Objective:To evaluate the effect of value orientation brief therapy(VBT)combined with selective serotonin reuptake inhibitors(SSRIs)on clinical symptoms,rumination,decision-making ability,and cognitive func-tion in patients with mild to moderate depression.Methods:Eighty patients meeting the DSM-5 diagnostic criteria for mild to moderate depression were randomly assigned to either a medication(SSRIs)group(36 completed)or a VBT combined group(38 completed)for a 6-week intervention.Baseline and post-intervention assessments includ-ed the Hamilton Depression Scale(HAMD),Hamilton Anxious Scale(HAMA),Ruminative Response Scale-Chi-nese Version(RRS-CV),Iowa Gambling Test(IGT),number of eye fixation(NEF),responsive search score(RSS)in exploratory eye trajectory movement were used to evaluate patients'anxiety and depression symptoms,ru-minative thinking,decision-making function,and cognitive function.Results:The VBT combined group showed sig-nificantly better therapeutic effects than the medication group(P＜0.05).Compared to baseline and the medication group,the VBT combined group had significantly lower post-intervention scores in HAMD,HAMA,symptom rumi-nation,introspective reflection,compulsive meditation,and RRS-CV total scores after intervention(Ps＜0.05),and significantly higher scores in IGT net profit scores,NEF,and RSS scores(Ps＜0.05).Compared with the medica-tion group,the VBT combined group demonstrated a greater reduction in HAMD,HAMA,symptom rumination,in-trospective reflection,compulsive meditation,and RRS-CV total scores before and after intervention(Ps＜0.05),and a larger increase in IGT net profit scores,NEF,and RSS scores(Ps＜0.05).Conclusion:VBT combined with SSRIs effectively improves the symptoms of depression,anxiety,decision-making ability,rumination thinking,and cognitive function in patients with mild to moderate depression.

The drug resistance of the carbapenem-resistant Enterobacteriaceae(CRE)strains was mainly induced by multiple approaches such as production of carbapenemases,increase of bacterial outer membrane permeability,activation of active efflux pump system,formation of biofilm and drug modifying mechanisms.Those mecha-nisms involve deletion,mutation,insertion and posttranscriptional modification of relevant encoding genes,which may affect the susceptibility of the CRE strains to antibiotics.At present,the conventional clinical thera-pies include the use of traditional antibiotics,either the one-drug use or combined use of drugs.The development of novel antibacterial therapy is under way.The epidemiological characteristics of CRE infections,drug resist-ance mechanisms,current and prospective treatment strategies for CRE infections(covering new application of the drugs in available,the novel drugs such as ceftazidime/avibactam,meropenem/vaborbactam and imipenem/rele-bactam)were deeply reviewed in this article,so as to provide reliable reference for clinical prevention,control and treatment of CRE infections.

Objective:To explore the influence of value orientation brief therapy (VBT) on anxiety and depression symptoms, social function, coping style and self-acceptance level of major depressive disorder adolescents with anxious distress.Methods:From June 2021 to June 2022, seventy adolescent major depressive disorder patients with anxious distress were included in the study, who were randomly divided into study group(35 people, 31 people completed)and control group (35 people, 30 people completed). The study group was given routine treatment combined with VBT, while the control group was given routine treatment only. Before and after treatment, Hamilton anxiety scale(HAMA), Hamilton depression scale (HAMD), social disability screening schedule (SDSS), coping style questionnaire(CSQ) and self-acceptance questionnaire (SAQ) were used to evaluate the two groups, and SPSS 26.0 software was used to statistically analyze the data of the two groups. Paired sample t-test was used for intra-group comparison, and independent sample t-test was used for inter-group comparison. Results:After 6 weeks of treatment, the scores of HAMA((6.03±3.58) vs (14.03±7.06), t=5.55, P<0.01), HAMD((8.77±5.52 ) vs (16.50±7.59), t=4.56, P<0.01)and SDSS((4.23±1.50) vs (6.63±0.96), t=7.43, P<0.01)in the study group were significantly lower than those in the control group, the differences were statistically significant. The scores of self-acceptance((19.23±1.33) vs (13.47±1.46), t=-16.12, P<0.01)and self-evaluation ((19.87±2.87) vs (12.77±1.68), t=-11.75, P<0.01) in the SAQ scale and the scores of problem-solving((8.71±2.30) vs (6.23±3.45), t=3.31, P<0.05) and rationalization ((6.20±3.11) vs (4.67±2.43), t=2.13, P<0.05) in the CSQ questionnaire were significantly higher than those in the control group, the differences were statistically significant. The total effective rate of the study group(90.3%(28/31) vs 66.7%(20/30), χ2=5.09, P<0.05) was significantly higher than that of the control group, the difference was statistically significant. Conclusion:The effect of routine treatment combined with VBT is better, which can effectively improve anxiety and depression symptoms, social function and coping style, and enhance self-acceptance and self-evaluation in adolescent major depressive disorder patients, which is worthy of clinical application.

