Cerebral blood flow directly affects the metabolism of substances and neural activity in the brain, and is closely associated with the occurrence and development of cerebral small vessel disease (CSVD). Multiple studies have revealed that various imaging biomarkers in patients with CSVD, such as lacunar infarction, enlarged perivascular spaces, cerebral microbleeds, cerebral atrophy, and white matter hyperintensities, are closely associated with cerebral autoregulation (CA) function. Therefore, understanding the regulatory mechanism of CA in patients with CSVD is of great significance for delaying the further development of CSVD, improving cerebral ischemia and cognitive impairment. This article reviews the correlation and mechanism between CA and CSVD.

Objective To compare the benefits and drawbacks of primary patch expansion versus pericardial tube right ventricular-pulmonary artery connection in patients diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD). Methods A retrospective study was conducted on patients diagnosed with PA/VSD who underwent primary right ventricular-pulmonary artery connection surgery at our center between 2010 and 2020. Patients were categorized into two groups based on the type of right ventricular-pulmonary artery connection: a pericardial tube group and a patch expansion group. Clinical data and imaging findings were compared between the two groups. Results A total of 51 patients were included in the study, comprising 31 males and 20 females, with a median age of 12.57 (4.57, 49.67) months. The pericardial tube group included 19 patients with a median age of 17.17 (7.33, 49.67) months, while the patch expansion group consisted of 32 patients with a median age of 8.58 (3.57, 52.72) months. In both groups, the diameter of pulmonary artery, McGoon index, and Nakata index significantly increased after treatment (P<0.001). However, the pericardial tube group exhibited a longer extracorporeal circulation time (P<0.001). The reoperation rate was notably high, with 74.51% of patients requiring further surgical intervention, including 26 (81.25%) patients in the patch expansion group and 12 (63.16%) patients in the pericardial tube group. No statistical differences were observed in long-term cure rates or mortality between the two groups (P＞0.005). Conclusion In patients with PA/VSD, both patch expansion and pericardial tube right ventricular-pulmonary artery connection serve as effective initial palliative treatment strategies that promote pulmonary vessel development and provide a favorable foundation for subsequent radical operations. However, compared to the pericardial tube approach, the patch expansion technique is simpler to perform and preserves some intrinsic potential for pulmonary artery development, making it the preferred procedure.

Objective To build an inpatient hospital discharge preparation service management platform,to explore its application outcomes,and to enhance the quality of discharge preparation service management.Methods A research team was set up,and the literature was referenced.The platform was built on the basis of connecting and optimizing various existing information systems in the hospital,including 6 modules:evaluation,implementation of nursing,referral,monitoring feedback,follow-up,and continued nursing.Patients admitted to a tertiary comprehensive hospital were conveniently selected as research subjects in Shandong Province from August 2023 to January 2024.The 97 patients included after the platform application(November 2023 to January 2024)were selected as an experimental group,and the 97 patients included before the platform application(August to October 2023)were selected as a control group.The rate of unplanned readmission within 30 days,the utilization rate of"Internet+Nursing Services",and the time for assessing the demand for discharge planning service were compared between the 2 groups.In addition,in February 2024,300 healthcare professionals from the same hospital were selected to evaluate their satisfaction with the use of the platform.Results There were 7 cases dropping out in each of the 2 groups.The rate of unplanned readmission within 30 days in the experimental group was lower than that in the control group;the utilization rate of"Internet+Nursing Services"was higher than that in the control group;the time for assessing the demand for discharge planning service was less than that in the control group,with statistically significant differences(P＜0.05).In the satisfaction survey of medical staff on the use of the platform,the effective questionnaire response rate was 94.67％,and the score of the clinical nursing information system effectiveness evaluation scale was(100.84±16.48)points.Conclusion The use of this platform can reduce the unplanned readmission rate of patients within 30 days,promote the development of"Internet+Nursing Services",reduce the time for assessing the needs of discharge planning services,and medical staff are highly satisfied with the use of the platform.

