Objective To explore the clinical value of serum stromal cell-derived factor-1(SDF-1)and macro-phage inflammatory protein-1α(MIP-1α)in predicting biliary tract infection after endoscopic retrograde cholangiopancreatography(ERCP)stone removal in patients with common bile duct stones.Methods From January 2022 to January 2024,100 patients with common bile duct stones who underwent ERCP stone removal surgery in Pingdingshan First People's Hospital were collected.They were grouped into an infection group(12 cases)and a non-infection group(88 cases)based on whether biliary tract infection occurred after surgery.The general information of patients in the two groups was compared.ELISA method was used to measure the levels of serum SDF-1 and MIP-1α.Spearman method was applied to analyze the correlation between the severity of infec-tion and serum level of SDF-1 and MIP-1α.ROC curve was applied to analyze the value of serum SDF-1 and MIP-1α to predict biliary tract infection after ERCP stone removal in patients with common bile duct stones.Results A total of 36 strains of pathogenic bacteria were detected in the biliary drainage fluid samples of the infection group,among which Gram-negative bacteria accounted for 55.56%and Gram-positive bacteria accounted for 44.44%.The infection group showed significantly higher serum levels of SDF-1 and MIP-1α(P＜0.05).As the infection wors-ened,SDF-1 and MIP-1α levels progressively increased(P＜0.05).The severity of biliary tract infection was sig-nificantly positively correlated with both serum SDF-1 and MIP-1α levels(P＜0.05).For predicting biliary tract in-fection,SDF-1 and MIP-1α exhibited AUC values of 0.761 and 0.825,sensitivities of 63.33%and 66.67%,and specificities of 83.33%and 83.33%,respectively.When combined,the predictive AUC reached 0.977,with a sensitivity of 83.33%and a specificity of 98.33%.Conclusions Serum level of SDF-1 and MIP-1α are significant-ly elevated in patients with common bile duct stones and biliary tract infections after ERCP stone removal surgery,showing a positive correlation with the severity of the infection.The combination of these two biomarkers demon-strates excellent predictive efficacy for postoperative infection.

Objective:To evaluate cerebrospinal fluid (CSF) flow dynamics and volume changes of pulsatile tinnitus (PT) patients induced by sigmoid sinus wall dehiscence (SSWD) using MRI.Methods:This was a cross-sectional study. Totally 55 SSWD-PT patients, and 35 age- and sex-matched healthy controls were prospectively enrolled at Beijing Tongren Hospital, Capital Medical University from October 2019 to September 2023. The CSF at the midbrain aqueduct level was analyzed based on phase-contrast MRI to obtain the flow dynamics information. Based on T 1-weighted turbo field echo sequence, the CSF was segmented and the volume of CSF was calculated using ITK-SNAP software. The Mann-Whitney U test was used to compare the differences of each parameter between the two groups. Binary logistic regression was used to analyze the parameters with statistically significant differences to obtain the independent influencing factors of SSWD-PT and establish the combined parameters. Receiver operating characteristic curve analysis was used to evaluate the efficacy of diagnosing SSWD-PT. Results:Compared with controls, the SSWD-PT group showed significantly decreased mean flux (MF), mean velocity, peak velocity( P<0.05), and significantly increased regurgitant fraction (RF), CSF volume ( P<0.05). No significant differences were observed in forward flow volume, backward flow volume, and stroke volume ( P>0.05). The logistic regression results showed that MF ( OR=0.497, 95% CI 0.305-0.808, P=0.005) and RF ( OR=1.809, 95% CI 1.040-3.147, P=0.036) were independent influencing factors of SSWD-PT. The area under the curve (AUC) of MF and RF for diagnosing SSWD-PT were 0.641 (95% CI 0.517-0.766) and 0.675 (95% CI 0.564-0.786), respectively. The AUC of the combination of MF and RF was 0.724 (95% CI 0.614-0.833). Conclusions:SSWD-PT patients have abnormal changes in CSF flow dynamics and volume. The MF and RF demonstrate moderate diagnostic value for diagnosing SSWD-PT.

