Objective To evaluate the clinical efficacy and safety of sulbactam-durlobactam in the treatment of pulmonary infection caused by extensively drug-resistant Acinetobacter baumannii (XDR-AB) after liver transplantation. Methods A retrospective analysis was performed on the data of 3 liver transplant recipients admitted to the First Affiliated Hospital of Xi'an Jiaotong University from May to December 2025, who developed postoperative XDR-AB pulmonary infection and received sulbactam-durlobactam-based anti-infective therapy. Clinical data, clinical efficacy, microbiological response, safety and outcomes were analyzed. Results All isolated strains were XDR-AB producing OXA-23 carbapenemase, and in vitro antimicrobial susceptibility testing showed sensitivity to sulbactam-durlobactam. After treatment with sulbactam-durlobactam, all 3 recipients achieved clinical cure and microbiological eradication, with a treatment course of 6-8 days and pathogen clearance time of 3-6 days. Septic shock was effectively controlled in all recipients, who were successfully weaned from mechanical ventilation, and oxygenation index and organ function scores were significantly improved. No definite nephrotoxicity or other severe adverse reactions related to sulbactam-durlobactam were observed during treatment, and the 30-day all-cause fatality was 0. Two critically ill recipients achieved rapid microbiological clearance after combined nebulized phage therapy. Conclusions Sulbactam-durlobactam-based regimen shows favorable efficacy and safety in liver transplant recipients with postoperative XDR-AB pulmonary infection, and has a promising clinical application prospect.

Objective:To compare the clinical and imaging characteristics of eyes with idiopathic focal choroidal excavation (FCE) and acquired FCE, and to preliminarily analyze the association of FCE with different fundus diseases.Methods:A retrospective clinical study. A total of 90 patients (93 eyes) diagnosed with FCE at the Ophthalmology Department of The First Affiliated Hospital of Zhengzhou University from March 2021 to May 2024 were included in the study. All affected eyes underwent best-corrected visual acuity (BCVA) testing, intraocular pressure (IOP) measurement, ophthalmoscope, fundus color photography, and swept-source optical coherence tomography (SS-OCT). SS-OCT was used to measure subfoveal choroidal thickness (SFCT), choroidal thickness at the temporal, nasal, and inferior margins of the FCE, as well as the maximum width and depth of the FCE. Based on the presence of concomitant fundus diseases, FCE cases were divided into an idiopathic FCE group (51 eyes) and an acquired FCE group (42 eyes). Clinical characteristics at the initial and final visits were compared between the two groups. Clinical features were also analyzed for acquired FCE eyes with different associated fundus diseases. A logistic regression model was used to identify potential risk factors for FCE coexisting with other fundus diseases.Results:Compared to the idiopathic FCE group, the acquired FCE group had significantly decreased BCVA ( Z=?8.290), significantly increased FCE width ( Z=?2.762), and significantly higher incidence rates of saucer-shaped FCE ( χ2=8.352) and ellipsoid zone disruption ( χ2=7.999). These differences were all statistically significant ( P<0.05). No significant differences were found between the two groups in age, gender distribution, IOP, foveal involvement, proportion of conforming FCE, retinal pigment epithelium-Bruch’s membrane rupture, presence of hyperreflective material under the excavation, presence of surrounding thick vessels, FCE depth, SFCT, or choroidal thickness at the inferior, temporal, and nasal margins of the FCE ( P>0.05). Logistic regression analysis revealed that FCE width (odds ratio=1.002, 95% confidence interval: 1.001-1.004, P=0.005) was the sole risk factor for FCE coexisting with other fundus complications. In both the idiopathic and acquired FCE groups, FCE depth and width remained relatively stable during follow-up. BCVA improved in the acquired FCE group after treatment. Conclusions:FCE can coexist with various fundus diseases. FCE width is the only risk factor for the development of other fundus complications in FCE-affected eyes. Treating retinal or choroidal diseases associated with acquired FCE can provide visual benefits to patients.

