Objective:To explore the efficacy and safety of intense pulsed light (IPL) for facial early linear scars.Methods:The patients who underwent facial plastic surgery and cosmetic suturing at the Department of Plastic and Aesthetic Surgery, the Second Affiliated Hospital of Soochow University from June to December 2023 were included. A randomized self-controlled study was conducted. Each post-operative wound was divided into the treatment and control sides by random number. The treatment side received 3 sessions of IPL treatment at 2-3 d after wound suturing, 6-7 d after suture removal and 6 weeks after surgery, respectively. The control side did not receive IPL treatment. After 3 months follow-up, the Vancouver scar scale (VSS), patient and observer scar assessment scale (POSAS) were used to evaluate the scars on both sides. Adverse reactions were recorded. VSS evaluated scar severity through four items: vascularity (0-3 points), pigmentation (0-3 points), thickness (0-4 points), and pliability (0-5 points), with a total score of 0-15 points. The higher the score, the more serious the scar was. POSAS consisted of observer scar assessment scale (OSAS) and patient scar assessment scale (PSAS), OSAS included vascularity, pigmentation, thickness, surface relief, pliability, surface area and overall opinion. While PSAS included pain, itching, color, thickness, stiffness, irregularity, and overall opinion. Each component was assessed on a scale ranging from 1 to 10, while maximum scores indicated the worst outcome. Statistical analysis was performed using the Graphpad Prism 8.0 software. Normal distributed measurement data were expressed as Mean±SD, and non-normally distributed measurement data were expressed as M( Q1, Q3). Comparisons of VSS, OSAS, PSAS scores between the treatment and control sides were performed using paired sample t-test or paired sample Wilcoxon rank sum test. P<0.05 was considered statistically significant. Results:A total of 23 facial trauma patients with 27 scars formed after debridement and aesthetic suture were enrolled in this study, including 17 males and 6 females, aged (28.2±6.1) years old. The length of the scars were (5.9±1.8) cm. After three sessions of treatment and 3 months follow-up, with regard to VSS, the treatment sides scored vascularity [0(0, 1) vs. 1(1, 1)], thickness [0(0, 0) vs. 0(0, 1)], and total scores [0.5(0, 1) vs. 1(1, 2.75)], which were statistically lower than the control sides (all P<0.05). With regard to OSAS, the treatment sides scored vascularity(2.1±0.9 vs. 3.0±1.0), pigmentation(2.2±0.8 vs. 2.3±0.8), thickness(1.4±0.7 vs. 1.9±0.9), surface relief(1.7±0.6 vs. 2.2±1.1), pliability(1.8±0.8 vs. 2.1±1.1), overall opinion(1.9±0.8 vs. 2.8±1.1) and total scores(12.6±4.4 vs. 16.2±6.2), which were statistically lower than the control sides(all P<0.05).With regard to PSAS, the treatment sides scored scar color(2.9±1.3 vs. 3.9±1.7), thickness(1.8±1.4 vs. 2.4±1.5), overall opinion(2.2±1.0 vs. 3.1±1.3) and total scores(14.3±6.7 vs. 17.7±7.7), which were statistically lower than the control sides(all P<0.05). No adverse reactions such as wound infection, delayed wound healing and blister formation were observed in all patients. Conclusion:IPL is effective in the treatment of early facial scars, which can significantly improve the vascularity, thickness, pigmentation, surface relief and pliability of scars, and improve the scars appearance. This treatment method is safe with few adverse reactions.

