ObjectiveTo investigate the clinical features of patients with acute-on-chronic liver failure （ACLF） and bacterial infection and early warning indicators associated with multidrug-resistant infections. MethodsA retrospective analysis was performed for 130 patients with ACLF and bacterial infection who attended The Second Affiliated Hospital of Air Force Medical University from January 1， 2010 to December 31， 2021， and according to the drug susceptibility results， the patients were divided into multidrug-resistant （MDR） bacterial infection group with 80 patients and non-MDR bacterial infection group with 50 patients. General information and laboratory examination results were compared between the two groups to screen for the early warning indicators associated with MDR bacterial infection. The Student’s t-test was used for comparison of normally distributed continuous data with homogeneity of variance between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data or continuous data with heterogeneity of variance between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The binary logistic regression analysis and the receiver operating characteristic （ROC） curve were used to assess the predictive value of early warning indicators. ResultsAmong the 130 patients with ACLF and bacterial infection， sputum （27.7%） was the most common specimen for detection， followed by blood （24.6%）， urine （18.5%）， and ascites （17.7%）. Bacterial infections were dominated by Gram-negative bacteria （58.5%）. Of all bacteria， Escherichia coli （18.5%）， Klebsiella pneumoniae （14.6%）， and Enterococcus faecium （13.8%） were the most common pathogens. Gram-positive bacteria had a high resistance rate to the antibacterial drugs such as erythromycin （72.2%）， penicillin （57.4%）， ampicillin （55.6%）， and ciprofloxacin （53.7%）， while Gram-negative bacteria had a high resistance rate to the antibacterial drugs such as ampicillin （73.3%）， cefazolin （50.0%）， and cefepime （47.4%）. The patients with ACLF and bacterial infection had a relatively high rate of MDR bacterial infection （61.5%）. Comparison of clinical data between the two groups showed that compared with the patients with non-MDR bacterial infection， the patients with MDR bacterial infection had significantly higher levels of alanine aminotransferase （Z=2.089， P=0.037）， aspartate aminotransferase （Z=2.063， P=0.039）， white blood cell count （Z=2.207， P=0.027）， and monocyte count （Z=4.413， P<0.001）. The binary logistic regression analysis showed that monocyte count was an independent risk factor for MDR bacterial infection （odds ratio=7.120， 95% confidence interval ［CI］： 2.478‍ ‍—‍ ‍20.456，P<0.001） and had an area under the ROC curve of 0.686 （95%CI： 0.597‍ ‍—‍ ‍0.776） in predicting ACLF with MDR bacterial infection（P<0.001）， with the optimal cut-off value of 0.50×10⁹/L， a sensitivity of 0.725， and a specificity of 0.400. ConclusionACLF combined with bacterial infections is mainly caused by Gram-negative bacteria， with the common pathogens of Escherichia coli and Klebsiella pneumoniae and a relatively high MDR rate in clinical practice. An increase in monocyte count can be used as an early warning indicator to distinguish MDR bacterial infection from non-MDR bacterial infection.

Objective To investigate the risk factors of postoperative vertebral body refracture after percutaneous vertebroplasty(PVP)in the treatment of thoracolumbar osteoporotic compression fracture.Methods The radiological and clinical data of 1258 patients who underwent single-level PVP surgery for thoracolumbar vertebral compression fracture in our hospital from January 1,2015 to December 31,2020 were retrospectively analyzed.Gender,age,body mass index(BMI),bone mineral density(BMD),surgical approach,injection amount of cement,diffusion state of,leakage,vertebral height restores,kyphotic angle reduction,wedge angle reduction of vertebral body,postoperative anti-osteoporosis drug application and other radiological and clinical data of patients were collected and analyzed by univariate and multivariate analysis.The differences of these parameters in the refracture group and the non-refracture group were compared to evaluate the correlation between these factors and postoperative vertebral refracture.Results A total of 247 patients were included in this study.The incidence of refracture was 3.90％in 49 patients.Univariate analysis showed that large kyphotic angle,intravertebral cleft sign,endplate cortical disruption,small injection amount of bone cement,non-contact between bone cement and endplate,and high reduction rate of vertebral body were risk factors for vertebral refracture after PVP.Multivariate analysis of these factors showed that large injection amount of bone cement(OR=0.37,95％CI:0.19-0.55,P=0.018)was a protective factor for vertebral refracture after PVP,and preoperative endplate cortical disruption(OR=2.86,95％CI:1.14-7.53,P=0.026),preoperative intravertebral cleft sign(OR=18.15,95％CI:3.07-44.79,P=0.003),large vertebral reduction rate(OR=3.58,95％CI:1.38-8.40,P=0.007),and poor contact between bone cement and endplate(OR=3.01,95％CI:1.92-10.65,P=0.004)were independent risk factors for vertebral refracture after PVP.Conclusion In this study,it was found that small injection amount of bone cement,endplate cortical disruption before surgery,intravertebral cleft sign,large vertebral reduction rate,and poor contact between bone cement and endplate were independent risk factors for postoperative refracture after PVP treatment of osteoporotic compression fractures in the elderly thoracolumbar spine.

