OBJECTIVE To observe the effects of measures dominated by intensifying link quality on prevention and control of carbapenem-resistant Klebsiella pneumoniae(CRKP)among general ICU patients.METHODS The conventional intervention measures were taken from Jan.2016 to Oct.2020,which was assigned as the pre-inter-vention period;the intervention measures dominated by enhancement of link quality were taken for the general ICU patients(the study group)from Nov.2020 to Oct.2021,which was set as the intervention period,the inter-vention measures were taken for the neurosurgery ICU patients and the surgery ICU patients(the control group).A two-group interrupted time series of a quasi-experimental study was analyzed,and whether or not the intervention measures could reduce the incidence of CRKP hospital-associated infection among the general ICU patients was evaluated.RESULTS A total of 23 713 case-times of patients from three ICU wards were enrolled in the study.The incidence of CRKP hospital-associated infection among the general ICU patients was 4.49 cases per thousand patient-days during intervention period,3.71 cases per thousand patient-days during pre-intervention pe-riod,and there was no significant difference(u=-1.412,P=0.079);it was lower than 7.06 cases per thousand patient-days during nearly one year before the intervention period(from Nov.2019 to Oct.2020),and there was significant difference(u=3.128,P=0.002).The result of analysis of the interrupted time series showed that there was significant difference in the slope change between the study group and the control group after the inter-vention(P=0.035),indicating that the intervention measures could reduce the incidence of CRKP hospital-associ-ated infection in the study group,and there was significant difference in the changing trend between the study group and the control group.CONCLUSIONS The prevention and control measures for CRKP dominated by the link quality management can effectively reduce the incidence of CRKP hospital-associated infection among the gen-eral ICU patients.The prevention and control strategies may provide reference for prevention and control of CRKP in ICUs of other medical institutions.

Objective:To explore the efficacy and safety of embolization of anterior cranial fossa dural arteriovenous fistula (ACF-DAVF) via different arterial approaches, and provide evidence for individualized treatment of ACF-DAVF. Methods:A retrospective study was performed; 25 patients with ACF-DAVF admitted to Department of Cerebrovascular Surgery, Neurosurgery Center, Zhujiang Hospital, Southern Medical University from January 2020 to December 2023 were enrolled. Vascular approaches, including the anterior cerebral artery ( n=7), facial artery ( n=3), middle meningeal artery ( n=8), ophthalmic artery ( n=6), and vein ( n=1), were selected based on angioarchitectural features and microcatheter accessibility. Fistula and proximal draining vein occlusions were confirmed by immediate post-embolization digital subtraction angiography (DSA), and perioperative complications were recorded. At a 6-month follow-up, prognoses were assessed by modified Rankin Scale (mRS), and DSA or MRA was performed to detect the recurrence of ACF-DAVF. Results:Six patients had complete embolization and 2 patients had near-total embolization of the fistula and proximal draining vein immediately after embolization via middle meningeal artery approach; 4 patients achieved complete embolization and 2 patients achieved near-total embolization via ophthalmic artery approach; 6 patients achieved complete embolization and one patient achieved near-total embolization via anterior cerebral artery approach; 3 patients achieved complete embolization via facial artery approach; one patient achieved complete embolization via venous approach. No perioperative intracranial hemorrhage or central retinal artery occlusion was noted. Follow-up for 6 months was performed in 25 patients: mRS score was 0 in 19 patients, 1 in 2 patients, and 2 in 4 patients; DSA in 19 patients and MRA in 6 patients indicated no ACF-DAVF recurrence. Conclusion:Based on the angioarchitectural features and microcatheter accessibility, individualized selection of vascular approaches for ACF-DAVF embolization can achieve better efficacy and safety.

