Due to the difficulty of overcoming the abnormal epidermal barriers and addressing S. aureus infections without disrupting indigenous skin microbiota, effective treatment of bacterial infection atopic dermatitis (AD) remains a significant clinical challenge. Skin microbiota-derived extracellular vesicles (EVs) shows protentional for skin disease treatment, but the lack of antimicrobial activity and limited skin penetration hamper their application in bacterial infection AD treatment. Here, we developed novel nanoantibiotics by loading Lev into S. epidermidis-derived EVs (Lev@SE-EVs), with supreme antimicrobial activity, regulating epidermal immune responses and enhanced epidermal barrier functionality. The nanoantibiotics were further integrated into hyaluronic acid-based microneedle (MN) for efficient transdermal delivery of therapeutic agents and effectively treating bacterial infection in AD. Upon insertion into the skin, the rapidly released Lev@SE-EVs from MN are uptake by S. aureus in a selective manner, fibroblasts, and surrounding immune cells to exert therapeutic effects in the infected dermal layer, resulting in mitigated skin inflammation, reduced S. aureus burden and increased dermis repair. Notably, Lev@SE-EVs induce IL-17A⁺ CD8⁺ T-cell accumulation in the skin in an unrelated inflammation manner, which may represent heterologous protection. This EVs-integrated MN assisted Lev@SE-EVs to alleviate skin inflammation, repair skin, and provide an effective and safe therapeutic approach for bacterial infection AD treatment.

Objective:To develop and validate a combined model integrating radiomics, dosiomics, and clinical parameters based on CT simulation and dosimetric images in order to predict the occurrence of radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC).Methods:A retrospective study was conducted on the clinic data of 143 NSCLC patients who received radiotherapy at the Affiliated Hospital of Jining Medical University from January 2016 to December 2022. Patients were randomly stratified into a training group ( n = 100) and an internal validation group ( n = 43) at a 7∶3 ratio. Moreover, clinic data were collected from 34 NSCLC patients who received radiotherapy at the Jining Cancer Hospital between January 2019 and December 2022 as an external validation group. All three groups (the training group, internal validation, and external validation groups) were further categorized into two groups based on the RP severity (i.e., RP ≥ grade 2 and RP < grade 2). Their radiotherapy dose, CT simulation, and 3D dose distribution images were collected. Then, the total lung minus planning target volume (TL-PTV) was defined as the region of interest (ROI) for radiomics and dosiomic feature extraction, followed by feature dimensionality reduction. Consequently, key features associated with RP were determined. Four predictive models were developed using machine learning approaches (especially multilayer perceptron, MLP): a clinical model (CM), a radiomics model (RM), a dosiomics model (DM), and a radiomics and dosiomics nomogram (RDN), with a nomogram subsequently constructed. Ultimately, the performance and clinical feasibility of these models were assessed using receiver operating characteristic (ROC), area under the curve (AUC), and decision curve analysis (DCA). Results:A total of 1 834 radiomic features and 1 834 dosiomic features were extracted. Using the occurrence of RP ≥ grade 2 as the marker variable, 14 radiomic features, 15 dosiomic features, and three clinical features were selected from the training group to construct the prediction models (CM, RM, DM, and RDN). The performance and generalizability of these models were subsequently validated in both the internal validation and external validation groups. Specifically, the RDN exhibited AUCs of 0.915 (95% CI: 0.852-0.978), 0.879 (95% CI: 0.777-0.982), and 0.838 (95% CI: 0.701-0.975) in the three groups, respectively. A nomogram was established for RDN by integrating the radiomics score (R-score), dosiomics score (D-score), mean lung dose (MLD), V20, and V30. This nomogram allowed for individualized risk estimation of RP and facilitated personalized radiotherapy planning. Conclusions:The RDN model that is developed based on CT simulation and 3D dose distribution images and integrates radiomics, dosiomics, and clinical features can effectively predict the RP risk of NSCLC patients. The integration of multidimensional data contributes to the formation of the optimal predictive model, offering guidance for clinicians.

To characterize the genomes of different emm-type group A Streptococcus (GAS), their virulence genes and drug resistance profiles in Tianjin City from 2011 to 2024. After PCR, a total of 42 strains with different years and emm types were selected for whole genome sequencing and multi-locus sequence typing (MLST), and the core genomes were used to generate a phylogenetic tree, after which the virulence genes and resistance genes were identified and analyzed, followed by the drug susceptibility test. In this study, the GAS strains were dominated by emm1 (50.0%) and emm12 (40.4%), and the MLST phenotypes were categorized into six types: ST36 (40.4%), ST1274 (26.1%), ST28 (23.8%), ST921 (4.7%), ST46 (2.3%), and ST403 (2.3%). There was a high consistency between their emm-types and ST types. A total of 68 virulence genes were detected in the genomes of 42 GAS strains, involving functional genes encoding exotoxin, bacterial adhesion, extracellular enzymes, etc. The virulence genes they carried were significantly different between emm1-type and emm12-type strains, such as speA. At the same time, the carrying rates of some virulence genes in the same emm-type strains changed with time, such as hyl. The resistance genes were basically the same among different emm-type strains except for the vanSE gene detected in all emm12 strains. The results of drug sensitivity showed that the GAS strains isolated in Tianjin City from 2011 to 2024 were sensitive to penicillin, cefazolin, chloramphenicol, vancomycin, and levofloxacin, while the resistance rates to erythromycin, azithromycin, clarithromycin, and clindamycin ranged from 88.5% to 100.0%, and there was a certain degree of consistency between the resistance phenotypes and the detected resistance genes. Overall, the main emm types and evolutionary features of GAS in Tianjin City from 2011 to 2024 were consistent with the dominant types in China, and the carrying rate of virulence genes and drug resistance genes differed significantly among different emm-type strains, and there were continuous evolution and variation in the prevalence of virulence genes in GAS.

