Objective To investigate the distribution and antimicrobial resistance profiles of clinical isolates in Xi'an No.3 Hospital from 2019 to 2023.Methods Clinical isolates were collected from January 1,2019 to December 31,2023.Antimicrobial susceptibility testing was carried out according to a unified protocol of China Antimicrobial Resistance Surveillance Network using Kirby-Bauer method or automated systems.The data were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2023.Results A total of 6 621 clinical isolates were collected from 2019 to 2023,including 1 569(23.7％)strains of Gram-positive bacteria and 5 052(76.3％)strains of Gram-negative bacteria.The prevalence of methicillin-resistant S.aureus,S.epidermidis and other Staphylococcus species(except SS.pseudintermedius and S.schleiferi)was 39.0％,62.3％,and 74.4％,respectively.Methicillin-resistant strains showed much higher resistance rates to most of other antimicrobial agents than methicillin-sensitive strains.No Staphylococcus strains were found resistant to vancomycin or linezolid.E.faecium strains demonstrated much higher resistance rates to most antimicrobial agents tested than E.faecalis.The prevalence of linezolid-resistant E.faecalis and vancomycin-resistant E.faecium was 0.9％and 0.4％,respectively.The prevalence of penicillin-nonsusceptible strains(PISP+PRSP)was 5.8％in nonmeningitis S.pneumoniae isolates.The prevalence of ESBL-producing E.coli,K.pneumoniae,and P.mirabilis in Enterobacterales was 48.5％,37.8％,and 47.2％,respectively.Among Enterobacterales strains,K.pneumoniae had the highest resistance rate to imipenem(18.2％)and meropenem(17.9％).Other Enterobacterales were highly sensitive to carbapenems.The resistance rates of P.aeruginosa to imipenem and meropenem were 22.5％and 19.5％,respectively.The resistance rates of A.baumannii to imipenem and meropenem were 65.0％and 71.6％,respectively.Conclusions Antibiotic resistance is still serious in this hospital.Nearly half of the strains of E.coli,K.pneumoniae and P.mirabilis produced ESBLs.K.pneumoniae and A.baumannii showed high resistance rates to carbapenems.Antimicrobial resistance surveillance should be performed appropriately.Relevant departments need to strengthen cooperation to curb the spread of drug-resistant bacteria.

Objective: To explore the efficacy of focal radiofrequency ablation (RFA) in the treatment of low-to-intermediate risk localized prostate cancer and its impact on postoperative urinary control and sexual function recovery，in order to explore the feasibility of minimally invasive methods for the treatment of localized prostate cancer. Methods: Clinical data of 28 patients with low-to-intermediate risk localized prostate cancer who underwent RFA in Nanjing Drum Tower Hospital，Affiliated Hospital of Medical School during Jun.2017 and Feb.2021 were retrospectively analyzed.The 5-year failure-free survival (FFS) rate，surgery related complications，postoperative urinary control and sexual function were collected.The differences between the survival curves of patients in the low-risk and intermediate-risk subgroups were assessed with log-rank test and Breslow test. Results: All surgeries were successfully completed under local anesthesia.During the median follow-up of 43 (40-49) months，the 5-year FFS rate predicted by Kaplan-Meier method was 78.57%; 25 patients (89.29%) did not experience surgery-related complications; 27 patients (96.43%) were able to control urination; 1 patient developed new-onset sexual dysfunction.There was no significant difference in the survival curves between patients in the low-risk and intermediate-risk groups (P>0.05). Conclusion: RFA for patients with low-to-intermediate risk localized prostate cancer has good clinical efficacy，little impact on urinary control and sexual function recovery，and few postoperative complications，which can be used as one of the treatment options for these patients.

