OBJECTIVE To explore the effects of meropenem exposure and degradation levels on clinical efficacy in patients with purulent meningitis （PM）. METHODS A total of 131 PM patients treated with meropenem at the Affiliated Suzhou Hospital of Nanjing Medical University from January 2022 to June 2025 were prospectively included. Relevant data were collected and divided into a cured group （91 cases） and a non-cured group （40 cases） based on the efficacy. High-performance liquid chromatography-tandem mass spectrometry was used to determine the concentration of meropenem and its open-loop metabolites. Risk factors that affect efficacy were screened， and their predictive power and correlation were evaluated by univariate analysis， and multivariate Logistic regression analysis， receiver operating characteristic （ROC） curves， and correlation analysis. RESULTS Univariate analysis showed that serum creatinine， creatinine clearance rate， minimum inhibitory concentration of meropenem ≥16 μg/mL， cerebrospinal fluid red blood cell count， cerebrospinal fluid white blood cell count， cerebrospinal fluid glucose content， blood trough concentration， blood open-loop metabolite concentration/trough concentration ratio， and intrathecal injection were all correlated with efficacy （P＜0.05）. The results of multiple Logistic regression analysis showed that serum creatinine blood open-loop metabolite concentration/trough concentration ratio， intrathecal injection， and cerebrospinal fluid glucose content were influencing factors for suboptimal anti-infective ltt efficacy （P＜0.05）. ROC curve analysis showed that when the blood open-loop metabolite concentration/trough concentration ratio was greater than 2.854 （AUC＝0.647）， serum creatinine was less than 59.5 μmol/L （AUC＝0.647）， and cerebrospinal fluid glucose content was less than 3.37 mmol/L （AUC＝0.709）， the risk of treatment failure significantly increased （P＜0.05）. Correlation analysis showed that the blood trough concentration of meropenem was positively correlated with the concentration of its open-loop metabolites （R 2＝0.134 5， P＜0.000 1）. CONCLUSIONS Insufficient exposure level and rapid degradation of meropenem are key mechanisms affecting the anti-infective efficacy of PM. Elevated blood open-loop metabolite concentration/ trough concentration ratio， low serum creatinine level， lack of intrathecal injection， and low cerebrospinal fluid glucose content are independent risk factors for poor efficacy.

Objective To investigate the effects of dihydroartemisinin(DHA)on the proliferation and metastasis of prostate cancer cells via the speckle-type POZ protein(SPOP)/heterogeneous nuclear ribonucleoprotein K(HnRNPK)pathway.Methods The prostate cancer cell line DU145 was cultured in vitro and treated with different concentrations of DHA.Cells were divided into groups based on DHA concentration:blank group(0 μmol/L),low-concentration group(10 μmol/L),medium-concentration group(50 μmol/L),and high-concentration group(100 μmol/L).Colony formation assay,scratch assay,and Transwell assay were performed to observe changes in proliferation,migration,and invasion of DU145 cells under different DHA treatments.Western blotting was used to detect the expression levels of SPOP,HnRNPK,Vimentin,Neural-cadherin(N-cadherin),Epithelial-cadherin(E-cadherin),and Zonula occludens-1(ZO-1).SPOP expression was knocked down in DU145 cells(SPOP-shNC-DU145,SPOP-sh-DU145),which were then subjected to the aforementioned low,medium,and high DHA concentration interventions for rescue experiments.A xenograft mouse model was established by injecting SPOP-knockdown cells into mice,followed by oral administration of low(2.5 mg/kg),medium(5 mg/kg),and high(10 mg/kg)concentrations of DHA.Results Compared with the blank group,the proliferation,migration,and invasion of DU145 cells in the low-,medium-,and high-concentration groups were significantly inhibited(P<0.05),Intracellular expression levels of HnRNPK,Vimentin,and N-cadherin were decreased(P<0.05),while the expression levels of SPOP,E-cadherin,and ZO-1 were increased(P<0.05).Compared with SPOP-shNC DU145 cells,the inhibitory effects of DHA on SPOP-sh DU145 cells were attenuated,with increased expression levels of HnRNPK,Vimentin,and N-cadherin(P<0.05),and decreased expression levels of E-cadherin and ZO-1(P<0.05).Conclusion DHA may target and induce increased SPOP expression,thereby inhibiting the proliferation and metastasis of DU145 cells.

Objective To discuss the safety of nephron sparing surgery for central renal tumors. Methods Thirty-eight cases of partial nephrectomies for central type renal masses were performed.One hundred and seventeen cases of partial nephrectomies with peripheral type renal tumors were compared. Results For the patients with central renal tumors,mean operative time was 118 minutes.Mean isehemic time was 34 minutes.Mean blood loss was 150 ml.The major postoperative complication included leakage of urine(1 case).For the patients with peripheral based tumors,mean operative time was 95 minutes.Mean ischemic time was 21 minutes(only renal artery clamped)and 17 minutes(complete block).Mean blood loss was 250 ml(only renal artery clamped)and 100 ml(complete block).The major postoperative complication included postoperative bleeding(4 cases). Conclusion According to the standard operative procedure,the nephron sparing surgery for central renal tumors is a safe procedure.