OBJECTIVE To analyze the non-genetic risk factors for severe cutaneous adverse reactions （SCARs） related to antiepileptic drugs （AEDs） in HLA-B*15：02 negative patients， and provide a basis for clinical precision medication. METHODS A retrospective case-control design was used to include patients who underwent HLA-B*15：02 testing at our hospital from January 2022 to December 2024. Patients were divided into SCARs group （15 cases who were HLA-B*15：02 negative and diagnosed with SCARs） and control group （38 cases who were HLA-B*15：02 negative and used AEDs）. Risk factors were evaluated using univariate analysis and a multivariable Firth penalty likelihood logistic regression model （Firth regression）， and Benjamin-Hochberg false discovery rate （FDR） and Firth regression were used for correction， and sensitivity analysis was used to quantify the impact of potential biases in carbamazepine exposure rates in the control group on the results. RESULTS Univariate analysis showed that age≥50 years， use of carbamazepine， and combination use of antibiotics/antiviral drugs were risk factors for developing AEDs- related SCARs （OR＝18.15， 7.54， 13.46， 95%CI of 4.13-79.84， 1.89-30.08， 1.36-133.18， all P＜0.05）， while taking lamotrigine was a protective factor [OR＝0.10， 95%CI of 0.02-0.39， P＜0.05]. After FDR correction， the above factors still maintained statistical significance （P＜0.05）. The results of multivariate analysis showed that age≥50 years [adjusted OR＝16.27， 95%CI of 3.98-66.55， P＜0.001] and taking carbamazepine [adjusted OR＝7.11， 95%CI of 1.82-27.85， P＝0.005] were independent risk factors for the occurrence of SCARs-related AEDs. The results of sensitivity analysis showed that the adjusted risk OR range for taking carbamazepine was between 14.2 and 28.4. CONCLUSIONS Age≥50 years and use of carbamazepine are independent non- genetic risk factors for the development of SCARs-related AEDs in HLA-B*15：02 negative patients. It is recommended that elderly patients should prioritize the use of AEDs other than carbamazepine.

Objective To analyze the epidemiological distribution of new occupational pneumoconiosis (hereinafter referred to as "pneumoconiosis") in Guangxi Zhuang Autonomous Region from 2013 to 2022. Methods Data of newly diagnosed pneumoconiosis cases reported in Guangxi Zhuang Autonomous Region from 2013 to 2022 were collected, and epidemiological characteristics were analyzed using descriptive analysis method. Results A total of 972 newly diagnosed pneumoconiosis cases were reported in Guangxi Zhuang Autonomous Region from 2013 to 2022. Except for mica pneumoconiosis, 12 other types of pneumoconiosis were reported. Most of the cases were males, accounting for 97.0%. The diagnosis age of the cases of 40-<60 years old accounted for 77.4%, and the dust exposure age<30 years of the cases accounted for 96.4%. Silicosis was the most common type of pneumoconiosis, followed by coal workers' pneumoconiosis, accounting for 64.6% and 27.9%, respectively. The cases of stage Ⅰ, Ⅱ and Ⅲ pneumoconiosis accounted for 77.7%, 14.9% and 7.4%, respectively. The regional distribution was mostly in Hechi City, accounting for 51.9%. Industry distribution was more common in non-ferrous metal mining, coal mining and washing industry, accounting for 64.9% in total. Most cases were reported in private enterprises and small to medium-sized enterprises, accounting for 53.7% and 76.6% respectively. The most common occupations were coal miners and drillers, accounting for 47.7% in total. Conclusion Newly diagnosed pneumoconiosis cases in Guangxi Zhuang Autonomous Region show certain clustering characteristics in terms of disease type, region, enterprise characteristics, and occupation distribution. The prevention and treatment of pneumoconiosis in small and medium-sized private enterprises in key areas and key industries should be strengthened, especially for workers over 40 years old and with less than 30 years of dust exposure.