Objective:To observe the effects of ultrasound intermediate frequency acupoint targeted drug guiding technology on the recovery of gastrointestinal function and serum gastrin levels in elderly patients after lumbar spine surgery under general anesthesia.Methods:This study used prospective research methods.A total of 90 elderly patients undergoing lumbar spine surgery after general anesthesia in the orthopaedic ward of Beijing Geriatrics Hospital from June 2019 to June 2021 were randomly divided into blank control group, drug control group, and drug-guided treatment group, with 30 cases each group. After the operation, no intervention was given to the blank control group, the drug control group received oral mosapride citrate tablets, the drug-guided treatment group used the D patch to guide the medicine at the two acupoints of Zusanli and Zhongwan with ultrasound medium frequency guided medicine instrument for 1 week each. The serum gastrin levels of the patients in each group were detected 1 d before operation, 3 d after operation, and 1 week after operation, and the time of first exhaust and first defecation after operation were recorded.Results:The results showed that the level of serum gastrin preoperativein the three groups was not significantly different ( P>0.05). On the third day after operation, the levelof serum gastrin in the drug guide treatment group, drug control group and blank control group were lower than those at 1 d before operation: (66.51 ± 5.34) ng/L vs. (69.36 ± 6.50) ng/L, (58.34 ± 5.71) ng/L vs. (68.75 ± 5.13) ng/L, (55.76 ± 6.23) ng/L vs. (70.20 ± 6.71) ng/L, the differences were statistically significant ( P<0.05), and showed a decreasing trend in turn. Among them, the level of serum gastrin in the drug guide treatment group was higher than that in the drug control group and blank control group, the difference was statistically significant ( P<0.05). One week after operation, the level of serum gastrin in the three groups increased compared with the third day after operation ( P<0.05), and the drug guiding treatment group was higher than the drug control group and the blank control group: (72.38 ± 6.78) ng/L vs. (67.15 ± 6.27) ng/L, (63.52 ± 5.38) ng/L, the differences were statistically significant ( P<0.05). The time of first exhaust and defecation after the operation of the three groups of patients, the drug-guided treatment group was significantly shorter than the drug control group and the blank control group: (15.25 ± 3.10) h vs. (20.38 ± 4.21) h and (28.52 ± 3.69) h, (24.14 ± 3.53) h vs. (36.15 ± 3.54) h and (49.51 ± 4.37) h, the differences were statistically significant ( P<0.05). Conclusions:Ultrasound intermediate frequency acupoint drug guiding technology can increase the patient′s serum gastrin level and promote the recovery of gastrointestinal function in elderly patients with lumbar spine surgery after general anesthesia.

Objective:To analyze the clinical epidemiological characteristics and the prognostic risk factors of patients with hemorrhagic fever with renal syndrome (HFRS).Methods:A total of 2 245 HFRS patients who were admitted to the Second Affiliated Hospital of Air Force Medical University from September 2008 to December 2021 were enrolled. Clinical epidemiological data (including gender, age, onset season, onset region, case fatality rate, et al) of HFRS patients were analyzed. The clinical epidemiological characteristics of patients with HFRS in the 2008 to 2012, 2013 to 2017, and 2018 to 2021 groups were compared. Statistical comparisons were performed using chi-square test. The Bonferroni adjusted P-value method was used for pairwise comparisons between groups, and logistic regression analysis was used to screen and evaluate the risk factors associated with the prognosis of HFRS patients. Results:The age of 2 245 HFRS patients was (42.3±15.9) years old. Most of them were male (79.24%(1 779/2 245)), and the main incidence area was Xi′an City (69.53%(1 561/2 245)). There were 132 deaths with an overall case fatality rate of 5.88%. There were 1 088 patients (48.46%) from 2008 to 2012, 647 patients (28.82%) from 2013 to 2017, and 510 patients (22.72%) from 2018 to 2021, with a mortality rate of 7.17%(78/1 088), 5.10%(33/647) and 4.12%(21/510), respectively. From 2008 to 2021, both the number of HFRS cases and the case fatality rate had shown a fluctuating downward trend. There were significant differences in case fatality rate, age distribution, onset season, and onset region among patients in the different year groups ( χ2=6.84, 49.22, 83.47 and 19.29, respectively, all P<0.05). The results of pairwise comparisons showed that the proportion of patients aged >60 years in the 2018 to 2021 group (23.33%(119/510)) was higher than those in the 2008 to 2012 group (12.13%(132/1 088)) and the 2013 to 2017 group (12.36%(80/647)), and the differences were statistically significant (both P<0.05). The proportions of patients at large peak (October to December) were 62.35%(318/510) in the 2018 to 2021 group and 56.26%(364/647) in the 2013 to 2017 group, which were both lower than that in the 2008 to 2012 group (75.18%(818/1 088)), and the differences were both statistically significant (both P<0.05). The case fatality rate of patients aged >60 years was 9.67%(32/331), which was higher than those of patients aged <30 years (2.86%(16/559)) and patients aged 30 to 60 years (6.20%(84/1 355)), with statistically significant differences (both P<0.05). Univariate analysis showed that age 30 to 60 years, age >60 years, smoking, complicated with hypertension, hypotensive shock and hypoxemia were significantly correlated with the prognosis of HFRS patients (odds ratio ( OR)=2.243, 3.632, 1.484, 3.532, 79.422 and 143.955, respectively, all P<0.05). The results of multivariate logistic regression analysis indicated that complicated with hypertension ( OR=2.467, P=0.004), hypotensive shock ( OR=11.658, P=0.001), and hypoxemia ( OR=67.767, P<0.001) were the independent risk factors affecting the prognosis of HFRS patients. Conclusions:The prevalence of HFRS has shown new changing characteristics from 2008 to 2021. The numbers of HFRS patients and the case fatality rates show a downward trend, and the proportion of HFRS patients aged >60 years increases. Complicated with hypertension, hypotensive shock and development with hypoxemia are the independent risk factors for the prognosis of HFRS.

