Objective To investigate the diagnostic value of computed tomography (CT) grading in evaluating sacroiliac joint lesions and the extent of joint injury in patients with ankylosing spondylitis (AS) so as to provide evidence-based evidence for CT imaging diagnosis and severity evaluation of AS. Methods A total of 107 patients with AS admitted to the hospital between December 2020 and December 2024 were selected. All patients underwent X-ray and CT examinations, and were graded based on the examination results. The diagnostic value of X-ray and CT in sacroiliac joint lesions and the severity of joint injury in patients with AS was compared. Results The detection rates of osteosclerosis, bone erosion, subchondral bone cystic changes, ankylosis, and soft tissue swelling using CT (90.65%、100.00%、87.85%、41.12%、56.07%、22.43%、33.64%) were higher than those using X-ray (75.70%、84.11%、58.88%、32.71%、48.60%、10.28%、7.48%) (P<0.05). The detection rates of osteosclerosis, bone erosion, subchondral bone cystic changes, joint space narrowing, joint space widening, ankylosis, and soft tissue swelling using CT combined with X-ray (97.20%、10.00%、95.33%、57.94%、73.83%、34.58%、39.25%) were higher than those using CT or X-ray alone (P<0.05). The comparison of the detection of grade I, grade II and grade III joint injury degrees by CT, X-ray and combined examination showed statistically significant differences (P<0.05). The detection rates of grades I and II joint injuries using CT (26.17%、35.51%) were higher than those using X-ray (14.95%、22.43%) (P<0.05). The detection rates of grades 0, I, II, and III joint injury by the combined examination of X-ray and CT were higher than those using X-ray alone (P<0.05). Conclusion CT has greater diagnostic value for sacroiliac joint lesions and severity of joint injury in patients with AS, and allowing for more accurate in AS grading, and combined it with X-ray further improves diagnostic efficacy.

Objective To investigate the diagnostic value of computed tomography (CT) grading in evaluating sacroiliac joint lesions and the extent of joint injury in patients with ankylosing spondylitis (AS) so as to provide evidence-based evidence for CT imaging diagnosis and severity evaluation of AS. Methods A total of 107 patients with AS admitted to the hospital between December 2020 and December 2024 were selected. All patients underwent X-ray and CT examinations, and were graded based on the examination results. The diagnostic value of X-ray and CT in sacroiliac joint lesions and the severity of joint injury in patients with AS was compared. Results The detection rates of osteosclerosis, bone erosion, subchondral bone cystic changes, ankylosis, and soft tissue swelling using CT (90.65%、100.00%、87.85%、41.12%、56.07%、22.43%、33.64%) were higher than those using X-ray (75.70%、84.11%、58.88%、32.71%、48.60%、10.28%、7.48%) (P<0.05). The detection rates of osteosclerosis, bone erosion, subchondral bone cystic changes, joint space narrowing, joint space widening, ankylosis, and soft tissue swelling using CT combined with X-ray (97.20%、10.00%、95.33%、57.94%、73.83%、34.58%、39.25%) were higher than those using CT or X-ray alone (P<0.05). The comparison of the detection of grade I, grade II and grade III joint injury degrees by CT, X-ray and combined examination showed statistically significant differences (P<0.05). The detection rates of grades I and II joint injuries using CT (26.17%、35.51%) were higher than those using X-ray (14.95%、22.43%) (P<0.05). The detection rates of grades 0, I, II, and III joint injury by the combined examination of X-ray and CT were higher than those using X-ray alone (P<0.05). Conclusion CT has greater diagnostic value for sacroiliac joint lesions and severity of joint injury in patients with AS, and allowing for more accurate in AS grading, and combined it with X-ray further improves diagnostic efficacy.

Objective To investigate the diagnostic value of computed tomography (CT) grading in evaluating sacroiliac joint lesions and the extent of joint injury in patients with ankylosing spondylitis (AS) so as to provide evidence-based evidence for CT imaging diagnosis and severity evaluation of AS. Methods A total of 107 patients with AS admitted to the hospital between December 2020 and December 2024 were selected. All patients underwent X-ray and CT examinations, and were graded based on the examination results. The diagnostic value of X-ray and CT in sacroiliac joint lesions and the severity of joint injury in patients with AS was compared. Results The detection rates of osteosclerosis, bone erosion, subchondral bone cystic changes, ankylosis, and soft tissue swelling using CT (90.65%、100.00%、87.85%、41.12%、56.07%、22.43%、33.64%) were higher than those using X-ray (75.70%、84.11%、58.88%、32.71%、48.60%、10.28%、7.48%) (P<0.05). The detection rates of osteosclerosis, bone erosion, subchondral bone cystic changes, joint space narrowing, joint space widening, ankylosis, and soft tissue swelling using CT combined with X-ray (97.20%、10.00%、95.33%、57.94%、73.83%、34.58%、39.25%) were higher than those using CT or X-ray alone (P<0.05). The comparison of the detection of grade I, grade II and grade III joint injury degrees by CT, X-ray and combined examination showed statistically significant differences (P<0.05). The detection rates of grades I and II joint injuries using CT (26.17%、35.51%) were higher than those using X-ray (14.95%、22.43%) (P<0.05). The detection rates of grades 0, I, II, and III joint injury by the combined examination of X-ray and CT were higher than those using X-ray alone (P<0.05). Conclusion CT has greater diagnostic value for sacroiliac joint lesions and severity of joint injury in patients with AS, and allowing for more accurate in AS grading, and combined it with X-ray further improves diagnostic efficacy.