Objective:To explore the efficacy and safety of intense pulsed light (IPL) for facial early linear scars.Methods:The patients who underwent facial plastic surgery and cosmetic suturing at the Department of Plastic and Aesthetic Surgery, the Second Affiliated Hospital of Soochow University from June to December 2023 were included. A randomized self-controlled study was conducted. Each post-operative wound was divided into the treatment and control sides by random number. The treatment side received 3 sessions of IPL treatment at 2-3 d after wound suturing, 6-7 d after suture removal and 6 weeks after surgery, respectively. The control side did not receive IPL treatment. After 3 months follow-up, the Vancouver scar scale (VSS), patient and observer scar assessment scale (POSAS) were used to evaluate the scars on both sides. Adverse reactions were recorded. VSS evaluated scar severity through four items: vascularity (0-3 points), pigmentation (0-3 points), thickness (0-4 points), and pliability (0-5 points), with a total score of 0-15 points. The higher the score, the more serious the scar was. POSAS consisted of observer scar assessment scale (OSAS) and patient scar assessment scale (PSAS), OSAS included vascularity, pigmentation, thickness, surface relief, pliability, surface area and overall opinion. While PSAS included pain, itching, color, thickness, stiffness, irregularity, and overall opinion. Each component was assessed on a scale ranging from 1 to 10, while maximum scores indicated the worst outcome. Statistical analysis was performed using the Graphpad Prism 8.0 software. Normal distributed measurement data were expressed as Mean±SD, and non-normally distributed measurement data were expressed as M( Q1, Q3). Comparisons of VSS, OSAS, PSAS scores between the treatment and control sides were performed using paired sample t-test or paired sample Wilcoxon rank sum test. P<0.05 was considered statistically significant. Results:A total of 23 facial trauma patients with 27 scars formed after debridement and aesthetic suture were enrolled in this study, including 17 males and 6 females, aged (28.2±6.1) years old. The length of the scars were (5.9±1.8) cm. After three sessions of treatment and 3 months follow-up, with regard to VSS, the treatment sides scored vascularity [0(0, 1) vs. 1(1, 1)], thickness [0(0, 0) vs. 0(0, 1)], and total scores [0.5(0, 1) vs. 1(1, 2.75)], which were statistically lower than the control sides (all P<0.05). With regard to OSAS, the treatment sides scored vascularity(2.1±0.9 vs. 3.0±1.0), pigmentation(2.2±0.8 vs. 2.3±0.8), thickness(1.4±0.7 vs. 1.9±0.9), surface relief(1.7±0.6 vs. 2.2±1.1), pliability(1.8±0.8 vs. 2.1±1.1), overall opinion(1.9±0.8 vs. 2.8±1.1) and total scores(12.6±4.4 vs. 16.2±6.2), which were statistically lower than the control sides(all P<0.05).With regard to PSAS, the treatment sides scored scar color(2.9±1.3 vs. 3.9±1.7), thickness(1.8±1.4 vs. 2.4±1.5), overall opinion(2.2±1.0 vs. 3.1±1.3) and total scores(14.3±6.7 vs. 17.7±7.7), which were statistically lower than the control sides(all P<0.05). No adverse reactions such as wound infection, delayed wound healing and blister formation were observed in all patients. Conclusion:IPL is effective in the treatment of early facial scars, which can significantly improve the vascularity, thickness, pigmentation, surface relief and pliability of scars, and improve the scars appearance. This treatment method is safe with few adverse reactions.

