A novel analytical method was developed in this study by combining online solid phase extraction with ultra performance liquid chromatography-tandem mass spectrometry(Online SPE-UPLC-MS/MS)for simultaneous determination of 50 kinds of steroid hormones in surface water.Specifically,after high-speed centrifugation of 4 mL water samples,the supernatant was directly injected into an Oasis HLB online SPE column for enrichment and purification.Subsequently,the target compounds were transferred to the analytical column via valve switching for separation and analysis.The chromatographic separation was performed on a Thermo Acclaim RSLC C18 column(100 mm×2.1 mm,2.2 μm),using a mobile phase composed of 5 mmol/L ammonium fluoride aqueous solution and acetonitrile.Mass spectrometric detection was conducted in positive ion mode,utilizing multiple reaction monitoring(MRM)with quantification achieved by the internal standard method.The method validation demonstrated that the limits of detection(LOD)for the 50 kinds of steroid hormones ranged from 0.02 to 0.50 ng/L,while the limits of quantification(LOQ)were between 0.08 and 1.67 ng/L.The average recoveries in surface water samples at spiked concentrations of 5,20 and 200 ng/L were between 74.1％and 119％,with relative standard deviations(RSDs)of 0.2％to 9.9％.This method was applied to analyze 11 surface water samples collected from sites surrounding a pharmaceutical and chemical industrial park.A total of 44 kinds of steroid hormones were detected,with concentrations ranging from 0.11 to 88.6 ng/L,revealing the presence of hormone contamination in the environmental waters surrounding industrial areas.Compared with the traditional offline SPE methods,the proposed online SPE technique significantly reduced sample volume requirements and pretreatment time,while minimizing the loss of target compounds during the pretreatment process.Moreover,compared to reported online SPE techniques,this method achieved high-throughput analysis of multiple classes of steroid hormones,with lower detection limits and higher recoveries.Overall,this method provided rapid sample preparation,high sensitivity,and excellent stability,making it suitable for the direct analysis of trace steroid hormones in surface water.

Objective To examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective To explore the prediction efficiency of Ki-67 expression status in pituitary adenoma(PA)based on a joint model of siamese network and transfer learning.Methods The preoperative MR T1WI enhanced sequence images of 370 patients with PA diagnosed by surgery and pathology were retrospectively collected.According to the results of immunohistochemical,all patients were divided into high proliferation index group(Ki-67≥3,n=97)and low proliferation index group(Ki-67＜3,n=273),and all the sample data were randomly divided into training set and test set according to the ratio of 7∶3.Two single predictive models,ResNet-50 and VGGNet-16 and combined them with the siamese network and transfer learning were built.The prediction efficiency of different models were evaluated via accuracy rate,precision rate,recall rate,F1 score and receiver operating characteristic(ROC)curve as the main criteria.Results Compared with a single predictive model,the model combined with siamese network and transfer learning showed a better performance for predicting the Ki-67 of PA.Additionally,the ResNet-50 joint model exhibited the superior predictive performance.The accuracy rate was 0.872 7,the precision rate was 0.812 5,the recall rate was 0.764 7,the F1 score was 0.787 9,and the area under the curve(AUC)was 0.841 6.Conclusion The joint model based on siamese network and transfer learning exhibits a higher efficiency for predicting the Ki-67 expression status in PA,which can help the clinicians to formulate more personalized treatment for the patients.

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 analyze the status of targeted monitoring of the health care-associated infections in in-tensive care unit(ICU)of a three-A hospital of northwest China in recent 7 years so as to provide bases for formu-lating effective prevention and control measures for the health care-associated infections.METHODS The related data were successively collected from the ICU hospitalized patients of the Second Affiliated Hospital of Air Force Medical University who were under the targeted monitoring by nosocomial infection real-time monitoring system from Jan.2017 to Dec.2023.The data included the incidence of infections,infection sites,use of catheters,inci-dence of catheter-related infections,and distribution and prevalence trend of pathogens.RESULTS A total of 49,137 hospitalized patients from five ICU wards of respiratory medicine department,neurosurgery department,neurology department,thoracic surgery department and critical care medicine department were under the monito-ring,1446(1681 case-times)of whom had health care-associated infections,with the infection rate 2.94％,the case-time infection rate 3.42％.The respiratory system was the major infection site of the patients with the health care-associated infections.Among the patients with instrument-associated infections,20.70％had ventilator-asso-ciated pneumonia(VAP),5.71％had urinary catheter-associated urinary tract infection(CAUTI),and 1.96％had catheter-related bloodstream infection(CRBSI).Totally 405 strains of non-repetitive pathogens were isolated from 477 patients with instruments-associated infections,78.77％of which were gram-negative bacteria.The iso-lation rate of multidrug-resistant organisms(MDROs)was 44.12％,and Acinetobacter baumannii was the pre-dominant species of pathogen isolated from the patients with VAP.CONCLUSIONS The targeted monitoring of health care-associated infections may facilitate the awareness of dynamic changes of the infections in a accurate and timely manner so as to provide bases for developing effective prevention and control measures for the health care-associated infection.It is necessary to strengthen the prevention and control of the infections in critical care medi-cine department,neurosurgery department as well as the lower respiratory tract infections and prevent the MDROs infection in the meantime.