Objective:To explore the diagnostic value of small field of view ZooMit diffusion weighted imaging(Z-DWI)sequence of magnetic resonance imaging(MRI)in assessing benign and malignant pulmonary nodules.Methods:A total of 60 patients with pulmonary nodules who underwent MR examination at the First Affiliated Hospital with Nanjing Medical University from January 2021 to December 2022 were prospectively collected.All patients underwent conventional DWI(C-DWI)and Z-DWI.The signal to noise ratio(SNR),contrast to noise ratio(CNR),and apparent diffusion coefficient(ADC)of them were measured and analyzed.Two physicians with more than 8 years of experience in diagnosing pulmonary nodules implemented subjective scores for the image quality.Then,the ADC values of benign and malignant nodules between two kinds of images were compared.Results:The scores of Z-DWI images quality in terms of artifact,display of anatomical detail,lesion clarity,and image distortion were respectively(3.53±0.52),(3.27±0.70),(2.87±0.64),and(2.93±0.71),which were all higher than those of C-DWI images,and the differences were statistically significant(t=-4.68,-3.56,-2.44,-2.87,P<0.05).The SNR and CNR values of Z-DWI sequence were respectively(123.4±39.9)and(124.9±24.7),all of which were higher than those of C-DWI sequence,and the differences were statistically significant(t=-8.63,-7.09,P<0.05).The ADC values of C-DWI images of benign and malignant nodules were respectively(1.53±0.27)and(1.09±0.22),and the difference of that between them were statistically significant(t=9.88,P<0.001).The ADC values of Z-DWI images of benign and malignant nodules were respectively(1.39±0.18)and(0.99±0.19),and the difference of that between them was statistically significant(t=7.30,P<0.001).The ADC values of benign and malignant nodules of C-DWI images were higher than those of Z-DWI images,and the differences were statistically significant(t=3.40,2.13,P<0.05).Conclusion:Z-DWI can improve the image quality of benign and malignant pulmonary nodules,which has important clinically diagnostic significance in assessing the benign and malignant natures of pulmonary nodules.

Objective To develop and implement a drug treatment pathway for the initial treatment of diffuse large B-cell lymphoma(DLBCL)and to provide a foundation for refined medication use and cost control management under the Diagnosis Related Groups(DRG)payment system.Methods Clinical pharmacists collaborated to develop a drug treatment pathway for the initial treatment of DLBCL,utilizing evidence-based medicine and evidence-based pharmacy principles.The PDCA(Plan-Do-Check-Act)cycle method was employed for administrative intervention.The hematology department served as a pilot unit to assess the impact on economic indicators,including inpatient costs,drug expenses,and DRG payment balance,as well as treatment efficacy and the incidence of adverse reactions.Results Compared to the control group,the RG13 intervention group exhibited a significant reduction in average total hospitalization costs and drug expenses,along with a decreased DRG payment balance deficits.All differences were statistically significant(P＜0.05).Conclusion The development and implementation of a drug treatment pathway for the initial treatment of DLBCL can effectively reduce treatment costs,prevent DRG overspending,and alleviate the economic burden on patients,while ensuring the safety and effectiveness of the treatment.

