Sixteen compounds were isolated from the solid rice culture of the endophytic fungus Alternaria alstroemeriae WZ-419 derived from Pseudostellariae Radix, using silica gel, ODS, Sephadex LH-20 column chromatography, and preparative HPLC. Their structures were elucidated based on physicochemical properties and comprehensive spectroscopic analyses, and identified as alterpenoid A (1), tricycloalternarene A (2), altenusin (3), 4'-epialtenuene (4), altenuene (5), alternariol (6), altenuisol (7), 3-hydroxyalternariol-5-O-methylether (8), alternariol-9-methyl ether (9), alternariol 1′-hydroxy-9-methyl ether (10), stemphyperylenol (11), dihydroalterperylenol (12), alterinone A (13), 4-hydroxy-3-methoxy-5-(2E,6E-3,7,11-trimethyldodeca-2,6,10-trien-1-yl) benzoic acid (14), hexylitaconic acid (15), and altechromone A (16). Among them, compound 1 and 13 were new, and compounds 14 and 15 were isolated from the genus Alternaria for the first time. The antibacterial activities of compounds 1–16 were evaluated in vitro. Compounds 3, 6–8, 10, 11, 13, and 14 exhibited notable inhibitory effects against Gram-positive bacteria, with minimal inhibitory concentrations ranging from 8 to 64 µg/mL.This study isolated a series of antimicrobial metabolites from the endophytic fungi of Pseudostellariae Radix, providing new insights into their bioactive constituents and laying a foundation for further pharmacological investigations.

Objective To investigate the diagnosis and treatment of 2 cases with spontaneous renal vascular rupture, and discuss the possible causes and treatment methods of this disease. Methods The clinical data and treatment methods of the 2 patients with spontaneous renal vascular rupture treated with renal artery embolization in Universal Global Xi'an Beihuan Hospital were analyzed. Relevant literature was reviewed to summarize the possible causes of this condition. Results The patients had no obvious history of trauma and no obvious abnormal coagulation function, and sought treatment due to sudden lumbar and abdominal pain. Laboratory tests revealed significantly decreased hemoglobin level, and elevated blood glucose (27.8, 27.6mmol/L). Abdominal computed tomography (CT) indicated perirenal hematoma and active bleeding. The bleeding arteries were located at the terminal branches of the anterior renal artery. Precise embolization was performed using CT angiography and selective renal artery angiography plus embolization, achieving an immediate hemostasis success rate of 100%. Postoperative hemoglobin level stabilized, and follow-up CT scans showed significant absorption of the perirenal hematoma without significant deterioration of renal function. Based on literature review and case analysis, the possible cause of spontaneous renal vascular rupture in these two patients was renal vascular sclerosis due to long-term diabetes. Other common etiologies of this condition included renal tumor, vascular malformation, and hypertension. Conclusion Spontaneous renal vascular rupture is rare. Renal artery embolization, as aminimally invasive treatment, can effectively control bleeding and protect renal function. The specific pathogenesis of this condition still requires further investigation. Long-term diabetes mellitus with poor blood glucose control may be associated factors, but more evidence is needed.

ObjectiveTo evaluate the public health governance capacity in Jiangsu Province and provide an optimized pathway for the construction of a “strong, rich, beautiful, and high-quality” new Jiangsu. MethodsA total of 806 policy documents, 658 public information reports, and 148 research literatures related to public health governance capacity in Jiangsu Province from January 1995 to December 2023 were collected. The status of current public health goverance was assessed based on the evaluation criteria suitable for public health systems, and the strengths and the weaknesses of the system were identified. ResultsThe public health governance capability of Jiangsu Province was scored at 738.3 points, ranking 3rd nationally. Maternal health care and emergency response capacities achieved leading positions nationwide, both ranking 2nd. Jiangsu had exhibited a standardized guidance in the strategic level, a well-established management mechanism, an extensive coverage in information collection, and a scientifically established health targets setting. However, bottlenecks remained, including an unclear division of responsibilities across organizational departments, an insufficient public-health workforce, the absence of a stable growth mechanism for government funding investment, and difficulties in promptly identifying public needs. ConclusionJiangsu’s public-health system demonstrates leading nationally, yet several components remain underdeveloped. Future efforts should consolidate advantages while addressing weaknesses, further diversify content and forms, establish a stable funding increase mechanism, and clarify departmental functions, thereby providing solid health support for realizing the developmental goals of a “strong, rich, beautiful and high-quality” new Jiangsu.

