OBJECTIVE To explore the risk factors for polymyxin-and carbapenem-resistant Klebsiella pneumoni-ae(PR-CRKP)infection and establish the prediction model.METHODS The clinical data were retrospectively col-lected from the patients with CRKP infection who were treated in the First Affiliated Hospital of Xi'an Jiaotong University from Jan.2023 to Mar.2024.The enrolled patients were divided into the CRKP group and the PR-CRKP group according to the result of drug susceptibility testing for polymyxin B.Totally 203 patients who were treated from Jan.2023 to Dec.2023 were assigned as the modeling group,and 91 patients who were treated from Jan.2024 to Mar.2024 were assigned as the validation group.Multivariate logistic regression analysis was per-formed for the risk factors for PR-CRKP infection,nomogram was built up for prediction of PR-CRKP infection by R software,and the predictive efficacy of the model was evaluated by means of receiver operating characteristic(ROC)curves.RESULTS The result of univariate analysis showed that the proportions of patients who received fi-berobronchoscopy,endotracheal intubation/tracheotomy,were complicated with other carbapenem-resistant or-ganisms(CROs)infections,bloodstream infections,were treated in intensive care unit(ICU)and had the history of exposure to polymyxins and carbapenems 3 months before the admission were higher in the PR-CRKP group than in the CRKP group(P＜0.05);the length of hospital stay and duration of use of polymyxins and carbapene-ms were longer in the PR-CRKP group than in the CRKP group(P＜0.05).Multivariate logistic regression analy-sis indicated that complication with other CROs infections,history of exposure to polymyxins and carbapenems 3 months before the admission,duration of use of polymyxins and ICU stay were the risk factors for the PR-CRKP infection(P＜0.05).The area under the curve(AUC)of the predictive model was 0.898 in the modeling group,with the sensitivity 80.33％,the specificity 84.51％.ROC curve analysis showed that the AUC was 0.901 in the validation group,with the sensitivity 75.00％,the specificity 92.73％.CONCLUSION The prediction model that is established based on the result of multivariate analysis has high value in prediction of PR-CRKP infection.

OBJECTIVE To investigate the risk factors for carbapenem-resistant gram-negative bacteria(GNB)bloodstream infection(BSI)in patients with hematological malignancies(HMs)and their prognosis,and to devel-op a nomogram prediction model.METHODS A total of 316 patients with HMs and GNB-BSI admitted to the First Affiliated Hospital of Xi'an Jiaotong University from Jan.2017 to Dec.2022 were selected as the training set,and 106 patients admitted from Jan.2023 to Oct.2024 were selected as the validation set.Variables were selected by lasso regression and multifactor logistic regression,and a nomogram model was constructed.The prediction model was internally validated by the receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA),respectively.RESULTS Granulocytopenia for ≥7 days(OR=14.525),use of cephalosporins/β-lactamase inhibitors within 30 days before BSI(OR=3.510),exposure history of carbapenem antibacterial drug(OR=4.840)and albumin＜30 g/L(OR=2.697)were risk factors for CR-GNB BSI in patients with HMs(P＜0.05).Septic shock(OR=6.934),central venous catheterization(OR=5.586),inappropriate empirical antibac-terial drug therapy(OR=4.744),CR-GNB infection(OR=2.916)and albumin＜30 g/L(OR=3.324)were risk factors for 30-day mortality in patients with HMs and GNB-BSI(P＜0.05).Based on these indicators,two nomogram models were constructed.The areas under the ROC curve(AUC)for the internal validation set were 0.775 and 0.849,respectively.The calibration curves demonstrated high predictive performance for the pre-diction models(P=0.998 and 0.660,respectively),and DCA showed high clinical application value for both models.CONCLUSION The nomogram prediction model constructed in this study based on multifactor analy-sis not only demonstrates good predictive value but also exhibits significant clinical efficacy,aiding in the early i-dentification of high-risk patients for targeted therapy.