Objective To investigate the distribution and antimicrobial resistance profiles of clinical isolates in Xi'an No.3 Hospital from 2019 to 2023.Methods Clinical isolates were collected from January 1,2019 to December 31,2023.Antimicrobial susceptibility testing was carried out according to a unified protocol of China Antimicrobial Resistance Surveillance Network using Kirby-Bauer method or automated systems.The data were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2023.Results A total of 6 621 clinical isolates were collected from 2019 to 2023,including 1 569(23.7％)strains of Gram-positive bacteria and 5 052(76.3％)strains of Gram-negative bacteria.The prevalence of methicillin-resistant S.aureus,S.epidermidis and other Staphylococcus species(except SS.pseudintermedius and S.schleiferi)was 39.0％,62.3％,and 74.4％,respectively.Methicillin-resistant strains showed much higher resistance rates to most of other antimicrobial agents than methicillin-sensitive strains.No Staphylococcus strains were found resistant to vancomycin or linezolid.E.faecium strains demonstrated much higher resistance rates to most antimicrobial agents tested than E.faecalis.The prevalence of linezolid-resistant E.faecalis and vancomycin-resistant E.faecium was 0.9％and 0.4％,respectively.The prevalence of penicillin-nonsusceptible strains(PISP+PRSP)was 5.8％in nonmeningitis S.pneumoniae isolates.The prevalence of ESBL-producing E.coli,K.pneumoniae,and P.mirabilis in Enterobacterales was 48.5％,37.8％,and 47.2％,respectively.Among Enterobacterales strains,K.pneumoniae had the highest resistance rate to imipenem(18.2％)and meropenem(17.9％).Other Enterobacterales were highly sensitive to carbapenems.The resistance rates of P.aeruginosa to imipenem and meropenem were 22.5％and 19.5％,respectively.The resistance rates of A.baumannii to imipenem and meropenem were 65.0％and 71.6％,respectively.Conclusions Antibiotic resistance is still serious in this hospital.Nearly half of the strains of E.coli,K.pneumoniae and P.mirabilis produced ESBLs.K.pneumoniae and A.baumannii showed high resistance rates to carbapenems.Antimicrobial resistance surveillance should be performed appropriately.Relevant departments need to strengthen cooperation to curb the spread of drug-resistant bacteria.

Objective To construct a decision-making aid for rehabilitation training in patients with ischemic stroke, providing structured guidance and support for patients'decision-making. Methods Based on literature review and semi-structured interviews, a decision-making aid for rehabilitation training in patients with ischemic stroke was initially developed. The Delphi expert consultation method was used to conduct a two-round consultation for 15 experts. Results The response rate and effective rate of the questionnaires in the two rounds of expert consultation were both 100%, indicating a high enthusiasm among the experts; the authority coefficients of the experts in the two rounds of consultation were 0.88 and 0.89, respectively, indicating a high level of expert authority; the Kendall's W coefficients of concordance in the two rounds of expert consultation were 0.298 and 0.398, respectively(P < 0.001), indicating a high degree of consistency among expert opinions. The final decision-making aid for rehabilitation training in patients with ischemic stroke included 4 primary indicators, 9 secondary indicators, and 25 tertiary indicators. Conclusion The decision-making aid for rehabilitation training in patients with ischemic stroke constructed in this study is both scientific and practical, and can help improve the quality of decision-making of patients.