Objective:To explore the correlation between quantitative parameters based on SUV acquired by dynamic SPECT/CT imaging of parotid glands and pathological grading of labial gland in patients with primary Sj?gren syndrome (pSS).Methods:Seventy-two patients (6 males, 66 females, age (51.5±13.8) years) with confirmed pSS diagnosed at Hebei General Hospital between August 2022 and March 2024 were prospectively included. The clinical data and pathological grading information from labial gland biopsies were analyzed. Dynamic SPECT/CT imaging of the parotid glands was performed, and quantitative parameters based on SUV were obtained using Q-metrix software: SUV max, SUV mean, uptake volume of parotid glands (UVP) and total parotid uptake (TPU) pre/post-acid stimulation, as well as the differences in quantitative parameters before and after acid stimulation (ΔSUV max, ΔSUV mean, ΔUVP, and ΔTPU). The independent-sample t test or Mann-Whitney U test was performed to evaluate the differences in parameters between patients with pathological grade 1-2 and those with pathological grade 3-4. Spearman rank correlation was used to analyze the correlation between quantitative parameters and pathological grading. The performance of quantitative parameters in distinguishing pathological grade 1-2 from grade 3-4 was assessed using ROC curve analysis with Delong test. Results:The SUV max pre/post-acid stimulation in patients with pathological grade 1-2 ( n=30) were higher than those in patients with grade 3-4 ( n=42) (36.38(27.81, 44.17) vs 15.45(10.77, 24.51), Z=-5.51, P<0.001(pre-acid stimulation); 21.53(16.93, 26.21) vs 11.33(7.32, 15.89), Z=-5.27, P<0.001 (post-acid stimulation)). SUV mean, UVP and TPU pre/post-acid stimulation in patients with pathological grade 1-2, as well as ΔSUV max, ΔSUV mean and ΔTPU, were all significantly higher ( Z values: from -4.73 to -3.04, t values: 6.39, 4.50, all P<0.01). Moreover, these parameters were negatively correlated with the pathological grading ( rs values: from -0.66 to -0.36, all P<0.05). No significant difference in ΔUVP was observed between patients with pathological grade 1-2 and those with grade 3-4 ( Z=-1.05, P=0.293), and ΔUVP showed no correlation with pathological grading ( rs=-0.13, P=0.297). Among all parameters, SUV max pre/post-acid stimulation and TPU pre-acid stimulation exhibited better diagnostic performance in differentiating pathological grade 1-2 from grade 3-4, with AUC values of 0.883, 0.866, and 0.888, respectively. Delong test showed that those 3 AUC values were all higher than AUC values of SUV mean, UVP post-acid stimulation and ΔUVP (all AUC<0.800; Z values: 2.09-4.65, all P<0.05). Conclusion:The quantitative parameters of parotid glands based on SUV acquired by dynamic SPECT/CT can reflect the damage degree of parotid glands in patients with pSS, providing novel quantitative analytical tools for the functional diagnosis and assessment of pSS.

