ObjectiveTo investigate the contamination status of ochratoxin A (OTA) in commercially available food products in Shanghai, and to assess OTA exposure levels and the associated non-carcinogenic and carcinogenic risks among pregnant women by integrating dietary consumption data of this population. MethodsThe levels of OTA contamination in 1 520 food samples collected in Shanghai from 2022 to 2023 were determined using liquid chromatography-tandem mass spectrometry. An exposure assessment model was developed based on the dietary consumption levels of pregnant women from the 2016‒2017 Shanghai Pregnant Women Dietary Monitoring Survey to calculate the estimated daily intake (EDI) of OTA, the margin of exposure for non-carcinogenic toxicity (MOE₁), and the margin of exposure for carcinogenic toxicity (MOE₂). An MOE₁ greater than 200 and an MOE₂ greater than 10 000 indicate that the non-carcinogenic toxicity and carcinogenic toxicity resulting from exposure are negligible, respectively. For samples with OTA contamination levels below the limit of detection (LOD), which accounted for more than 80% of the samples, the OTA levels were assigned values of 0 and LOD, respectively, for subsequent calculations. ResultsThe detection rates of OTA in cereals, nuts, dried fruits, and alcohol samples collected in 2022 were 2.03%, 0, 0, and 0, respectively. The OTA detection rates in cereals, nuts, dried fruits, beans, and alcohol samples collected in 2023 were 2.50%, 0.39%, 2.47%, 1.67%, and 13.33%, respectively. For pregnant women in Shanghai in 2022, simulation results indicated that when assigning a value of 0 and the LOD, theP₅₀ values of EDI for dietary OTA exposure were 0.05 and 0.72 ng·(kg·d)^-1, respectively, and the P₉₅ values of EDI for dietary OTA exposure were 0.25 and 2.40 ng·(kg·d)^-1, respectively. For pregnant women in Shanghai in 2023, the P₅₀ values of EDI for dietary OTA exposure were 0.04 and 1.00 ng·(kg·d)^-1, respectively, and the P₉₅ values of EDI for dietary OTA exposure were 0.23 and 2.67 ng·(kg·d)^-1, respectively, both substantially below the tolerable daily intake (TDI) for OTA [17 ng·(kg·d)^-1]. The EDI for dietary OTA exposure in 100.0% of Shanghai pregnant women was lower than the TDI, indicating an overall low level of dietary OTA exposure among this population. For 100.0% of pregnant women, the MOE₁ for dietary OTA exposure exceeded 200. When assigned a value of 0, the MOE₂ for 100.0% of pregnant women in both 2022 and 2023 exceeded10 000. When assigned the LOD value, 72.3% and 81.8% of pregnant women in 2022 and 2023, respectively, had an MOE₂ exceeding 10 000. ConclusionFrom 2022 to 2023, samples of cereals, nuts, dried fruits, beans, and alcohol sold in Shanghai exhibited varying degrees of OTA contamination. The overall EDI of OTA exposure among pregnant women in Shanghai remained at a low level. The non-carcinogenic and carcinogenic risks associated with OTA exposure were generally low and at controllable levels.