OBJECTIVE To investigate the risk factors for carbapenem-resistant gram-negative bacteria(GNB)bloodstream infection(BSI)in patients with hematological malignancies(HMs)and their prognosis,and to devel-op a nomogram prediction model.METHODS A total of 316 patients with HMs and GNB-BSI admitted to the First Affiliated Hospital of Xi'an Jiaotong University from Jan.2017 to Dec.2022 were selected as the training set,and 106 patients admitted from Jan.2023 to Oct.2024 were selected as the validation set.Variables were selected by lasso regression and multifactor logistic regression,and a nomogram model was constructed.The prediction model was internally validated by the receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA),respectively.RESULTS Granulocytopenia for ≥7 days(OR=14.525),use of cephalosporins/β-lactamase inhibitors within 30 days before BSI(OR=3.510),exposure history of carbapenem antibacterial drug(OR=4.840)and albumin＜30 g/L(OR=2.697)were risk factors for CR-GNB BSI in patients with HMs(P＜0.05).Septic shock(OR=6.934),central venous catheterization(OR=5.586),inappropriate empirical antibac-terial drug therapy(OR=4.744),CR-GNB infection(OR=2.916)and albumin＜30 g/L(OR=3.324)were risk factors for 30-day mortality in patients with HMs and GNB-BSI(P＜0.05).Based on these indicators,two nomogram models were constructed.The areas under the ROC curve(AUC)for the internal validation set were 0.775 and 0.849,respectively.The calibration curves demonstrated high predictive performance for the pre-diction models(P=0.998 and 0.660,respectively),and DCA showed high clinical application value for both models.CONCLUSION The nomogram prediction model constructed in this study based on multifactor analy-sis not only demonstrates good predictive value but also exhibits significant clinical efficacy,aiding in the early i-dentification of high-risk patients for targeted therapy.

OBJECTIVE To explore the risk factors for polymyxin-and carbapenem-resistant Klebsiella pneumoni-ae(PR-CRKP)infection and establish the prediction model.METHODS The clinical data were retrospectively col-lected from the patients with CRKP infection who were treated in the First Affiliated Hospital of Xi'an Jiaotong University from Jan.2023 to Mar.2024.The enrolled patients were divided into the CRKP group and the PR-CRKP group according to the result of drug susceptibility testing for polymyxin B.Totally 203 patients who were treated from Jan.2023 to Dec.2023 were assigned as the modeling group,and 91 patients who were treated from Jan.2024 to Mar.2024 were assigned as the validation group.Multivariate logistic regression analysis was per-formed for the risk factors for PR-CRKP infection,nomogram was built up for prediction of PR-CRKP infection by R software,and the predictive efficacy of the model was evaluated by means of receiver operating characteristic(ROC)curves.RESULTS The result of univariate analysis showed that the proportions of patients who received fi-berobronchoscopy,endotracheal intubation/tracheotomy,were complicated with other carbapenem-resistant or-ganisms(CROs)infections,bloodstream infections,were treated in intensive care unit(ICU)and had the history of exposure to polymyxins and carbapenems 3 months before the admission were higher in the PR-CRKP group than in the CRKP group(P＜0.05);the length of hospital stay and duration of use of polymyxins and carbapene-ms were longer in the PR-CRKP group than in the CRKP group(P＜0.05).Multivariate logistic regression analy-sis indicated that complication with other CROs infections,history of exposure to polymyxins and carbapenems 3 months before the admission,duration of use of polymyxins and ICU stay were the risk factors for the PR-CRKP infection(P＜0.05).The area under the curve(AUC)of the predictive model was 0.898 in the modeling group,with the sensitivity 80.33％,the specificity 84.51％.ROC curve analysis showed that the AUC was 0.901 in the validation group,with the sensitivity 75.00％,the specificity 92.73％.CONCLUSION The prediction model that is established based on the result of multivariate analysis has high value in prediction of PR-CRKP infection.

