin[(1.10±0.25)pg/ml vs.(1.58±0.17)pg/ml]level(P＜0.001 all).ROC curve indicated that the area under the curve(AUC)of combined detection of above five indexes diagno-sing HCM was 0.933(95％CI 0.895～0.961),significantly higher than any single detection(Z=3.681～6.428,P＜0.001 all),the H-L goodness of fit test showed P=0.056,suggesting that the model was well accepted,and DCA showed that ET-1 and Apelin combined ECG detection model had good clinical application value in HCM.Multivariate Logistic regression indicated that ET-1,∑QRS,SV3+RaV and SV1+RV5 were independent risk factors for death within 6-month in HCM patients(OR=2.617～3.600,P＜0.001 all),and Apelin was its inde-pendent protective factor(OR=0.271,P＜0.001).The nomogram model of HCM patients dying within 6 months was 4.627+0.452 × ET-1+0.536 × Apelin+0.575 × ∑QRS+0.541 × SV3+RaVL+0.352 × SV1+RV5.Conclusion:Serum ET-1 and Apelin levels significantly change in HCM patients,and the combination of ECG detection and both indexes have good performance diagnosing HCM and are independent influential factors for the death of HCM patients within 6 months.