ObjectiveTo investigate the epidemiological characteristics of human brucellosis (hereinafter referred to as brucellosis) in Baoshan City, Yunnan Province, and to provide scientific evidence for adjusting prevention and control strategies. MethodsBased on the surveillance data of reported brucellosis cases in Baoshan City from 2020 to 2023 and the information collected through individual epidemiological questionnaire surveys, the epidemic status and clinical characteristics of brucellosis in Baoshan City were analyzed using descriptive epidemiological methods. ResultsA total of 85 brucellosis cases were reported in Baoshan City from 2020 to 2023, and detailed individual information was obtained for 83 of them. Brucellosis in Baoshan City showed a clear seasonal pattern, with peak incidence from May to September. The average annual incidence rate was 0.80/100 000, with a male-to-female ratio of 7.5∶1. And 82.35% of the cases aged 30 to 60 years, with farmers being the predominant affected group. The main clinical manifestations of the cases were myalgia and arthralgia. Regarding transmission routes, 87.95% of the cases had a contact history with cattle, with livestock rearing and grazing being the main exposure modes. Most infections occurred at home. ConclusionFrom 2020 to 2023, the incidence of brucellosis in Baoshan City exhibited a fluctuating upward trend, with a peak period from May to September. Males and farmers were identified as the primary affected populations. It is recommended to strengthen livestock surveillance and control, and to enhance both awareness and self-protection capacity among high-risk groups.

ObjectiveTo explore the mechanism through which Gantou Fumu decoction （GDFMT）-containing serum inhibits the activation of hepatic stellate cells. MethodsSerum pharmacology techniques were employed to prepare GDFMT-containing serum samples. Rat hepatic stellate cells （HSCT6） were randomly allocated into three groups： Control， penicillamine （90 mg·kg^-1）， and GDFMT （6.8 g·kg^-1）. Cell viability was assessed by the cell counting kti-8 （CCK-8） assay， intracellular ROS levels were determined by flow cytometry using the DCFH‑DA fluorescent probe and while extracellular collagen Ⅰ （ColⅠ） levels were quantified via enzyme linked immunosorbent assay （ELISA）. Intracellular α-smooth muscle actin （α-SMA） expression was visualized through immunofluorescence staining. Real-time polymerase chain reaction（Real-time PCR） and Western blot were performed to evaluate alterations in the expression of nuclear factor-erythroid 2-related factor 2 （Nrf2）， glutamate cysteine ligase， catalytic （GCLC）， glutamate-cysteine ligase， modifier subunit （GCLM）， Kelch-like ECH-associated protein 1 （Keap1）， NAD（P）H：Quinone oxidoreductase 1 （NQO1）， and heme oxygenase-1 （HO-1）. Genetic knockdown of Nrf2 was achieved through small interfering （siRNA） transfection to validate pathway specificity. ResultsCCK-8 data indicated that under the selected experimental conditions， culturing HSCT6 cells with 10% （volume fraction） GDFMT-containing serum for 48 h demonstrated equivalent effect in inhibiting HSCT6 cell proliferation compared with culturing HSCT6 cells with 10% （volume fraction） penicillamine-containing serum for 36 h， with no statistically significant difference between the two groups. After treatment of HSCT6 cells with siRNA-mediated Nrf2 gene transfection technique， the inhibitory effect of GDFMT on the activation process of HSCT6 cells was significantly weakened. After HSCT6 cells were cultured with GDFMT-containing serum for 48 h， the flow cytometry with a fluorescence probe showed that the content of reactive oxygen species （ROS） in the cells was significantly reduced. After the expression level of the Nrf2 gene in HSCT6 cells was knocked down by siRNA transfection， the content of ROS increased （P<0.01）， indicating that GDFMT significantly reduced the ROS level in activated HSCT6 cells， and this effect strictly depended on the integrity of the Nrf2 pathway. Quantitative analysis by ELISA showed that the synthesis of ColⅠ in the HSCT6 cell culture system treated with GDFMT-containing serum for 48 h was lower than that in the control group （P<0.01）. After the Nrf2 gene level of HSCT6 cells was knocked down by siRNA transfection， the ColⅠ concentration in the culture supernatant increased （P<0.01）. The results of α-SMA detection by IF method showed that compared with the normal group， GDFMT-containing serum reduced the expression of α-SMA （P<0.01） and the protein level of α-SMA in HSCT6 cells was increased （P<0.01） after siRNA-mediated Nrf2 silencing， suggesting that Nrf2 signaling pathway may be involved in regulating the phenotypic transformation process of the cells. Real-time PCR and Western blot results showed that GDFMT-containing serum reduced the protein level of α-SMA （P<0.01） and enhanced the gene and protein levels of Nrf2 in the nucleus and GCLC， HO-1， Keap1， GCLM， and NQO1 in the cytoplasm of HSCT6 cells （P<0.05， P<0.01）. After the Nrf2 gene level of HSCT6 cells was knocked down by siRNA transfection， the protein level of α-SMA was increased （P<0.01）， and the levels of GCLC， GCLM， Keap1， NQO1， and HO-1 were decreased （P<0.05， P<0.01）. These results indicated that GDFMT-containing serum successfully triggered the Nrf2 signaling pathway of HSCT6 cells. ConclusionThe anti-hepatic fibrosis effect of 10%GDFMT was equivalent to that of penicillamine. In addition， GDFMT can inhibit HSC activation and reduce oxidative stress damage by activating the Nrf2/antioxidant response element （ARE） pathway， as manifested by the up-regulated expression of Nrf2 and downstream antioxidant genes （GCLC， GCLM， HO-1， Keap1， and NQO1） and reduced secretion of ROS， α-SMA， and ColⅠ.