Objective:To retrospectively analyze the changes in the proportion of refined lymphocyte subsets in peripheral blood of patients with Graves disease (GD), and their correlation with the clinical characteristics and efficacy of GD, and to explore the immunological pathogenesis of Graves disease for seeking new therapeutic targets.Methods:A total of 97 newly diagnosed GD patients (GD group), 27 patients after treatment (treatment group), and 31 healthy individuals (control group) who visited the Fifth Medical Center of the PLA General Hospital from 2018 to 2021 were included in this study. The data of refined lymphocyte subsets, thyroid function, blood routine and clinical treatment of the three groups were compared and analyzed. The t-test and rank sum test were used to compare the proportions of lymphocyte subsets among different groups, and Pearson correlation analysis was used to analyze the correlation between the proportions of lymphocyte subsets and thyroid function indicators.Results:The proportion of B cells in GD group was higher than that in the control group [16.2%(11.8%, 21.8%) vs 10.2%(8.1%,13.6%)], while the proportion of natural killer (NK) cells was lower [9.4%(4.9%, 13.6%) vs 14.6%(12.1%,18.8%)], and the differences were statistically significant ( P<0.05). Abnormal T cell differentiation: the proportions of functional cells, including activated T cells, memory T cells, clustering antigen(CD)4+memory T cells, Th1 cells, and Tc1 cells, were lower than that in the control group [3.2%(2.1%, 5.7%) vs 5.8%(3.0%, 9.3%), P<0.05; 36.7% (29.9%, 48.1%) vs 48.0%(39.2%,57.7%), P<0.05; 23.1%(17.4%, 30.1%) vs 28.9%(23.3%,34.6%), P<0.05; 16.4% (11.8%, 23.6%) vs 24.3%(16.9%,28.5%), P<0.05; 28.5% (14.7%, 39.2%) vs 46.3%(21.6%,69.2%), P<0.05]. The proportion of activated T cells in the treatment group was higher than that in the GD group [6.5% (4.6%, 13.6%) vs 3.2% (2.1%, 5.7%), P<0.05]. The total triiodothyronine results showed positive correlations with B cells ( r=0.356, P<0.01) and negative correlations with NK cells ( r=?0.416, P<0.01), while the total thyroxine values showed negative correlations with NK cells and activated T cells ( r=?0.318,?0.335; P<0.01). Thyroid stimulating hormone and CD8+initial T cells were positively correlated ( r=0.382, P<0.01). The proportion of B cells, cytotoxic T cells and suppressor T cells in CD8+cells of patients with complications [such as Graves orbitopathy (GO), thyroid toxic cardiomyopathy, etc.] was significantly different from that of the simple GD patients [18.3% (14.1%, 27.1%) vs 14.6% (10.8%, 21.4%), Z=2.54, P<0.05; 73.4%(65.6%,83.6%)vs 65.0%(50.3%,79.3%), Z=2.93, P<0.05; 26.6%(16.4%, 37.5%)vs 35.0%(20.7%,49.7%), Z=?2.74, P<0.05]. The proportion of suppressor T cells in GO patients was lower than that in non-GO patients [6.1% (3.4%, 8.1%) vs 8.5% (4.9%, 13.6%), Z=?3.20 P<0.05]. Conclusion:There are significant alterations in the circulating immune cells of GD patients, suggesting that immunological abnormalities play a crucial role in the onset and progression of the disease.

Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.
Humans ; Chemoradiotherapy/adverse effects* ; Consensus ; Risk Factors ; Stomatitis/etiology*

AIM: To investigate the risk factors associated with the recurrence of macular edema secondary to branch retinal vein occlusion(BRVO-ME)after anti-vascular endothelial growth factor(anti-VEGF)therapy.METHODS:A total of 32 patients(32 eyes)with BRVO-ME who were treated at the ophthalmology department of the Affiliated Hospital of Shandong Second Medical University from February 2021 to June 2022 were selected. They were treated with a 3+pro re nata (PRN)anti-VEGF regimen and followed up for 6 mo. Following 3 consecutive anti-VEGF injections, patients were categorized into a non-recurrence group and a recurrence group based on central macular thickness(CMT)measured by optical coherence tomography(OCT)at 6 mo post-treatment. Aqueous humor levels of various cytokines levels were quantified using suspension assay method. Demographic characteristics, CMT, and cytokine levels were compared between the two groups, and their correlations with the recurrence of BRVO-ME after anti-VEGF treatment were analyzed.RESULTS:At 6 months post-treatment, ME resolved in 19 eyes(no recurrence group), while 13 eyes showed persistent or recurrent ME(recurrence group). Compared to baseline, the CMT significantly improved in both groups at 1 d, 1, and 6 mo post-treatment(all P<0.05). However, the recurrence group exhibited significantly higher baseline, 1 d and 6 mo post-treatment CMT values than the non-recurrence group(all P<0.05). The aqueous humor levels of VEGF and monocyte chemoattractant protein-1(MCP-1)at baseline were significantly higher in the recurrence group than the non-recurrence group(all P<0.05). Spearman correlation analysis revealed positive associations between baseline CMT and interlukin IL-1β, IL-5, IL-12, MCP-1 and IP-10 levels(all P<0.05). Multivariable Logistic regression analysis identified baseline CMT and MCP-1 levels as independent risk factors for BRVO-ME recurrence(OR>1, P<0.05).CONCLUSION: Elevated baseline CMT and aqueous humor MCP-1 levels were identified as independent risk factors for BRVO-ME recurrence after anti-VEGF therapy. Patients exhibiting higher baseline CMT and MCP-1 levels demonstrated significantly increased susceptibility to recurrence.