Objective:To evaluate the impact of orthopedic robotic assistance and conventional freehand methods on surgical strategies, the safety of pedicle screw placement, and clinical efficacy in patients with upper cervical spine diseases.Methods:From January 2017 to March 2023, a total of 63 cases with upper cervical spine disease, were divided into two groups based on the screw placement technique: the robot-assisted pedicle screw placement (RA) group (41 cases) and the conventional freehand pedicle screw placement (CF) group (22 cases), were retrospectively included. These patients in the RA and CF groups underwent two types of posterior cervical surgery, including occipitocervical fusion (9 cases and 8 cases) and fixation and fusion of atlantoaxial and distal vertebrae (32 cases and 14 cases). The outcome parameters, including the disease course, surgical time, intraoperative blood loss, fluoroscopy frequency, radiation dose, hospital stay, treatment costs, complications, the rate of the pedicle screw placement, accuracy of upper cervical pedicle screw placement, and the risk factors that possibly affected the accuracy were recorded and analyzed. Postoperative follow-up was conducted for at least 6 months, and the efficacy of patients was assessed using imaging parameters, ASIS classification, VAS, and JOA scores.Results:Both groups had no screw-related complications and no spinal cord or vertebral artery injuries. In the RA group, the pedicle screw placement rates for the patients with occipitocervical fusion, and fixation and fusion of atlantoaxial and distal vertebrae were 100% (48/48) and 89.6% (138/154), respectively, far exceeding the placement rate in the CF group 42.9% (18/42) and 78.3% (54/69) (χ 2=37.403, P<0.001; χ 2=5.128, P=0.024). The fluoroscopic exposure dose and operation time of the two types of surgical patients in the RA group were both higher than those in the CF group ( P<0.05). Compared with the CF group, the accuracy of C 1 screws in the RA group increased from 42% (11/26) to 80% (51/64), with statistical significance (χ 2=13.342, P=0.004); while the accuracy of C 2 screws improved from 77% (33/43) to 88% (63/72) with no statistical difference (χ 2=2.863, P=0.413). Non-parametric correlation analysis found a significant correlation between the accuracy of C 1 and C 2 pedicle screw placement and the order of guide wire insertion in the RA group ( r=0.580, P<0.001; r=0.369, P=0.001). Postoperatively, both groups showed significant differences in cervicomedullary angle (CMA), Chamberlain angle (CL), McGregor angle, Boogard angle, Bull angle, clivus-canal angle (CCA), occipitocervical (C 0-C 2) angle, posterior occipitocervical angle (POCA), C 2-C 7 angle, and anterior atlantodental interval (ADI) ( P<0.05). The ASIA classification improved to varying degrees for both groups postoperatively, but there were no statistically significant differences between preoperative, postoperative, and last follow-up evaluations. VAS and JOA scores significantly improved for both groups postoperatively and at the last follow-up ( P<0.05). Conclusion:Both orthopedic robotic-assisted and conventional freehand pedicle screw placement techniques achieved satisfactory therapeutic effects in the treatment of upper cervical spine diseases. The orthopedic robot can effectively ensure the accuracy of upper cervical pedicle screw placement, the increase placement rate of pedicle screws in the upper cervical spine, and reduce fluoroscopy exposure. However, it is necessary to avoid the vertebral displacement caused by the priority insertion of the guide needle, which may affect the accuracy of subsequent planning.

Catheter associated urinary tract infection (CAUTI) refer to urinary system infections that occur after the insertion of a urinary catheter or within 48 hours after its removal. CAUTI exacerbate patient conditions, prolong hospital stays, increase medical costs and economic burdens on patients, and can be life-threatening in severe cases. The Asia Pacific Society of Infection Control (APSIC) convened a working group of infection prevention and control experts from the Asia-Pacific region to publish the APSIC guideline for prevention of catheter associated urinary tract infections (CAUTIs) (referred to as the "APSIC Guideline"). This guideline encompasses the prevention and management of CAUTI in patients with indwelling catheters, covering the entire process from catheter insertion, maintenance, to removal, and are characterized by their practicability and directive nature. This article interprets the APSIC Guideline from aspects such as risk factors of CAUTI, diagnosis, development of prevention strategies, monitoring, and implementation of prevention plans, aiming to provide scientific guidance for clinical healthcare professionals in preventing CAUTI.

Objective:To evaluate the performance of the automated digital cell morphology instrument in detecting platelet (PLT) clumps.Methods:A total of 4271 blood samples whose PLT reached the reviewing rules of thrombocytopenia were selected from inpatients having blood analysis in Xijing Hospital from January 1 st to June 30 th, 2019, including 2 200 males and 2 071 females,with a median age of (35±7.03) years old. The smears for these cases were made, stained by Wright-Giemsa, and examined to capture PLT clumps by digital cell morphology system and manual microscope separately. The digital cell analysis system (hereinafter referred to as the instrument method) as an evaluation method and the microscope method as a reference method were used to calculate the positive rate of platelet clump detection and evaluate the comparison of two methods and bias assessments. The chi-square test was used to compare counting data rates. Results:Among 4, 271 samples reaching the reviewing rule of thrombocytopenia, 128 cases with platelet clumps were detected by manual microscope(initial) with a positive detection rate of 96.24%, and a total 133 of cases with PLT clumps were detected by microscope (initial+reconfirmation) with a positive detection rate of 100 %. Meanwhile, 129 cases with platelet clumps were detected by instrument method with a positive detection rate of 96.9%. There was no significant difference in terms of positive rate of PLT clumps detection between the instrumental method and the microscope method (initial) ( χ2 =0.115, P=0.73); the positive rate of clumps detection by the instrumental method was lower than microscope method (initial+reconfirmation), and the difference was statistically significant (χ 2 =4.061, P=0.04). For instrument method, the positive rate of PLT clumps detection by simultaneous observation of RBC analysis interface+PLT aggregation interface+WBC analysis interface was higher than only observation of PLT aggregation interface, and the difference was statistically significant (χ 2 =5.090, P=0.02). The average error of the deviation of PLT counting results before and after correction of the cases with PLT plumps missed by instrument method was significantly higher than microscope method (initial), and the difference was statistically significant (χ 2 =56.26, P<0.001). Conclusion:The automated digital cell morphology system has a good consistency with manual microscope(initial) in terms of the sensitivity of platelet clumps detection and can be used as a supplementary method for detecting platelet aggregation.