The drug resistance of the carbapenem-resistant Enterobacteriaceae(CRE)strains was mainly induced by multiple approaches such as production of carbapenemases,increase of bacterial outer membrane permeability,activation of active efflux pump system,formation of biofilm and drug modifying mechanisms.Those mecha-nisms involve deletion,mutation,insertion and posttranscriptional modification of relevant encoding genes,which may affect the susceptibility of the CRE strains to antibiotics.At present,the conventional clinical thera-pies include the use of traditional antibiotics,either the one-drug use or combined use of drugs.The development of novel antibacterial therapy is under way.The epidemiological characteristics of CRE infections,drug resist-ance mechanisms,current and prospective treatment strategies for CRE infections(covering new application of the drugs in available,the novel drugs such as ceftazidime/avibactam,meropenem/vaborbactam and imipenem/rele-bactam)were deeply reviewed in this article,so as to provide reliable reference for clinical prevention,control and treatment of CRE infections.

Objective:To explore the influence of value orientation brief therapy (VBT) on anxiety and depression symptoms, social function, coping style and self-acceptance level of major depressive disorder adolescents with anxious distress.Methods:From June 2021 to June 2022, seventy adolescent major depressive disorder patients with anxious distress were included in the study, who were randomly divided into study group(35 people, 31 people completed)and control group (35 people, 30 people completed). The study group was given routine treatment combined with VBT, while the control group was given routine treatment only. Before and after treatment, Hamilton anxiety scale(HAMA), Hamilton depression scale (HAMD), social disability screening schedule (SDSS), coping style questionnaire(CSQ) and self-acceptance questionnaire (SAQ) were used to evaluate the two groups, and SPSS 26.0 software was used to statistically analyze the data of the two groups. Paired sample t-test was used for intra-group comparison, and independent sample t-test was used for inter-group comparison. Results:After 6 weeks of treatment, the scores of HAMA((6.03±3.58) vs (14.03±7.06), t=5.55, P<0.01), HAMD((8.77±5.52 ) vs (16.50±7.59), t=4.56, P<0.01)and SDSS((4.23±1.50) vs (6.63±0.96), t=7.43, P<0.01)in the study group were significantly lower than those in the control group, the differences were statistically significant. The scores of self-acceptance((19.23±1.33) vs (13.47±1.46), t=-16.12, P<0.01)and self-evaluation ((19.87±2.87) vs (12.77±1.68), t=-11.75, P<0.01) in the SAQ scale and the scores of problem-solving((8.71±2.30) vs (6.23±3.45), t=3.31, P<0.05) and rationalization ((6.20±3.11) vs (4.67±2.43), t=2.13, P<0.05) in the CSQ questionnaire were significantly higher than those in the control group, the differences were statistically significant. The total effective rate of the study group(90.3%(28/31) vs 66.7%(20/30), χ2=5.09, P<0.05) was significantly higher than that of the control group, the difference was statistically significant. Conclusion:The effect of routine treatment combined with VBT is better, which can effectively improve anxiety and depression symptoms, social function and coping style, and enhance self-acceptance and self-evaluation in adolescent major depressive disorder patients, which is worthy of clinical application.

Objective:To evaluate the effect of value orientation brief therapy(VBT)combined with selective serotonin reuptake inhibitors(SSRIs)on clinical symptoms,rumination,decision-making ability,and cognitive func-tion in patients with mild to moderate depression.Methods:Eighty patients meeting the DSM-5 diagnostic criteria for mild to moderate depression were randomly assigned to either a medication(SSRIs)group(36 completed)or a VBT combined group(38 completed)for a 6-week intervention.Baseline and post-intervention assessments includ-ed the Hamilton Depression Scale(HAMD),Hamilton Anxious Scale(HAMA),Ruminative Response Scale-Chi-nese Version(RRS-CV),Iowa Gambling Test(IGT),number of eye fixation(NEF),responsive search score(RSS)in exploratory eye trajectory movement were used to evaluate patients'anxiety and depression symptoms,ru-minative thinking,decision-making function,and cognitive function.Results:The VBT combined group showed sig-nificantly better therapeutic effects than the medication group(P＜0.05).Compared to baseline and the medication group,the VBT combined group had significantly lower post-intervention scores in HAMD,HAMA,symptom rumi-nation,introspective reflection,compulsive meditation,and RRS-CV total scores after intervention(Ps＜0.05),and significantly higher scores in IGT net profit scores,NEF,and RSS scores(Ps＜0.05).Compared with the medica-tion group,the VBT combined group demonstrated a greater reduction in HAMD,HAMA,symptom rumination,in-trospective reflection,compulsive meditation,and RRS-CV total scores before and after intervention(Ps＜0.05),and a larger increase in IGT net profit scores,NEF,and RSS scores(Ps＜0.05).Conclusion:VBT combined with SSRIs effectively improves the symptoms of depression,anxiety,decision-making ability,rumination thinking,and cognitive function in patients with mild to moderate depression.