Objective:To compare the short-term outcomes of arthroscopic suture bridge technique versus those of arthroscopic tie knot technique in the treatment of tibial avulsion fractures of the anterior cruciate ligament (ACL).Methods:A retrospective study was conducted to analyze the 53 patients with ACL tibial avulsion fracture who had been treated arthroscopically at Department of Sports Medicine, Wuhai People's Hospital between February 2018 and February 2024. There were 31 males and 22 females, with an age of (48.2±5.1) years. The left knee was affected in 27 cases and the right knee in 26 cases. According to the Meyers-Mckeever classification, 32 cases were of type Ⅱ and 21 cases of type Ⅲ. The patients were divided into 2 groups according to different fixation methods: 20 cases were fixed by the arthroscopic tie knot technique (the tie knot group) and 33 cases by the arthroscopic suture bridge technique (the suture bridge group). The operation time and fracture healing time were recorded and compared between the 2 groups. At preoperation, 3 and 6 months after operation, and the last follow-up, the knee pain was evaluated by visual analogue scale (VAS) pain score, the knee stability (side to side disparity) by a KT-1000 arthrometer, and the knee function by The International Knee Documentation Committee (IKDC) subjective score, Lysholm score, knee range of motion, and activities of daily living (ADL) scale. Comparisons were made between and within the 2 groups.Results:The differences in the general preoperative data were not statistically significant between the 2 groups, indicating comparability ( P>0.05). The tie knot group and the suture bridge group were followed up respectively for (13.9±2.1) and (14.5±2.1) months. The surgical time for the suture bridge group [(66.9±8.4) min] was significantly longer than that for the tie knot group [(51.2±6.3) min] ( P<0.05). At 3 months after operation, the VAS pain score [(1.2±0.2) points], side to side disparity [(2.5±0.6) mm], IKDC subjective score [(89.6±1.6) points], Lysholm score [(88.0±1.4) points], knee range of motion (132.1°±2.1°), and ADL score [(88.8±3.3) points] in the suture bridge group were significantly better than those in the tie knot group [(2.1±0.3) points, (3.0±0.9) mm, (87.0±1.4) points, (84.0±1.6) points, 102.1°±2.1°, and (80.3±3.4) points] ( P<0.05). However, there were no significant differences in VAS pain score, side to side disparity, IKDC subjective score, Lysholm score, knee range of motion or ADL score between the 2 groups at 6 months after operation or at the last follow-up ( P>0.05). Statistically significant differences were observed between all time points for VAS pain scores, side-to-side disparity, IKDC subjective scores, Lysholm scores, knee range of motion, and ADL scores in all patients ( P<0.05). No incision infection, nerve injury or other complications occurred in the 2 groups after operation. Conclusions:Both arthroscopic suture bridge technique and arthroscopic tie knot technique are safe and effective intervention options for avulsion fractures of the ACL tibial insertion. The suture bridge technique, with its stable biomechanical properties, can significantly accelerate the process of early postoperative knee function recovery to shorten the recovery period. However, it requires longer surgical time.

Objective:To explore the clinical efficacy of modified Yiqi Huayu pelvic inflammation decoction combined with retention enema of traditional Chinese medicine (TCM) and moxibustion at Shenque acupoint in the treatment of patients with chronic pelvic inflammatory disease (CPID).Methods:A total of 120 CPID patients admitted to the Qian′an City Traditional Chinese Medicine Hospital from January 2023 to June 2024 were prospectively enrolled and randomly divided into the control group (60 cases, treated with modified Yiqi Huayu pelvic inflammation decoction) and the observation group (60 cases, treated with modified Yiqi Huayu pelvic inflammation decoction plus TCM retention enema and moxibustion at Shenque acupoint) using a random number table. Each course of treatment was 3 weeks, with drug withdrawal for 1 week during menstruation, and continuous treatment for 2 courses. The clinical efficacy of the two groups was observed. The TCM symptom scores, blood microcirculation indicators [whole blood low shear viscosity (LBV), whole blood high shear viscosity (HBV), platelet aggregation rate (PAR), hematocrit (HCT)], and serum inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), high mobility group box 1 (HMGB1), granulocyte-macrophage colony-stimulating factor (GM-CSF)] before and after treatment were compared. The patients were followed up for 3 months after treatment to compare the incidence of adverse reactions and recurrence between the two groups.Results:The total clinical effective rate of the observation group (95.00%, 57/60) was higher than that of the control group (83.33%, 50/60) ( P<0.05). After treatment, the individual scores of main and secondary symptoms and the total score of TCM syndrome in the observation group were lower than those in the control group (all P<0.05). After treatment, the levels of LBV, HBV, PAR, HCT, TNF-α, IL-2, HMGB1, and GM-CSF in the observation group were lower than those in the control group (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups ( P>0.05). During the 3-month follow-up after treatment, the recurrence rate of the observation group was 3.33%(2/60), which was lower than 15.00%(9/60) of the control group ( P<0.05). Conclusions:Modified Yiqi Huayu pelvic inflammation decoction combined with TCM retention enema and moxibustion at Shenque acupoint has a definite efficacy in the treatment of CPID. It can effectively relieve clinical symptoms, improve blood microcirculation and inflammatory factor levels of patients, with a low short-term recurrence rate and no significant increase in the incidence of adverse reactions.

Objective To establish a laser diffraction method for determining globule size distribution in medium and long chain fat emulsion injection(C8～24Ve).Methods The Mastersizer 3000 laser particle size analyzer and Hydro EV wet sampling device were used,with water as the dispersion medium.Critical parameters,including refractive index,absorption coefficient,obscuration,measurement duration,stirring speed,and sonication parameters,were systematically optimized.Comparative evaluations were conducted across different computational models(Mie vs.Fraunhofer theories)and instrument platforms.Results The optimized optical parameters for particle size distribution analysis of medium and long chain fat emulsion injection(C8～24Ve)were determined as follows:absorption rate 0.001,refractive index 1.52,measurement duration 10 s,stirring speed 1 200 r·min-1,with no sonication applied.Under these conditions,the method demonstrated satisfactory precision,repeatability,and robustness.Conclusions This method demonstrates operational simplicity,high accuracy,and excellent reproducibility,making it suitable for particle size distribution analysis of medium and long chain fat emulsion injection(C8～24Ve).The established protocol provides a valuable reference for the development of particle size determination methods for emulsion formulations.