Objective:To compare the efficacy of Wnt3a factor and small molecule compound CHIR99021 in culturing colorectal cancer organoid, and to explore the feasibility of replacing Wnt3a with CHIR99021.Methods:The organoids were cultured using 2 culture systems containing Wnt3a or CHIR99021, based on the colorectal cancer cell line HCT116 and rectal cancer tissue from one patient (surgical specimen from the Department of Gastrointestinal Surgery, Zhongshan Hospital Affiliated to Dalian University), including Wnt3a cell organoid, CHIR99021 cell organoid, Wnt3a tissue organoid, and CHIR99021 tissue organoid. The growth of organoids was observed under the optical microscope. The pathological characteristics of organoids and the rectal cancer tissue were analyzed by hematoxylin-eosin (HE) staining and immunohistochemical (IHC) staining, which included cytokeratin(CK) 7, CK20, Ki-67, and stemness marker CD133. The expression of β-catenin (a key Wnt pathway protein) was analyzed by Western blotting (WB) method. The half maximal inhibitory concentration (IC50) values of Wnt3a and CHIR99021 cell organoids were analyzed by drug susceptible test and GraphPad Prism 9.0 software. Independent sample- t test was used for statistical analysis. Results:Under the optical microscope, the size of CHIR99021 cell organoid was relatively uniform, while the size of the Wnt3a cell organoid was uneven, compact and dense spherical structure was formed in both organoids. HE staining showed tumor features including increased nuclear-cytoplasmic ratio and obvious nuclear atypia in the Wnt3a and CHIR99021 cell organoids. The results of IHC staining showed that CK7 was negative, and CK20 and Ki-67 were positive in the Wnt3a and CHIR99021 cell organoids. The results of WB method showed that the relative expression level of β-catenin of the CHIR99021 cell organoid was higher than that of the Wnt3a cell organoid (0.89±0.09 vs. 0.26±0.04), and the difference was statistically significant ( t=13.80, P<0.001). The results of drug susceptible test demonstrated that the IC50 value of the Wnt3a and CHIR99021 cell organoid was 10.91 and 14.55 μmol/L, respectively. Further IHC staining showed that CD133 was positive in the Wnt3a and CHIR99021 cell organoids, with stronger intensity in the CHIR99021 cell organoid. The pathological characteristics of Wnt3a and CHIR99021 tissue organoid were consistent with those of the rectal cancer tissue of the patient, with all CK7 being negative and CK20 and Ki-67 being positive. Conclusions:Both Wnt3a and CHIR99021 can successfully establish colorectal cancer organoids with consistent pathological characteristics. The IC50 value of the CHIR99021 cell organoid is high, which is related to the increased stemness of organoids. The pathological characteristics of Wnt3a and CHIR99021 tissue organoid are consistent with those of the rectal cancer tissue from the patient.

To analyze the clinical data of patients with recurrent Clostridioides difficile infection(rCDI)in the southwestern region,and help clinicians identify high-risk populations early and adopt appropriate treatment strate-gies.Methods Clinical data of rCDI cases from a tertiary first-class hospital in southwest China from July 2019 to June 2024 were collected,and their host-related risk factors,exogenous risk factors,treatment schemes,and end-point outcomes were analyzed.Results In the past five years,a total of 26 cases of rCDI were detected from a ter-tiary first-class hospital in southwest China,accounting for 4.04％of the total positive cases(n=643)detected during the same period.19.23％of the recurrent patients experienced a second recurrence.The median age of rCDI patients was 66.5 years old,with males accounting for 73.08％.The major comorbidity included diabetes mellitus(34.62％),malignant tumors(30.77％),and chronic renal diseases(23.08％).In the 8 weeks before the first on-set of rCDI in patients,the top three drugs used were β-lactam and enzyme inhibitor compound(69.23％),proton pump inhibitors(65.38％),and carbapenems(46.15％).In the initial treatment of recurrent patients,3.85％(1/26)of the cases were treated with metronidazole,19.23％(5/26)of the cases received non-standard vancomy-cin/norvancomycin treatment in usage or dosage,46.15％(12/26)of the cases received treatment with course less than 10 days.In the treatment of the first recurrence,34.78％(8/26)of the cases received treatment with course less than 10 days.Conclusion For elderly patients and patients with diabetes mellitus,malignant tumors,and chronic renal diseases,who have used β-lactam and enzyme inhibitor compound,proton pump inhibitors,carbapene-ms within 8 weeks before disease onset,standard dose and treatment course of vancomycin or norvancomycin are recommended under permitted conditions,so as to reduce the risk of recurrence.

As the defining characteristic and essence of traditional Chinese medicine(TCM),the integration of disease and syndrome,along with the correlation between syndrome and prescription,forms the foundation for syndrome differentiation and treatment,and guides the clinical diagnosis and treatment practice of TCM.However,key scientific questions remain unresolved regarding the"disease-syndrome-prescription"framework,particularly the biological basis of diseases and syndromes,the active pharmacodynamic constituents of compound formulas,and their mechanism of action.Furthermore,a systematic paradigm for investigating"disease-syndrome-prescription"relationships has not been established,restricting the innovation and development of TCM theory and practice.Xiaoyao Powder,which was first described in a medical book named Taiping Huimin Heji Ju Fang written during the Song Dynasty of China,disperses stagnated liver qi for relieving qi stagnation,thus nourishing the blood and strengthening the spleen,making it a representative prescription for addressing depression due to liver qi stagnation and spleen deficiency under the guidance of correspondence between syndrome and prescription.Therefore,base on the combination of disease and syndrome,and correspondence between syndrome and prescription,investigating the formula-syndrome scientific connotation of Xiaoyao Powder and exploring the research paradigm for the"disease-syndrome-prescription"can provide insights into TCM theory from the perspective of modern science.