Objective:To explore the predictive value of 18F-FDG PET/CT in molecular subtyping of triple-negative breast cancer. Methods:A retrospective analysis was performed on the clinical and imaging data of 227 breast cancer patients who underwent 18F-FDG PET/CT examination in the Tianjin Medical University Cancer Institute & Hospital from January 1, 2010 to December 31, 2022. Based on the expression levels of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) in the primary breast cancer, the patients were categorized into two groups: triple-negative breast cancer (TNBC) and non-TNBC. Radiomic features were extracted from images of both groups, and a radiomic model was constructed to predict the molecular subtype of the TNBC groups. In addition, the clinical data, CT morphological features, and PET metabolic parameters of both groups were compared to determine the indicators with statistically significant differences and develop a comprehensive radiomic model combined with clinical characteristics. Results:Compared to the non-TNBC group, the TNBC groups exhibited more significant invasiveness in terms of tumor diameter, margins, ipsilateral axillary lymph node metastasis, invasion of neighboring skin or papillae, and PET metabolic parameters ( t = -3.19; χ2 = 7.30, 8.10, 5.34; t = 3.80, 3.30, 3.42, P < 0.05). The constructed 18F-FDG PET/CT radiomic model proved effective in predicting the molecular subtype of the TNBC group, and the receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.83 (95% CI 0.78-0.88), an accuracy of 75.9%, a sensitivity of 74.5%, and a specificity of 77.2%. In contrast, the constructed comprehensive radiomic model displayed an AUC of 0.86 (95% CI 0.81-0.90), an accuracy of 77.2%, a sensitivity of 78.6%, and a specificity of 75.9%. Conclusions:18F-FDG PET/CT plays an important role in predicting molecular subtypes of TNBC. The constructed radiomic model and comprehensive radiomic model can further enhance the prediction efficacy of PET metabolic parameters and accelerate the development of accurate treatment protocols in clinical practice, thus improving the prognosis of breast cancer.

Objective:To establish and verify a simple clinical prediction model for obstructive sleep apnea syndrome(OSAS)in children.Methods:The clinical data of 95 children aged 2-12 years underwent polysomnography(PSG)were screened.The subjects with OAHI≤1 were included into non-OSAS group(n=22)and those with OAHI＞1 into OSAS group(n=73).Gender,age,body mass index(BMI),night pulse minimum oxygen saturation(SpO2),tonsil grading and adenoid grading of the 2 groups were compared and analyzed.Binary Logistic regression analysis was used to statistically analyze the data and establish a clinical prediction model for OSAS in children.Results:There was significant difference in age,BMI,SpO2,tonsil grading and adenoid grading between the 2 groups(P＜0.05),there was no significant gender difference(P＞0.05).The model equation was as follows:X=2.366-0.769(age-continuous variable)+0.248(BMI-continuous variable)-3.413(SPO2-continuous variable)+2.104(tonsil grade Ⅲ-Ⅳ"yes").The result of internally validated Hosmer-Lemeshow test was P=0.612(P＞0.05),AUC was 0.821(0.713-0.929,P＜0.01),sensi-tivity was 83.3％,specificity was 76.4％.The accuracy of external validation was 73.8％,the AUC was 0.805(0.664-0.943,P＜0.01),the sensitivity was 84.6％and the specificity was 75％.Conclusion:The predictive model may have good predictive efficacy for 2-12 years old children with OSAS,and may assist clinicians in diagnosing children with OSAS.