Objective:To investigate the clinical features of patients with congenital atresia of the oval window (CAOW).Methods:A retrospective analysis was conducted on 7 cases (8 ears) of surgically confirmed CAOW treated at our department from July 2018 to July 2024. Among the cases, 1 patient had bilateral CAOW, and 4 patients had unilateral CAOW combined with other types of ossicular chain malformations in the contralateral ear. We collected and analyzed the clinical data, audiological features, and temporal bone HRCT results of all patients.Results:The 7 patients were diagnosed at ages ranging from 8 to 19 years, with a mean age of (13.2±6.9) years. None of the patients exhibited significant auricular deformities. All presented with conductive hearing loss or mixed hearing loss predominantly of the conductive type, with an intact tympanic membrane. The diagnosis of CAOW was confirmed via endoscopic tympanotomy, revealing a concave oval window area on the medial wall of the tympanic cavity, sealed by a bony plate. All 8 ears exhibited additional ossicular chain deformities. Stapes absence was present in all 8 ears. Partial absence of the incus long process was observed in 3 ears, while, abnormal bony connections between the incus long process and the promontory were seen in 4 ears, 1 ear had a short malleolar handle, 1 ear had a smaller than normal malleus volume. In addition, facial nerve deformities were found in 6 ears, with 4 ears showing bifurcation of the facial nerve and 2 ears showing facial nerve obscuration of the oval window. Pure-tone audiometry revealed that 62.5% (5/8 ears) of patients had air conduction (AC) thresholds≥60 dB preoperatively, with a mean pure-tone average (PTA) of (69.0±11.8) dB HL and a mean air-bone gap (ABG) of (52.0±7.0) dB. The mean AC threshold and ABG were higher in the low-frequency (125-1 000 Hz) range compared to the high-frequency (2 000-8 000 Hz) range (both P<0.05). Preoperative HRCT showed abnormalities in all patients, with 7 ears being diagnosable as CAOW. Although the remaining 1 ear could not be diagnosed as CAOW, stapes and incus long process absence were detected. Conclusion:CAOW is rare in clinical, as the patients with non-progressive conductive hearing loss (AC≥60 dB, ABG≥50 dB) since childhood, intact tympanic membrane without malformations of auricle and external auditory canal, and thick bony plate covered the oval window of the HRCT imaging, CAOW should be highly suspected, which could be confirmed by the exploratory tympanotomy.

Objective To explore the impact of antimicrobial volume-based procurement(VBP)and classification management policy on the clinical use of carbapenem antibiotics.Methods Changing trend in defined daily doses(DDDs),procurement cost(Cost),defined daily dose cost(DDDc),and DDDs per 1 000 inhabitants daily(DID)of carbapenem antibiotics in all levels of medical institutions were analyzed by Mann-Kendall trend test.May 1,2020 was taken as the intervention cut-off point of VBP policy,September 2021 was as intervention cut-off point of cla-ssification management list.The impact of VBP and classification management policy on the clinical use of carbape-nem antibiotics were studied by interrupted time series analysis.Results After implementing VBP policy,the DDDs and DID of carbapenem antibiotics increased obviously,but the long-term trend didn't change significantly.Compared with before the implementation of the policy,the cost and DDDc of carbapenem antibiotics decreased im-mediately,the long-term trend of DDDc changed significantly,but the long-term trend of cost didn't change signifi-cantly.The DDDs and Cost of carbapenem antibiotics decreased immediately after the update of classification ma-nagement list,but the long-term downward trend was not significant,and DDDc presented a long-term upward trend.Conclusion VBP policy reduces the DDDc and short-term cost of carbapenem antibiotics,but its long-term impact on DDDs,cost and DID is limited.Classification management has limited impact on the use of carbapenem antibiotics in medical institutions.