Objective:To explore the clinical characteristics and serogroup distribution of meningococcal meningitis.Methods:This study was a case series summary of the demographic data, laboratory results, vaccination history, clinical diagnoses,treatment and prognosis of 16 children with meningococcal meningitis who were hospitalized in Department of Infectious Diseases, Hunan Children′s Hospital from April 2014 to March 2024. According to ages, these patients were divided into infants and toddlers (≤3 years) and school-aged children (6-15 years) groups. Between-group comparison was performed using Independent samples t-test and Mann-Whitney U test. Results:A total of 16 hospitalized patients were included, of whom 8 were male and 8 female. The age of these patients at visit was 4.25 (0.33, 12.30) years. The cases presented a sporadic distribution. There were 11 cases from rural regions, 6 patients were unvaccinated due to age restriction.All patients presented with acute onset, with neurological symptoms manifesting within 0.6 (0.5, 1.0) days, and the duration of hospitalization was 20 (12, 28) days. There were 10 typical cases and 6 fulminant cases, with fever duration ≤7 days in 7 cases. Clinical manifestations included petechiae and purpura in 8 cases, shock in 3 cases, respiratory failure in 3 cases, and disseminated intravascular coagulation in 4 cases. There were 8 cases in both the infant and toddlers group and the school-aged childrengroup, 5 cases in the infant and toddler group manifested seizures. In contrast, in the school-aged children group, 6 individuals exhibited headache, nausea, and vomiting, while 4 cases demonstrated signs of altered consciousness. The C-reactive protein level in the 16 patients was 124.5 (71.3, 212.3) mg/L, and the procalcitonin level was 26.8 (11.0, 92.8) μg/L, the normal values are 0-8.0 mg/L for C-reactive protein and 0-0.5 μg/L for procalcitonin. Compared to the school-aged children group, the infants and toddlers group showed lower white blood cell counts ((7±4)×10 9vs. (17±10)×10 9/L, t=-2.36, P=0.034). All patients tested positive for pathogens, serogroup identification revealed a diverse distribution, including 1 case each of serogroups C, W135, and X; 4 cases of serogroup B; 3 cases of serogroup Y; and 6 cases that remained ungrouped. A total of 10 strains of Neisseria meningitidis were cultured, 7 strains were resistant to sulfonamides, 5 strains to penicillin, and 3 strains to levofloxacin and ciprofloxacin. A total of 9 patients treated with meropenem, and all cases showed improvement and were discharged without any fatalities. At discharge, 1 case had profound sensorineural hearing loss, and 5 patients required rehabilitation treatment due to sequelae. Conclusions:Meningococcal meningitis predominantly affected children aged ≤3 years and 6-15 years. The white blood cell count in meningococcal meningitis patients aged ≤3 years was lower. The serogroups of Neisseria meningitidis were highly diverse, with cases of serogroups X and Y identified. Since isolated Neisseria meningitidis has shown resistance to penicillin and other antibiotics, it is crucial to be vigilant about potential antimicrobial susceptibility when clinical efficacy is poor.

Objective To establish a full-chain follow-up system for tumor patients during chemotherapy and to evaluate its application effect.Methods A full-chain follow-up system was built according to the actual needs of cancer patients during chemotherapy,including 5 modules:patient health records,follow-up plan,risk identification and abnormal reminder,online consultation,interaction between doctors and patients and data visualization analysis and intelligent statistical management.Convenience sampling method was used to select 96 patients with tumor at chemotherapy stage who were treated in a tertiary A hospital in Deyang City,Sichuan Province from February to June 2023 as a test group,and the full chain follow-up system for tumor patients at chemotherapy stage was applied for follow-up;93 patients with tumor at chemotherapy stage were treated from February to June 2022 as a control group for routine follow-up care.Indicators of self-management ability,quality of life and satisfaction with follow-up services were compared between the 2 groups before and after the application of the system.Results 94 cases in the test group and 92 cases in the control group completed the study.After the application of the system,the test group scored(169.44±11.96)on the Cancer Patients Self-Management Scale,higher than(150.76±13.44)in the control group.The score on the Cancer Patients Quality of Life Core Scale was(65.50±7.90),higher than(59.81±7.27)in the control group.The score on the Questionnaire of Satisfaction with the Follow-Up Service was(52.00±3.30),higher than(48.89±3.54)in the control group,and the difference between the 2 groups was statistically significant(P＜0.001).Conclusion The application of the full-chain follow-up system can meet the diversified and multi-level follow-up needs of tumor patients during chemotherapy,achieve accurate,professional and intelligent nursing follow-up services,effectively improve patients'symptom self-management ability and quality of life,and improve patients'satisfaction with nursing services.

