OBJECTIVE To investigate the causal relationships between gut microbiota， blood metabolites and antidepressant treatment response from a genetic perspective， and to assess the potential mediating role of blood metabolites. METHODS This study utilized a two-sample Mendelian randomization （MR） design. Exposure data were derived from four large-scale gut microbiome genome-wide association study （GWAS） datasets and two blood metabolite GWAS datasets. The inverse variance weighted method was used as the primary method to evaluate the causal relationships between gut microbiota， blood metabolites and antidepressant effects. The robustness， heterogeneity and horizontal pleiotropy of the results were evaluated through various sensitivity analyses. Additionally， the false discovery rate （FDR） was applied to correct type Ⅰ errors caused by multiple hypothesis testing. Finally， MR mediation analysis was conducted to test the potential mediating effect of blood metabolites. RESULTS The s_ Bilophila was negatively associated with the effectiveness of antidepressant treatment （ P ＝8.030×10 －5 ， then P ＝0.033 after FDR correction）， and the f_Bacteroidales was positively associated with the effectiveness of antidepressant treatment （ P ＝3.275×10 －4 ， then P ＝0.034 after FDR correction）. Over a hundred blood metabolites were also screened out as being associated with antidepressant response， but after FDR correction， no significant causal relationship was observed. The P value of the mediation effect proportion of blood metabolites in the “gut microbiota-blood metabolites-antidepressant efficacy” pathway was greater than 0.05. CONCLUSIONS The s_ Bilophila may represent a risk factor for antidepressant effects， whereas the f_Bacteroidales may serve as a protective factor for antidepressant effects. The correlation between blood metabolites and antidepressant efficacy is not strong， and no genetic evidence is found to support that the investigated blood metabolites play a key mediating role between the gut microbiota and antidepressant response.

Serotonin-selective reuptake inhibitors （SSRIs）， as widely used antidepressants in clinical practice， exhibit significant individual differences in antidepressant efficacy. Gut microbiota plays an important role in the development and progression of depression， and the use of SSRIs exerts a significant impact on the gut microbiota of patients with depression. Based on this， this article reviews the research progress on the interactions between the antidepressant effects of SSRIs and gut microbiota. It has been found that SSRIs can influence the diversity， abundance， and function of the gut microbiota directly or indirectly. Conversely， the composition of the gut microbiota and differences in its functional metabolic pathways， and other factors， can in turn affect the antidepressant effects of SSRIs. Therefore， in clinical practice， gut microbiota diversity can be utilized as a predictive indicator for the antidepressant effects of SSRIs. Probiotics can be employed as an adjunct therapy alongside SSRIs， and dietary adjustments， as well as fecal microbiota transplantation， can be used to enhance the therapeutic efficacy of SSRIs. In the future， large-scale， multicenter clinical studies should be conducted， enrolling a broadly representative cohort of patients with depression， to uncover the true association between the antidepressant effects of SSRIs and gut microbiota， thereby opening up more effective avenues for the comprehensive treatment of depression.

Objective:To investigate the potential value of cerebral glucose metabolism characteristics in anti-leucine-rich glioma-inactivated protein 1 (LGI1) antibody-related encephalitic patients during acute phase as the clinical indicator of disease outcomes.Methods:From October 2019 to December 2023, 28 patients (18 males, 10 females; age (56.6±11.9) year) with anti-LGI1 antibody-related encephalitis diagnosed at Huashan Hospital, Fudan University were prospectively enrolled. All patients received baseline brain 18F-FDG PET imaging and were divided into different subgroups according to the prognosis (good prognosis and poor prognosis groups) and recurrence (recurrence and non-recurrence groups) after follow-up. The difference of Montreal Cognitive Assessment (MoCA) score between the two groups was compared by Mann-Whitney U test. Statistical parametric mapping (SPM) analysis was used to analyze the PET images of different groups by independent-sample t test, and the characteristics of cerebral glucose metabolism of patients with different outcomes were obtained. Results:MoCA scores between the recurrence group ( n=6) and the non-recurrence group ( n=22; 14.0(9.8, 20.5) vs 22.0(18.0, 24.0); Z=2.17, P=0.030), and between the poor prognosis group ( n=13) and the good prognosis group ( n=15; 14.0(10.0, 22.0) vs 22.0(19.8, 25.3); Z=2.47, P=0.013) were significantly different. Compared with the good prognosis group, the cerebral glucose metabolism in the poor prognosis group was decreased in the bilateral frontal lobe, lateral temporal lobe, inferior parietal lobule and cingulate gyrus, but increased in the brainstem, bilateral lentiform nucleus and bilateral paracentral lobule/postcentral gyrus (all t=1.71, all P<0.05). Compared with the non-recurrence group, the metabolism of bilateral medial frontal gyrus, anterior cingulate gyrus, bilateral insula, superior temporal gyrus and thalamus decreased in the recurrence group, while the metabolism of bilateral precentral gyrus, inferior frontal gyrus and bilateral lentiform nucleus increased (all t=1.71, all P<0.05). Conclusion:18F-FDG PET imaging reveals the differences in brain metabolism of anti-LGI1 antibody-related encephalitic patients at baseline with different outcomes (prognosis, recurrence or not), which can provide a new perspective for the clinical evaluation of the disease at baseline.