ObjectiveTo investigate the mechanism of gamma-chain (γC) cytokines in regulating the expression of T-cell immunoglobulin and mucin domain-containing molecule 3 (TIM-3) in CD8+ T cells of chronic hepatitis B (CHB) patients. MethodsA total of 23 CHB patients who attended Tangdu Hospital, Fourth Military Medical University, from January to May, 2017, were enrolled. Peripheral blood was collected from all patients, and Ficoll density gradient centrifugation was used to isolate peripheral blood mononuclear cells (PBMCs). PBMCs were stimulated with interleukin-7 (IL-7), interleukin-15 (IL-15), and interleukin-21, respectively, and then anti-γC antibody and/or anti-IL-7Rα, anti-IL-2Rβ, and anti-IL-21R were added to the culture solution. After 96 hours of culture, flow cytometry was used to measure the expression of TIM-3, interleukin-2 (IL-2), interleukin-10 (IL-10), and interferon-γ (IFNγ) and the phosphorylation level of signal transducer and activator of transcription (STAT) in CD8+ T cells. A one-way analysis of variance and the least significant difference t-test were used for comparison of continuous data. ResultsThe CD8+ T cells stimulated by IL-7 and IL-15 had a significantly higher percentage of TIM-3-positive CD8+ T cells than those without stimulation (t=9.966 and 9074, P＜0.05), as well as significantly higher expression levels of IL-2, IL-10, and IFN-γ and phosphorylation levels of STAT-5 and STAT-1 (all P＜0.05). Stimulation with anti-IL-7Rα and anti-γC antibody significantly reduced the elevated expression levels of TIM-3, IL-2, and IL-10 in the IL-7 stimulation group (t=5.537, 6.224, and 4.500, P＜0.05). Stimulation with anti-IL-2Rβ alone or in combination with anti-γC antibody significantly reduced the expression levels of TIM-3 and IL-2 and the phosphorylation level of STAT-1 in the IL-15 stimulation group (P ＜0.05). ConclusionIL-7 and IL-15 can upregulate the expression of TIM-3 in CD8+ T cells of CHB patients, possibly via the γC receptor-mediated STAT-cytokine signaling pathway.

Objective To compare the function recovery of multiple injuries combined with floating knee joint injury and simple knee joint injury,and to analyze the risk factors.Methods A retrospective case control study was conducted to analyze the clinical data of 41 patients with multiple injuries combined with Blake and McBryde Ⅱ A floating knee injury admitted to Xijing Hospital of Air Force Medical University from June 2011 to June 2017.There were 26 males and 15 females,aged 18-76 years,with an average of 34.5 years.There were 25 patients with simple knee joint injury and and 16 patients with multi-joint combined injury involving knee joint and ipsilateral hip joint or ankle joint injury.Surgical fixation was performed in different parts by external fixation,intramedullary nail and plate screw fixation.According to the Kalstr(o)m and Olerud functional evaluation criteria,the excellent and good rate of postoperative functional recovery was compared between the two groups.The surgical fixation methods of the two groups were compared.Logistic regression analysis was performed on the influencing factors of functional recovery.Results The patients were followed up for 1-7 years,with an average of 3 years.The excellent and good rate of overall functional recovery in the two groups was 68％,and the rate was 84％ in simple knee injury group and 44％ in multi-joint combined injury group (P ＜ 0.01).There was no significant difference in the ratio of intramedullary nail and plate screw fixation between the two groups (P ＞ 0.05),while the proportion of the external fixation in the multi-joint combined injury group [31％ (5/16)] was significantly higher than that in the simple knee joint injury group [16％ (4/25)] (P ＜ 0.05).Logistic regression analysis showed that the rate of external fixation was an independent factor affecting the postoperative function (OR =0.15,P ＜ 0.01).Conclusions The postoperative function in multi-joint injury patients is poorer than in the single joint injury patients.The higher rate of using external fixation in multi-joint injury patients is a risk factor.For Blake and McBryde Ⅱ A floating knee injury combined with multi-joint injury,less external fixation should be used,so as to improve the postoperative function.