ObjectiveTo investigate the genotyping and drug resistance trends of 461 strains of diarrheagenic Escherichia coli (DEC) isolated and identified in Suzhou, Jiangsu Province from 2019 to 2023. MethodsDEC detected in Suzhou in the past 5 years was used as the research subject, and the virulence genotyping was tested by real-time fluorescence quantitative polymerase chain reaction (PCR). The microbroth dilution method was used to perform drug susceptibility test, and the corresponding susceptibility (S), intermediate (I) and resistance (R) results were obtained based on the minimum inhibitory concentration (MIC) values, according to the criteria of United States Clinical and Laboratory Standardization Committee (CLSI) 2017. Differences of DEC drug resistance among different virulence genotypes were compared by χ² test or Fisher exact probability method. ResultsA total of 461 DEC strains were detected in Suzhou from 2019 to 2023, of which the highest proportion was enterotoxigenic Escherichia coli (ETEC) accounting for 45.77% (211/461), followed by enteropathogenic Escherichia coli (EPEC) accounting for 32.32% (149/461) and enteroaggregative Escherichia coli (EAEC) accounting for 20.39% (94/461), while enterohemor-rhagic Escherichia coli (EHEC) and enteroinvasive Escherichia coli (EIEC) were individually distributed. The antimicrobial drug with the highest resistance rate was ampicillin (61.61%), followed by cefazolin (49.89%) and nalidixic acid (44.47%). There were statistically significant differences in drug resistence rates of the three major virulence genotypes of DEC (ETEC, EPEC and EAEC) to ampicillin (AMP), ampicillin/sulbactam (AMS), amoxicillin/clavulanic acid (AMC), cefoxetine (CFX), gentamicin (GEN), streptomycin (STR), tetracycline (TET), nalidixic acid (NAL), and chloramphenicol (CHL), and methotrexate/sulfamethoxazole (SXT). The multi-drug resistance (MDR) rate of DEC was 59.87% (276/461), and the MDR rate of each genotype, from high to low, was EIEC (75.00%), EAEC (71.28%), EHEC (66.66%), EPEC (61.74%) and ETEC (52.86%). ConclusionETEC, EPEC and EAEC are the main genotypes prevalent in DEC in Suzhou in recent years. The drug resistance strains and MDR are still serious, which should arouse wide public health concern and take targeted prevention and control measures.

Objective To investigate the relationship between systemic immune-inflammation index (SII)and lower extremity vascular disease in patients with type 2 diabetes mellitus (T2DM).Methods A cross-sectional study was conducted on 390 T2DM patients admitted in our department from January 2013 to January 2024.According to the diagnostic criteria for lower extremity vascular disease in T2DM patients,they were divided into a lower extremity vascular disease group (n=158)and a control group (n=232).General data and results of laboratory tests were compared between the 2 groups.Spearman correlation analysis was used to identify the related factors for lower extremity vascular diseases in T2DM patients.The correlation between SII and lower extremity vascular diseases in T2DM patients was analyzed using the Row Mean Scores and Cochran-Armitage Trend analysis.Multivariate logistic regression analysis was applied to identify the risk factors for lower limb vascular lesions in T2DM patients.Receiver operating characteristic (ROC)curve was plotted to evaluate the diagnostic efficacy of SII for lower extremity vascular disease in the patients.Results Compared with T2DMpatients without lower extremity vascular disease,those with lower extremity vascular disease were older,had higher levels of total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),SII,larger proportion of carotid vascular lesions,and increased proportion of no-taking statins.The lower extremity vascular disease in T2DM patients was positively correlated with SII/100 (r=0.429,P<0.001),age (r=0.517,P<0.001),TC (r=0.161,P=0.001),LDL-C (r=0.117,P=0.021),carotid artery lesions (r=0.101,P=0.047),no-taking statins (r=0.266,P<0.001).Logistic regression analysis showed that SII,age,LDL-C,and no-taking statins were the risk factors for lower extremity vascular lesions in T2DM patients (P<0.01).The area under the curve (AUC)value of SII combined with age,LDL-C,and no-taking statins in predicting lower extremity vascular disease in T2DM patients was 0.896.Conclusion SII is not only a risk factor,but also a simple marker for lower extremity vascular disease in T2DM patients,suggesting that inflammatory response plays an important role in the occurrence and development of lower extremity vascular disease in T2DM.