Ferroptosis is a form of regulated cell death, characterized by excessive membrane lipid peroxidation in an iron- and ROS-dependent manner. Celastrol, a natural bioactive triterpenoid extracted from Tripterygium wilfordii, shows effective anti-fibrotic and anti-inflammatory activities in multiple hepatic diseases. However, the exact molecular mechanisms of action and the direct protein targets of celastrol in the treatment of liver fibrosis remain largely elusive. Here, we discover that celastrol exerts anti-fibrotic effects via promoting the production of reactive oxygen species (ROS) and inducing ferroptosis in activated hepatic stellate cells (HSCs). By using activity-based protein profiling (ABPP) in combination with bio-orthogonal click chemistry reaction and cellular thermal shift assay (CETSA), we show that celastrol directly binds to peroxiredoxins (PRDXs), including PRDX1, PRDX2, PRDX4 and PRDX6, through the active cysteine sites, and inhibits their anti-oxidant activities. Celastrol also targets to heme oxygenase 1 (HO-1) and upregulates its expression in activated-HSCs. Knockdown of PRDX1, PRDX2, PRDX4, PRDX6 or HO-1 in HSCs, to varying extent, elevated cellular ROS levels and induced ferroptosis. Taken together, our findings reveal the direct protein targets and molecular mechanisms via which celastrol ameliorates hepatic fibrosis, thus supporting the further development of celastrol as a promising therapeutic agent for liver fibrosis.

As a new type of intercellular signaling rector, extracellular vesicles (EV) are involved in almost the whole process of tumorigenesis, progression, metastasis, and drug resistance. Therefore, EV have become the ideal biomarker candidates and research hotspots for cancer diagnosis and treatment. However, EV tumor biomarker research mainly focused on RNA and protein, and a small part of the research focused on lipids at the early stage. EV DNA has received little attention and its diagnostic value has gradually been recognized in recent years. Study on the biological characteristics and function of EV DNA may highlight its potential in tumor diagnosis.

Objective To investigate the distribution and antimicrobial resistance of multidrug‐resistant organisms(MDROs) . Methods The distribution and antimicrobial resistance of MDROs ,isolated from 2010 to 2014 ,were retrospectively analyzed . MDROs were identified according to international consensus .The WHONET5 .6 software was used to analyze data .Results A to‐tal of 5 709 strains of MDROs were isolated in five years ,in which 2 441 strains were Staphylococcus(42 .76% ) ,2 091 strains were non‐fermentive bacterial(36 .63% ) ,737 strains were Enterococcus(12 .90% ) ,440 strains were Enterobacter(7 .71% ) .Of the 5 709 MDROs isolates ,55 .04% were isolated from respiratory tract specimens .The resistant rate of multidrug‐resistant E .coli and K . pneumoniae against cefoperazone/sulbactam ,imipenem and meropenem was less than 30% .The resistance of multidrug‐resistant A . baumanii was higher than 90% ,except to minocycline and cefoperazone/sulbactam ,20 .2% and 50 .6% respectively .The resistant rate of multidrug‐resistant P .aeruginosa was 71 .4% -97 .0% against other antimicrobial agents ,except to polymyxin B .The resist‐ance of multidrug‐resistant E .faecium against the antimicrobials was higher than 90% ,except 13 .8% to minocycline and less than 3% to linezolid ,teicoplanin and vancomycin .Meanwhile ,1 linezolid resistant strain was identified in 1 914 methicillin resistant S .au‐reus(MRSA) strains and all MRSA strains were susceptible to vancomycin and teicoplanin .Conclusion MDROs could be predomi‐nated by A .bauman and MRSA in this hospital .Monitoring and control measures to healthcare‐associated infections should be in‐tensified to prevent the spread of MDROs .

