Traumatic brain injury (TBI) is intricately linked to the most severe clinical manifestations of brain damage. It encompasses dynamic pathological mechanisms, including hemodynamic disorders, excitotoxic injury, oxidative stress, mitochondrial dysfunction, inflammation, and neuronal death. This review provides a comprehensive analysis and summary of biomaterial-based tissue engineering scaffolds and nano-drug delivery systems. As an example of functionalized biomaterials, nano-drug delivery systems alter the pharmacokinetic properties of drugs. They provide multiple targeting strategies relying on factors such as morphology and scale, magnetic fields, pH, photosensitivity, and enzymes to facilitate the transport of therapeutics across the blood-brain barrier and to promote selective accumulation at the injury site. Furthermore, therapeutic agents can be incorporated into bioscaffolds to interact with the biochemical and biophysical environment of the brain. Bioscaffolds can mimic the extracellular matrix environment, regulate cellular interactions, and increase the effectiveness of local treatments following surgical interventions. Additionally, stem cell-based and exosome-dominated extracellular vesicle carriers exhibit high bioreactivity and low immunogenicity and can be used to design therapeutic agents with high bioactivity. This review also examines the utilization of endogenous bioactive materials in the treatment of TBI.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Objective:To investigate the clinical characteristics of acute ischemic stroke with anterior circulation large vessel occlusion caused by cardioembolism (CE) and large artery atherosclerosis (LAA) and the efficacy of endovascular treatment.Methods:Patients with acute ischemic stroke caused by large vessel occlusion in anterior circulation and received endovascular treatment in the Stroke Center of the 971 st Hospital of the PLA Navy from April 2014 to April 2021 were retrospectively enrolled. The etiological classification of stroke was CE or LAA. According to the modified Rankin Scale score at 90 d after onset, the patients were divided into good outcome group (0-2) and poor outcome group (>2). The demographic and clinical data between the groups were compared. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 106 patients were enrollded. Their age was 61.39±13.73 years and 70 (66.0%) were males. Seventy-four patients (69.8%) were in the CE group and 32 (30.2%) were in the LAA group. Sixty-six patients (62.3%) had good outcomes. Univariate analysis showed that there were significant differences in gender, age, smoking, systolic blood pressure, diastolic blood pressure, baseline National Institutes of Health Stroke Scale (NIHSS) score, time from onset to femoral artery puncture, time from puncture to vascular recanalization, and the number of retrieval attempts between the CE group and the LAA group (all P<0.05), and there were no significant differences in the incidences of poor outcome, hemorrhagic transformation, and symptomatic intracranial hemorrhage. There were significant differences in systolic blood pressure, diastolic blood pressure, baseline NIHSS score, time from onset to femoral artery puncture, and blood perfusion grade after treatment between the good outcome group and the poor outcome group (all P<0.05). Multivariable logistic regression analysis showed that higher systolic blood pressure (odds ratio [ OR] 1.046, 95% confidence interval [ CI] 1.014-1.078; P=0.004), higher baseline NIHSS score ( OR 1.117, 95% CI 1.037-1.203; P=0.003), longer time from onset to femoral artery puncture ( OR 1.008, 95% CI 1.001-1.015; P=0.019) and poor blood perfusion after treatment ( OR 8.042, 95% CI 1.532-42.215; P=0.014) were significantly and independently associated with the poor outcomes. Conclusions:Compared with LAA, CE do not increase the risks of hemorrhagic transformation and symptomatic intracranial hemorrhage. The safety and efficacy of the two are similar.

A 25-year-old female patient presented with recurrent painful erythema and blisters on the palms and soles as well as in the axillary and inguinal regions for 1 month. Seven years ago, the patient underwent a small-incision sweat gland resection in the bilateral axillae for the treatment of axillary osmidrosis. One month ago, she underwent chemotherapy with pegylated liposomal doxorubicin (PLD) after surgery for stage-ⅡB cervical synovial sarcoma. During the 3 sessions of chemotherapy, she developed painful edematous erythema on the palms, soles, axillae and groins, which gradually worsened along with the increase in the number of chemotherapy sessions. Skin examination showed large areas of edematous erythema with clear boundaries at bilateral palms, soles, and intertriginous sites including axillae and groins, with millet- to soybean-sized blisters and erosions on the surface; the skin lesions showed relatively high temperature and positive Nikolsky's sign with obvious tenderness; there was no skin lesions or tenderness at the site of small-incision surgery for axillary osmidrosis in bilateral axillae. Histopathological examination of the axillary skin lesions showed formation of blisters under the basal layer and necrosis of some sweat glands. The diagnosis of PLD-associated intertrigo-like hand-foot syndrome was confirmed. The history of surgery for axillary osmidrosis and normal skin at the surgical site in this case suggest that the pathogenesis of this disease may be related to toxic skin reactions to the drug excreted through sweat glands.