Objective:To explore the risk factors related to delayed pleural effusion in multiple trauma patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 145 multiple trauma patients admitted to the First Affiliated Hospital of Soochow University from January 2022 to October 2023, including 99 males and 46 females, aged 18-81 years [56.0(46.5, 64.5)years]. Based on whether delayed pleural effusion developed after injury, the patients were divided into delayed pleural effusion group ( n=66) and non-delayed pleural effusion group ( n=79). The clinical data of the patients in both groups were collected, including gender, age, underlying disease (diabetes mellitus and hypertension), cause of injury (traffic injury, blow injury, fall from height, and others), comorbid injuries (traumatic brain injury, maxillofacial fracture, clavicular fracture, scapular fracture, sternal fracture, spinal fracture, multiple rib fracture, pneumothorax, lung contusion, and pelvic fracture), severity of injury [injury severity score (ISS) and abbreviated injury scale (AIS) score for the chest], location and number of rib fractures, vital signs at admission (body temperature, heart rate, respiration, systolic blood pressure, diastolic blood pressure), and clinical test indices [white blood cells (WBC), hemoglobin (Hb), platelets (PLT), total protein (TP), albumin (ALB), C-reactive protein (CRP), procalcitonin (PCT), fibrinogen (FIB), fibrin degradation product (FDP), D-dimer (D-D), aspartate transaminase (AST), alanine transferase (ALT), and creatinine (Cr)]. Univariate analysis was conducted to assess the correlation between the forementioned factors and the development of delayed pleural effusion after multiple traumas. Multivariate Logistic regression analysis was used to determine the independent risk factors for the development of delayed pleural effusion after multiple traumas. Results:The results of univariate analysis showed that multiple rib fracture, pneumothorax, pulmonary contusion, chest AIS score, posterior rib fracture, number of rib fractures, TP, ALB, CRP, PCT and FDP were correlated with delayed pleural effusion in multiple trauma patients ( P<0.05 or 0.01); whereas gender, age, underlying disease, cause of injury, sternal fracture, spinal fracture, clavicular fracture, scapular fracture, pelvic fracture, maxillofacial fracture, traumatic brain injury, anterior rib fracture, ISS, vital signs at admission, WBC, Hb, PLT, FIB, D-D, AST, ALT, and Cr were not correlated with delayed pleural effusion in multiple trauma patients ( P>0.05). The results of multivariate Logistic regression analysis revealed that lung contusion ( OR=3.96, 95% CI 1.59, 9.85, P<0.01), ALB ( OR=0.79, 95% CI 0.66, 0.94, P<0.01), and CRP ( OR=1.02, 95% CI 1.01, 1.03, P<0.01) were significantly correlated with delayed pleural effusion in multiple trauma patients. Conclusion:Lung contusion, ALB, and CRP are the independent risk factors for delayed pleural effusion in multiple trauma patients.

Over-expression of glutathione S-transferase(GST)can promote Cisplatin resistance in hepatocellular carcinoma(HCC)treatment.Hence,inhibiting GST is an attractive strategy to improve Cisplatin sensi-tivity in HCC therapy.Although several synthesized GST inhibitors have been developed,the side effects and narrow spectrum for anticancer seriously limit their clinical application.Considering the abundance of natural compounds with anticancer activity,this study developed a rapid fluorescence technique to screen"green"natural GST inhibitors with high specificity.The fluorescence assay demonstrated that schisanlactone B(hereafter abbreviated as C1)isolated from Xue tong significantly down-regulated GST levels in Cisplatin-resistant HCC cells in vitro and in vivo.Importantly,C1 can selectively kill HCC cells from normal liver cells,effectively improving the therapeutic effect of Cisplatin on HCC mice by down-regulating GST expression.Considering the high GST levels in HCC patients,this compound demon-strated the high potential for sensitizing HCC therapy in clinical practice by down-regulating GST levels.