Objective To investigate the expression of syntaxin 8(STX8)in glioma and its clinical signif-icance. Methods Specimens of glioma were collected from 57 patients at Beijing Renhe Hospital from May 2013 to December 2015. 57 pieces of glioma tissue were used as a study group ,12 of which were Ⅰ+ Ⅱ(low grade) and the rest 45 were Ⅲ+Ⅳ;normal brain tissues from 15 individuals were used as a control group. Real-time PCR,immunohistochemistry,and Western blot were used to detect expression of STX8. Results As compared with the normal brain tissue ,the mRNA expression of STX8 was significantly increased in glioma tissue ,with a relative expression volume of 1.6855 ± 0.07124 in low grade and 2.8207 ± 0.0692 in high grade tissues,there was significant differences between the two groups;and the difference was also significant as compared with the control group(P < 0.05). The results of immunohistochemistry showed that the expression of STX8 was higher in glioma tissue than in normal tissue. Western Blot showed that the expression of STX8 protein was significantly higher in glioma than in normal tissue(P<0.05);the relative expression volume of STX8 was 2.271 ± 0.1621 in low grade tissue and 4.937 ± 0.1851 in high grade tissue,with a significant difference between the two groups;the difference was also significant as compared with the control group(P<0.05). The correlation analysis showed that higher STX8 expression in glioma was not significantly related to gender,age and pathological types,but there was a significant difference between pathological stages. Conclusion STX8 has abnormal high expression in glioma,which may be closely related with the occurrence and development of glioma.

Objective To simultaneously determinate the contents of four active ingredients (Ephedrine Hydrochloride, Pseudoephedrine Hydrochloride, Amygdalin and Glycyrrhizinate) ofSan Ao Decoction by HPLC; To optimize the extracting process ofSan Ao Decoction.Methods The orthogonal test was employed. Volume of water, time of extraction and times of extraction were set as investigation factors; the transport rates of Ephedrine Hydrochloride, Pseudoephedrine Hydrochloride, Amygdalin and Glycyrrhizinate and the extraction rates were set as investigation indexes to conduct multi-indexes grading.Results The influence factors of the extraction ofSao Ao Decoction were the times of extraction > decoction time > the volume of water. The best extraction condition was: ten fold water; extract for three times; 1 h for each time.Conclusion The optimized extraction process is stable and feasible.

Objective To compare the curative effect of 360° arthroscopic denervation and routine arthroscopic debridement in treatment of knee osteoarthritis.Methods A total of 85 patients were included in the study after excluding the 5 follow-up dropout among the 90 patients with knee osteoarthritis treated between May 2006 and May 2011.Subsequently,the odd and even quality of the mantissa of admission number was used to determine the groups:Group A,42 patients underwent routine arthroscopic debridement; Group B,43 patients underwent arthroscopic debridement plus 360 degree denervation.Traumatic and degenerative arthritis occurred in 30 and 55 patients respectively.There were 34 male and 51 female patients whose mean age was 63 years (range,52-73 years).Western Ontario and McMaster University Osteoarthritis Index (WOMAC),MOS item short from health survey (SF-36),and visual analogue score (VAS) were compared between the two groups before and after operation.Results WOMAC score and SF-36 score of the two groups improved after surgery.At postoperative 6 months,12 months,and 24 months,WOMAC in Group B scored 81.0,78.5,and 82.4 respectively,lower than 86.8,83.8,and 91.7 in Group A (P ＜ 0.05) ; SF-36 in group B scored 47.4,46.3,and 44.4 respectively,higher than 43.9,41.4,and 39.5 in group A (P ＜ 0.05).At postoperative 1 week,VAS of group B was 1.6 points,lower than 2.6 points in group A (P ＜ 0.05).There was no statistical difference between the two groups in postoperative swelling of joint (P ＞ 0.05).Conclusions According to the area involved in knee osteoarthritis and characteristics of innervation of knee joint synovium,arthroscopic 360° denervation provides thorough debridement and removes as many innervation of knee joint synovium.Arthroscopic 360° denervation is superior to the routine arthroscopic debridement in improvement and duration of the symptoms.