Objective:To explore the correlation between quantitative parameters based on SUV acquired by dynamic SPECT/CT imaging of parotid glands and pathological grading of labial gland in patients with primary Sj?gren syndrome (pSS).Methods:Seventy-two patients (6 males, 66 females, age (51.5±13.8) years) with confirmed pSS diagnosed at Hebei General Hospital between August 2022 and March 2024 were prospectively included. The clinical data and pathological grading information from labial gland biopsies were analyzed. Dynamic SPECT/CT imaging of the parotid glands was performed, and quantitative parameters based on SUV were obtained using Q-metrix software: SUV max, SUV mean, uptake volume of parotid glands (UVP) and total parotid uptake (TPU) pre/post-acid stimulation, as well as the differences in quantitative parameters before and after acid stimulation (ΔSUV max, ΔSUV mean, ΔUVP, and ΔTPU). The independent-sample t test or Mann-Whitney U test was performed to evaluate the differences in parameters between patients with pathological grade 1-2 and those with pathological grade 3-4. Spearman rank correlation was used to analyze the correlation between quantitative parameters and pathological grading. The performance of quantitative parameters in distinguishing pathological grade 1-2 from grade 3-4 was assessed using ROC curve analysis with Delong test. Results:The SUV max pre/post-acid stimulation in patients with pathological grade 1-2 ( n=30) were higher than those in patients with grade 3-4 ( n=42) (36.38(27.81, 44.17) vs 15.45(10.77, 24.51), Z=-5.51, P<0.001(pre-acid stimulation); 21.53(16.93, 26.21) vs 11.33(7.32, 15.89), Z=-5.27, P<0.001 (post-acid stimulation)). SUV mean, UVP and TPU pre/post-acid stimulation in patients with pathological grade 1-2, as well as ΔSUV max, ΔSUV mean and ΔTPU, were all significantly higher ( Z values: from -4.73 to -3.04, t values: 6.39, 4.50, all P<0.01). Moreover, these parameters were negatively correlated with the pathological grading ( rs values: from -0.66 to -0.36, all P<0.05). No significant difference in ΔUVP was observed between patients with pathological grade 1-2 and those with grade 3-4 ( Z=-1.05, P=0.293), and ΔUVP showed no correlation with pathological grading ( rs=-0.13, P=0.297). Among all parameters, SUV max pre/post-acid stimulation and TPU pre-acid stimulation exhibited better diagnostic performance in differentiating pathological grade 1-2 from grade 3-4, with AUC values of 0.883, 0.866, and 0.888, respectively. Delong test showed that those 3 AUC values were all higher than AUC values of SUV mean, UVP post-acid stimulation and ΔUVP (all AUC<0.800; Z values: 2.09-4.65, all P<0.05). Conclusion:The quantitative parameters of parotid glands based on SUV acquired by dynamic SPECT/CT can reflect the damage degree of parotid glands in patients with pSS, providing novel quantitative analytical tools for the functional diagnosis and assessment of pSS.

