This article reports a postcraniotomy patient with renal insufficiency and electrolyte imbalance who developed ventilator-associated pneumonia caused by extensively drug-resistant Klebsiella pneumoniae.According to the patient's pathophysiological characteristics,bacterial epidemiological characteristics,and bacterial culture results,combined with the latest guidelines and the pharmacokinetic/pharmacodynamic characteristics of antibiotics,a full-dose ceftazidime/avibactam regimen was initially suggested by the clinical pharmacist,and which was adopted by doctor.When the effect of ceftazidime/avibactam was poor and no guideline-recommended alternatives were available,the clinical pharmacist,in conjunction with clinical experience,proposed a combination therapy of colistin sulfate and tigecycline,with the implementation of adverse reaction monitoring and mucin sulfate blood concentration monitoring.Finally,the pneumonia was effectively controlled,the inflammatory indicators such as temperature and the white blood cell count returned to normal,no adverse drug reactions occurred,and the patient was successfully transferred to the rehabilitation institution.Clinical pharmacists stay updated on the latest medication knowledge both domestically and internationally,recommend advanced drug treatment protocols for clinical practice,assist in managing severe infections,and play an important role in the clinical team.

Objective To explore the relationship between lipid metabolism and the risk of proliferative retinopathy(PDR)in patients with peripheral diabetic retinopathy(DR).Methods A total of 276 patients with type 2 diabetes mellitus(T2DM)who visited our hospital from May 2022 to July 2023 were selected and divided into the simple T2DM group(n=164)and the combined DR(DR)group(n=112).The DR group was further divided into the non-proliferative retinopathy(NPDR)subgroup(n=58)and the PDR subgroup(n=54)based on the severity of DR.Spearman correlation analysis was used to analyze the relationship between lipid metabolism indicators and PDR,and Logistic regression analysis was used to analyze the influencing factors of PDR.Results In the DR group,DM duration,the utilization rate of insulin(Ins),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FPG),glycated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),Leptin,TG/high-density lipoprotein cholesterol(HDL-C),residual cholesterol(RC),serum creatinine(Scr),and serum uric acid(SUA)were higher than those in the T2DM group(P<0.05),while fasting C-peptide(FC-P),HDL-C and adiponectin(APN)were lower than those in the T2DM group(P<0.05).The levels of SBP,HbA1c,TC,TG,LDL-C,Leptin,TG/HDL-C,RC,Scr and SUA in the PDR subgroup were higher than those in the NPDR subgroup(P<0.05),while FC-P,HDL-C and APN were lower than those in the NPDR subgroup(P<0.05).Spearman correlation analysis showed that PDR was positively correlated with the levels of TG/HDL,RC,and Leptin(r=0.331,0.264,0.358,P<0.05),and negatively correlated with APN(r=-0.174,P<0.05).Logistic regression analysis showed that TG/HDL-C(OR 2.067,95%CI 1.827～2.643),RC(OR 1.538,95%CI 1.336～2.372),Leptin(OR 1.673,95%CI 1.361～2.474),APN(OR 0.674,95%CI 0.231～0.865),and FC-P(OR 0.147,95%CI 0.067～0.887)were the influencing factors for the progression of NPDR to PDR.Conclusions Lipid metabolism is closely related to the progression from DR to PDR.Clinically,lipid metabolism monitoring of DR patients should be done well to improve prognosis.

Objective To explore the impact of the interaction between fasting plasma glucose(FPG)and serum uric acid(SUA)on peripheral diabetic retinopathy(DR).Methods Peripheral DR patients(n=188)admitted to our hospital from July 2022 to June 2023 were selected as the research subjects and divided into mild to moderate non-proliferative diabetic retinopathy(NPDR)group(M-NPDR,n=114)and severe NPDR(S-NPDR,n=74)group.DM patients without diabetic retinopathy admitted to our hospital during the same period were set as the control(T2DM,n=100)group.The general data and biochemical indicators were compared among the three groups.Logistic regression was used to analyze the relationship between FPG and SUA and the severity of DR.The interaction between FPG and SUA was evaluated.A nomogram model was established to predict the occurrence of severe NPDR.Results The DM duration,best corrected visual acuity converted to logarithm of minimum resolution angles(logMAR BCVA),FPG,SUA and urinary albumin/creatinine ratio(UACR)in M-NPDR and S-NPDR groups were higher than those in T2DM group(P＜0.05).Subfoveal choroidal thickness(SFCT),albumin(ALB)and free triiodothyronine(FT3)were lower than those in the T2DM group(P＜0.05).BUN in S-NPDR group was higher than that in T2DM group(P＜0.05).The DM duration,logMAR BCVA,FPG,TC,TG and SUA in S-NPDR group were higher than those in M-NPDR group(P＜0.05),and SFCT was lower than that in M-NPDR group(P＜0.05).SFCT,FPG,ALB,SUA,and(UACR)were independent influencing factors of severe NPDR(P＜0.05).The column chart model predicted the probability of severe NPDR occurrence,with area under curve of 0.919 and 0.910 before and after validation,and the average absolute error of the calibration curve 0.013,which can be used as risk tool to predict DR severity of T2DM patients.Conclusions FPG and SUA are risk factors affecting the severity of DR and there is an interaction.Early warning of risk factors based on the nomogram model is helpful to improve the prognosis of patients with peripheral DR.