Objective To investigate the impact of chronic observational social defeat stress on multidimensional behaviors in female mice,including social interaction,emotion,and cognition,as well as the underlying molecular mechanisms.Methods Adult female C57BL6N mice were divided into a stress group and a control group.Behavioral assessment were conducted through social interaction tests,anxiety-like behavior tests,and cognitive tests(novel object recognition and spatial memory).Synaptic plasticity-related proteins in the hippocampus were detected using Western blot.Results Behavioral tests revealed that the stress group showed reduced social interaction time compared to the control group[(106.2±9.31)s vs.(156.5±14.81)s,P<0.05].In a novel environment,the stress group consumed less food than the control group[(0.10±0.01)g vs.(0.16±0.02)g,P<0.05].Cognitive tests demonstrated that the stress group exhibited impaired novel object recognition[(52.17%%±2.67%)vs.(65.91%±5.23%)]and spatial memory[(61.84%±3.14%)vs.(74.13%±1.94%)]compared to the control group(P<0.05).Western blot analysis showed that the expression of hippocampal synaptic plasticity-related proteins,including the glutamate ionotropic receptor N-methyl-D-aspartate(NMDA)receptor subunit NR2A[(0.66±0.05)vs.(0.89±0.08)]and brain-derived neurotrophic factor(BDNF)[(0.81±0.05)vs.(1.14±0.06)],was significantly decreased in the stress group(P<0.05).Conclusion Chronic observational social defeat stress induces social withdrawal,anxiety-like behaviors,and cognitive deficits in female mice.These effects may be associated with reduced expression of NR2A and BDNF in the hippocampus.

Glioblastoma (GBM) is the most aggressive malignant tumor of the adult central nervous system, with limited treatment options and poor prognosis. Radiotherapy (RT) remains a cornerstone of GBM treatment; however, tumor cell resistance to RT severely limits its efficacy. Recently, metabolic reprogramming (MR) has gained widespread attention as a critical mechanism enabling GBM cells to evade RT‐induced stress. In this review, the central roles of glucose, lipid, and amino acid metabolic reprogramming in GBM's resistance to RT were outlined, highlighting how GBM remodels metabolic pathways to enhance DNA damage repair, antioxidant defenses, and immune evasion after RT. Although combining metabolic inhibitors with RT has shown potential in improving GBM treatment outcomes, challenges such as overcoming the blood‐brain barrier and addressing tumor heterogeneity remain. The integration of nanomedicine‐based delivery systems and immunotherapy offers new hope for GBM treatment. Future research should focus on developing multidimensional, personalized metabolic targeting strategies, combined with immunotherapy and emerging technologies, to further improve therapeutic outcomes and survival rates for GBM patients.

OBJECTIVE To study the anatomic characteristics of the anterior ethmoidal canal(AEC)based on 0.1 mm ultra-high resolution CT.METHODS Nine cadavers(18 side orbits)fixed in 10%buffered formalin were enrolled and underwent U-HRCT and MSCT.Divided AEC into horizontal,superior oblique,and inferior oblique segments and observed the displaying rate of each section.Subjective evaluation of display situation was performed by two experienced radiologists independently.The diameter of each AEC segment was measured.RESULTS No significant difference was found in the display rate of the horizontal and superior oblique segments between U-HRCT and MSCT groups(P>0.05),the display rate of inferior oblique segment of U-HRCT group was significantly higher than MSCT group(P<0.05).There was no significant difference in the objective evaluation results between two evaluators and consistency was strong.Subjective scores of each segment of AEC in U-HRCT group were 10.00 points(9.75 points,10.00 points),2.00 points(2.00 points,3.00 points)and 8.00 points(6.00 points,10.00 points),in MSCT group were7.00 points(5.75 points,8.00 points),2.00 points(2.00 points,2.00 points)and 2.00 points(2.00 points,4.00 points).Subjective scores of horizontal and inferior oblique segments of AEC in U-HRCT were higher than MSCT(P<0.05).The anteroposterior diameter of the horizontal section of AEC is(0.92±0.12)mm,the axial diameter is(1.04±0.22)mm.The anteroposterior diameter of the inferior oblique segment is(0.47±0.08)mm,and the transverse diameter is(0.50±0.06)mm.The anteroposterior diameter of the superior oblique segments is(0.66±0.11)mm,and the transverse diameter is(0.72±0.20)mm.CONCLUSION U-HRCT is better to evaluate AEC than MSCT.It could be used to help to study the anatomic characteristics of AEC before surgery to avoid complications.