As a major global public health concern,the incidence of depression disorder is increasing annually.The pathological mechanism of depression involves bidirectional dysregulation between the hypothalamic-pituitary-adrenal(HPA)and gut-brain axes.According to traditional Chinese medicine(TCM),the liver controls conveyance and dispersion,the spleen governs transportation and transformation,and both jointly maintain the balance between ascending and descending qi movement and zang fu viscera function in the body.Liver qi stagnation and spleen deficiency result in qi movement disorder and a lack of source qi and blood,leading to depression induced by malnutrition of heart spirit.As a classic prescription for soothing the liver,invigorating the spleen,and replenishing blood,Xiaoyao Powder is used to reinforce healthy qi and eliminate pathogenic factors.Xiaoyao Powder not only regulates the"yin in property of liver"but also strengthens the"ascending and descending"of the spleen.As commonly used by ancient and modern physicians,also indirectly inhibits HPA axis upregulation and improves depression-related gastrointestinal dysfunction.This paper systematically expounds the multi-dimensional mechanism of Xiaoyao Powder in treating depression through the two-way regulation of the HPA-gut-brain axis.It reveals the therapeutic characteristics of"multi-component and multi-target"in TCM to provide a novel theoretical basis for the modernization of TCM and the treatment of depression by combining TCM and Western medicine.

Depression is closely associated with a neuro-endocrine-immune(NEI)system imbalance.The"excessive vitality leading to restraint and counter-regulation(Kang Hai Cheng Zhi)"theory elucidates the self-regulating mechanism for maintaining dynamic equilibrium in the body,and serves as an importance principle guiding treatment formulation and medication selection.Based on the correlation between NEI system imbalance and the traditional Chinese medicine pathogenesis of depression,and integrating the"Kang Hai Cheng Zhi"theory,the author posits that the pathogenesis of depression lies in overactive liver invading spleen,earth dampness impeding wood′s ascendancy,and disharmony between body and mind,as well as imbalance in storage and discharge functions of liver and kidney,disharmony between Yin and Yang,and disrupted counter-regulation.This dosely aligns with two key pathological methanisms at the micro level:microglial-limbic system homeostatic imbalance and hypothalamic-pituitary-adrenal axis-inflammatory circuit dysregulation.Clinically,the treatment principle for depression adheres to supporting the counter-regulation to restrain excess,with herbal interventions using strategies such as restraining wood to support earth,dredging earth to unblock wood,and harmonizing pivotal functions,as well as nourishing water to nurture wood,warming kidney to tonify liver,and relieving depression to calm the spirit.These approaches aim to regulate the liver,spleen,and kidney,embodying the core therapeutic tenet of"striving for equilibrium,"thereby restoring the body′s self-regulating capability.

OBJECTIVE To observe the effects of measures dominated by intensifying link quality on prevention and control of carbapenem-resistant Klebsiella pneumoniae(CRKP)among general ICU patients.METHODS The conventional intervention measures were taken from Jan.2016 to Oct.2020,which was assigned as the pre-inter-vention period;the intervention measures dominated by enhancement of link quality were taken for the general ICU patients(the study group)from Nov.2020 to Oct.2021,which was set as the intervention period,the inter-vention measures were taken for the neurosurgery ICU patients and the surgery ICU patients(the control group).A two-group interrupted time series of a quasi-experimental study was analyzed,and whether or not the intervention measures could reduce the incidence of CRKP hospital-associated infection among the general ICU patients was evaluated.RESULTS A total of 23 713 case-times of patients from three ICU wards were enrolled in the study.The incidence of CRKP hospital-associated infection among the general ICU patients was 4.49 cases per thousand patient-days during intervention period,3.71 cases per thousand patient-days during pre-intervention pe-riod,and there was no significant difference(u=-1.412,P=0.079);it was lower than 7.06 cases per thousand patient-days during nearly one year before the intervention period(from Nov.2019 to Oct.2020),and there was significant difference(u=3.128,P=0.002).The result of analysis of the interrupted time series showed that there was significant difference in the slope change between the study group and the control group after the inter-vention(P=0.035),indicating that the intervention measures could reduce the incidence of CRKP hospital-associ-ated infection in the study group,and there was significant difference in the changing trend between the study group and the control group.CONCLUSIONS The prevention and control measures for CRKP dominated by the link quality management can effectively reduce the incidence of CRKP hospital-associated infection among the gen-eral ICU patients.The prevention and control strategies may provide reference for prevention and control of CRKP in ICUs of other medical institutions.

