OBJECTIVE To investigate the mechanisms of adrenal dysfunction among adult offspring rats caused by prenatal ethanol exposure(PEE)aggravated by high-fat diet(HFD)and unpredictable chronic stress(UCS).METHODS Pregnant rats were randomly divided into the control group(saline,ig,once)and PEE group(4 g·kg-1,ig,once)from gestational day(GD)11 until delivery.At postnatal week 4(PW4),offspring rats from the control group and PEE group were randomly assigned to three sub-groups:the normal diet(ND)group,HFD group,and HFD-UCS group(n=20 per subgroup,at an equal male-to-female ratio).The rats in each group were given a corresponding diet until PW24.The HFD-UCS group received HFD until PW24,with additional UCS treatment initiated at PW21 and continued for 3 weeks.Serum adrenocorticotropic hormone(ACTH)levels were measured by radioimmunoassay,and corticosterone(CORT)levels were quantified via enzyme-linked immunosorbent assay(ELISA).Adrenal mRNA expressions of steroidogenic factor 1(Sf1),steroidogenic acute regulatory protein(Star),cyto-chrome P450 cholesterol side chain cleavage(P450scc),3β-hydroxysteroid dehydrogenase(3β-Hsd),steroid 21-hydroxylase(P450c21),steroid 11β-hydroxylase(P450c11),11β-hydroxysteroid dehydrogenase type 1(11β-Hsd1),11β-Hsd 2,mineralocorticoid receptor(Mr),glucocorticoid receptor(Gr),insulin-like growth factor 1(Igf1),IGF1 receptor(Igf1r),and serine/threonine kinase 1(Akt1)were determined using real-time quantitative PCR.Protein expressions of Akt1 and phosphorylated Akt1(p-Akt1)were analyzed via immunohistochemistry.RESULTS In male offspring,HFD/PEE significantly reduced serum ACTH and CORT levels,downregulated Star,P450scc,3β-Hsd and P450c11 mRNA,decreased 11β-Hsd1 mRNA expressions and 11β-Hsd1/11β-Hsd2 ratio,but increased Igf1,Igf1r mRNA,and p-Akt1 protein.Conversely,HFD-UCS/PEE elevated ACTH,CORT,P450scc,3β-Hsd and P450c11 mRNA,increased 11β-Hsd1 and 11β-Hsd1/11β-Hsd2 ratio while suppressing Igf1 mRNA,and p-Akt1 protein.In females,HFD/PEE decreased ACTH but upregulated Igf1,Akt1 mRNA,and p-Akt1 protein.HFD-UCS/PEE increased ACTH,CORT,Sf1,Star,P450scc and P450c11 mRNA,and 11β-Hsd1/11β-Hsd2 ratio,but reduced lgf1 and Igf1r mRNA.CONCLUSION HFD/UCS can aggravate PEE-induced adrenal dysfunction in adult offspring.The adrenal"GC-IGF1 axis"is an endocrine negative feedback one,and its decompensation may increase the susceptibility of a wide range of GC-related adult chronic diseases,such as diabetes.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

The background of revising GB 19083-2023 Protective face mask for medical use was introduced.GB 19083-2023 was compared with GB 19083-2010 Technical requirements for protective face mask for medical use.The revision points were described in detail involving in dead space,total leakage rate,respiratory resistance,resistance to synthetic blood penetration,microbial indicators,biocompatibility and etc,and the convergence between GB 19083-2023 and international mainstream standards was analyzed.References were provided for the understanding of the standard for the production enterprises and consumers.[Chinese Medical Equipment Journal,2025,46(1):73-77]

OBJECTIVE To investigate the mechanisms of adrenal dysfunction among adult offspring rats caused by prenatal ethanol exposure(PEE)aggravated by high-fat diet(HFD)and unpredictable chronic stress(UCS).METHODS Pregnant rats were randomly divided into the control group(saline,ig,once)and PEE group(4 g·kg-1,ig,once)from gestational day(GD)11 until delivery.At postnatal week 4(PW4),offspring rats from the control group and PEE group were randomly assigned to three sub-groups:the normal diet(ND)group,HFD group,and HFD-UCS group(n=20 per subgroup,at an equal male-to-female ratio).The rats in each group were given a corresponding diet until PW24.The HFD-UCS group received HFD until PW24,with additional UCS treatment initiated at PW21 and continued for 3 weeks.Serum adrenocorticotropic hormone(ACTH)levels were measured by radioimmunoassay,and corticosterone(CORT)levels were quantified via enzyme-linked immunosorbent assay(ELISA).Adrenal mRNA expressions of steroidogenic factor 1(Sf1),steroidogenic acute regulatory protein(Star),cyto-chrome P450 cholesterol side chain cleavage(P450scc),3β-hydroxysteroid dehydrogenase(3β-Hsd),steroid 21-hydroxylase(P450c21),steroid 11β-hydroxylase(P450c11),11β-hydroxysteroid dehydrogenase type 1(11β-Hsd1),11β-Hsd 2,mineralocorticoid receptor(Mr),glucocorticoid receptor(Gr),insulin-like growth factor 1(Igf1),IGF1 receptor(Igf1r),and serine/threonine kinase 1(Akt1)were determined using real-time quantitative PCR.Protein expressions of Akt1 and phosphorylated Akt1(p-Akt1)were analyzed via immunohistochemistry.RESULTS In male offspring,HFD/PEE significantly reduced serum ACTH and CORT levels,downregulated Star,P450scc,3β-Hsd and P450c11 mRNA,decreased 11β-Hsd1 mRNA expressions and 11β-Hsd1/11β-Hsd2 ratio,but increased Igf1,Igf1r mRNA,and p-Akt1 protein.Conversely,HFD-UCS/PEE elevated ACTH,CORT,P450scc,3β-Hsd and P450c11 mRNA,increased 11β-Hsd1 and 11β-Hsd1/11β-Hsd2 ratio while suppressing Igf1 mRNA,and p-Akt1 protein.In females,HFD/PEE decreased ACTH but upregulated Igf1,Akt1 mRNA,and p-Akt1 protein.HFD-UCS/PEE increased ACTH,CORT,Sf1,Star,P450scc and P450c11 mRNA,and 11β-Hsd1/11β-Hsd2 ratio,but reduced lgf1 and Igf1r mRNA.CONCLUSION HFD/UCS can aggravate PEE-induced adrenal dysfunction in adult offspring.The adrenal"GC-IGF1 axis"is an endocrine negative feedback one,and its decompensation may increase the susceptibility of a wide range of GC-related adult chronic diseases,such as diabetes.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

