Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective To develop and validate a predictive model for autologous arteriovenous fistula(AVF)maturation in hemodialysis patients using conventional ultrasonography and three-dimensional speckle tracking imaging.Methods This case-control study enrolled 200 AVF patients from Chongqing Hospital of Traditional Chinese Medicine from July 2021 to June 2024.Clinical data,vascular ultrasound,and cardiac ultrasound parameters were systematically collected.After applying predefined inclusion criteria,186 patients were stratified into 2 cohorts based on arteriovenous fistula(AVF)maturation status:the spontaneous maturation group(n=111)and the assisted maturation requirement group(n=75).Comparative analysis between the 2 cohorts was conducted using univariate and multivariate logistic regression for variable selection,leading to the construction of a predictive model(model1)for spontaneous AVF maturation.A nomogram was subsequently developed based on model1.Internal validation was performed through 1 000 bootstrap resamples with calibration curve analysis.Model discrimination was quantified by the area under the receiver operating characteristic curve(AUC),while clinical utility was assessed via decision curve analysis(DCA).After excluding 104 patients lacking three-dimensional speckle tracking echocardiography data,the remaining 82 subjects were included in novel predictive model development.Three strain parameters,two-dimensional global longitudinal strain(2DGLS),three-dimensional global longitudinal strain(3DGLS),and three-dimensional left ventricular ejection fraction(3DEF),were independently incorporated into multivariable logistic regression analyses to establish three distinct models(designated as model2,model3 and model4 respectively).Model comparisons employed AUC,net reclassification improvement(NRI),and integrated discrimination improvement(IDI).Results Independent predictors for model1 included:2DEF(OR=1.133,95%CI:1.058～1.213),mid-cephalic vein depth(OR=1.453,95%CI:1.068～1.978),distal cephalic vein diameter(OR=2.141,95%CI:1.120～4.091),post-occlusive brachial artery resistance index(OR=0.004,95%CI:0.000～0.140),and postoperative brachial flow(OR=1.004,95%CI:1.002～1.007).model1 demonstrated excellent discrimination(AUC=0.869,95%CI:0.817～0.921)and calibration(mean absolute error=0.017).DCA showed superior net benefit at 0.1～1.0 threshold probabilities.Compared with model1,non-significant improvements in AUC and IDI,while model4 achieved significant NRI improvements(P<0.05).Conclusion The prediction performance of AVF natural maturity prediction models constructed with 2DGLS,3DGLS,3DEF,or 2DEF is relatively high;The NRI of the model involving 3DEF is better than that of the model involving 2DEF,indicating that it may have better clinical application value within a specific threshold probability range.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

AIM:To investigate the effect of drug-containing serum of oxytropis falcata extract on oxi-dative stress injury of podocyte induced by high glucose through PI3K/AKT/Nrf2 pathway.METH-ODS:The rat renal podocyte was cultured in vitro,and the concentration and time of D-glucose mod-elling and the optimal concentration and time of administration in the drug-containing serum of oxy-tropis falcata extract were screened.The cells were divided into normal group,high glucose group,high glucose+blank serum group,oxytropis falcata group,inhibitor group,oxytropis falcata+inhibitor group.Rhodamine staining and electron microsco-py were used to observe the morphological and pathological changes of podocyte,flow cytometry was used to detect apoptosis rate,and cell migra-tion ability was detected by scratch test.Immuno-fluorescence and fluorescence probe were used to detect the fluorescence expression of p-AKT and ROS level of cells,ELISA was used to detect the con-tent of MDA,NO,SOD and T-AOC in the superna-tant of cells,and Western Blot was used to detect the protein expression of p-PI3K/PI3K,p-AKT/AKT and Nrf2 in cells.The mRNA expressions of Nrf2,HO-1,GCLM and SOD were detected