Objective:To investigate the effect of peripheral blood neutrophil-to-lymphocyte ratio (NLR) before radical radiotherapy on overall survival (OS) of patients with esophageal squamous cell carcinoma.Methods:The clinical data of 359 patients with esophageal squamous cell carcinoma from March 2011 to January 2017 in Shanxi Provincial Cancer Hospital were retrospectively analyzed. The gender, age, smoking index, Karnofsky score, lesion site, lesion length, tumor length, TNM stage, concurrent chemoradiotherapy, NLR, etc., were observed. Receiver operating characteristic (ROC) curve was drawn according to patients' NLR to find the optimal cut-off value, the patients were divided into the low NLR group and the high NLR group, and the OS of the two groups was analyzed. Univariate log-rank test and multivariate Cox analysis were used to determine the factors affecting the OS of patients.Results:The area under the curve (AUC) of NLR for predicting OS was 0.576, the best cut-off value for OS prediction was 2.103 6, and the sensitivity and specificity were 60.8% and 55.2%, respectively. According to the best cut-off value of peripheral blood NLR 2.103 6, the 359 patients were divided into the low NLR group (NLR < 2.103 6, 156 cases, 43.5%) and high NLR group (NLR ≥ 2.103 6, 203 cases, 56.5%). There were statistical differences in gender ( χ2 = 8.960, P = 0.003) and lesion length ( χ2 = 12.948, P = 0.002) between low NLR group and high NLR group. Univariate analysis showed that the lesion length, NLR, N stage, M stage and total TNM clinical stage were influencing factors affecting OS of patients (all P < 0.05). Multivariate Cox regression analysis showed that the lesion length ( HR = 1.456, 95% CI 1.215-1.745, P < 0.01), NLR ( HR = 1.313, 95% CI 1.020-1.690, P = 0.035) and N stage ( HR = 1.768, 95% CI 1.391-2.248, P < 0.01) were independent influencing factors affecting OS of patients with esophageal squamous cell carcinoma before radical radiotherapy. Conclusions:Peripheral blood NLR is an independent influencing factor affecting OS of esophageal squamous cell carcinoma patients before radical radiotherapy. NLR has important reference value for predicting the OS of patients with esophageal squamous cell carcinoma after radical radiotherapy.

Objective In order to solve the obvious adverse reactions of ribavirin, to develop ribavirin liposome inhalation powder and to evaluate its quality characteristics. Methods The ribavirin liposomes were prepared by the thin film dispersion method, and then lyophilized to prepare ribavirin liposome powder. The appearance, fluidity, bulk density, encapsulation efficiency, particle size of the complex solution, PDI, potential and hydrophilicity were examined. Results Ribavirin liposome powder has good morphology, particle size, potential, fluidity and hydrophilicity, which can meet the basic requirements of powder medicine for drug administration. Conclusion The technique of preparing ribavirin liposome powder aerosol preparation by this method is feasible, and it provides the basic technology for future in vivo and in vitro studies.

Objective To explore the effect of prognostic nutrition index (PNI) on the overall survival time of patients with brain metastases of lung adenocarcinoma.Methods A retrospective analysis was performed on the clinic data of 274 patients who were admitted to our hospital and confirmed with brain metastases of lung adenocarcinoma from May 2013 to May 2016.The prognosic factors for brain metastases such as PNI,gender,age,smoking history,epidermal growth factor receptor (EGFR) mutation status,Karnofsky performance status (KPS) score,the number of brain lesions,treatment of brain lesions,extracranial metastases and the status of primary disease were analyzed.The receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value of PNI,and the patients were divided into high PNI group and low PNI group.The univariate and multivariate prognostic analyses were performed by the Log-rank test and the Cox proportional hazards model.Results The patients were divided into high PNI (＞ 50.45) group (n =72) and low PNI (≤50.45) group (n =202).The median overall survival (OS) was 11.20 months in all patients with brain metastases,and the median OS of the low PNI group and high PNI group were 10.13 months and 15.17 months respectively.The univariate analysis results showed that gender (x2 =5.459,P =0.019),age (x2 =3.986,P =0.046),smoking or not (x2 =6.878,P =0.009),EGFR mutation status (x2 =20.484,P＜0.001),KPS score (x2 =126.573,P ＜ 0.001),extracranial metastases or not (x2 =4.403,P =0.036),treatment on the brain lesions (x2 =40.444,P ＜ 0.001) and PNI (x2 =7.972,P =0.005) were related to the prognosis.The Cox multivariate analysis results showed that age (HR =1.580,95％ CI:1.104-2.295,P =0.012),EGFR mutation status (HR =0.549,95％ CI:0.408-0.738,P ＜ 0.001),KPS score (HR =0.077,95％CI:0.045-0.134,P ＜ 0.001),treatment on brain metastases (HR =0.882,95％ CI:0.789-0.987,P =0.029) and PNI (HR =0.614,95％ CI:0.437-0.861,P =0.005) were related to the prognosis.Conclusion PNI is an independent prognostic predictor of brain metastases in patients with lung adenocarcinoma,and the high-PNI is correlated to the long OS of patients with brain metastases of lung adenocarcinoma,which has certain clinical practical value.