OBJECTIVE To evaluate cerebrospinal fluid(CSF)flow dynamics and volume changes of pulsatile tinnitus(PT)patients caused by sigmoid sinus wall dehiscence(SSWD)with different intracranial pressure via MRI.METHODS Prospective enrolled 35 SSWD-PT patients with intracranial hypertension,25 SSWD-PT patients with normal intracranial pressure and 35 age-,sex-matched healthy controls.Demographic characteristics were recorded.Intracranial pressure was assessed by the index of transverse sinus stenosis(ITSS)and morphology changes.CSF flow dynamics were evaluated via phase-contrast magnetic resonance imaging(PC-MRI)and CSF volume were evaluated via three-dimensional T1-weighted turbo field echo(3D T1-TFE)sequence and ITK-SNAP software.Compared the differences of each index between three groups.RESULTS The mean flux and regurgitant fraction were significantly different among the three groups(P<0.05).The intracranial hypertension group presented significantly decreased mean flux(MF)and significantly increased regurgitant fraction(RF)compared to controls(P<0.017).There were no significant differences in MF and RF of normal intracranial pressure group compared with intracranial hypertension group and control group(P>0.017).There were no statistical differences in age,sex,body mass index,forward flow volume,backward flow volume,mean velocity,peak velocity,stroke volume and CSF volume(P>0.05).CONCLUSION SSW D-PT patients have abnormal changes in CSF,and those with increased intracranial pressure are more obvious.These changes may be associated with abnormal hemodynamics in the sigmoid sinus and the occurrence of PT.

The sound generation and conduction of pulsatile tinnitus(PT)caused by sigmoid sinus wall dehiscence(SSWD)are closely related to abnormal blood flow and intracranial pressure,sigmoid plate and temporal bone air cells.Clarifying the mechanism of tinnitus is the premise of targeted treatment.This article reviews the research progress on the mechanism of SSWD-PT.

Objective:To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) for pyogenic spinal infections.Methods:A total of 255 patients diagnosed with pyogenic spinal infections were enrolled between September 2022 and September 2024 at Qingdao University Affiliated Hospital, Fuzhou Second General Hospital, First Affiliated Hospital of Nanchang University, Shandong University Affiliated Public Health Clinical Center, and the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Among them, 155 were male and 100 were female, with an average age of 62.5±14.2 years (ranging from 13 to 90 years). All patients had samples of infected tissue and/or pus collected for microbial culture and mNGS testing. The number, types, and positive rates of pathogens detected by microbial culture and mNGS were compared. Using culture results as the gold standard, receiver operating characteristic (ROC) curve analysis was performed for mNGS testing and the combined method of mNGS and microbial culture, calculating the area under the curve (AUC) and 95% CI. Results:All 255 cases were clinically diagnosed as pyogenic spinal infections, with 194 cases providing microbiological evidence. The most common Gram-positive bacterium was Staphylococcus aureus, while the most common Gram-negative bacterium was Escherichia coli. A total of 33 pathogenic microorganisms were detected by mNGS, while microbial culture detected 18 pathogenic microorganisms. The positive rate of mNGS was 72.2% (184 out of 255), which was significantly higher than that of 30.2% (77 out of 255) for microbial culture, showing a significant difference (χ 2=90.150, P<0.001); the positive rate of mNGS combined with microbial culture was 76.1% (194 out of 255) with significant difference compared to mNGS alone (χ 2=8.100, P<0.001). Among 178 culture-negative samples, the detection rate of mNGS was 65.7% (117 out of 178); among 77 culture-positive samples, the detection rate of mNGS was 87.0% (67 out of 77), and 97.0% (65 out of 67) of the detected pathogens matched the culture results at the species level. The AUCs of the ROC curves for mNGS testing and the combination of mNGS with microbial culture were 0.606 [95% CI (0.534, 0.678)] and 0.671 [95% CI (0.606, 0.736)], respectively, with significant differences compared to microbial culture ( P=0.007; P=0.007). Conclusions:mNGS demonstrates superior performance over conventional culture in identifying pathogens in pyogenic spinal infections. Moreover, combining mNGS with culture further improves diagnostic yield, supporting its integration into clinical practice.