by RT-qPCR.RESULTS:It was selected that 45 mmol/LD-glucose induction for 48 hours was the best modeling con-dition,and the 1-fold dilution of the medicated se-rum of oxytropis falcata extract for 48 hours was the best concentration and intervention time.Com-pared with the normal group,the foot processes of the high glucose group were widely fused and ad-hered to each other,the apoptosis rate,migration ability and intracellular ROS level were significantly increased(P＜0.01),the fluorescence expression of p-AKT was markedly decreased(P＜0.01),the con-tents of MDA and NO were dramatically enhanced,and the contents of SOD and T-AOC were signifi-cantly downregulated(P＜0.01).The protein expres-sion of p-PI3K/PI3K,p-AKT/AKT,Nrf2 and the mRNA expression of Nrf2,HO-1,GCLM and SOD markedly declined(P＜0.01).Compared with high glucose group,foot process fusion and adhesion of podo-cytes in oxytropis falcata group and oxytropis falca-ta+inhibitor group were improved in varying de-grees,apoptosis rate,migration ability and intracel-lular ROS level significantly declined(P＜0.05,P＜0.01),p-AKT fluorescence expression increased(P＜0.01),NO content decreased,T-AOC level elevated(P＜0.01);the content of MDA decreased and the activity of SOD notably rose(P＜0.01),the protein expression of p-PI3K/PI3K,p-AKT/AKT,Nrf2 and the mRNA expression of Nrf2,HO-1,GCLM and SOD markedly increased in oxytropis falcata group(P＜0.05,P＜0.01);the level of ROS in podocytes im-proved(P＜0.01),the fluorescence expression of p-AKT decreased(P＜0.05),the content of NO upregu-lated,the content of T-AOC downregulated,and the expression of p-PI3K/PI3K,p-AKT/AKT,Nrf2 pro-tein and HO-1,GCLM,SOD mRNA decreased in in-hibitor group(P＜0.05,P＜0.01).Compared with oxy-tropis falcata group,the apoptosis rate,migration ability and intracellular ROS level of podocytes in oxytropis falcata+inhibitor group markedly in-creased(P＜0.05,P＜0.01),p-AKT fluorescence ex-pression declined(P＜0.01),MDA and NO content increased,SOD and T-AOC content decreased(P＜0.05,P＜0.01),p-PI3K/PI3K,p-AKT/AKT,Nrf2 protein and Nrf2,HO-1,GCLM,SOD mRNA expression all dramatically downregulated(P＜0.05,P＜0.01).CON-CLUSION:Oxytropis falcata extract may protect podocytes by activating the PI3K/AKT/Nrf2 signal-ing pathway,thereby improving the morphological,structural and functional changes of podocytes in-duced by high glucose and inhibiting oxidative stress response.

AIM:To investigate the effect of drug-containing serum of oxytropis falcata extract on oxi-dative stress injury of podocyte induced by high glucose through PI3K/AKT/Nrf2 pathway.METH-ODS:The rat renal podocyte was cultured in vitro,and the concentration and time of D-glucose mod-elling and the optimal concentration and time of administration in the drug-containing serum of oxy-tropis falcata extract were screened.The cells were divided into normal group,high glucose group,high glucose+blank serum group,oxytropis falcata group,inhibitor group,oxytropis falcata+inhibitor group.Rhodamine staining and electron microsco-py were used to observe the morphological and pathological changes of podocyte,flow cytometry was used to detect apoptosis rate,and cell migra-tion ability was detected by scratch test.Immuno-fluorescence and fluorescence probe were used to detect the fluorescence expression of p-AKT and ROS level of cells,ELISA was used to detect the con-tent of MDA,NO,SOD and T-AOC in the superna-tant of cells,and Western Blot was used to detect the protein expression of p-PI3K/PI3K,p-AKT/AKT and Nrf2 in cells.The mRNA expressions of Nrf2,HO-1,GCLM and SOD were detected by RT-qPCR.RESULTS:It was selected that 45 mmol/LD-glucose induction for 48 hours was the best modeling con-dition,and the 1-fold dilution of the medicated se-rum of oxytropis falcata extract for 48 hours was the best concentration and intervention time.Com-pared with the normal group,the foot processes of the high glucose group were widely fused and ad-hered to each other,the apoptosis rate,migration ability and intracellular ROS level were significantly increased(P＜0.01),the fluorescence expression of p-AKT was markedly