Central serous chorioretinopathy (CSC) predominantly affects males aged 20 to 50.It is characterized by serous neurosensory retinal detachment.CSC can be classified as acute (self-limiting) or chronic (lasting ≥3 months) types.Complications of chronic CSC include choroidal neovascularization and retinal pigment epithelium (RPE) atrophy, which can lead to irreversible vision damage.Studies have found that the onset of CSC is associated with genetic predisposition (e.g., CFH and NR3C2 gene loci), exposure to corticosteroid, endocrine disorders, elevated androgen levels, and psychological stress.Pathological changes center on choroidal thickening and venous overload, manifesting as vortex vein anastomosis and choroidal capillary attenuation.These changes subsequently lead to RPE dysfunction.Multimodal imaging reveals characteristic changes: fundus autofluorescence displays gravity-dependent granular fluorescence signals, while optical coherence tomography indicates damage to the ellipsoid zone and shortening of photoreceptor outer segments, both of which are significantly correlated with visual prognosis.Evidence-based treatment indicates that half-dose photodynamic therapy provides the most advantages in terms of anatomical reattachment and visual improvement.However, the efficacy of micropulse laser and mineralocorticoid receptor antagonists requires validation through large-sample studies.Further exploration of gene-environment interaction mechanisms and targeted treatment strategies is necessary in the future.This article reviews research advances in CSC.

Objective:To observe the imaging features of extramacular retinoschisis (EMRS) and paravascular abnormalities (PVA) in myopic patients, and preliminary analyze the differences in age, best corrected visual acuity (BCVA), spherical equivalent (SE), axial length (AL), and subfoveal choroidal thickness (SFCT).Methods:A cross-sectional clinical study. A total of 60 myopia patients with EMRS who were admitted to Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University from January 2023 to June 2024 were included in the study. There were 18 male cases with 18 eyes and 42 female cases with 42 eyes. Age was (37.57±17.14) years; SE was (-10.76±4.66) D; AL was (28.36±1.87) mm. According to the characteristics of ultra-wide-angle optical coherence tomography images, PVA was divided into perivascular cysts (PC), perivascular microfolds (PM) and perivascular lamellar holes (PLH). According to the splitting level, EMRS can be divided into inner layer, middle layer and outer layer. According to SE, the affected eyes were divided into low myopia group, moderate myopia group and high myopia group. The occurrence of EMRS near optic disc, supratemporal, suprasal and subnasal, as well as the clinical characteristics of patients with EMRS at different locations, levels and forms of PVA were observed. Age, BCVA, SE, AL and SFCT of EMRS patients at different locations and levels were compared by independent sample t test. χ2 test or Fisher exact probability test were used to compare the categorical variables between groups. Results:In 60 eyes, EMRS were located in supratemporal, infratemporal, supranasal, subnasal, and paratopic discs in 36, 43, 15, 13, and 14 eyes, respectively. The EMRS in the inner and outer layers were 59 (98.3%, 59/60) and 35 (58.3%, 35/60) eyes, respectively. PVA was present in 47 eyes (78.3%, 47/60). Among them, PC, PM and PLH were 45, 39 and 18 eyes, respectively. The age of those with paratopic splitting was older than those without paratopic splitting ( t=2.720). Those with temporal splitting had worse BCVA and longer AL than those without splitting ( t=2.139, 2.119). Those with subnasal splitting had worse BCVA, higher myopia, longer AL and thinner SFCT than those without splitting. The differences were statistically significant ( t=2.926, -2.640, 2.635, -3.938; P<0.05). Compared with other types of EMRS, patients with inner EMRS had younger age ( t=-2.383), better BCVA ( t=-4.825), shorter AL ( t=-4.767), lower myopia ( t=4.791), and thicker SFCT ( t=4.791); patients with full-layer EMRS were older ( t=2.419), worse BCVA ( t=3.656), longer AL ( t=2.677), higher degree of myopia ( t=-2.755), and thinner SFCT ( t=-3.283), with statistical significance ( P<0.05). There was significant difference in SFCT among patients with or without PC ( t=-2.396, P<0.05). Compared with eyes without PM and PLH, eyes with PM had worse BCVA, longer AL, higher myopia, and thinner SFCT, and the differences were statistically significant (PM: t=2.514, 3.078, -2.811, -4.205; P<0.05; PLH: t=2.514, 2.992, -2.949, -1.773; P<0.05). Conclusions:EMRS primarily occurs in the temporal side, with the highest frequency in the inner layer. Patients with inner-layer EMRS are younger, have better BCVA, shorter AL, lower myopia, and thicker SFCT, whereas patients with full-layer EMRS exhibit the opposite characteristics.