Objective:To explore the efficacy and safety of embolization of anterior cranial fossa dural arteriovenous fistula (ACF-DAVF) via different arterial approaches, and provide evidence for individualized treatment of ACF-DAVF. Methods:A retrospective study was performed; 25 patients with ACF-DAVF admitted to Department of Cerebrovascular Surgery, Neurosurgery Center, Zhujiang Hospital, Southern Medical University from January 2020 to December 2023 were enrolled. Vascular approaches, including the anterior cerebral artery ( n=7), facial artery ( n=3), middle meningeal artery ( n=8), ophthalmic artery ( n=6), and vein ( n=1), were selected based on angioarchitectural features and microcatheter accessibility. Fistula and proximal draining vein occlusions were confirmed by immediate post-embolization digital subtraction angiography (DSA), and perioperative complications were recorded. At a 6-month follow-up, prognoses were assessed by modified Rankin Scale (mRS), and DSA or MRA was performed to detect the recurrence of ACF-DAVF. Results:Six patients had complete embolization and 2 patients had near-total embolization of the fistula and proximal draining vein immediately after embolization via middle meningeal artery approach; 4 patients achieved complete embolization and 2 patients achieved near-total embolization via ophthalmic artery approach; 6 patients achieved complete embolization and one patient achieved near-total embolization via anterior cerebral artery approach; 3 patients achieved complete embolization via facial artery approach; one patient achieved complete embolization via venous approach. No perioperative intracranial hemorrhage or central retinal artery occlusion was noted. Follow-up for 6 months was performed in 25 patients: mRS score was 0 in 19 patients, 1 in 2 patients, and 2 in 4 patients; DSA in 19 patients and MRA in 6 patients indicated no ACF-DAVF recurrence. Conclusion:Based on the angioarchitectural features and microcatheter accessibility, individualized selection of vascular approaches for ACF-DAVF embolization can achieve better efficacy and safety.

Objective:To explore the effects of deep hyperthermia on chemotherapy-related adverse effects and immune-inflammatory indicators in the patients undergoing postoperative adjuvant chemotherapy for colorectal cancer.Methods:This retrospective study included 52 patients who underwent surgery for colorectal cancer at the Affiliated Zhongshan Hospital of Dalian University from September 2021 to December 2023. The patients were divided into two groups based on treatment method: the combination group ( n=29) received postoperative adjuvant chemotherapy combined with deep hyperthermia, while the chemotherapy group ( n=23) received postoperative adjuvant chemotherapy alone. Both groups were treated with the XELOX regimen (oxaliplatin + capecitabine). The degree of bone marrow suppression during treatment was assessed by analyzing peripheral blood parameters, including hemoglobin, leukocyte count, neutrophil count, and platelet count. Immune-inflammatory indicators, including complement, procalcitonin (PCT), interleukin-6 (IL-6), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), were compared before and after treatment in both groups to evaluate the effects of deep hyperthermia on the immune-inflammatory response. Chi-square test or Fisher's exact test (two-tailed) was used to compare bone marrow suppression rates, and the immune-inflammatory indicators between the two groups were compared using t-tests or non-parametric tests, depending on whether the data conformed to a normal distribution. Results:In terms of myelosuppression, the incidence rates of moderate to severe decreases in leukocytes, neutrophils, platelets, and hemoglobin in the combination group were 31%, 31%, 21%, and 14%, respectively, compared to 52%, 61%, 48%, and 9% in the chemotherapy group. The change in PCT levels before and after treatment was significantly greater in the combination group than in the chemotherapy group ( P = 0.010). Both the combination group and the chemotherapy group showed significant reductions in SII, NLR and PLR after treatment, and the differences were statistically significant (all P < 0.05). The change in NLR before and after treatment was significantly greater in the combination group than in the chemotherapy group ( P = 0.031). Conclusions:Deep hyperthermia can alleviate chemotherapy-induced adverse effects such as thrombocytopenia and neutropenia in patients undergoing postoperative adjuvant chemotherapy for colorectal cancer. It also appears to improve the inflammatory response in these patients.