Background Bacteria are the most diverse and widely sourced microorganisms in the indoor air of subway stations, where pathogenic bacteria can spread through the air, leading to increased health risks. Objective To understand the status and distribution characteristics of indoor air bacterial pollution in subway stations and compartments in a city of Central South China, and to provide a scientific basis for formulating intervention measures to address indoor air bacteria pollution in subways. Methods Three subway stations and the compartments of trains parking there in a city in Central South China were selected according to passenger flow for synchronous air sampling and monitoring. Temperature, humidity, wind speed, carbon dioxide (CO₂), fine particulate matter (PM_2.5), and inhalable particulate matter (PM₁₀) were measured by direct reading method. In accordance with the requirements of Examination methods for public places-Part 3: Airborne microorganisms (GB/T 18204.3-2013), air samples were collected at a flow rate of 28.3 L·min⁻¹, and total bacterial count was estimated. Bacterial microbial species were identified with a mass spectrometer and pathogenic bacteria were distinguished from non-pathogenic bacteria according to the Catalogue of pathogenic microorganisms transmitted to human beings issued by National Health Commission. Kruskal-Wallis H test was used to compare the subway hygiene indicators in different regions and time periods, and Bonferroni test was used for pairwise comparison. Spearman correlation test was used to evaluate the correlation between CO₂ concentration and total bacterial count. Results The pass rates were 100.0% for airborne total bacteria count, PM_2.5, and PM₁₀ in the subway stations and train compartments, 94.4% for temperature and wind speed, 98.6% for CO₂, but 0% for humidity. The overall median (P₂₅, P₇₅) total bacteria count was 177 (138,262) CFU·m⁻³. Specifically, the total bacteria count was higher in station halls than in platforms, and higher during morning peak hours than during evening peak hours (P<0.05). A total of 874 strains and 82 species were identified by automatic microbial mass spectrometry. The results of identification were all over 9 points, and the predominant bacteria in the air were Micrococcus luteus (52.2%) and Staphylococcus hominis (9.8%). Three pathogens, Acinetobacter baumannii (0.3%), Corynebacterium striatum (0.1%), and Staphylococcus epidermidis bacilli (2.2%) were detected in 23 samples (2.6%), and the associated locations were mainly distributed in train compartments during evening rush hours. Conclusion The total bacteria count in indoor air varies by monitoring sites of subway stations and time periods, and there is a risk of opportunistic bacterial infection. Attention should be paid to cleaning and disinfection during peak passenger flow hours in all areas.

Objective To investigate the effect of Alogliptin benzoate on the serum autophagy markers in type 2 diabetes mellitus(T2DM)patients.Methods Eighty newly diagnosed T2DM patients who visited the Department of Endocrinology in Baoding No.1 Central Hospital from December 2021 to October 2022 were randomly divided into a group treated with Metformin(Met group,n=40)and a group treated with Met and Alog(Met+Alog group,n=40).The differences in BMI,WHR,FPG,HbA1c,Atg7 and Beclin-1 between two groups before and after 12 weeks of treatment were compared.Results After treatment,the levels of Atg7 and Beclin-1 increased in both groups(P<0.05),while FPG,HbA1c and HOMA-IR decreased(P<0.05).After treatment,Atg7,Beclin-1 and HDL-C in Met+Alog group were higher than those in Met group(P<0.05).Pearson correlation analysis showed that Atg7 was negatively correlated with BMI,FPG and HbA1c(P<0.05);Beclin-1 was positively correlated with HDL-C(P<0.05),and negatively correlated with BMI,FPG,HbA1c,and TG(P<0.05).Meta linear regression analysis showed that BMI was the influencing factor of Atg7,while BMI and HDL-C were the influencing factors of Beclin-1.Conclusion Alogliptin benzoate may improve islet β cell function by up-regulating the expression of autophagy related factors Atg7 and Beclin-1 in patients with T2DM.