AIM To investigate the clinical effects of Huoxue Qingre Formula combined with radiofrequency ablation on patients with thyroid nodules due to Phlegm Stagnation and Blood Stasis.METHODS Ninety patients were randomly assigned into control group(45 cases)for 3-month intervention of both Huoxue Qingre Formula placebo and radiofrequency ablation,and observation group(45 cases)for 3-month intervention of both Huoxue Qingre Formula and radiofrequency ablation.The changes in clinical effects,VRR,TCM syndrome score,cytokines(TNF-α,IFN-γ,IL-23,IL-1β),biochemical indices[Ca2+,25(OH)D,CRP],thyroid function indices(TSH,FT3,FT4)and safety indices were detected.RESULTS At postoperative 12 months,the observation group demonstrated higher total effective rate than the control group(P＜0.05).At postoperative 3-12 months,the two groups displayed increased VRR(P＜0.05),especially for the observation group(P＜0.05,P＜0.01).At the 7th,30th postoperative days,the two groups displayed decreased TCM syndrome score and cytokines(P＜0.05,P＜0.01),especially for the observation group(P＜0.05,P＜0.01).At the 30th postoperative day,the two groups displayed decreased Ca2+(P＜0.01)and increased 25(OH)D(P＜0.01),especially for the observation group(P＜0.01).At the 7th postoperative day,the two groups displayed increased CRP(P＜0.01),especially for the control group(P＜0.05),which were decreased at the 30th postoperative day(P＜0.05,P＜0.01),especially for the observation group(P＜0.01).No significant differences in thyroid function indices and safety indices were found between the two groups(P＞0.05).CONCLUSION For the patients with thyroid nodules due to Phlegm Stagnation and Blood Stasis,Huoxue Qingre Formula combined with radiofrequency ablation can safely and effectively enhance nodule VRR,alleviate discomfort symptoms,reduce TCM syndrome score,inflammatory factor levels,and accelerate recovery.

Objective:To elucidate the genomic characteristics of the immunoglobulin (IG) heavy-chain variable region and light-chain variable region, the expression of subclones, and the prognostic significance in patients with CLL.Methods:Blood and/or bone marrow specimens were gathered from a cohort of 36 patients with CLL diagnosed at Jiangsu Province Hospital from December 2018 to May 2023, including 12 cases of B cell receptor (BCR) stereotyped patients. IG heavy-chain (IGH) and light-chain (IG Kappa [IGK] and IG lambda [IGL]) gene rearrangements were performed using next-generation sequencing (NGS) technology to analyze the characteristics and prognostic value in CLL.Results:NGS detection of IG variable region (IGHV) demonstrated a significant correlation and superior consistency with Sanger sequencing ( r=0.957, P < 0.001). Among the 36 patients, the IGH variant (IGHV) was observed in 9 (25.0%) but not in 27 (75.0%) participants. The incidence of the MYD88 mutation was higher among patients with mutated IGHV [1/27 (3.7%) vs 4/9 (44.4%), P=0.00]. A high incidence of trisomy 12 was observed in the IGHV #8/#8B subset [4/11 (36.4%) vs 1/25 (4.0%), P=0.023], which were more likely to develop Richter transformation [8/11 (72.7%) vs 4/25 (16.0%), P=0.002]. In the patient cohort, 36 individuals (36/36, 100.0%) used the IGK variable, whereas 15 individuals (15/36, 41.7%) employed the IGL variable (IGLV). IGLV3 - 21 reported the highest utilization rate in IGLV (5/15, 33.3%). Remarkably, patients with CLL with IGLV3-21 fragments were exclusively observed in the Binet C stage and Rai Phase Ⅲ-Ⅳ, with an incidence of del (13) (q14) at 60.0% (3/5). The median time to first treatment (TTFT) of patients with or without IGLV3 - 21 fragments was 5.2 (1.1 - 41.5) and 9.9 (0.1 - 94.4) months, respectively. Using the total reads threshold of 2.5%, 4 (4/36, 11.1%) samples were detected to have two IGHV productive clones. The median TTFT and overall survival (OS) time were 2.8 (0.9-72.7) and 12.8 months in patients with one mutated clone and 57.5 (32.0-120.7) and 51.8 months in those with two mutated clones, respectively. The median TTFT and OS time were 10.9 (0.3-94.4) and 6.3 (0.1 - 12.5) months in patients with one unmutated clone and 49.9 (22.2 - 211.1) and 30.0 (9.6 - 50.3) months in those with multiple unmutated clones, respectively ( P>0.05) . Conclusions:Detection of IG gene rearrangements using NGS technology not only facilitates the analysis of the IGHV mutation status, dominant clones, and prognostic value but also contributes to the exploration of IGK/IGL gene rearrangement fragments and the utilization of subclones. Further, it provides information about the poor prognosis of IGLV3 - 21 CLL. The shortened survival of the two unmutated clone groups in the IGHV unmutated group may indicate a poor prognosis.