At present, the incidence and mortality rate of severe acute pancreatitis is 15%-20% and about 20%, respectively, which can lead to local and systemic complications of patients and huge medical costs. The occurrence of acute pancreatitis is closely related to inflammatory response. This article reviews the progress of anti-inflammation therapy and immunotherapy of acute pancreatitis, aiming to provide reference for treatment in patients with acute pancreatitis.

Objective To explore the application effect of key point nursing from the perspective of cluster analysis in preventing complications among patients with acute myocardial infarction(AMI)undergoing percutaneous coronary intervention(PCI).Methods A total of 97 AMI patients who un-derwent PCI in the cardiology department of our hospital from March 2022 to October 2023 were se-lected and divided into control group with 51 patients(March to December 2022)and observation group with 46 patients(January to October 2023)based on their admission time.The control group received routine nursing,while the observation group received key point nursing from the perspective of cluster analysis.The emergency nursing conditions,occurrence of complications during hospitaliza-tion,major adverse cardiovascular events(MACE),and satisfaction of patients were compared be-tween the two groups.Results The door-to-balloon(D2B)time,results of time to myocardial injury markers,and length of hospital stay were shorter in the observation group than those in the control group(P＜0.05).The incidence rates of reperfusion arrhythmia during surgery,total vascular com-plications after surgery,unplanned extubation,and total MACE within 6 months after surgery were lower in the observation group than those in the control group(P＜0.05).The overall satisfaction rate with nursing in the observation group was 95.65％(44/46),which was higher than 82.35％(42/51)in the control group(P＜0.05).Conclusion Key point nursing from the perspective of cluster analysis can shorten the rescue time and length of hospital stay for patients undergoing PCI,reduce the incidence of vascular complications and MACE during hospitalization,and improve satis-faction of patients.

Objective To investigate the effect of APOE4 in regulating LRP1 and on β-amyloid protein Aβ25-35-induced oxidative stress and inflammatory response in astrocytes.Methods Human astrocytes were transfected with sh-NC,sh-APOE4,pcDNA-NC,and pcDNA-LRP1,and then induced with 10 μM Aβ25-35 for 24 h to establish an AD cell model.The roles of APOE4 and LRP1 in Aβ25-35-induced oxidative stress and inflammatory response were assessed using Western blot,flow cytometry,the detection kits of MDA,SOD,and GSH,as well as enzyme-linked immunosorbent assay(ELISA)kits for TNF-α,IL-6,and IL-1β.The protein-protein interaction between APOE4 and LRP1 was detected through co-immunoprecipitation and western blot experiments.Results Aβ25-35 induction upregulated APOE4 expression(P<0.01),promoted the levels of ROS(P<0.001),MDA(P<0.001),and inflammatory cytokines TNF-α,IL-6,and IL-1β(P<0.001)in astrocytes,while inhibited the expression of SOD,GSH,and LRP1(P<0.001).Knockdown of APOE4 or overexpression of LRP1 suppressed the Aβ25-35-induced increase in ROS,oxidative stress markers,and inflammatory cytokines in cells(P<0.05).APOE4 negatively regulated LRP1 protein expression through protein-protein interactions.The levels of ROS,MDA,and inflammatory cytokines were higher(P<0.05),and the concentrations of SOD and GSH were lower(P<0.001),in cells with simultaneous knockdown of APOE4 and LRP1 compared to those with APOE4 knockdown alone.Conclusion Knockdown of APOE4 attenuates Aβ25-35-induced oxidative stress and inflammatory response in astrocytes by upregulating LRP1.