Objective: To construct a phenolamine cross-linked coating composed of epigallocatechin gallate(EGCG) and poly-L-lysine(PLL) on the surface of the porous pure Ti integrated with the antibacterial substance chlorhexidine(CHX), and to study the antibacterial property and biosafety. Methods: A porous structure(pTi group) was formed on the surface of titanium samples by alkaline heat treatment. Then the pTi group was immersed in the mixed solution of EGCG and PLL in an alkaline aerobic environment for 24 h to obtain the phenolamine group samples(EP group). Finally, the titanium tablets were further immersed in the aqueous solution of chlorhexidine(CHX) for 24 h to obtain the antibacterial groups(EPC group). Microstructure and properties of the surface were characterized by scanning electron microscopy(SEM), X-ray photoelectron spectrometer(XPS) and water contact angle measuring instrument. The antibacterial properties of coating were observed and evaluated by nephelometry, inhibition zone method and live/dead bacterial staining. The cytocompatibility of the coating was evaluated by MTT method and cell fluorescence staining, and the cell adhesion and proliferation ability in bacterial environment were evaluated by the co-culture of bacteria and cells. Results: SEM results showed that the pore size of samples after alkali heat treatment decreased with the deposition of the phenolamine coating. The measurement of water contact angle showed that the contact angle increased significantly with the grafting of coating. The intensity of N1s and C1s peaks increased and Ti2p and O1s peaks decreased detected by XPS tests. The Cl2p peak appeared in EPC group referred to the control group. The antibacterial experimentsin vitroshowed that the antibacterial samples could perform effective antibacterial effects on Staphylococcus aureus and Aggregatibacter actinomycetem-comitans for at least 7 days. In the biocompatibility experiments, MTT and cell fluorescence staining results showed that the adherent cells had good morphology and proliferative activity. The bacteria-cell co-culture results showed that the EPC groups could provide a good environment for cell proliferation and growth with excellent antibacterial properties. Conclusion Chlorhexidine-grafted phenolamine deposited on porous titanium surface displays an effective antibacterial effect with good biosafety performance, which can play an antibacterial role in the bacterial environment while ensuring cell adhesion and proliferation.

Hepatocellular carcinoma （HCC） is a common malignant tumor with a high mortality rate， an insidious onset， and complex pathological mechanisms. In the tumor microenvironment， tumor-promoting immune cells protect tumor cells from immune attacks， while dysfunction of anti-tumor immune cells causes the inhibition of immune response， thereby leading to the continuous deterioration of cancer. In recent years， traditional Chinese medicine has shown good efficacy in the treatment of HCC， and it can inhibit the proliferation and metastasis of cancer cells by regulating immune cells. By analyzing related articles in China and globally， this article summarizes how immune cells affect the progression of HCC through the immunosuppressive pathway and how traditional Chinese medicine exerts an anti-HCC effect by regulating immune cells， in order to provide theoretical basis and reference for optimizing the treatment of HCC.

Objective: To explore glymphatic impairment in pediatric refractory epilepsy (RE) using multi-parameter magnetic resonance imaging (MRI), assess its relationship with white-matter (WM) abnormalities and clinical indicators, and preliminarily evaluate the performance of multi-parameter MRI in discriminating RE from drug-sensitive epilepsy (DSE). Materials and Methods: We retrospectively included 70 patients with DSE (mean age, 9.7 ± 3.5 years; male:female, 37:33) and 26 patients with RE (9.0 ± 2.9 years; male:female, 12:14). The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index as well as fractional anisotropy (FA), mean diffusivity (MD), and nodal efficiency values were measured and compared between patients with RE and DSE. With sex and age as covariables, differences in the FA and MD values were analyzed using tract-based spatial statistics, and nodal efficiency was analyzed using a linear model. Pearson’s partial correlation was analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the discrimination performance of the MRI-based machine-learning models through five-fold cross-validation. Results: In the RE group, FA decreased and MD increased in comparison with the corresponding values in the DSE group, and these differences mainly involved the callosum, right and left corona radiata, inferior and superior longitudinal fasciculus, and posterior thalamic radiation (threshold-free cluster enhancement, P < 0.05). The RE group also showed reduced nodal efficiency, which mainly involved the limbic system, default mode network, and visual network (false discovery rate, P < 0.05), and significantly lower DTI-ALPS index (F = 2.0, P = 0.049). The DTI-ALPS index was positively correlated with FA (0.25 ≤ r ≤ 0.32) and nodal efficiency (0.22 ≤ r ≤ 0.37), and was negatively correlated with the MD (-0.24 ≤ r≤ -0.34) and seizure frequency (r = -0.47). A machine-learning model combining DTI-ALPS, FA, MD, and nodal efficiency achieved a cross-validated ROC curve area of 0.83 (sensitivity, 78.2%; specificity, 84.8%). Conclusion Pediatric patients with RE showed impaired glymphatic function in comparison with patients with DSE, which was correlated with WM abnormalities and seizure frequency. Multi-parameter MRI may be feasible for distinguishing RE from DSE.