Objective To investigate the effects of soluble receptor for advanced glycation end products(sRAGE)on the changes and functions of myocardial tissue proteins in mice during myocardial ischemia/reperfusion(I/R).Methods Establish the myocardial I/R model using cardiac-specific sRAGE transgenic mice,and apply proteomic methods to detect the types and levels of protein expression in myocardial tissue.Results Compared with the I/R+sRAGE KIfl/fl group,the I/R+sRAGE CKI group had 59 upregulated proteins and 42 downregulated proteins in myocardial tissue.The volcano plot showed that the significantly upregulated proteins were lghg1,lgh2b,Mcm7,and Nifk,and the significantly downregulated proteins were Abca7,Colla2,Ablim1,Crebrf,and Kcp,respectively.The subcellular localization results showed that the proteins with significant changes were mainly distributed in the nucleus,cytoplasm,extracellular space,plasma membrane,endoplasmic reticulum,cytoskeleton,and others.The results of functional enrichment showed that the significantly changed proteins were mainly involved in regulating signal transduction,cell motility,metabolism,infectious diseases,tumors and the immune system.Conclusion sRAGE can inhibit myocardial I/R injury by increasing or decreasing target proteins involved in regulating intracellular and extracellular signal transduction processes following myocardial I/R.

Objective To investigate the effects of soluble receptor for advanced glycation end products(sRAGE)on the changes and functions of myocardial tissue proteins in mice during myocardial ischemia/reperfusion(I/R).Methods Establish the myocardial I/R model using cardiac-specific sRAGE transgenic mice,and apply proteomic methods to detect the types and levels of protein expression in myocardial tissue.Results Compared with the I/R+sRAGE KIfl/fl group,the I/R+sRAGE CKI group had 59 upregulated proteins and 42 downregulated proteins in myocardial tissue.The volcano plot showed that the significantly upregulated proteins were lghg1,lgh2b,Mcm7,and Nifk,and the significantly downregulated proteins were Abca7,Colla2,Ablim1,Crebrf,and Kcp,respectively.The subcellular localization results showed that the proteins with significant changes were mainly distributed in the nucleus,cytoplasm,extracellular space,plasma membrane,endoplasmic reticulum,cytoskeleton,and others.The results of functional enrichment showed that the significantly changed proteins were mainly involved in regulating signal transduction,cell motility,metabolism,infectious diseases,tumors and the immune system.Conclusion sRAGE can inhibit myocardial I/R injury by increasing or decreasing target proteins involved in regulating intracellular and extracellular signal transduction processes following myocardial I/R.