decreased(P＜0.01),the con-tents of MDA and NO were dramatically enhanced,and the contents of SOD and T-AOC were signifi-cantly downregulated(P＜0.01).The protein expres-sion of p-PI3K/PI3K,p-AKT/AKT,Nrf2 and the mRNA expression of Nrf2,HO-1,GCLM and SOD markedly declined(P＜0.01).Compared with high glucose group,foot process fusion and adhesion of podo-cytes in oxytropis falcata group and oxytropis falca-ta+inhibitor group were improved in varying de-grees,apoptosis rate,migration ability and intracel-lular ROS level significantly declined(P＜0.05,P＜0.01),p-AKT fluorescence expression increased(P＜0.01),NO content decreased,T-AOC level elevated(P＜0.01);the content of MDA decreased and the activity of SOD notably rose(P＜0.01),the protein expression of p-PI3K/PI3K,p-AKT/AKT,Nrf2 and the mRNA expression of Nrf2,HO-1,GCLM and SOD markedly increased in oxytropis falcata group(P＜0.05,P＜0.01);the level of ROS in podocytes im-proved(P＜0.01),the fluorescence expression of p-AKT decreased(P＜0.05),the content of NO upregu-lated,the content of T-AOC downregulated,and the expression of p-PI3K/PI3K,p-AKT/AKT,Nrf2 pro-tein and HO-1,GCLM,SOD mRNA decreased in in-hibitor group(P＜0.05,P＜0.01).Compared with oxy-tropis falcata group,the apoptosis rate,migration ability and intracellular ROS level of podocytes in oxytropis falcata+inhibitor group markedly in-creased(P＜0.05,P＜0.01),p-AKT fluorescence ex-pression declined(P＜0.01),MDA and NO content increased,SOD and T-AOC content decreased(P＜0.05,P＜0.01),p-PI3K/PI3K,p-AKT/AKT,Nrf2 protein and Nrf2,HO-1,GCLM,SOD mRNA expression all dramatically downregulated(P＜0.05,P＜0.01).CON-CLUSION:Oxytropis falcata extract may protect podocytes by activating the PI3K/AKT/Nrf2 signal-ing pathway,thereby improving the morphological,structural and functional changes of podocytes in-duced by high glucose and inhibiting oxidative stress response.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective To analyze the radiomic and clinical features extracted from 2D ultrasound images of thyroid tumors in patients with Hashimoto's thyroiditis(HT)combined with papillary thyroid carcinoma(PTC)using machine learning(ML)models,and to explore the diagnostic performance of the method in making preoperative noninvasive identification of cervical lymph node metastasis(LNM).Methods A total of 528 patients with HT combined with PTC were enrolled and divided into two groups based on their pathological results of the presence or absence of LNM.The groups were subsequently designated the With LNM Group and the Without LNM Group.Three ultrasound doctors independently delineated the regions of interest and extracted radiomic features.Two modes,radiomic features and radiomics-clinical features,were used to construct random forest(RF),support vector machine(SVM),LightGBM,K-nearest neighbor(KNN),and XGBoost models.The performance of these five ML models in the two modes was evaluated by the receiver operating characteristic(ROC)curves on the test dataset,and SHapley Additive exPlanations(SHAP)was used for model visualization.Results All five ML models showed good performance,with area under the ROC curve(AUC)ranging from 0.798 to 0.921.LightGBM and XGBoost demonstrated the best performance,outperforming the other models(P＜0.05).The ML models constructed with radiomics-clinical features performed better than those constructed using only radiomic features(P＜0.05).The SHAP visualization of the best-performing models indicated that the anteroposterior diameter,superoinferior diameter,original_shape_VoxelVolume,age,wavelet-LHL_firstorder_10Percentile,and left-to-right diameter had the most significant effect on the LightGBM model.On the other hand,the superoinferior diameter,anteroposterior diameter,left-to-right diameter,original_shape_VoxelVolume,original_firstorder_InterquartileRange,and age had the most significant effect on the XGBoost model.Conclusion ML models based on radiomics and clinical features can accurately evaluate the cervical lymph node status in patients with HT combined with PTC.Among the 5 ML models,LightGBM and XGBoost demonstrate the best evaluation performance.