The background of revising GB 19083-2023 Protective face mask for medical use was introduced.GB 19083-2023 was compared with GB 19083-2010 Technical requirements for protective face mask for medical use.The revision points were described in detail involving in dead space,total leakage rate,respiratory resistance,resistance to synthetic blood penetration,microbial indicators,biocompatibility and etc,and the convergence between GB 19083-2023 and international mainstream standards was analyzed.References were provided for the understanding of the standard for the production enterprises and consumers.[Chinese Medical Equipment Journal,2025,46(1):73-77]

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective:To investigate the current situation of the use of transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension, which should aid the development of TIPS in China.Methods:The China Portal Hypertension Alliance (CHESS) initiated this study that comprehensively investigated the basic situation of TIPS for portal hypertension in China through network research. The survey included the following: the number of surgical cases, main indications, the development of Early-TIPS, TIPS for portal vein cavernous transformation, collateral circulation embolization, intraoperative portal pressure gradient measurement, commonly used stent types, conventional anticoagulation and time, postoperative follow-up, obstacles, and the application of domestic instruments.Results:According to the survey, a total of 13 527 TIPS operations were carried out in 545 hospitals participating in the survey in 2021, and 94.1% of the hospital had the habit of routine follow-up after TIPS. Most hospitals believed that the main indications of TIPS were the control of acute bleeding (42.6%) and the prevention of rebleeding (40.7%). 48.1% of the teams carried out early or priority TIPS, 53.0% of the teams carried out TIPS for the cavernous transformation of the portal vein, and 81.0% chose routine embolization of collateral circulation during operation. Most of them used coils and biological glue as embolic materials, and 78.5% of the team routinely performed intraoperative portal pressure gradient measurements. In selecting TIPS stents, 57.1% of the hospitals woulel choose Viator-specific stents, 57.2% woulel choose conventional anticoagulation after TIPS, and the duration of anticoagulation was between 3-6 months (55.4%). The limitation of TIPS surgery was mainly due to cost (72.3%) and insufficient understanding of doctors in related departments (77.4%). Most teams accepted the domestic instruments used in TIPS (92.7%).Conclusions:This survey shows that TIPS treatment is an essential part of treating portal hypertension in China. The total number of TIPS cases is far from that of patients with portal hypertension. In the future, it is still necessary to popularize TIPS technology and further standardize surgical indications, routine operations, and instrument application.

Objective: To explore the balance of peripheral blood T helper 17 cells/regulatory T cell (Th17/Treg) ratio and the polarization ratio of M1 and M2 macrophages in lower extremity arteriosclerosis obliterans (ASO). Methods: A rat model of lower extremity ASO was established, and blood samples from patients with lower extremity ASO before and after surgery were obtained. ELISA was used to detect interleukin 6 (IL-6), IL-10, and IL-17. Real-time RCR and Western blot analyses were used to detect Foxp3, IL-6, IL-10, and IL-17 expression. Moreover, flow cytometry was applied to detect the Th17/Treg ratio and M1/M2 ratio. Results: Compared with the control group, the iliac artery wall of ASO rats showed significant hyperplasia, and the concentrations of cholesterol and triglyceride were significantly increased (P<0.01), indicating the successful establishment of ASO. Moreover, the levels of IL-6 and IL-17 in ASO rats were pronouncedly increased (P<0.05), while the IL-10 level was significantly decreased (P<0.05). In addition to increased IL-6 and IL-17 levels, the mRNA and protein levels of Foxp3 and IL-10 in ASO rats were significantly decreased compared with the control group. The Th17/Treg and M1/M2 ratios in the ASO group were markedly increased (P<0.05). These alternations were also observed in ASO patients. After endovascular surgery (such as percutaneous transluminal angioplasty and arterial stenting), all these changes were significantly improved (P<0.05). Conclusions: The Th17/Treg and M1/M2 ratios were significantly increased in ASO, and surgery can effectively improve the balance of Th17/Treg, and reduce the ratio of M1/M2, and the expression of inflammatory factors.