Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

Objective To analyze the epidemiological characteristics and disease burden of liver cancer in Guangdong Province in 2020, and to provide a scientific foundation for the development of regionalized prevention and control strategies for liver cancer. Methods According to the cancer registry data of Guangdong Province, the incidence, mortality and age-standardized rate by Chinese standard population in 2020 were calculated to analyze the epidemiological characteristics of liver cancer. The disability adjusted life years (DALYs), year of life loss (YLL), year of lived with disability (YLD), and cause-eliminated life expectancy were used to assess the disease burden of liver cancer. Results In 2020, the crude incidence rate and the age-standardized incidence rate of liver cancer in Guangdong Province were 27.79/100 000 and 20.84/100 000，respectively, and the crude mortality rate and the age-standardized mortality rate of liver cancer were 25.49/100,000 and 17.64/100 000, respectively. The total DALY and DALY rate of liver cancer in Guangdong Province were 515 311 person-years and 513.83/100 000, respectively. After eliminating the causes of death from liver cancer, the life expectancy in Guangdong Province increased from 84.60 years to 84.99 years. All indicators consistently demonstrated that the burden of liver cancer was higher in males than that in females, and the burden of liver cancer was higher in rural areas than that in urban areas. Conclusion Liver cancer in Guangdong Province exhibits a high incidence, mortality and disease burden level in 2020. There are obvious differences of gender, age and region in cancer burden. It is necessary to strengthen liver cancer screening and diagnosis and treatment in men, the elderly and those in rural areas to reduce the burden of liver cancer gradually in Guangdong Province.

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 compare the embryo development potential and clinical outcomes between the patients with and without oocyte degeneration.Methods:This retrospective cohort study included a total of 242 cycles underwent ICSI that cultured in time-lapse incubator from January 2019 to June 2023 at the Reproductive and Genetic Center of Suzhou Municipal Hospital and all 3 119 oocytes were evaluated. Data collection continued to February 5th,2024 until the last birthing of the study. Patients were divided into degenerated group (140 cycles) and control group (102 cycles) according to whether oocyte degenerated after ICSI. Then the embryo developmental potential and clinical outcomes were compared. Furthermore, we also investigated whether embryo morphokinetics could be different between the two groups.Results:Female age, duration of infertility, body mass index, basal follicle sitmulating hormone, basal luteinizing hormone, basal estrogen (E 2), antral follicle count, anti-Müllerian hormone, factors of infertility and source of semen were similar between the two groups ( P>0.05). E 2 on human chorionic gonadotropin triggered day [2 513.00 (1 842.20, 3 638.50) ng/L], number of oocytes retrieved (13.56±4.80) and oocyte maturation rate [84.35% (1 601/1 898)] were significantly higher in degenerated group than those in control group [2 270.50 (1 472.00, 3 044.20) ng/L, P=0.019; 11.97±4.71, P=0.011; 81.08% (990/1 221), P=0.017], while normal fertilization rate [69.33% (1 103/1 591)], day 3 (D3) good-quality embryos [57.85% (634/1 096)], blastocyst formation rate [50.87% (469/922)] and embryo utilized rate [58.30% (643/1 103)] were significantly lower in degenerated group than those in control group [85.56% (847/990), P<0.001; 65.72% (556/846), P<0.001; 61.26% (446/728), P<0.001; 66.12% (560/847), P<0.001] . In addition, the proportion of low cell number (<7) of D3 embryos [33.76% (370/1 096)] and high fragmentation (fragmentation ≥50%, fragmentation 20%-50%) of D3 embryos [10.01% (109/1 089), 18.64% (203/1 089)] in degenerated group were significantly higher than those in control group [27.19% (230/846), P=0.002; 6.06% (51/841), P=0.002; 14.15% (119/841), P=0.009], and so were the incidence of DC1 and CC [5.98% (66/1 103) vs. 2.48% (21/847), P<0.001; 2.45% (27/1 103) vs. 0.94% (8/847), P=0.013]. As regard to the utilized embryos, there were no significant differences in t5, cc2, cc3 and s2 ( P>0.05), but tPNf [22.82(21.13, 24.84) h], t2 [25.37 (23.62, 27.37) h], t3 [35.64 (33.10, 38.03) h] and t4 [36.85 (34.70, 39.52) h] in degenerated group were significantly earlier than those in control group [23.04 (21.76, 25.41) h, P=0.001; 25.91 (24.15, 28.05) h, P=0.001; 36.16 (33.11, 38.81) h, P=0.040; 37.39 (35.11, 40.27) h, P=0.026]. Further more, after the first transfer of fresh or frozen embryos, there were no significant differences in clinical pregnancy rate, implantation rate, early abortion rate, live birth rate, sex ratio, preterm birth rate, low birth weight rate and birth defect rate between the two groups (all P>0.05). ICSI degeneration was not an independent factor of implantation rate, early abortion rate and live birth rate after ICSI treatment, but number of embryos transferred was an independent factor of implantation rate and live birth rate after ICSI treatment ( OR=2.806, 95% CI: 1.179-6.677, P=0.020; OR=2.622, 95% CI: 1.129-6.090, P=0.025). Conclusion:The presence of oocyte degeneration after ICSI may affect the overall developmental potential of its sibling oocytes and may also disturb the morphokinetics of the embyos, however the pregnancy outcomes and neonatal birth outcomes may not be affected if transfer the best embryo in the first fresh or frozen cycle.