Objective:To explore the clinical application values of radiofrequency thermocoagulation (RF-TC) based on stereotactic electroencephalogram (SEEG) high-frequency oscillations (HFOs) analysis in patients with refractory epilepsy.Methods:Fourteen patients with refractory epilepsy treated with SEEG-guided RF-TC were selected from Department of Neurosurgery, PLA Western Theater Command General Hospital from August 2019 to December 2021. Automatic detection algorithm of Matlab was used to calculate the HFOs incidence in each montage, and the fitting curves of HFOs incidences were used to formulate the threshold of HFOs and delimit the HFOs regions (ripples and fast ripples). These patients were divided into non-seizure group and seizure group according to the prognoses 3 and 6 months after RF-TC. At the last follow-up, these patients were divided into good prognosis group and poor prognosis group according to Engel grading; the differences of ripple thermocoagulation rate and fast ripple thermocoagulation rate between the 2 groups were compared.Results:A total of 7,332 ripples and 1,144 fast ripples were detected in SEEG data from 14 patients. Six months after surgery, neurological dysfunction incidence was 14.3%, without permanent neurological dysfunction, intracranial infection, intracranial hemorrhage, or electrode equipment failure. Within 3 months of RF-TC, seizure-free rate was 71.4% (10/14), and fast ripple thermocoagulation rate in non-seizure group was significantly higher than that in seizure group ( P<0.05); within 6 months of RF-TC, seizure-free rate was 57.1% (8/14), and ripple thermocoagulation rate in non-seizure group was significantly higher than that in seizure group ( P<0.05). At last follow-up, 6 patients had good prognosis and 8 patients had poor prognosis; the ripple thermocoagulation rate in good prognosis group was significantly higher than that in poor prognosis ( P<0.05). Conclusions:HFOs can assist in designating epileptogenic regions. Patients with wider range of thermocoagulation ripples or fast ripples will have better short-term efficacy; patients with wider range ofthermocoagulation ripples will have better prognosis.

Hevin is one of the extracellular matrix proteins secreted by astrocytes. Under physiological conditions, Hevin plays an important role in synaptogenesis in the central nervous system (CNS); secreted protein, acidic and rich in cysteine (SPARC) is its homologue and antagonizes the synaptogenic effects of Hevin. In pathological conditions, the expressions of Hevin and SPARC are altered, suggesting their possible roles at synaptic reorganization in various disease process, such as brain injury, Alzheimer's disease, epilepsy and brain tumors; however, the specific mechanism is not totally understood yet. So this paper reviews the mechanism of Hevin/SPARC in CNS synaptogenesis, reorganization and diseases to provide ideas for further research.

【Objective】 To observe the reactive change of cortical perivascular cells after craniocerebral injury and explore its mechanism. 【Methods】 The controllable cortical impact animal model was used to simulate craniocerebral injury, the expressions of cortical pericyte markers at different time points after trauma were studied by Western blotting, and the biological behavior of vascular pericytes after craniocerebral injury was determined by transmission electron microscopy. Post-traumatic high mobility group box 1 (HMGB1), receptor for advanced glycation end product (RAGE), and nuclear factor κB (NF-κB) were detected by Western blotting. The experimental animals were divided into FPS-ZM1 (a specific RAGE receptor blocker) injection group and wild-type group. Wet and dry brain weight and transmission electron microscopy were used to study the post-traumatic effects of HMGB1-RAGE on pericytes. The primary mouse brain microvascular pericytes were cultured and supplemented with HMGB1 recombinant protein; the cultured pericytes supplemented with FPS-ZM1 were used as the control to explore the effect of HMGB1-RAGE pathway on vascular pericytes in vitro. 【Results】 The expression levels of early post-traumatic cortical pericyte markers platelet-derived growth factor receptor beta (PDGFR-β) and NG2 proteoglycan (NG2) decreased (PDGFR-β, Control vs. CCI 3D P<0.05; NG2, Control vs. CCI 6H P<0.05; Control vs. CCI 1D P<0.05). We found that pericytes were detached from blood vessels, accompanied by local blood-brain barrier opening. The expression of HMGB1-RAGE-NF-κB signaling pathway was increased in the early cortex after trauma (HMGB1, Control vs. CCI 6H P<0.05, Control vs. CCI 1D P<0.05; RAGE, Control vs. CCI 6H P<0.05, Control vs. CCI 1D P<0.05, Control vs. CCI 3D P<0.05, Control vs. CCI 5D P<0.05, Control vs. CCI 7D P<0.05; NF-κB, Control vs. CCI 6H P<0.05, Control vs. CCI 1D P<0.05). After blocking the binding of RAGE with the ligand, cortical edema was reduced (CCI 6H P<0.05, CCI 1D P<0.05), and neurovascular unit damage was reduced. HMGB1 recombinant protein could increase the migration ability of cultured pericytes (Control vs. HMGB1 P<0.05, Control vs. HMGB1+FPS-ZM1 P<0.05), and could be reversed by FPS-ZM1 (HMGB1 vs. HMGB1+FPS-ZM1 P<0.05). 【Conclusion】 High-level HMGB1 after traumatic brain injury mediates pericytes’ detachment from blood vessels through RAGE on pericytes and leads to the occurrence of local cerebral edema.