End-stage dilated cardiomyopathy belongs to the irreversible cardiac decompensation stage,and neither drugs nor cardiac resynchronization therapy can improve the symptoms of heart failure in patients.Orthotopic heart transplantation is a surgical procedure that involves removing the diseased heart of the recipient and implanting the donor heart in its original position.With the advancements in surgical transplantation techniques and immunosuppressive therapy,it has become an effective treatment for end-stage heart disease.Coronary artery disease after heart transplantation is one of the issues that need attention after heart transplantation.This article reports a 68-year-old male who suffered from recurrent heart failure and ventricular tachycardia due to"dilated cardiomyopathy"and underwent allogeneic orthotopic heart transplantation 5 years ago.The patient underwent coronary angiography and intravascular ultrasound examination under local anesthesia.This case has certain guiding significance for studying the progression of coronary artery disease in heart transplant patients.

End-stage dilated cardiomyopathy belongs to the irreversible cardiac decompensation stage,and neither drugs nor cardiac resynchronization therapy can improve the symptoms of heart failure in patients.Orthotopic heart transplantation is a surgical procedure that involves removing the diseased heart of the recipient and implanting the donor heart in its original position.With the advancements in surgical transplantation techniques and immunosuppressive therapy,it has become an effective treatment for end-stage heart disease.Coronary artery disease after heart transplantation is one of the issues that need attention after heart transplantation.This article reports a 68-year-old male who suffered from recurrent heart failure and ventricular tachycardia due to"dilated cardiomyopathy"and underwent allogeneic orthotopic heart transplantation 5 years ago.The patient underwent coronary angiography and intravascular ultrasound examination under local anesthesia.This case has certain guiding significance for studying the progression of coronary artery disease in heart transplant patients.

Objective:To investigate the immuno-inflammatory regulatory effects of the Qing Gan San Jie Xiao Ying Formula(QGSJXYF)on Hashimoto's thyroiditis(HT)by modulating thyroid cell-derived exosomes to provide experi-mental evidence for its immunomodulatory mechanisms.Methods:Nthy-ori-3-1 thyroid cells were treated with QGSJXYF-medicated serum,with untreated cells serving as controls.Exosomes from both groups were extracted and analyzed using nanoparticle tracking analysis(NTA),transmission electron microscopy(TEM),and Western blot to assess concentration,size distribution,morphology,and the expression of characteristic exosomal markers.An inflammatory model of human T lymphocytes(H9)was established and co-incubated with normal exosomes(EXO-C group)or QGSJXYF-treated exosomes(EXO-T group).The levels of inflammatory cytokines in H9 cells were measured using Western blot(WB)and ELISA.Results:Exosome characterization showed that the particle concentration of Nthy-ori-3-1 cell-derived exosomes in both the control and QGSJXYF groups ranged from 1×109 to 1×1011/mL,with particle diameters between 80～300 nm.The exosomes exhibited a typical spherical or cup-shaped morphology with positive expression of TSG101,CD63,and HSP70.Compared with the inflammation model group and the EXO-C group,the EXO-T group significantly reduced the intracellular expression of IL-17A protein in H9 cells(P<0.05)and suppressed IL-17 and IL-6 levels in the cell supernatant(P<0.01).Conclusion:QGSJXYF may exert its anti-inflammatory and thyroid-protective effects by modulating the functional state of thyroid cell-derived exosomes,regulating the inflamma-tory microenvironment,and inhibiting the expression of inflammatory cytokines associated with Hashimoto's thyroiditis.