Objective: To explore glymphatic impairment in pediatric refractory epilepsy (RE) using multi-parameter magnetic resonance imaging (MRI), assess its relationship with white-matter (WM) abnormalities and clinical indicators, and preliminarily evaluate the performance of multi-parameter MRI in discriminating RE from drug-sensitive epilepsy (DSE). Materials and Methods: We retrospectively included 70 patients with DSE (mean age, 9.7 ± 3.5 years; male:female, 37:33) and 26 patients with RE (9.0 ± 2.9 years; male:female, 12:14). The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index as well as fractional anisotropy (FA), mean diffusivity (MD), and nodal efficiency values were measured and compared between patients with RE and DSE. With sex and age as covariables, differences in the FA and MD values were analyzed using tract-based spatial statistics, and nodal efficiency was analyzed using a linear model. Pearson’s partial correlation was analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the discrimination performance of the MRI-based machine-learning models through five-fold cross-validation. Results: In the RE group, FA decreased and MD increased in comparison with the corresponding values in the DSE group, and these differences mainly involved the callosum, right and left corona radiata, inferior and superior longitudinal fasciculus, and posterior thalamic radiation (threshold-free cluster enhancement, P < 0.05). The RE group also showed reduced nodal efficiency, which mainly involved the limbic system, default mode network, and visual network (false discovery rate, P < 0.05), and significantly lower DTI-ALPS index (F = 2.0, P = 0.049). The DTI-ALPS index was positively correlated with FA (0.25 ≤ r ≤ 0.32) and nodal efficiency (0.22 ≤ r ≤ 0.37), and was negatively correlated with the MD (-0.24 ≤ r≤ -0.34) and seizure frequency (r = -0.47). A machine-learning model combining DTI-ALPS, FA, MD, and nodal efficiency achieved a cross-validated ROC curve area of 0.83 (sensitivity, 78.2%; specificity, 84.8%). Conclusion Pediatric patients with RE showed impaired glymphatic function in comparison with patients with DSE, which was correlated with WM abnormalities and seizure frequency. Multi-parameter MRI may be feasible for distinguishing RE from DSE.

Objective: To explore glymphatic impairment in pediatric refractory epilepsy (RE) using multi-parameter magnetic resonance imaging (MRI), assess its relationship with white-matter (WM) abnormalities and clinical indicators, and preliminarily evaluate the performance of multi-parameter MRI in discriminating RE from drug-sensitive epilepsy (DSE). Materials and Methods: We retrospectively included 70 patients with DSE (mean age, 9.7 ± 3.5 years; male:female, 37:33) and 26 patients with RE (9.0 ± 2.9 years; male:female, 12:14). The diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index as well as fractional anisotropy (FA), mean diffusivity (MD), and nodal efficiency values were measured and compared between patients with RE and DSE. With sex and age as covariables, differences in the FA and MD values were analyzed using tract-based spatial statistics, and nodal efficiency was analyzed using a linear model. Pearson’s partial correlation was analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the discrimination performance of the MRI-based machine-learning models through five-fold cross-validation. Results: In the RE group, FA decreased and MD increased in comparison with the corresponding values in the DSE group, and these differences mainly involved the callosum, right and left corona radiata, inferior and superior longitudinal fasciculus, and posterior thalamic radiation (threshold-free cluster enhancement, P < 0.05). The RE group also showed reduced nodal efficiency, which mainly involved the limbic system, default mode network, and visual network (false discovery rate, P < 0.05), and significantly lower DTI-ALPS index (F = 2.0, P = 0.049). The DTI-ALPS index was positively correlated with FA (0.25 ≤ r ≤ 0.32) and nodal efficiency (0.22 ≤ r ≤ 0.37), and was negatively correlated with the MD (-0.24 ≤ r≤ -0.34) and seizure frequency (r = -0.47). A machine-learning model combining DTI-ALPS, FA, MD, and nodal efficiency achieved a cross-validated ROC curve area of 0.83 (sensitivity, 78.2%; specificity, 84.8%). Conclusion Pediatric patients with RE showed impaired glymphatic function in comparison with patients with DSE, which was correlated with WM abnormalities and seizure frequency. Multi-parameter MRI may be feasible for distinguishing RE from DSE.