Objective To explore the association between epidermal growth factor receptor (EGFR) mutation subtypes and the prognosis of brain metastasis in patients with lung adenocarcinoma.Methods A retrospective analysis was performed on the clinical data of 256 patients who were admitted to our hospital and confirmed with brain metastases of lung adenocarcinoma by EGFR mutation detection from 2010 to 2015.The prognostic factors for brain metastases were analyzed.The survival rate was calculated by the Kaplan-Meier method and analyzed by the log-rank test.The univariate and multivariate prognostic analyses were performed by the log-rank test and the Cox proportional hazards model.Results The median survival time was 10.13 months in all patients.The univariate analysis showed that sex,EGFR mutation status,exon 19 deletion,the Karnofsky Performance Status (KPS) score of brain metastases,and targeted therapy were prognostic predictors (P=0.006,0.001,0.010,0.000,0.003).The multivariate analysis showed that the KPS score and exon 19 deletion were prognostic factors for brain metastases (P=O.000,0.045).When grouped into the recursive partitioning analysis classes,all the patients were split into three subgroups with significantly different prognosis (P =0.000).Conclusions Exon 19 deletion is a prognostic predictor of brain metastases in patieuts with lung adenocarcinoma,which can be integrated into the prognosis scoring system for brain metastases of lung adenocarcinoma.EGFR tyrosine kinase inhibitors improve the survival in patients with brain metastases of lung adenocarcinoma and EGFR mutation,particularly,in those with exon 19 deletion.

Objective To explore the incidence of brain metastases from esophageal cancer,survival-related factors after brain metastases,and the result of different treatment methods.Methods From January 2000 to October 2016 treated 11 338 cases of esophageal cancer patients,84 cases of brain metastases,were collected with complete clinical data.Results Eighty four cases of patients with brain metastases included esophageal squamous carcinoma in 74 cases,adenocarcinoma in 6 cases,and small cell undifferentiated carcinoma 4 cases;single brain metastases in 19 cases,65 cases of multiple brain metastases included 59 cases with brain metastasis symptoms,58 with extracranial metastases,primary tumors and brain metastases interval time less than 6 months in 31 cases,24 cases of 6-12,16 cases for 12-24 months.Prognostic logrank univariate analysis of survival rate found 24-36 months survival for 13 patients.All patients were followed for a median of 19.31 months after brain metastases,the median survival time was 5.43 months.Conclusions About 0.7％ of brain metastases from esophageal cancer occurs.Esophageal carcinoma metastatic to the brain:There was no extracranial metastasis,recursive partitioning analysis classification (RPA),Karnofsky (KPS) score,brain metastases different treatment methods is a poor prognostic factor for esophageal cancer brain metastasis.

Objective: To investigate the relationship between the status of epidermal growth factor receptor (EGFR) mutations and brain metastases in patients with lung adenocarcinoma. Methods: From August 2010 to May 2015, a total of 1 063 lung adenocarcinoma patients with identified status of EGFR mutations in Shanxi Cancer Hospital were enrolled, of which 456 patients had EGFR mutations. Multivariate Logistic regression model was used to analyze the correlation between EGFR mutation status and brain metastases in patients with lung adenocarcinoma. Results: In 125 patients with brain metastases before initial treatment, 65 patients had EGFR mutations, including 36 patients with deletion mutations in exon 19. The frequency of EGFR 19 exon mutation was 28.8% (36/125). Among 456 patients with EGFR mutations, 65(14.3%) patients were with brain metastases, in which 36(55.0%) had deletion mutations in exon 19. The multivariate analysis showed that age, Eastern Cooperative Oncology Group (ECOG) score, EGFR mutations and N staging were associated with brain metastases(P<0.05). Further subgroup multivariate analyses showed that age, ECOG score, mutation status in exon 19 and N staging were associated with brain metastases (P<0.05). Conclusions EGFR mutation status is related to brain metastases. Mutations in EGFR exon 19 is an independent risk factor for brain metastases.