Objective:To observe and analyze the imaging features of pathologic myopic paravascular abnormalities (PVA) and macular retinoschisis (MRS) and their relationship with clinical features.Methods:A retrospective case series study. A total of 371 eyes of 224 patients with pathological myopia with PVA and/or MRS diagnosed by examination in Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University from September 2021 to December 2023 were included in the study. There were 74 eyes in 48 males and 297 eyes in 176 females. Age were 54 (49, 61) years; equivalent spherical lens (SE) was -13.375 (-18.00,-10.00) D. Axial length (AL) was 29.84 (28.27, 31.24) mm. According to the features of ultra-wide-angle sweep source optical coherence tomography, PVA morphology was divided into blood vessels and paravascular microfolds, paravascular retinal cysts, paravascular retinal splits and paravascular lamellar macular holes. MRS was divided into inner layer, outer layer and mixed layer according to splitting level, and grouped accordingly. The presence of dome-shaped macula (DSM), internal and external lamellar macular hole, and full lamellar macular hole (FTMH) were recorded. According to whether PVA combined with MRS or not, the affected eyes were divided into PVA group and PVA combined with MRS group. According to whether MRS involved the fovea, the affected eyes were divided into two groups: MRS not involved the fovea group and MRS involved the fovea group. Mann-Whitney U test was used to compare age, SE and AL among different groups. Qualitative data were compared by χ2 test. Results:In 371 eyes, there were 120 eyes in the simple PVA group; in the MRS group, there were 251 eyes, of which 208 eyes were in the PVA combined with MRS group. There were 33, 27, 3, 14, 12, 56, 28, and 7 eyes with or without retinal detachment, choroidal neovascularization, DSM, preretinal membrane, and simple superficial detachment of neuroepithelium in inner lamina, outer lamina, and FTMH, respectively. In 328 eyes with PVA, blood vessels and paravascular microfolds, paravascular retinal cysts, paravascular retinal splits and paravascular lamellar macular holes were 151, 236, 202 and 72 eyes, respectively. There were 142 eyes with single lesion (43.29%, 142/328). There were 186 eyes with 2 or more lesions (56.71%, 186/328). There were 34 eyes in the inner MRS group, 92 eyes in the outer MRS group and 125 eyes in the mixed MRS group, respectively. It involved 155 eyes in the fovea group; 96 eyes in the fovea group were not involved. There were significant differences in the number of PVA eyes between the outer MRS group, the inner MRS group and the mixed MRS group ( χ2=30.614, 28.379; P<0.001). Compared with PVA group, PVA group combined with MRS group was more likely to have two or more PVA lesions, the difference was statistically significant ( χ2=30.535, P<0.001). Compared with the inner MRS group and mixed MRS group, the age of the simple PVA group was younger, and the age of the outer MRS group was older, and the differences were statistically significant ( P<0.05). Compared with the inner MRS group and the outer MRS group, the simple PVA group had short AL, less myopia and better optimal corrected visual acuity (BCVA), while the mixed MRS group had long AL, more myopia and worse BCVA, and the differences were statistically significant ( P<0.05). Compared with the PVA group and the inner MRS group, the fovea was more involved in the outer MRS group and the mixed MRS group, and the difference was statistically significant ( χ2=3.906, 10.836; P<0.05). Those with MRS involved in fovea were older, AL was longer, myopia was more severe, and BCVA was worse ( P<0.001). DSM-associated splits were less likely to involve macula ( P<0.001). Conclusion:PVA and MRS exhibit a variety of presentations, and their imaging features correlate with clinical features.