Objective:To investigate the characteristics and change trends of electroencephalogram (EEG) in patients with drug resistant epilepsy (DRE) after vagus nerve stimulation (VNS).Methods:Twenty-five patients with DRE, admitted to our hospital from July 2016 to May 2019, were chosen; all patients accepted VNS and followed up for 12 months. Long range video EEG (VEEG) monitoring was performed before VNS, and 3, 6 and 12 months after VNS, and the tracing time of each monitoring was longer than 12 h. The EEG characteristics of these patients before and different times after VNS were analyzed.Results:In the VEEG monitoring before VNS, 25 patients showed sharp wave, spike wave, sharp slow wave, and compound spike slow wave in the interictal period; 3 patients (12%) could locate the brain region. The interictal EEG of 11 patients 3 months after VNS showed different degrees of improvement as compared with the preoperative one, which manifested as mixed rhythms: mono-spiking as sharp wave, sharp slow wave or spike wave; 8 patients had McHugh grading I-II. The interictal EEG of 18 patients 6 months after VNS showed different degrees of improvement as compared with the preoperative one; 11 patients had McHugh grading I-II. The interictal EEG of 21 patients 12 months after VNS showed different degrees of improvement as compared with the preoperative one; 15 patients had McHugh grading I-II.Conclusion:The EEG improvement effect of DRE patients after VNS is gradually improved with time; in some patients, the EEG improvement is earlier than improvement of clinical symptoms.

Objective:To investigate the characteristics and change trends of electroencephalogram (EEG) in patients with drug resistant epilepsy (DRE) after vagus nerve stimulation (VNS).Methods:Twenty-five patients with DRE, admitted to our hospital from July 2016 to May 2019, were chosen; all patients accepted VNS and followed up for 12 months. Long range video EEG (VEEG) monitoring was performed before VNS, and 3, 6 and 12 months after VNS, and the tracing time of each monitoring was longer than 12 h. The EEG characteristics of these patients before and different times after VNS were analyzed.Results:In the VEEG monitoring before VNS, 25 patients showed sharp wave, spike wave, sharp slow wave, and compound spike slow wave in the interictal period; 3 patients (12%) could locate the brain region. The interictal EEG of 11 patients 3 months after VNS showed different degrees of improvement as compared with the preoperative one, which manifested as mixed rhythms: mono-spiking as sharp wave, sharp slow wave or spike wave; 8 patients had McHugh grading I-II. The interictal EEG of 18 patients 6 months after VNS showed different degrees of improvement as compared with the preoperative one; 11 patients had McHugh grading I-II. The interictal EEG of 21 patients 12 months after VNS showed different degrees of improvement as compared with the preoperative one; 15 patients had McHugh grading I-II.Conclusion:The EEG improvement effect of DRE patients after VNS is gradually improved with time; in some patients, the EEG improvement is earlier than improvement of clinical symptoms.

Neurodegenerative disease is a kind of degenerative diseases of the central nervous system that seriously endanger human health. The complement 3 (C3)-complement 3a receptor (C3aR) pathway is one of the important pathways for classical complement cascade activation. A large number of studies have shown that the C3-C3aR pathway can mediate and regulate the interaction of astrocyte-microglia axis in neurons, resulting in function changes in central nervous system. In addition, studies in recent years have found that the C3-C3aR pathway is closely related to the occurrence and progress of neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, stroke, and epilepsy. This article reviews the progress of C3-C3aR pathway and discuss the role of C3-C3aR pathway in several important neurodegenerative diseases, and it provides a new idea fo treatment of these diseases.