Objective To analyze the difference of CT features between hyperlipidemic acute pancreatitis (HLAP) and acute biliary pancreatitis (ABP). Methods Retrospective analysis was performed on 66 HLAP patients and 96 ABP patients admitted to East Hospital Affiliated to Tongji University from January 2018 to December 2019. The clinical data and CT features of patients between the two groups were compared. Results There were statistically significant differences in the clinical data and CT grades (A-E) between the HLAP group and the ABP group (P＜0.01). ABP group showed more swelling and effusion in pancreatic body and tail (58.3%), 16.7% of swelling and effusion in whole pancreas, but rare swelling and effusion located in pancreatic head and neck alone (3.1%). The HLAP group showed more swelling and effusion in whole pancreas (48.5%), 39.4% of swelling and effusion in pancreatic head and neck, but rare swelling and effusion located in pancreatic body and tail alone (12.1%). Conclusions CT features of HLAP are significantly different from the ABP, which may be useful for early precise diagnosis and treatment for HLAP.

Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice.Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol.The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute(CLSI)M100 31st ed in 2021.Results Over the seven-year period(2015-2021),the overall prevalence of carbapenem-resistant Enterobacterales(CRE)was 9.43％(62 342/661 235).The prevalence of CRE strains in Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae was 22.38％,9.73％,and 8.47％,respectively.The prevalence of CRE strains in Escherichia coli was 1.99％.A few CRE strains were also identified in Salmonella and Shigella.The CRE strains were mainly isolated from respiratory specimens(44.23±2.80)％,followed by blood(20.88±3.40)％and urine(18.40±3.45)％.Intensive care units(ICUs)were the major source of the CRE strains(27.43±5.20)％.CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents.The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates.Conclusions The prevalence of CRE strains was increasing from 2015 to 2021.CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice.Clinicians should prescribe antimicrobial agents rationally.Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs,and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.

Objective To characterize the changing species distribution and antibiotic resistance profiles of respiratory isolates in hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Methods Commercial automated antimicrobial susceptibility testing systems and disk diffusion method were used to test the susceptibility of respiratory bacterial isolates to antimicrobial agents following the standardized technical protocol established by the CHINET program.Results A total of 589 746 respiratory isolates were collected from 2015 to 2021.Overall,82.6％of the isolates were Gram-negative bacteria and 17.4％were Gram-positive bacteria.The bacterial isolates from outpatients and inpatients accounted for(6.0±0.9)％and(94.0±0.1)％,respectively.The top microorganisms were Klebsiella spp.,Acinetobacter spp.,Pseudomonas aeruginosa,Staphylococcus aureus,Haemophilus spp.,Stenotrophomonas maltophilia,Escherichia coli,and Streptococcus pneumoniae.Each microorganism was isolated from significantly more males than from females(P＜0.05).The overall prevalence of methicillin-resistant S.aureus(MRSA)was 39.9％.The prevalence of penicillin-resistant S.pneumoniae was 1.4％.The prevalence of extended-spectrum β-lactamase(ESBL)-producing E.coli and K.pneumoniae was 67.8％and 41.3％,respectively.The overall prevalence of carbapenem-resistant E.coli,K.pneumoniae,Enterobacter cloacae,Pseudomonas aeruginosa,and Acinetobacter baumannii was 3.7％,20.8％,9.4％,29.8％,and 73.3％,respectively.The prevalence of β-lactamase was 96.1％in Moraxella catarrhalis and 60.0％in Haemophilus influenzae.The H.influenzae isolates from children(＜18 years)showed significantly higher resistance rates to β-lactam antibiotics than the isolates from adults(P＜0.05).Conclusions Gram-negative bacteria are still predominant in respiratory isolates associated with serious antibiotic resistance.Antimicrobial resistance surveillance should be strengthened in clinical practice to support accurate etiological diagnosis and appropriate antimicrobial therapy based on antimicrobial susceptibility testing results.