Objective Based on data mining,the medication patterns and characteristics of traditional Chinese medicine compound in treatment of radiotherapy-induced oral mucositis(RIOM)were studied to provide references for clinical diagnosis and treatment.Methods Search for relevant literatures on the intervention of traditional Chinese medicine in RIOM published in databases such as CNKI,VIP,and Wanfang Data Knowledge Service Platform from their establishment to December 6,2024.High-frequency drug statistics,association rules,systematic clustering and complex network analysis were conducted using Excel 2010,SPSS Modeler 18.0 and Origin 2024 software.Results A total of 70 prescriptions involving 154 herbs were selected.There were 16 herbs with a frequency≥ 12,and the top 10 were Maidong,Shengdihuang,Shenggancao,Xuanshen,Jinyinhua,Beishashen,Lianqiao,Jiegeng,Taizishen,Fuling.The four qi were mainly cold,while the five flavors were mainly sweet and bitter.The channel tropism were most concentrated in lung meridian,stomach meridian,and heart meridian.Association rule analysis identified 10 commonly used drug pairs,systematic clustering yielded 5 novel drug combinations,and complex network analysis results were consistent with systematic clustering.Conclusion Traditional Chinese medicine treatment for RIOM mainly focuses on clearing heat and removing toxicity,supplement qi and nourish yin,while also promoting production of fluid,promoting blood circulation for removing blood stasis,and dispersing pathogenic factors.The new formulas obtained from data mining,such as Maidong,Beishashen,Yuzhu,Shihu,Tiandong,Jinyinhua,Lianqiao,Shenggancao,can provide good clinical reference.

OBJECTIVE To evaluate the economic burden of the intensive care unit(ICU)patients due to hospital-associated multidrug-resistant organisms(MDROs)infections based on propensity score matching(PSM)so as to provide evidence-based bases for prevention and control of hospital-associated MDROs infection and improvement of utilization efficiency of medical resources.METHODS A total of 2118 patients who were hospitalized in Zibo Central Hospital from Jan.1,2023 to Dec.31,2024 and conformed to the inclusion and exclusion criteria were re-cruited as the research subjects.The patients with hospital-associated MDROs infections were matched in a 1∶1 ratio by PSM(with the clamp value 0.02).Totally 309 pairs were successfully matched.The length of hospital stay and the costs were observed and compared between the MDROs group and the non-MDROs group.RESULTS The MDROs group was with the length of hospital stay 14.00 days longer than the non-MDROs group after the matching(Z=-5.750,P＜0.001),with the total cost of hospitalization increased by 91,420.84 yuan(Z=-8.271,P＜0.001).With the respect to the medical treatment expenses,the expenses of the MDROs group were higher than those of the non-MDROs group,covering the cost of medical service,therapeutic procedures,nursing,western medicine and TCM,and there were significant differences(P＜0.05).Among the differences in the costs between the two groups,the difference in the cost of western medicine was the most signif-icant(22,182.91 yuan),followed by the cost of clinical laboratory test for diagnosis(19,529.60 yuan)and the cost of therapeutic procedures(16,333.50 yuan).CONCLUSIONS The hospital-associated MDROs infections may lead to the extension of hospital stay length of the ICU patients,which then increases the economic burden.There-fore,it is necessary to strengthen the multidisciplinary collaboration and formulate corresponding measures so as to reduce the risk of such infections among the ICU patients.