OBJECTIVE To explore the ameliorative effect of ursolic acid on carbon tetrachloride-induced acute liver injury in mice,and the feasibility of multispectral optoacoustic tomography(MSOT)for characteristic structural and functional imaging of liver tissues.METHODS Kunming mice were randomly divided into the normal control group,model group,model+ursolic acid 30,60 mg·kg-1 groups and model+bifendate 5.625 mg·kg-1 group,with 14 mice in each.Each group was given the corresponding drug once daily for 7 days.An acute liver injury model was established in mice by intraperitoneal injection of 0.2％carbon tetrachloride in olive oil solution after the last administration.Blood was collected,liver tissues were taken 24 h after modeling,and the liver index was calculated,8 mice from each group and the levels of serum glutamic pyruciv transaminase(GPT)and glutamic oxaloacetic transaminase(GOT),as well as superoxide dismutase(SOD)activity and malondialdehyde(MDA)content in liver tissues were measured.The enzyme-linked immunosorbent assay(ELISA)method was used to detect the level ofα-glutathione S-transferase(α-GST)in serum.The histopathological changes of the liver were observed under a light microscope.The remaining 6 mice in each group underwent MSOT technique was used for characteristic structural and functional imaging of liver tissue.Levels of oxygenated hemoglobin(HbO2)and deoxygenated hemoglobin(Hb)were analyzed,oxygen saturation was calculated,and the extent of liver injury was assessed by examining the intrahepatic distribution of indocyanine green(ICG).RESULTS Compared with the normal group,the levels of GPT,GOT and α-GST in serum,content of MDA in liver tissues and the liver index in the model control group were significantly increased while the activity of SOD in liver tissues were significantly decreased.Compared with the model group,ursolic acid in each dose group significantly reduced the liver index of mice,lowered the serum levels of GPT and GOT as well as the level of α-GST,decreased the content of MDA in liver tissues,and elevated the activity of SOD in liver-injured mice.Hematoxylin-eosin staining showed that significant steatosis and hepatocyte necrosis and inflammatory cell infiltration in hepatocytes of mice in the model group.Ursolic acid significantly attenuated the degree of hepatocellular lesions and markedly reduced steatosis in mice.MSOT imaging showed that the HbO2 level and oxygen saturation were significantly lower while the Hb level was remarkably higher in the liver of mice in the model group.In each administration group,the level of HbO2 significantly increased,the level of Hb was significantly decreased,oxygen saturation was significantly increased in the liver of model mice and the accumulation of ICG dye probe was atten-uated in the body after hepatocyte injury.CONCLUSION Ursolic acid can elevate the hepatic oxygen saturation,improve the metabolism of ICG,reduce the degree of hepatic necrosis in mice,and help protect against carbon tetrachloride-induced hepatic injury in mice.The mechanism is probably related to the inhibition of oxidative stress.