Objective:To explore the clinical effect of the whole-process management scheme of daytime minimally invasive liver resection surgery based on the enhanced recovery after surgery (ERAS) concept.Methods:This is a retrospective case series study. The data of 55 patients who underwent minimally invasive daytime liver resection surgery under the ERAS concept at the Department of General Surgery,Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2023 to August 2024. There were 22 males and 33 females;aged (48.2±15.1) years (range: 16 to 77 years). All patients were classified as Grade 2 according to the American Society of Anesthesiologists physical status classification. Among them, 7 cases were complicated with liver cirrhosis and 10 cases had fatty liver. A multidisciplinary team was formed, consisting of surgeons, anesthesiologists, rehabilitation physicians, psychologists, pharmacists, acute pain management team, operating room nurses, day surgery ward nurses, and ERAS specialized nurses. After strict evaluation by surgeons and anesthesiologists, patients suitable for daytime liver resection surgery were implemented with the ERAS whole-process management plan for liver resection on the basis of routine nursing care.Results:Among the 55 patients, 50 were discharged smoothly within 48 hours, while 5 were transferred to specialized departments for further treatment due to not meeting the discharge criteria, with a smooth daytime discharge rate of 90.9%. Among the 50 patients, 30 underwent laparoscopic surgery and 20 underwent robotic-assisted surgery. The surgery time was (91.6±28.2)minutes(range:45 to 165 minutes), with the intraoperative blood loss of only (30.5±25.5)ml(range:5 to 100 ml). Pathological examination results showed that among the 50 patients, 13 cases had hepatocellular carcinoma, 21 cases had hepatic hemangioma, 4 cases had hepatic cyst, 8 cases had focal nodular hyperplasia, 1 case had low-grade dysplastic nodule, 1 case had hepatolithiasis, 1 case had lymphoma, and 1 case had vascular, fibrous and lymphoid tissue proliferation. There were 44.0% patients who were able to get out of bed on the day of surgery. The hospital stay was (1.8±0.4)days(range:1 to 2 days), and the hospitalization cost was (34 499±20 330)yuan(range:11 724 to 73 488 yuan). No complications requiring special treatment outside the conventional pathway were observed during the hospital stay and follow-up period. At the 2-week outpatient follow-up, no significant abnormalities were found in all patients, and the wound healing was good.Conclusions:The daytime liver resection surgery based on the ERAS whole-process management plan has shown good feasibility in clinical practice. It helps to simplify medical process, shorten hospital stay, and reduce medical costs.

Lung cancer is one of the malignant tumours with the highest morbidity and mortality rates worldwide today, posing a major threat to human health. Accurate diagnosis and standardised treatment play a crucial role in improving the survival rate of lung cancer patients. In recent years, the rapid rise of artificial intelligence (AI) has brought about significant changes in the medical field, providing a new diagnostic and treatment model for lung cancer, and making a series of breakthroughs in lung cancer diagnostic imaging, pathological diagnosis, surgical oncology, radiotherapy, and drug development and treatment. This article introduces the current status of AI application in the field of lung cancer diagnosis and treatment, and extensively discusses the current challenges and future prospects, hoping to provide references and suggestions for future clinical practice.

The aryl hydrocarbon receptor (AhR) plays a crucial role in regulating many physiological processes. Activating the AhR-CYP1A1 axis has emerged as a novel therapeutic strategy against various inflammatory diseases. Here, a practical in situ cell-based fluorometric assay was constructed to screen AhR-CYP1A1 axis modulators, via functional sensing of CYP1A1 activities in live cells. Firstly, a cell-permeable, isoform-specific enzyme-activable fluorogenic substrate for CYP1A1 was rationally constructed for in-situ visualizing the dynamic changes of CYP1A1 function in living systems, which was subsequently used for discovering the efficacious modulators of the AhR-CYP1A1 axis. Following screening of a compound library, LAC-7 was identified as an efficacious activator of the AhR-CYP1A1 axis, which dose-dependently up-regulated the expression levels of both CYP1A1 and AhR in multiple cell lines. LAC-7 also suppressed macrophage M1 polarization and reduced the levels of inflammatory factors in LPS-induced bone marrow-derived macrophages. Animal tests showed that LAC-7 could significantly mitigate DSS-induced ulcerative colitis and LPS-induced acute lung injury in mice, and markedly reduced the levels of multiple inflammatory factors. Collectively, an optimized fluorometric cell-based assay was devised for in situ functional imaging of CYP1A1 activities in living systems, which strongly facilitated the discovery of efficacious modulators of the AhR-CYP1A1 axis as novel anti-inflammatory agents.

Patients with periodontal disease often require combined periodontal-orthodontic interventions to restore periodontal health, function, and aesthetics, ensuring both patient satisfaction and long-term stability. Managing these patients involving orthodontic tooth movement can be particularly challenging due to compromised periodontal soft and hard tissues, especially in severe cases. Therefore, close collaboration between orthodontists and periodontists for comprehensive diagnosis and sequential treatment, along with diligent patient compliance throughout the entire process, is crucial for achieving favorable treatment outcomes. Moreover, long-term orthodontic retention and periodontal follow-up are essential to sustain treatment success. This expert consensus, informed by the latest clinical research and practical experience, addresses clinical considerations for orthodontic treatment of periodontal patients, delineating indications, objectives, procedures, and principles with the aim of providing clear and practical guidance for clinical practitioners.
Humans ; Consensus ; Orthodontics, Corrective/standards* ; Periodontal Diseases/complications* ; Tooth Movement Techniques/methods* ; Practice Guidelines as Topic

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*