Objectives:To analyze the correction of postoperative coronal imbalance in adult degenerative scoliosis patients undergoing spinal fusion surgery,and to explore the impact of leveling of the most tilted vertebra(L4 or L5)in the lumbosacral curve on the correction of coronal imbalance.Methods:A retrospective analysis was conducted on 61 patients(17 male and 44 female;aged 51 to 78 years,mean 63.57±8.41 years;body mass index 15.79-35.55kg/m2,mean 25.83±3.69kg/m2)who underwent degenerative scoliosis correction surgery between January 2019 and March 2023 in Tianjin Union Medical Center.The patients were catego-rized based on the Obeid classification and the length of fusion segments into concave long segment group(17 cases),concave short segment group(15 cases),convex long segment group(15 cases),and convex short seg-ment group(14 cases).Coronal radiographic parameters[Cobb angle,coronal balance distance(CBD),coronal tilt angle]and sagittal radiographic parameters(sagittal vertical axis,thoracic kyphosis,lumbar lordosis,pelvic inci-dence,pelvic tilt,sacral slope)were measured on full spine anteroposterior and lateral X-rays preoperatively and on 3d postoperatively.The postoperative coronal and sagittal imbalance corrections were compared be-tween groups.Pearson correlation analysis was performed to investigate the relationship between the correction ratio of the maximal coronal tilt angle in the lumbosacral curve(L4 or L5)and postoperative CBD.The opera-tive time,blood loss,and visual analogue scale(VAS)pre-and postoperatively were compared between the four groups.Results:The postoperative coronal Cobb angle,CBD,and maximal coronal tilt angle at L4 or L5 of the concave long segment group,convex long segment group,and convex short segment group were statisti-cally different from those before operation(P＜0.05).In the concave short segment group,the postoperative coronal Cobb angle and maximal coronal tilt angle at L4 or L5 were significantly different from those before operation(P＜0.05),while no significant difference was found between pre-and postoperative CBD(P=0.085).Pearson correlation analysis revealed a significant negative correlation(r=-0.570,P＜0.01)between postoperative CBD and coronal tilt correction ratio in the convex group,with the linear regression equation being postoper-ative CBD=32.81-28.38 x coronal tilt correction ratio.When the correction ratio of the maximal coronal tilt angle at L4 or L5 exceeding 45％in convex coronal malalignment patients,it's predicted that the CBD could be corrected to within 20mm.No significant correlation was found between postoperative CBD and the coronal tilt correction ratio in the concave group(r=0.098,P=0.59).Patients in both the convex and concave short segment groups had shorter operative time and less blood loss than long segment groups.Postoperative VAS scores improved significantly in all groups(P＜0.05).Conclusions:In adult degenerative scoliosis patients with convex coronal malalignment,both short and long segment fusions are capable of correcting coronal imbalance.Concave coronal malalignment patients require long segment fusion for the correction of coronal imbalance.To achieve optimal coronal balance in convex coronal malalignment patients,a correction ratio of the maximal coronal tilt angle at L4 or L5 shall exceed 45％.

To investigate the genomic features and perform cluster analysis of Carbapenem-resistant Klebsiella pneumoniae (CRKP) to provide an experimental basis for guiding the prevention and treatment of CRKP infections.A retrospective case-cohort study was conducted on 19 non-redundant CRKP strains isolated from the Tenth Affiliated Hospital of Southern Medical University between January and June 2023. Whole genome sequencing (WGS) and multilocus sequence typing (MLST) were performed to compare genomic features and analyze the resistance genes and homology of the strains.The results showed that the 19 CRKP strains were isolated from 8 different clinical departments, mainly from respiratory specimens. The whole genome sequencing revealed that the genomic lengths of CRKP ranged from 4.90 to 5.85 Mbp, with contigs N50 values>20 kb for each genome. The median overall GC content was 57.0% (50.4%-57.1%). Comparative genomic analysis identified three regions with high genomic variability. WGS detected 32 resistance genes across 11 categories. All 19 strains carried carbapenem resistance genes ( blaKPC-2 and blaOXA-48), blaTEM-1B extended-spectrum β-lactamase resistance genes, qnrS1 quinolone resistance gene, and fosA fosfomycin resistance gene, with each strain carrying only one carbapenemase gene. The detection rate of blaKPC-2 was 94.7% (18/19). MLST identified three sequence types: ST11, ST437 and ST147, with ST11 being predominant (89.5%, 17/19). Clustering analysis based on acquired resistance genes revealed three clonal transmission patterns among strains 72 and 90, and strains 88, 84, 66 and 79.In conclusion, CRKP strains carry multiple resistance genes, and clustering analysis indicating that nosocomial clonal transmission is closely related to acquired resistance genes. The ST11- blaKPC-2 type strain is the predominant clone. Strengthened surveillance and effective control strategies are necessary to reduce nosocomial transmission of CRKP.