Objective To explore the relationship between lipid metabolism and the risk of proliferative retinopathy(PDR)in patients with peripheral diabetic retinopathy(DR).Methods A total of 276 patients with type 2 diabetes mellitus(T2DM)who visited our hospital from May 2022 to July 2023 were selected and divided into the simple T2DM group(n=164)and the combined DR(DR)group(n=112).The DR group was further divided into the non-proliferative retinopathy(NPDR)subgroup(n=58)and the PDR subgroup(n=54)based on the severity of DR.Spearman correlation analysis was used to analyze the relationship between lipid metabolism indicators and PDR,and Logistic regression analysis was used to analyze the influencing factors of PDR.Results In the DR group,DM duration,the utilization rate of insulin(Ins),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FPG),glycated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),Leptin,TG/high-density lipoprotein cholesterol(HDL-C),residual cholesterol(RC),serum creatinine(Scr),and serum uric acid(SUA)were higher than those in the T2DM group(P<0.05),while fasting C-peptide(FC-P),HDL-C and adiponectin(APN)were lower than those in the T2DM group(P<0.05).The levels of SBP,HbA1c,TC,TG,LDL-C,Leptin,TG/HDL-C,RC,Scr and SUA in the PDR subgroup were higher than those in the NPDR subgroup(P<0.05),while FC-P,HDL-C and APN were lower than those in the NPDR subgroup(P<0.05).Spearman correlation analysis showed that PDR was positively correlated with the levels of TG/HDL,RC,and Leptin(r=0.331,0.264,0.358,P<0.05),and negatively correlated with APN(r=-0.174,P<0.05).Logistic regression analysis showed that TG/HDL-C(OR 2.067,95%CI 1.827～2.643),RC(OR 1.538,95%CI 1.336～2.372),Leptin(OR 1.673,95%CI 1.361～2.474),APN(OR 0.674,95%CI 0.231～0.865),and FC-P(OR 0.147,95%CI 0.067～0.887)were the influencing factors for the progression of NPDR to PDR.Conclusions Lipid metabolism is closely related to the progression from DR to PDR.Clinically,lipid metabolism monitoring of DR patients should be done well to improve prognosis.

This article reports a postcraniotomy patient with renal insufficiency and electrolyte imbalance who developed ventilator-associated pneumonia caused by extensively drug-resistant Klebsiella pneumoniae.According to the patient's pathophysiological characteristics,bacterial epidemiological characteristics,and bacterial culture results,combined with the latest guidelines and the pharmacokinetic/pharmacodynamic characteristics of antibiotics,a full-dose ceftazidime/avibactam regimen was initially suggested by the clinical pharmacist,and which was adopted by doctor.When the effect of ceftazidime/avibactam was poor and no guideline-recommended alternatives were available,the clinical pharmacist,in conjunction with clinical experience,proposed a combination therapy of colistin sulfate and tigecycline,with the implementation of adverse reaction monitoring and mucin sulfate blood concentration monitoring.Finally,the pneumonia was effectively controlled,the inflammatory indicators such as temperature and the white blood cell count returned to normal,no adverse drug reactions occurred,and the patient was successfully transferred to the rehabilitation institution.Clinical pharmacists stay updated on the latest medication knowledge both domestically and internationally,recommend advanced drug treatment protocols for clinical practice,assist in managing severe infections,and play an important role in the clinical team.

Objective To explore the impact of the interaction between fasting plasma glucose(FPG)and serum uric acid(SUA)on peripheral diabetic retinopathy(DR).Methods Peripheral DR patients(n=188)admitted to our hospital from July 2022 to June 2023 were selected as the research subjects and divided into mild to moderate non-proliferative diabetic retinopathy(NPDR)group(M-NPDR,n=114)and severe NPDR(S-NPDR,n=74)group.DM patients without diabetic retinopathy admitted to our hospital during the same period were set as the control(T2DM,n=100)group.The general data and biochemical indicators were compared among the three groups.Logistic regression was used to analyze the relationship between FPG and SUA and the severity of DR.The interaction between FPG and SUA was evaluated.A nomogram model was established to predict the occurrence of severe NPDR.Results The DM duration,best corrected visual acuity converted to logarithm of minimum resolution angles(logMAR BCVA),FPG,SUA and urinary albumin/creatinine ratio(UACR)in M-NPDR and S-NPDR groups were higher than those in T2DM group(P＜0.05).Subfoveal choroidal thickness(SFCT),albumin(ALB)and free triiodothyronine(FT3)were lower than those in the T2DM group(P＜0.05).BUN in S-NPDR group was higher than that in T2DM group(P＜0.05).The DM duration,logMAR BCVA,FPG,TC,TG and SUA in S-NPDR group were higher than those in M-NPDR group(P＜0.05),and SFCT was lower than that in M-NPDR group(P＜0.05).SFCT,FPG,ALB,SUA,and(UACR)were independent influencing factors of severe NPDR(P＜0.05).The column chart model predicted the probability of severe NPDR occurrence,with area under curve of 0.919 and 0.910 before and after validation,and the average absolute error of the calibration curve 0.013,which can be used as risk tool to predict DR severity of T2DM patients.Conclusions FPG and SUA are risk factors affecting the severity of DR and there is an interaction.Early warning of risk factors based on the nomogram model is helpful to improve the prognosis of patients with peripheral DR.