Background/Aims: Transmembrane 4 L six family member 1 (TM4SF1) is highly expressed and contributes to the progression of various malignancies. However, how it modulates hepatocellular carcinoma (HCC) progression and senescence remains to be elucidated. Methods: TM4SF1 expression in HCC samples was evaluated using immunohistochemistry and flow cytometry. Cellular senescence was assessed through SA-β-gal activity assays and Western blot analysis. TM4SF1-related protein interactions were investigated using immunoprecipitation-mass spectrometry, co-immunoprecipitation, bimolecular fluorescence complementation, and immunofluorescence. Tumor-infiltrating immune cells were analyzed by flow cytometry. The HCC mouse model was established via hydrodynamic tail vein injection. Results: TM4SF1 was highly expressed in human HCC samples and murine models. Knockdown of TM4SF1 suppressed HCC proliferation both in vitro and in vivo, inducing non-secretory senescence through upregulation of p16 and p21. TM4SF1 enhanced the interaction between AKT1 and PDPK1, thereby promoting AKT phosphorylation, which subsequently downregulated p16 and p21. Meanwhile, TM4SF1-mediated AKT phosphorylation enhanced PD-L1 expression while reducing major histocompatibility complex class I level on tumor cells, leading to impaired cytotoxic function of CD8+ T cells and an increased proportion of exhausted CD8+ T cells. In clinical HCC samples, elevated TM4SF1 expression was associated with resistance to anti-PD-1 immunotherapy. Targeting TM4SF1 via adeno-associated virus induced tumor senescence, reduced tumor burden and synergistically enhanced the efficacy of anti-PD-1 therapy. Conclusions Our results revealed that TM4SF1 regulated tumor cell senescence and immune evasion through the AKT pathway, highlighting its potential as a therapeutic target in HCC, particularly in combination with first-line immunotherapy.

Background/Aims: Transmembrane 4 L six family member 1 (TM4SF1) is highly expressed and contributes to the progression of various malignancies. However, how it modulates hepatocellular carcinoma (HCC) progression and senescence remains to be elucidated. Methods: TM4SF1 expression in HCC samples was evaluated using immunohistochemistry and flow cytometry. Cellular senescence was assessed through SA-β-gal activity assays and Western blot analysis. TM4SF1-related protein interactions were investigated using immunoprecipitation-mass spectrometry, co-immunoprecipitation, bimolecular fluorescence complementation, and immunofluorescence. Tumor-infiltrating immune cells were analyzed by flow cytometry. The HCC mouse model was established via hydrodynamic tail vein injection. Results: TM4SF1 was highly expressed in human HCC samples and murine models. Knockdown of TM4SF1 suppressed HCC proliferation both in vitro and in vivo, inducing non-secretory senescence through upregulation of p16 and p21. TM4SF1 enhanced the interaction between AKT1 and PDPK1, thereby promoting AKT phosphorylation, which subsequently downregulated p16 and p21. Meanwhile, TM4SF1-mediated AKT phosphorylation enhanced PD-L1 expression while reducing major histocompatibility complex class I level on tumor cells, leading to impaired cytotoxic function of CD8+ T cells and an increased proportion of exhausted CD8+ T cells. In clinical HCC samples, elevated TM4SF1 expression was associated with resistance to anti-PD-1 immunotherapy. Targeting TM4SF1 via adeno-associated virus induced tumor senescence, reduced tumor burden and synergistically enhanced the efficacy of anti-PD-1 therapy. Conclusions Our results revealed that TM4SF1 regulated tumor cell senescence and immune evasion through the AKT pathway, highlighting its potential as a therapeutic target in HCC, particularly in combination with first-line immunotherapy.