Depression is a heterogeneous mental disorder in which the interaction between genetic susceptibility and environ-mental factors plays a key role in its pathogenesis.Although the specific mechanisms of the disease still need to be thoroughly studied and elucidated,there is now a broad consensus that epi-genetic markers have a central influence on its mechanism of ac-tion.DNA methylation of brain-derived neurotrophic factor(BD-NF)is not only regarded as a promising epigenetic biomarker of pathology,but may also help predict the efficacy of antidepres-sants.In this paper we reviewed the gene structure of BDNF and its DNA methylation regulation mechanism,and also analyzed the changes of DNA methylation of this factor in depression pa-tients and animal models,aiming to provide new ideas and theo-retical support for clinical research.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Chronic non-specific lower back pain(CNLBP)is one of the most common symptoms in clinical lower back pain,which is prone to recurrence and shows a trend towards younger age.Patients with CNLBP typically experience local pain,reduced joint mobility and balance dysfunction.In depth analysis of the relevant factors that cause balance dysfunction in CNLBP patients and intervention methods can reveal the biological(mechanical)mechanisms of balance dysfunction in patients with CNLBP and provide references and basis for the subsequent improvement of CNLBP intervention methods.This review summarizes the research status of the impact of CNLBP on patients' balance function and disease intervention methods from several aspects,including balance dysfunction in patients with CNLBP,damage to the motor and nervous system,and intervention methods for the disease.The aim is to provide references for the subsequent research on the pathogenesis and intervention methods of CNLBP.

Objective:To investigate the effect of oleanolic acid(OA)on inflammatory injury of pancreatic acinar cells in-duced by lipopolysaccharide(LPS)by regulating stromal cell-derived factor-1(SDF-1)/CXC chemokine receptor 4(CXCR4)signal axis.Methods:Rat pancreatic acinar cells AR42J were treated with 5,10,20 and 40 μmol/L OA,and the cell viability was detected using CCK-8 method to determine the optimal dosage for subsequent experimental OA treatment;AR42J cells were randomly divided into control group(NC),LPS group(10 mg/L LPS),OA low-dose group(OA-L group,10 mg/L LPS+5 μmol/L OA),OA medium dose group(OA-M group,10 mg/L LPS+10 μmol/L OA),OA high-dose group(OA-H group,10 mg/L LPS+20 μmol/L OA),Rr-SDF-1 activator(SDF-1)group(10 mg/L LPS+20 ng/ml Rr-SDF-1)and OA-H+Rr-SDF-1 group(10 mg/L LPS+20 μmol/L OA+20 ng/ml Rr-SDF-1).CCK-8 method and EdU staining were applied to detect proliferation of AR42J cells;flow cytometry was applied to detect apoptosis of AR42J cells;activity of superoxide dismutase(SOD)and content of malondialdehyde(MDA)in cell supernatant were detected by spectrophotometry;ELISA was applied to detect levels of IL-6 and TNF-α in cell supernatant;Western blot was applied to detect expressions of CyclinD1,Bcl-2 associated X protein(Bax),SDF-1 and CXCR4 proteins in cells.Results:5,10 and 20 μmol/L OA were selected as the low,medium and high doses for subsequent treatment of AR42J cells;compared with NC group,A450 value,EdU positive cell rate,SOD activity,and CyclinD1 protein expression in LPS group decreased,while apoptosis rate,MDA content,IL-6,TNF-α levels,Bax,SDF-1 and CXCR4 protein expressions increased(P<0.05);compared with LPS group,A450 value,EdU positive cell rate,SOD activity,and CyclinD1 protein expression in OA-L group,OA-M group and OA-H group increased,while apoptosis rate,MDA content,IL-6,TNF-α levels,Bax,SDF-1 and CXCR4 protein expressions reduced,the change trends of corre-sponding indicators in Rr-SDF-1 group was opposite to the above(P<0.05);compared with OA-H group,A450 value,EdU positive cell rate,SOD activity,and CyclinD1 protein expression in OA-H+Rr-SDF-1 group decreased,while apoptosis rate,MDA content,IL-6,TNF-α levels,Bax,SDF-1 and CXCR4 protein expressions increased(P<0.05).Conclusion:OA may alleviate LPS induced inflam-matory damage to pancreatic acinar cells in rats by inhibiting the SDF-1/CXCR4 pathway.

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.