Objective To investigate the relationship between the phenotypes and the patterns of genetic mutations in the corresponding resistance genes (rpoB, katG, inhA, ahpC, rrs, rpsL, embB and gyrA) in resistant Mycobacterium tuberculosis (MTB) isolates. Methods Rifampicin-resistant gene (rpoB), isoniazid-resistant genes (katG, inhA, ahpC), streptomycin-resistant genes (rrs, rpsL), ethambutol-resistant gene (embB) and quinolinone-resistant gene (gyrA) were amplified by PCR with sequence-specific primers, then mutants screened by single-stranded conformation polymorphism (SSCP) were sequenced. Results rpoB mutation with predominant Ser450Trp pattern was 94. 9% (56/59) in 59 rifampicin-resistant isolates;katG mutation rate was 38. 9% (35/90) and the main pattern was Ser315Thr, but only 3 inhA mutants and no ahpC mutation were determined in 90 isoniazid-resistant isolates;gyrA mutation with main Asp94Gly then Ala90Val pattern was 82.4% (28/34) in 34 quinolinone-resistant isolates;the total mutation rate was 77.4% in 31 streptomycin-resistant isolates, of which 15 isolates mutated in rrs with main pattern A514C or A1041G, 10 isolates mutated in rpsL Lys88Arg;and embB mutation with main Met306Val accounted for 19.4% (6/31) in 31 ethambutol-resistant isolates. Conclusions The results showed that resistance of resistant MTB may be complicated, and DNA sequencing-based mutation analysis could efficiently detect the molecular makers such as rpoB, katG, gyrA, rrs, rpsL and embB in resistant MTB isolates. Meanwhile, it is notable that the rpoB mutation pattern in our isolates is different from previous report, further effort are needed to confirm the characteristics. The spectrum of potential resistance-related mutations in MTB clinical isolates may lay substantial foundation for the rapid molecular diagnosis and rational use of drug to MTB patients.

Objective To investigate antifungal activities of AMB, ICZ, VRC, CBF against 72 strains of filamentous fungi in vitro. Methods Based on CLSI M38-P and M38-A scheme, MIC of antifungal drugs were determined. The growing inhibitory concentration of 100%, 100%,≥80%, for AMB, VRC ,ICZ act as respective MIC. For caspofungin, the minimal effective concentration (MEC) was determined as the lowest drug concentration showing morphology change of filaments. The fractional inhibitory concentration (FIC) was used to evaluate the effect of combination therapy. FIC was calculated by the following equation: FIC = MICcombination/MICA drug alone+ MICcombination/MICB drug alone. Results MIC90 of AMB, ICZ, CBF, VRC against 72 isolates of filamentous fungi were 8 μg/ml, 4 μg/ml, 2 μg/ml, 8 μg/ml, respectively. MICs range of combined AMB + ICZ, AMB + VRC, ICZ + VRC were 0. 125-16. 97, 0. 2452-1.25, and 0.0625-8. 25 μg/ml respectively. The percent of synergistic interaction of AMB + VRC against filamentous fungi (20.0%-88.9% ) was higher than those of AMB + ICZ ( 10.0% -62.5% ) and ICZ + VRC ( 20.0% - 44.4% ) ( P=0.007 <0.05 ). Conclusions The antifungal activities of four kinds antifungal drugs against 72 strains of filamentous fungi vary in vitro. The therapy of AMB combined with VRC is maybe better than AMB + ICZ and ICZ + VRC for severe fungi infection.