Objective:To investigate the stability and feasibility of using absorbable screws during Bernese periacetabular osteotomy.Methods:A retrospective analysis was conducted on a 36 year-old woman diagnosed with developmental dysplasia of the hip, who had undergone Bernese periacetabular osteotomy. Finite element analysis was used to simulate the stability of the acetabulum under loads of 10%, 20%, 50%, and 100% of the patient's weight. The structural stiffness of the pelvis and the maximum equivalent stress on the absorbable screws were observed under different conditions, including whether the acetabular bone block and the ilium were in contact, whether 3 or 4 screws were used, and whether a graft (including fibular cortical bone and PEEK grafts) was used.Results:The structural stiffness of the pelvis fixed with four screws increased by 67%-94% compared to that with three screws. After using a graft, the structural stiffness of the pelvis increased by 50%-83%. As the load increased, the maximum equivalent stress on the screws also increased. When the acetabular bone block and the ilium had no contact, no graft was used, and only three screws were used for fixation, the maximum equivalent stress could reach 518.9 MPa, while this value dropped to 61% when four screws were used (318.7 MPa). When the acetabular bone block and the ilium were in contact, the maximum equivalent stress was about 12% of that when there was no contact, regardless of the number of screws used. When a cortical bone graft or a PEEK graft was used, the maximum equivalent stress could drop to 21%-26% of that without a graft. When the screw strength was 130 MPa, a load of 20% of body weight was applied, and only three screws were used without a graft, the equivalent stress could exceed the strength of the screw; if four screws were used, the equivalent stress was slightly higher than the strength of the screw when a load of 50% of body weight was applied. However, when a graft was used (either cortical bone or PEEK), even when a load of 100% of body weight was applied, the equivalent stress was slightly lower than the strength of the screw.Conclusion:Absorbable screws can provide sufficient stability for Bernese periacetabular osteotomy. The contact between the acetabular bone block and the ilium, an increase in the number of screws, and the use of grafts (cortical bone and PEEK grafts) can further improve stability. Therefore, absorbable screws have broad application prospects in Bernese periacetabular osteotomy.

Objective:To observe the efficacy and safety of mechanical ventilation combined with different doses of sildenafil in the treatment of persistent pulmonary hypertension of newborn (PPHN).Methods:A total of 160 children with PPHN admitted to Dezhou Maternal and Child Health Hospital from January 2018 to December 2019 were selected and divided into group A, B, C and D by random stratification, with 40 cases in each group. All the children in the group were actively corrected for acidosis, provided with intravenous nutrition support, warmth, anti-infection and other measures, and adopted ventilator to assist mechanical ventilation. Group A, B, and C were given different doses of sildenafil 0.5, 1.0, and 2.0 mg/(kg·time) respectively, while group D was not given sildenafil treatment, but only mechanical ventilation. Blood gas analysis indexes including partial arterial oxygenpressure (PaO 2), partial arterial carbon dioxide pressure (PaCO 2), saturationoxygen (SaO 2), and pulmonary artery pressure (SPAP), systemic blood pressure (SBP) of children were tested before the treatment and 72 h after the treatment. The treatment time, hospitalization time, hospitalization expenses and the incidence of adverse reactions of mechanical ventilation in 4 groups were recorded and compared. Results:The effective rate in the group A, B and C was higher than that in the group D: 80.0%(32/40), 85.0%(34/40), 87.5%(35/40) vs. 57.5%(23/40), the difference was statistically significant ( P<0.05). Before treatment, the levels of blood gas analysis indexes in 4 groups had no significant differences ( P>0.05). After treatment, the level of PaO 2 in the group A, B and C was significantly higher than that in the group D ( P<0.05), the level of PaCO 2 in the group B and C was significantly lower than that in group D ( P<0.05), and the level of SaO 2 in the group B and C was significantly higher than that in the group D ( P<0.05). After treatment, the level of SPAP in group B and C was significantly lower than that in the group D: (28.56 ± 3.93), (27.14 ± 3.32) mmHg(1 mmHg = 0.133 kPa) vs. (33.57 ± 4.68) mmHg, P<0.05, and the level of SBP in 4 groups had no significant difference ( P>0.05). The hospitalization time and mechanical ventilation time in group A, B and C were significantly shorter than those in group D ( P<0.05). No drug-related adverse reactions, pulmonary hemorrhage, hypotension, arrhythmia, pneumothorax and other complications occurred during the treatment in the 4 groups. Conclusions:Mechanical ventilation combined with sildenafil can significantly reduce pulmonary artery pressure and improve pulmonary oxygenation in children with PPHN. In the range of 0.5 - 1.0 mg/kg, the efficacy is more obvious when increasing the dose of sildenafil.