The morphological changes and functions of mitochondria are closely associated with the development and progression of non-alcoholic fatty liver disease （NAFLD）. Dynamin-related protein 1 （Drp1） is one of the primary proteins determining mitochondrial fission， and its activity is strictly controlled to ensure the balance of mitochondrial dynamics according to cellular needs. Drp1 can enhance mitochondrial interactions and mitochondrial fission by promoting the formation of endoplasmic reticulum tubules， and the phosphorylation state and deacetylation of Drp1 can also affect the morphological changes of mitochondria， thereby affecting the status of NAFLD. This article elaborates on the role and mechanism of action of Drp1 in the progression of NAFLD， in order to provide ideas for targeted therapy for NAFLD.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective:To compare the efficacy of neuroendoscopy-assisted small bone window craniotomy and large bone flap craniotomy for acute subdural hematoma (ASDH) evacuation in elderly patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 57 elderly patients with ASDH admitted to Chongqing University Fuling Hospital from November 2020 to November 2023, including 27 males and 30 females, aged 65-89 years [(75.0±7.0)years]. The preoperative Glasgow coma scale (GCS) ranged 8-15 points [11.0(11.0, 12.0)points]. Among them, 27 patients were treated with neuroendoscopy-assisted small bone window craniotomy to evacuate ASDH (small bone window group) and 30 received large bone flap craniotomy to evacuate ASDH (large bone flap group). The following parameters were compared between the two groups: surgical duration, intraoperative blood loss, and length of hospital stay; residual subdural hematoma volume before surgery and at 1 day after surgery; GCS before surgery, at 1 and 3 days after surgery; good rate of Glasgow outcome scale (GOS) at 7 days and 6 months after surgery; and postoperative complication rate.Results:All the patients were followed up for 6 months. The surgical duration, intraoperative blood loss, and length of hospital stay were 89.0(85.0, 96.0)minutes, 65.0(55.0, 85.0)ml, and 15.0(14.0, 16.0)days, respectively in the small bone window group, which were shorter or less than 135.0(127.5, 150.0)minutes, 332.0(308.0, 367.5)ml, and 18.5(16.0, 20.0)days in the large bone flap group ( P<0.01). There was no statistically significant difference in the residual subdural hematoma volume between the two groups before surgery and at 1 day after surgery ( P>0.05). No statistically significant difference was found in GCS scores between the two groups before surgery ( P>0.05), while the GCS scores in the small bone window group at 1 and 3 days after surgery [12.0(12.0, 13.0)points and 15.0(14.0, 15.0)points] were higher than 11.5(11.0, 12.0)points and 13.0(12.8, 14.0)points in the large bone flap group ( P<0.01). The good rate of GOS in the small bone window group at 7 days after surgery was 100% (27/27), higher than 77% (23/30) in the large bone flap group ( P<0.05), but no statistically significant difference was found in the good rate of GOS between the two groups at 6 months after surgery ( P>0.05). Two patients in the small bone window group had pulmonary infection after surgery, with a complication rate of 7% (2/27), while in the large bone flap group, four patients had pulmonary infection, two epidural hematoma, one intracranial infection, one delayed wound healing, one subcutaneous fluid accumulation, and one epilepsy after surgery, with a complication rate of 33% (10/30) ( P<0.05). Conclusion:Compared with the conventional large bone flap craniotomy, neuroendoscopy-assisted small bone window craniotomy can shorten the surgical duration and length of hospital stay, reduce the intraoperative bleeding volume, promote early functional recovery, improve prognosis, and reduce the complication rate in elderly patients with ASDH.

objective:To investigate the factors influencing failure of preoperative optimisation with exclusive enteral nutrition(EEN)in patients with Crohn's disease(CD)and to construct a predictive model.Methods:Clinical data of 161 patients with Crohn's disease who underwent surgical treatment after preoperative EEN optimization at the Inflammatory Bowel Disease Center of General Surgery of the Eastern Theater General Hospital from June 2021 to November 2023 were retrospectively analyzed.Patients were divided into two groups according to the preoperative EEN optimisation effect:optimisation success and optimisation failure.Logistic regression analysis was used to determine the factors influencing optimisation failure,and a column line graphical model was constructed using R4.4.0 software.Results:After at least 4 weeks of EEN treatment,a total of 44 patients(27.33%)failed preoperative optimization.Multifactorial analysis showed that FC>500 μg/g and use of corticosteroids were independent risk factors for failure of preoperative optimization,and an increase in prealbumin after 1 week of treatment was a protective factor for successful preoperative optimization.Based on the results of the multivariate analysis,a column graph was constructed,and the C-index was 0.873(95%CI=0.783～0.964).The calibration curve shows that the probability of failure predicted by the nomogram model prior to optimization is in good agreement with the actual probability.The clinical decision curve confirms that the risk threshold is between 0.03～0.96,and the nomogram model can be used to predict the failure of preoperative EEN optimization over other treatment options.Conclusion:FC>500μg/g and history of corticosteroid use were independent risk factors for failure of preoperative optimization,and an increase in prealbumin after 1 week of treatment was a protective factor for successful preoperative optimization.The nomogram constructed on the basis of these results has a good predictive value and is clinically applicable.

Objective:To analyze the predictive value of platelet parameters and prognostic nutritional index(PNI)in activity of ulcerative colitis(UC).Methods:This retrospective study included 158 UC patients from the Department of anorectal medicine of our hospital from January 2020 to June 2022.Mayo total score and Truelove-Witts score were used to evaluate clinical activity.Patients with Mayo score>2 was defined as clinically active UC,and patients with Mayo score≤2 was defined as clinically remission.The histological activity was evaluated by Riley score.Evaluation of endoscopic activity of UC patients by Mayo endoscopic score.Results:Among the 158 patients included in the analysis,111 were in remission phase and the remaining 47 were in clinical active phase.Compared with the remission group,the levels of albumin,lymphocytes,and PNI in the clinically active group reduced significantly(P<0.05),while the levels of CRP,fecal calprotectin,neutrophils,white blood cells,NPR,and NLR increased significantly(P<0.05).Fecal calprotectin,CRP,NPR,NLR were significantly positively correlated with Mayo endoscopic score,Riley score,Truelove Witts score,and Mayo total score(P<0.05),while PNI was significantly negatively correlated with Mayo endoscopic score,Truelove Witts score,and Mayo total score(P<0.05).The ROC curve analysis results showed that fecal calprotectin and NPR had similar performance in predicting clinical activity in UC patients(AUC=0.868,0.850),followed by PNI(AUC=0.770)and NLR(AUC=0.756);Fecal calprotectin had the highest performance in predicting endoscopic activity in UC patients(AUC=0.840),followed by NPR(AUC=0.731),NLR(AUC=0.677),and PNI(AUC=0.671).Conclusions:NPR has demonstrated sufficient diagnostic utility in identifying UC patients with clinical and endoscopic activity,and is comparable in diagnostic performance to the fecal biomarker calprotectin.However,PNI has lower performance as a monitoring tool for UC disease activity.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

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.