Objective:To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2016 to December 2017. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute (CLSI) 2019. WHONET 5.6 was used to analyze data.Results:During the study period, 8 154 bacterial strains were collected from 33 hospitals, of which 2 325 (28.5%) were Gram-positive bacteria and 5 829 (71.5%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (34.7%), Klebsiella pneumoniae (15.8%), Staphylococcus aureus (11.3%), coagulase-negative Staphylococci (7.4%), Acinetobacter baumannii (4.6%), Pseudomonas aeruginosa (3.9%), Enterococcus faecium (3.8%), Streptococci (2.9%), Enterobacter cloacae (2.7%) and Enterococcus faecalis (2.5%). Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) accounted for 34.2%(315/922) and 77.7%(470/605), respectively. No vancomycin-resistant Staphylococcus was detected. The resistance rate of Enterococcus faecium to vancomycin was 0.6%(2/312), and no vancomycin-resistant Enterococcus faecium was detected. The ESBLs-producing rates in Escherichia coli, Klebsiella pneumoniae and Proteus were 55.7%(1 576/2 831), 29.9%(386/1 289) and 38.5%(15/39), respectively. The incidences of carbapenem-resistance in Escherichia coli, Klebsiella pneumoniae were 1.2%(33/2 831), 17.5%(226/1 289), respectively. The resistance rates of Acinetobacter baumannii to polymyxin and tigecycline were 14.8%(55/372) and 5.9%(22/372) respectively, and those of Pseudomonas aeruginosa to polymyxin and carbapenem were 1.3%(4/315) and 18.7%(59/315), respectively. Conclusion:The surveillance results from 2016 to 2017 showed that the main pathogens of blood stream infection in China were gram-negative bacteria, while Escherichia coli was the most common pathogen; the MRSA incidence was lower than other surveillance data in the same period in China; carbapenem-resistant Escherichia coli was at a low level during this surveillance, while carbapenem-resistant Klebsiella pneumoniae is on the rise.

Objective:To compare the effects between video-assisted thoracoscopic surgery (VATS) and conventional surgery in internal fixation of multiple rib fractures.Methods:Patients with multiple rib fractures, who were admitted to Emergency Center of Shenzhen People's Hospital from June 2010 to May 2020, were included. Patients were divided into the VATS group (incision positioning with VATS) and the conventional group (incisionpositioning with CT scan). The primary outcome measures was the risk of complications, and the secondary outcome measures included postoperative pain, incision length, operation time, and mechanical ventilation rate. Continuous and categorical variables were compared using LSD- t test and Chi-square test. Repeated measures analysis of variance was performed to assess the trend of postoperative pain over time. A logistic regression analysis was used to explore the association of VATS with postoperative complications. Results:A total of 221 patients, including 128 patients in the VATS group and 93 patitents in the conventional group, were enrolled. Baseline characteristics were identical between the two groups ( P>0.05). In the VATS group, the length of incision, intraoperative blood loss, operation time, mechanical ventilation rate after operation, ventilation time, thoracic tube indwelling time, ICU and total length of stay, and medical costs were better than those in the conventional group (all P<0.05). Repeated measures analysis of variance showed that pain relief was faster and more profoundly in the VATS group than in the conventional group ( F=3 517.808, P<0.01). Logistic regression analysis indicated that VATS was an independent protective factor for reducing postoperative complications ( OR=0.225, 95% CI:0.121-0.416, P<0.01). Conclusions:During internal fixation of multiple rib fractures, VATS is an effective approach to reduce postoperative pain and complications. Moreover, video-assisted technique is associated with a rapid recovery for patients, resulting in shorter length of hospital stay and less medical costs.