Objective To comprehensively analyze the clinical characteristics and risk factors of children with refractory mycoplasma pneumonia(RMPP),precisely identify the joint predictors in these children,and construct a prediction model.This aims to offer a scientific foundation for the early identification of RMPP and the formulation of accurate treatment and medication strategies.Methods A retrospective analysis was performed on the clinical data of 282 children diagnosed with mycoplasma pneumoniae pneumonia(MPP)who were admitted to the Pediatric Department of the Seventh Medical Center of the Chinese People's Liberation Army General Hospital between August 1,2023,and February 29,2024.Among these children,119 with RMPP were classified into the RMPP group,while the remaining 163 with general MPP(GMPP)were assigned to the GMPP group.The clinical data of both groups,encompassing age,gender,duration of fever,symptoms,laboratory test indices,chest imaging data,complications,etc.,were compared.A logistic probability model(LogP model)for joint application was constructed.The discriminatory ability of the model was evaluated using the area under the receiver operating characteristic(ROC)curve,and the calibration of the model was assessed by means of a calibration curve.Results In comparison with the GMPP group,children in the RMPP group exhibited a significantly longer duration of fever(P=0.002).Moreover,they had a higher incidence of complications,including myocardial damage and coagulation dysfunction(P<0.05).Regarding inflammatory markers,the levels of C-reactive protein(CRP),procalcitonin(PCT),and lactate dehydrogenase(LDH)were notably elevated in the RMPP group(P<0.05),whereas the level of albumin(Alb)was lower(P=0.001).In the RMPP group,the levels of interleukin-2(IL-2),interleukin-5(IL-5),interleukin-8(IL-8),interleukin-1β(IL-1β),and D-Dimer were increased,while the levels of interleukin-6(IL-6)and interleukin-17(IL-17)were decreased(P<0.05).Chest computed tomography(CT)scans revealed a higher proportion of lung consolidation,pleural effusion,and atelectasis in the RMPP group(P<0.05).Multivariate logistic regression analysis demonstrated that CRP,total bilirubin(T-BIL),LDH,IL-17,and prothrombin time(PT)were independent risk factors for RMPP(P<0.05).The receiver operating characteristic(ROC)predictive model established based on these factors had an area under the curve(AUC)of 0.787(95%confidence interval[CI]:0.693～0.880),with a cutoff value of 0.421,a sensitivity of 0.786,and a specificity of 0.660.The calibration curve indicated that the predicted probability matched well with the reference probability,and there was no statistical difference in the results of the Hosmer-Lemeshow test(P>0.05).Conclusions The clinical features of children with RMPP are predominantly characterized by prolonged fever,moderate lung lesions,other organ injuries,and high inflammatory markers.CRP,T-BIL,LDH,IL-17,and PT can act as independent risk factors for RMPP.

As the first defense of respiratory system,airway epi-thelial cells(AECs)play an important role in separating the re-spiratory internal and external environment.They are essential for the natural immune function.Small airway lesions are an im-portant early pathology of chronic obstructive pulmonary disease(COPD),when AECs are exposed to harmful particles or gases for a long time,the epithelial barrier is damaged,and the signa-ling pathways which involved in differentiation,repair,and in-flammatory are disordered,resulting in epithelial cell cycle stag-nation and accelerated aging.A number of studies have sugges-ted that AECs of COPD patients express high levels of aging markers,suggesting that senescence of AECs is closely related to COPD.This review discusses the potential mechanisms of AECs senescence in COPD,the impact of AECs senescence on the de-velopment and severity of the disease,and highlights potential targets for modulating cellular senescence in airway epithelium as a therapeutic approach in COPD.