Objective:To explore the clinical features, histopathological morphology, and differential diagnosis of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers.Methods:From 2020 to 2021, 4 cases of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers diagnosed in Fujian Cancer Hospital (2 cases) and the Second Affiliated Hospital of Fujian Medical University (2 cases) were collected. Different ancillary procedures such as HE, special stains, immunohistochemistry, and in situ hybridization techniques were used to assess the histopathological features and immunophenotypes. The clinical data were collected and literature was reviewed.Results:All 4 cases of lymphoepithelioma-like carcinoma with abnormal expression of follicular dendritic cell markers were male. They were 32, 45, 67 and 39 years old, respectively. The main clinical manifestations were bloody phlegm, abdominal pain, fatigue and anorexia. The clinical stages at diagnosis were stage Ⅳ (3 cases) and stage Ⅱ (1 case). Cases 2 and 3 had two pathological examinations at different sites, with a total of six pathological examinations. The histomorphology showed singly scattered or nests of tumor cells in a background of abundant small lymphocytes. The tumor cells were enlarged and pleomorphic, some appeared polygonal with inconspicuous cell borders, and they were arranged in a syncytial pattern. There were megakaryocytes, multinucleated tumor cells, and a few spindle-shaped cells seen. Atypical mitosis was commonly noted. By immunohistochemistry, the tumor cells were positive for CKpan(5/6), CK8/18(4/4), CAM5.2(2/5), CK-H(0/4), CK-L(3/4), EMA(4/5), CK5/6(3/6), p63(1/6), p40(1/6), E-cadherin (4/6), SSTR2(6/6), PD-L1(5/5), LCA(0/6), vimentin(5/6), CD2 (6/6), CD23(6/6), CD35(5/6), CXCL-13(4/5) and D2-40(1/5). The Ki-67 proliferative index was 60%-95%. In situ hybridization for EBER were all positive (6/6). Special stain for reticulin showed positive staining surrounding nests of tumor cells.Conclusions:The expression of follicular dendritic cell markers in lymphoepithelioma-like carcinoma is very rare, which may be related to EBV infection. Occasionally, it can overlap with follicular dendritic cell sarcoma by morphology and immunophenotype, which can lead to misdiagnosis. Only by combining clinical information, morphological characteristics and immunophenotype can an appropriate diagnosis be made.

Objective To observe the effect of human umbilical cord mesenchymal stem cell-derived exo-somes(HUC-MSC-Exo)on microglial polarization in neonatal rats with white matter injury(WMI).Methods Three-day-old Sprague-Dawley rats were randomly divided into sham group(Sham),hypoxia-ischemia group(HI)and HUC-MSC-Exo group,with 12 rats in each group.Unilateral common carotid artery ligation combined with hy-poxia(8％oxygen and 92％nitrogen)was used to construct a WMI rat model.Exosomes were extracted by ultra-high-speed centrifugation and characterized by nanoflow cytometry,western blot experiments and transmission electron mi-croscopy.Brain stereotaxic-assisted inferior ventricular transplantation exo(2×108 particles/μL)was performed and brain tissue samples were collected 14 days after HI.Hematoxylin-eosin(HE)staining was used to observe morpho-logical changes of brain tissue.Nissl staining was used to observe Nissl body formation in brain tissue;Luxol fast blue(LFB)staining was used to observe the formation of myelin sheath in brain tissue.Immunofluorescence staining was used to observe the localized expression of ionic calcium binds adaptor molecule 1(Iba1).The protein expres-sion levels of cluster of differentiation 86(CD86),inducible nitric oxide synthase(iNOS),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),CD206,arginase-1(Arg-1),IL-10 and transforming growth factor-β(TGF-β)were detected by western blot.Results The results of nanoflow cytometry,western blot and transmission electron microscopy showed that the diameter of HUC-MSC-Exo particles was between 30 and 150 nm,and the oval-like shape and membrane-like structure were visible,and the exo markers CD9,CD63 and TSG101 were positive,while calnexin was negative.HE staining,Nissl staining and LFB staining showed that compared with the Sham group,the HI group had brain tissue structure destruction,which was manifested by cell morphological changes,nerve fiber ar-rangement disorder and vacuolation,Nissl body dissolution or even disappearance,and myelination was blocked.HUC-MSC-Exo significantly reversed the pathological changes in the HI group.The results of immunofluorescence staining and western blot showed that the microglial marker Iba1 was mainly expressed in the subventricular zone(SVZ),and the expression of Iba1 protein in the SVZ region increased after HI compared with the Sham group(t=15.95、20.31,P<0.01).HUC-MSC-Exo significantly reduced the expression of Iba1 protein in the HI group(t=10.35、11.01,P<0.01).The results of western blot showed that the expressions of M1 microglia markers(CD86 and iNOS)and pro-inflammatory cytokines(TNF-α and IL-1β)were significantly increased after HI(t=10.98、7.68、15.13、13.13,both P<0.01),and the expressions of M2 microglia markers(CD206 and Arg-1)and anti-inflammatory cytokines(IL-10 and TGF-β)were also increased after HI(t=14.26、9.38、8.82、7.42,both P<0.01).HUC-MSC-Exo decreased the protein expression of CD86,iNOS,TNF-α and IL-1β(t=9.79、5.81、8.06、7.03,all P<0.01)and increased the protein expression levels of CD206,Arg-1,IL-10 and TGF-β compared to the HI group(t=12.90、8.16、8.98、9.49,both P<0.01).Conclusion HUC-MSC-Exo attenuates WMI in neonatal rats by regulating microglial polarization.