Objective:To evaluate the clinical effects of modified everStick C&B fiber resin bonded bridge in the restoration of inci-sor missing teeth in senile patients.Methods:32 patients over 65 years with incisor loss old were included.13 of them were with missing maxillary incisors and 19 with missing mandibular incisors.13 had 1 missing tooth,11 had 2,5 had 3 and 3 had 4 missing teeth.The abutment was loose in 24 cases and not loose in 8 cases.All patients were treated with modified everStick C&B fiber resin bonded bridge repair.Re-examination was conducted at 6,12 and 18 months after completion of repair.The re-examination includ-ed 6 indexes including prosthesis debonding,fracture,color change,defect,abutment loosening and periodontal tissue inflamma-tion.The patients'satisfaction was investigated 6 months after the repair was completed.The investigation included 3 indexes:whether the treatment was comfortable,whether the aesthetic effect was satisfactory,and whether the pronunciation and chewing were comfortable after the repair.Results:The 32 patients were reexamined 6 months after completion of the repair,and all 6 indexes were grade A.Reexamination at 12 months showed that 1 case of treated defect was grade B,2 cases of abutal periodontal tissue in-flammation was grade B,and the rest indexes were grade A.Reexamination at 18 months showed that 1 case of treated defect was grade B,3 cases of abutal periodontal tissue inflammation was grade B,and the rest indexes were grade A.All the 2 cases of grade B defects reached grade A after resin filling.All the 5 cases of abutal periodontal tissue inflammation grade B reached grade A 5-7 days after periodontal cleaning.All 3 indicators in the patient satisfaction survey were graded A.Conclusion:The modified ever-Stick C&B fiber resin bonded bridge is effective in the restoration of incisor missing teeth in senile patients.

To introduce a strategy for a case of severe pneumonia caused by carbapenem-resistant Klebsiella pneumonia,which have failed to treat with tigecycline combined with meropenem,ceftazidime avibactam,and ceftazidime avibactam combined with aztreonam.Clinical pharmacist made anti-infective regimen based on colistin sulfate drip(750 000 units,ivd,q12h,first dose of 1.5 million units)and atomization(250 000 units,q12h)combined with tigecycline(100 mg,ivd,q12h,first dose 200 mg)according to patient's clinical manifestations,renal function,the dynamic changes of infection indicators,metagenomics next-generation sequencing results and the PK/PD characteristics of the anti-bacterial drugs.The anti-infection regimens(intravenous plus aerosolized colistin combined with tigecycline)proposed by the clinical pharmacist were adopted by doctors and the pneumonia was effectively controlled.Clinical pharmacists played an effective role in the clinical healthcare team by tracking frontier of antibacterial drugs,which fully embodied the professional value in optimizing treatment regimens of intractable infections.

Bacteremia is a life-threating syndrome often caused by methicillin-resistant (MRSA). Thus, there is an urgent need to develop novel approaches to successfully treat this infection. Staphylococcal accessory regulator A (SarA), a global virulence regulator, plays a critical role in pathogenesis and -lactam antibiotic resistance in . Hypericin is believed to act as an antibiotic, antidepressant, antiviral and non-specific kinase inhibitor. In the current study, we investigated the impact of hypericin on -lactam antibiotics susceptibility and mechanism(s) of its activity. We demonstrated that hypericin significantly decreased the minimum inhibitory concentrations of -lactam antibiotics (.., oxacillin, cefazolin and nafcillin), biofilm formation and fibronectin binding in MRSA strain JE2. In addition, hypericin significantly reduced expression, and subsequently decreased and virulence-related regulators (.., ) and genes (.., and ) expression in the studied MRSA strain. Importantly, the synergistic effect of hypericin with -lactam antibiotic (.., oxacillin) translated into therapeutic outcome in a murine MRSA bacteremia model. These findings suggest that hypericin plays an important role in abrogation of -lactam resistance against MRSA through inhibition, and may allow us to repurpose the use of -lactam antibiotics, which are normally ineffective in the treatment of MRSA infections (.., oxacillin).

Eukaryotic elongation factor 2 kinase (eEF2K) is well known as a Ca2+/calmodulin (CaM)-dependent kinase. eEF2K catalyzes the phosphorylation of eEF2 and subsequently inactivates eEF2 by impairing its ability to bind to the ribosome, thereby negatively modulates protein synthesis. The high expression of eEF2K has been found recently in several types of malignancies. As participating in the progress of tumor, eEF2K emerges a potential target for future cancer therapy. The relationship between eEF2K and tumor, and the latest progress of eEF2K inhibitors were summarized in this article.