Objective:To investigate the potential value of cerebral glucose metabolism characteristics in anti-leucine-rich glioma-inactivated protein 1 (LGI1) antibody-related encephalitic patients during acute phase as the clinical indicator of disease outcomes.Methods:From October 2019 to December 2023, 28 patients (18 males, 10 females; age (56.6±11.9) year) with anti-LGI1 antibody-related encephalitis diagnosed at Huashan Hospital, Fudan University were prospectively enrolled. All patients received baseline brain 18F-FDG PET imaging and were divided into different subgroups according to the prognosis (good prognosis and poor prognosis groups) and recurrence (recurrence and non-recurrence groups) after follow-up. The difference of Montreal Cognitive Assessment (MoCA) score between the two groups was compared by Mann-Whitney U test. Statistical parametric mapping (SPM) analysis was used to analyze the PET images of different groups by independent-sample t test, and the characteristics of cerebral glucose metabolism of patients with different outcomes were obtained. Results:MoCA scores between the recurrence group ( n=6) and the non-recurrence group ( n=22; 14.0(9.8, 20.5) vs 22.0(18.0, 24.0); Z=2.17, P=0.030), and between the poor prognosis group ( n=13) and the good prognosis group ( n=15; 14.0(10.0, 22.0) vs 22.0(19.8, 25.3); Z=2.47, P=0.013) were significantly different. Compared with the good prognosis group, the cerebral glucose metabolism in the poor prognosis group was decreased in the bilateral frontal lobe, lateral temporal lobe, inferior parietal lobule and cingulate gyrus, but increased in the brainstem, bilateral lentiform nucleus and bilateral paracentral lobule/postcentral gyrus (all t=1.71, all P<0.05). Compared with the non-recurrence group, the metabolism of bilateral medial frontal gyrus, anterior cingulate gyrus, bilateral insula, superior temporal gyrus and thalamus decreased in the recurrence group, while the metabolism of bilateral precentral gyrus, inferior frontal gyrus and bilateral lentiform nucleus increased (all t=1.71, all P<0.05). Conclusion:18F-FDG PET imaging reveals the differences in brain metabolism of anti-LGI1 antibody-related encephalitic patients at baseline with different outcomes (prognosis, recurrence or not), which can provide a new perspective for the clinical evaluation of the disease at baseline.

Objective:To Summarize the best evidence of follow-up management of patients with acute kidney injury to provide reference for clinical nursing work.Methods:Retrieved relevant literature on follow-up management of ICU transferred acute kidney injury patients from databases such as Cochrane Library, PubMed, CNKI, Wanfang Database, Chinese Biomedical Literature, and related professional websites based on the "6S" model system.The search deadline was from database establishment to May 30, 2023.Two researchers independently conducted literature quality evaluation, evidence screening, and evidence level assessment, and summarized the evidence.Results:Eight articles were selected, including 4 guidelines, 3 systematic review, 1 expert consensuses. Finally 16 pieces of best evidence from 6 dimensions of follow-up principles and methods, follow-up time/requency, follow- up assessment content, nutritional guidance, drug guidance and life guidance.Conclusions:This study summarized the best evidence summary of the follow-up management of patients with ICU transfer out of acute kidney dormitory, providing a reference for the clinical work of ICU medical staff. Medical staff can develop scientific and effective follow-up management based on patients and clinical conditions to improve the quality of care for ICU transferred patients.

With the continuous development of medical science and the widespread use of antibiotics,the problem of bacterial resistance is increasing,especially the increasing carbapenem-resistant Enterobacteriaceae(CRE)infection,and the high mortality rate,which brings great challenges to clinical treatment.In this paper,the mechanism of drug resistance,existing antibac-terial drugs,and exploratory treatment options for CRE are reviewed,and the research progress in treating CRE infection is dis-cussed to provide more reliable evidence and a theoretical basis for clinical practice.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Objective:To construct follow-up index system of ICU patients with acute kidney injury based on the Omaha nursing outcome classification system, and to provide a reference for the clinical care quality and the follow-up work of ICU patients after discharge.Methods:Based on the Omaha nursing outcome classification system, the Delphi method was used to establish the content of the follow-up index system for ICU patients with acute kidney injury, and determine the weight of all levels of indicators.Results:After two rounds of expert consultation, questionnaire response rates were 95.00%and 100.00%, expert authority coefficients were 0.861 and 0.892 (both P<0.01), coordination coefficients ranged from 0.296 to 0.667 and 0.240 to 0.804, the difference were statistically significant ( χ2 values were 60.77-288.17, and P<0.01). The final index system consisted of 4 first-level indicators, 16 second-level indicators, and 52 third-level indicators. The analytic hierarchy process was used to determine the weights of all indexes, and the consistency test (consistency ratio<0.1) was performed. Conclusions:The follow-up index system of ICU patients with acute kidney injury was constructed to provide a reference for the clinical care quality and the follow-up work of ICU patients after discharge, and to provide a theoretical basis for the follow-up mode after ICU.