Objective:To explore the risk factors and etiological characteristics of urinary tract infection caused by urinary calculi in eastern Fujian region,in order to attract clinical attention and improve the prevention and treatment of urinary tract infection caused by urinary calculi.Methods:A total of 154 patients with urinary calculi admitted to Ningde People's Hospital(n=80)and Ningde Mindong Hospital(n=74)from November 2022 to October 2023 were selected as the main research objects.According to whether the patients had urinary tract infection,they were divided into infection group and non-infection group.The baseline data of the two groups were analyzed in detail,and the risk factors and pathogen distribution of urinary tract infection in patients with urinary calculi were analyzed.Results:There were 33 cases of urinary tract infection in 154 patients with urinary calculi,accounting for 21.43％.Univariate analysis showed that the urinary white blood cell count in the infection group was higher than that in the non-infection group,and the proportion of patients with effusion,urinary tract obstruction,calculi in the upper urinary tract,staghorn calculi,smoking history,diabetes,and urinary nitrite positive was higher than that in the uninfected group(P＜0.05).The results of binary logistic regression analysis showed that effusion,urinary tract obstruction,staghorn calculi,smoking history,diabetes,high urine white blood cell count and positive urine nitrite were independent risk factors for urinary tract infection in patients with urinary calculi(OR＞1,P＜0.05).A total of 33 strains of pathogenic bacteria were isolated from 33 patients in the infection group.Among them,23 strains(69.70％)were gram-negative bacteria,8 strains(24.24％)were gram-positive bacteria,and 2 strains(6.06％)were fungi.Among gram-negative bacteria,escherichia coli accounted for the highest proportion(48.48％),followed by klebsiella pneumoniae(9.09％).Among gram-positive bacteria,enterococcus faecalis accounted for the highest proportion(12.12％),followed by enterococcus faecium(6.06％).Candida and candida tropicalis in fungi was the same,accounted for 3.03％.Conclusion:The risk of urinary tract infection in patients with urinary calculi in eastern Fujian region is high.Effusion,urinary tract obstruction,staghorn calculi,smoking history,diabetes,high urine white blood cell count and positive urine nitrite are independent risk factors for urinary tract infection in patients with urinary calculi.The main urinary tract pathogens are gram-negative bacteria.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective To explore the potential effect of dapagliflozin on cardiac function and inflammatory factors in patients with heart failure with preserved ejection fraction(HFpEF)and type 2 diabetes mellitus(T2DM).Methods One hundred patients with heart failure and T2DM who were admitted to Taihe Hospital,Wannan Medical College from June 2021 to August 2023 were selected as research objects.According to the random number table,they were assigned to experimental group or control group(n=50).The control group received routine treatment,while the experimental group gave dapagliflozin apart from the routine treatment.The therapeutic effect,cardiac function,inflammatory factors,and adverse reactions were compared between the two groups.Results The experimental group had higher effective rate than the control group(96.00%vs 74.00%,P<0.05).After treatment,left ventricular ejection fraction(LVEF)increased in both groups,and LVEF in the experimental group was significantly higher than that in the control group(59.02%±4.72%vs 54.70%±4.10%,P<0.05).After treatment,left ventricular end-diastolic dimension(LVEDD),brain natriuretic peptide(BNP),interleukin 6(IL-6),procaicltonin(PCT),and C-reactive protein(CRP)were decreased in both groups,and these indexes in the experimental group was significantly lower than those in the control group([52.92±1.56]mm vs[55.70±2.19]mm,[200.63±75.73]ng/L vs[265.80±95.47]ng/L,[234.47±21.51]μg/L vs[307.51±27.81]μg/L,[6.23±2.51]μg/L vs[11.27±2.42]μg/L,[5.33±0.41]mg/L vs[6.82±0.73]mg/L,P<0.05).The incidence of adverse reactions in the experimental group was significantly lower than that in the control group(14.00%[7/50]vs 36.00%[18/50],P<0.05).Conclusion Dapagliflozin can improve cardiac function indexes and reduce inflammatory factor levels and adverse reactions in patients with HFpEF and T2DM.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective:To investigate the trends in detection, treatment, and outcomes of rifampicin-resistant tuberculosis (TB) in Jiangsu Province from 2013 to 2023, assess the effectiveness of control policies and measures for drug-resistant TB, and provide evidence for better control of drug-resistant TB.Methods:Data and indicators related to the screening, diagnosis, treatment, and outcomes of rifampicin-resistant TB in Jiangsu Province from 2013 to 2023 were obtained from the Tuberculosis Management Information System. The Joinpoint regression method was employed to analyze the trends over this period, and annual percent change (APC) and average annual percent change (AAPC) were calculated. A comparative analysis was also conducted to evaluate the changes before and after implementing relevant policies and measures.Results:From 2013 to 2023, the number of registered rifampicin-resistant TB patients in Jiangsu Province showed a consistent upward trend (APC=AAPC=1.45%, P=0.035). The screening rates for drug resistance among new TB patients in high-risk groups and the proportion of molecular biological testing for drug resistance all exhibited increasing trends, with a notable turning point occurring in 2018. The trend of the treatment enrollment rate for rifampicin-resistant TB patients experienced a significant shift in 2020, showing a marked increase from 2013 to 2020 (APC=12.91%, P=0.008). The treatment success rate of rifampicin-resistant TB patients also showed a significant upward trend after a turning point in 2020 (APC=9.94%, P=0.004). Conclusion:From 2013 to 2023, significant progress was seen in preventing and treating rifampicin-resistant TB in Jiangsu Province, with relevant policies and measures proving to be highly effective.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

Objective To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.