Objective:To investigate the effects of target-oriented liquid therapy on the treatment outcomes of skin grafting in patients with severe burns.Methods:A total of 60 patients with severe burns (total burn area over 20%, and deep second-degree burn area ≥ 10%) who were scheduled for skin graft surgery at the Marine Police Corps Hospital of Chinese People's Armed Police Force from January 2019 to January 2022 were included in this cohort study. The patients were randomly divided into a control group (conventional fluid therapy) and an observation group (target-oriented fluid therapy) using a random number table method, with 30 patients in each group.The levels of lactate (Lac) and high-sensitivity cardiac troponin I (cTnI) were compared between the two groups. The usage of colloid and crystalloid fluids, urine output, length of hospital stay, and the incidence of complications were compared between the two groups.Results:At the end of the surgery, the levels of Lac and cTnI in the observation group were (1.13 ± 0.22) mmol/L and (0.95 ± 0.25) μg/L, respectively, both of which were significantly lower than those in the control group [(1.52 ± 0.34) mmol/L, (1.10 ± 0.31) μg/L; t = 5.24, 0.83, P < 0.001, P = 0.044]. The differences in Lac and cTnI levels in the observation group were (0.53 ± 0.36) and (0.13 ± 0.07), respectively, which were significantly greater than those in the control group [(0.23 ± 0.16), (0.02 ± 0.01), t = -4.17 and -3.45, P < 0.001, P = 0.001]. The volumes of colloid and crystalloid fluids and the length of hospital stay in the observation group were (960.25 ± 153.32) mL, (1 680.52 ± 253.08) mL, and (51.36 ± 17.25) days, respectively. These values were significantly lower or shorter than those in the control group [(1 459.73 ± 203.41) mL, (2 401.89 ± 301.23) mL, (81.05 ± 25.08) days, t = 10.74, 10.04, 5.34,all P < 0.001]. The incidences of postoperative infection, pneumonia, and arrhythmia in the observation group were 33.33% (10/30), 16.67% (5/30), and 16.67% (5/30), respectively, which were significantly lower than those in the control group [63.33% (19/30), 46.67% (14/30), 30.00% (15/30); χ2 = 5.41, 6.24, 7.50, P = 0.020, P = 0.013, P = 0.006]. However, there was no statistically significant difference in acute lung injury, heart failure, and myocardial injury between the two groups ( χ2 = 1.36, 1.92, 0.29; P = 0.243, 0.166, 0.592). Conclusions:Compared with traditional fluid replacement therapy, target-oriented fluid therapy has a more significant therapeutic effect on patients with severe burns. It not only reduces fluid usage and the length of hospital stay but also decreases the incidence of infection, pneumonia, and arrhythmia in these patients.

Objective To investigate the current situation of the ventilator use and management in secondary and tertiary medical institutions in Sichuan Province to provide references for management and training of ventilator users.Methods A questionnaire survey involving in 235 nurses from 13 secondary and tertiary medical institutions in Sichuan Province was conducted in terms of general information of the respondents,pipeline connection and parameter setup of ventilators,cleaning,sterilization and maintenance of ventilators,identification and treatment of ventilator alarms and hospital-acquired infection prevention and control.Results The results showed 20.4％of the respondents were nurses from critical care departments,and 79.6％of the respondents underwent the training for using the ventilator in their department;91.9％of the respondents could conduct ventilator self-testing by connecting the simulated lungs after the ventilator was switched on;66.4％of the respondents indicated that the initial parameters of the ventilator were set by the doctor;60.9％of the respondents proved that the performance monitoring and routine maintenance of the ventilator were carried out by the nurse;63.4％of the respondents showed disposable lines were commonly used in the departments.There were 89.8％of the respondents said the daily sterilization and management of the ventilator were performed by the nurse;46.0％of the respondents expressed the external surface of the ventilator was disinfected mainly with gamma disinfectant wipes;44.7％of the respondents indicated the external surface of the ventilator was sterilized every day;48.5％of the respondents said the internal airway of the ventilator was disinfected;57.0％of the respondents proved the disinfection was conducted after the expiratory flow sensors were used by any patient.There were 74.5％of the respondents that had paid attention to the ventilator waveform,and by the ventilator waveform only 21.3％were correct in determining whether there was secretion or fluid in the circuit and 22.1％in clarifying whether there was air leakage in the circuit.There were 59.1％of the respondents indicated that the closed suction tube was replaced once every 24 h;71.1％of the respondents could perform airbag pressure monitoring by the special pressure gauge.Conclusion Most of the nurses from secondary and tertiary medical institutions in Sichuan Province can use ventilators correctly,who have problems in disinfection specifications,infection prevention and control or recognition of ventilation waveform.It's suggested the training be strengthened to enhance the clinical nursing staffs in ventilator management.[Chinese Medical Equipment Journal,2025,46(3):75-80]