Objective To analyze the distribution and antimicrobial resistance profile of clinical bacterial strains isolated from blood culture in China.Methods Clinical bacterial strains isolated from blood culture from participating hospitals of Blood Bacterial Resistance Investigation Collaborative System (BRICS) during January 2014 to December 2015 were collected.Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods as recommended by US Clinical and Laboratory Standards Institute(CLSI)2018.The data were analyzed with Whonet 5.6 software.Results During the study period,4 801 clinical bacterial isolates were collected from 26 hospitals,of which 1 798 (37.5％) were Gram-positive bacteria and 3 003 (62.5％) were gram-negative bacteria.The top 10 isolates were Escherichia coli (33.8％),coagulase-negative Staphylococcus (19.0％),Klebsiella pneumoniae (11.9％),Staphylococcus aureus (10.1％),Acinetobacter baumannii (4.0％),Pseudomonas aeruginosa (3.8％),Streptococcus (3.0％),Enterobacter sulcus (2.9％),Enterococcus faecium (2.8％) and Enterococcus faecalis (1.8％).Methicillin-resistant Staphylococcus aureus (MRSA) and methicillinresistant coagulase-negative Staphylococcus (MRCNS) accounted for 33.9％ (165/487) and 56.9％ (520/913) of Staphylococcus aureus and coagulase-negative Staphylococcus respectively.No vancomycinresistant Staphylococcus was detected.The resistance rate of Enterococcus faecium to vancomycin was 0.7％ (1/135),and no vancomycin-resistant Enterococcus faecaliss was detected.The positive rates of extendedspectrum β-1actamases(ESBLs)-producing Escherichia coli,Klebsiella pneumoniae and Proteus were 56.9％ (923/1 621),30.1％ (172/572) and 29.2％ (7/24),respectively.The positive rates of carbapenemresistant Escherichia coli,Klebsiella pneumoniae,Enterobacter,Salmonella and Citrobacter were 1.2％ (20/1 621),7.2％ (41/572),4.3％ (6/141),1.5％ (1/67) and 2.9％ (1/34),respectively.The resistance rates of Acinetobacter baumannii to polymyxin and tegacycline were 2.6％ (5/190) and 8.9％ (17/190)respectively,and that of Pseudomonas aeruginosa to polymyxin and fosfomycin were 1.1％ (2/183)and 0.6％ (1/183),respectively.Conclusions The surveillance results from 2014 to 2015 show that the main pathogens of blood stream infection in China are Gram-negative bacteria,while Escherichia coli is the most common pathogen,the detection rate of MRSA is lower than other surveillance data in the same period in China;carbapenem-resistant Klebsiella pneumoniae and Escherichia coli are at a low level as shown in this surveillance.

Objective To study whether SGK1 is involved in the phenotypic transformation in adventitial fibroblasts (AF).Methods Vascular AF were separated from the thoracic aortas of SD rats.The AF not stimulated with TGF-β1 were divided into blank group,control group 1 and control group 2.The AF induced with 2.5,5.0,10.0 and 15.0 ng/ml TGF-β1 were divided into groups A-D.The AF pretreated with 50 μmol/1 EMD638683 and SB203580 were divided into inhibitor group 1 and inhibitor group 2.The AF stimulated with 5 ng/ml TGF-β1 were divided into stimulation group 1 and stimulation group 2.The expression of SGK1,α-SMA and collagen Ⅰ was detected by Western blot.Results The expression of SGK1 was significantly higher in groups AC than in blank group.The expression of α-SMA was significantly higher in groups B-D than in controlgroup (P＜0.05).The α-SMA and collage Ⅰ expression levels were significantly higher in stimulation group 1 than in control group 1,and were significantly lower in inhibitor group 1 than in stimulation group 1 (P＜0.05).The SGK1 expression level was significantly higher in stimulation group 2 than in control group 2 and was significantly lower in inhibitor group 2 than in stimulation group 2 (P＜0.05).Conclusion SGK1 participates in TGF-β1-induced phenotypic transformation via p38 MAPK and is thus involved in vascular remodeling.

Objective: To investigate the influential factors of efficacy of the first ¹³¹I ablation therapy for thyroid remnant in papillary thyroid microcarcinoma (PTMC) patients after thyroidectomy. Methods: Eighty-nine PTMC patients who underwent twice ¹³¹I ablation therapy and ¹³¹I whole body follow-up scan (¹³¹I-WBS) within 5 to 8 months in our department from September 2007 to October 2016 were identified and enrolled in present study. Patients were divided into complete-ablation group and uncomplete-ablation group according to whether or not radioactivity was detected at the thyroid bed in ¹³¹I-WBS. The χ² test and multi-variance Binary logistic regression were performed for the factors which might affect the therapeutic efficacy. Results: The first ¹³¹I ablation therapy was successful in 41 of 89 patients (46.07%). Residual thyroid weight was found to be associated with therapeutic efficacy (P<0.05), while gender, age, surgical method, lesions′maximum diameter, with or without LN metastasis, with or without distant metastasis, time of operation from first ¹³¹I treatment, lesions′number, thyroid stimulating hormone (TSH), thyroglobulin (Tg), the consistency of ¹³¹I-WBS and ⁹⁹Tc^m-pertechnatate, TNM stage, ATA risk, Tg/TSH ratio were not significant associated with therapeutic efficacy. Binary logistic regression analysis was performed in these respects and it indicated that residual thyroid weight and ATA risk were not statistically significant independent variable (P>0.05). Conclusions Residual thyroid weight might affect efficacy of the first ¹³¹I ablation therapy on thyroid remnant in PTMC patients after thyroidectomy, but it is not an independent factor. Multiple interrelated factors should be considered when predicting the efficacy of the first ¹³¹I ablation therapy.