AIM:Hepatotoxicity of Brucea javani-ca picryl with broad-spectrum anticancer effect in nude mice based on hepatic drug metabolizing en-zyme CYP450 activity.METHODS:Fifty-six nude mice were randomly divided into blank group,Bru-cea javanica low-dose group(2 mg/kg),Brucea ja-vanica high-dose group(4 mg/kg),and cisplatin group(2 mg/kg),with 14 mice in each group.The blank group was injected with the same amount of normal saline every 3 days for 6 weeks.Calculate the mortality rate of nude mice in each group,ob-serve the general growth state of nude mice,re-cord the weight change of nude mice before and af-ter administration,weigh and record the liver weight after taking materials,and calculate the liv-er coefficient(liver weight/weight mass×100％),ob-serve and record the liver color and morphology.Hematoxylin-eosin(HE)staining was used to ob-serve the pathological changes of liver tissue.De-tection of alanine aminotransferase(ALT),aspar-tate aminotransferase(AST),lactate dehydrogenase(LDH),alkaline phosphatase(AKP)and albumin(ALB)levels in serum of nude mice by ELISA.Real-time PCR and Western blot were used to detect the mRNA and protein expression levels of CYP2E1,CYP3A11,CYP2C19,CYP1A2,CYP2D6 and CYP2C9,which were key enzymes of drug metabolism in nude mice liver.RESULTS:Compared with the blank group,the mortality rate of nude mice in the low-dose Brucea javanica bitter alcohol group was 0,the growth state was good,the diet,movement,and mental state were normal,the weight change and liver coefficient ratio were consistent,the liver color was ruddy,the liver lobule morphology was complete under the microscope,the structure was clear,the liver cells were arranged regularly,and there was no inflammatory cell infiltration.There was no significant difference in the content of ALT,AST,LDH,AKP,and ALB.There was no significant difference in the mRNA and protein expression of CYP2E1,CYP3A11,CYP2C19,CYP1A2,CYP2D6,and CYP2C9(all P＞0.05).Compared with the blank group,the mortality rate of nude mice in the high-dose group of Brucea javanica bitter alcohol was 14.3％,the growth state was slightly poor,the diet,movement,and mental state were reduced,the weight growth was slow,the liver coefficient ratio was increased,the liver color was reddish brown,some liver lobule boundaries were unclear,a small number of liver cells were loosely arranged,the contents of ALT,AST,LDH,AKP,and ALB were signif-icantly increased,the mRNA levels of CYP2E1,CYP3A11,CYP2C19,CYP1A2,CYP2D6,and CYP2C9 were significantly reduced,and the protein expres-sions of CYP2E1,CYP3A11,CYP1A2,and CYP2D6 were significantly reduced(all P＜0.05 or P＜0.01),but there was no statistical difference in the mRNA and protein expression of CYP2C19,and the pro-tein expression of CYP2C9(P＞0.05).Compared with the blank group,the mortality rate of nude mice in the cisplatin group was 35.7％,the growth state was poor,the diet,action,and mental state were low,the weight gain was less,the liver coefficient ratio was significantly increased,the liver color was dark red,the liver sinusoids and central veins were congested,the hepatocytes were disordered,the nuclei were consolidated and contracted,and the arrangement was loose,the contents of ALT,AST,LDH,AKP,and ALB were significantly increased,and the mRNA and protein expressions of CYP2E1,CYP3A11,CYP2C19,CYP1A2,CYP2D6,and CYP2C9 were significantly reduced(all P＜0.05 or P＜0.01).CONCLUSION:The dose of Brucea javanica bitter alcohol is correlated with hepatotoxicity to nude mice.High doses of Brucea javanica bitter alcohol have hepatotoxicity to nude mice,which may be re-lated to reducing serum levels of ALT,AST,LDH,AKP,and ALB,inhibiting the expression of multiple subtypes of enzymes in the key enzyme CYP450 of liver drug metabolism,and then reducing the me-tabolism of toxic substances.

Chronic kidney disease(CKD)is a chronic disease characterized by renal structural damage and dysfunction.At present,there is still a lack of effective therapeutic drugs and prevention and treatment methods for CKD in clinical practice.More and more studies have shown that necroptosis,as a new type of programmed cell death,plays a vital role in the onset and progression of CKD.Targeting key molecules in the necroptosis pathway,such as RIPK1,RIPK3 and MLKL,the development of small molecule inhibitors has become an emerging strategy for the treatment of CKD,and has shown significant potential to pro-tect the kidneys and alleviate renal fibrosis in a variety of in vitro and in vivo models.Therefore,this article summarizes the re-search progress of the mechanism of necroptosis in recent years,and focuses on the potential role of necroptosis in the pathogene-sis of CKD and the therapeutic potential of targeting this path-way,providing a new perspective and research direction for the prevention and treatment of CKD in the future.

Objective:To characterize the epidemiology, antimicrobial susceptibility, and molecular mechanisms of carbapenem-resistant Enterobacterales (CRE) carrying multiple carbapenemase genes in China, and to provide evidence for infection control and antibiotic stewardship.Methods:From 2016 to 2023, 115 CRE isolates harboring at least two carbapenemase genes were collected from 41 hospitals in 18 provinces across China. Species identification, antimicrobial susceptibility testing, and whole-genome sequencing were performed. Multilocus sequence typing (MLST) and capsular typing were conducted using Kleborate, plasmid replicon types were identified with PlasmidFinder, and a core genome phylogenetic tree was constructed.Results:The majority of isolates belonged to Klebsiella spp. (80.0%, 92/115), followed by E. cloacae (8.7%, 10/115) and E. coli (6.1%, 7/115). The isolates were mainly from Hebei, Beijing, Shandong, and Hunan (60.9%, 70/115), and sputum was the predominant specimen (43.5%, 50/115). The most common genotype was bla KPC+bla NDM (73.0%, 84/115), primarily in Klebsiella spp. (79.8%, 67/84), followed by bla NDM+bla IMP (15.7%, 18/115). The prevalent plasmid replicon types were IncFII (77.5%, 86/111), IncFIB (68.5%, 76/111), IncR (51.4%, 57/111), and IncX3 (20.7%, 23/111). Notably, 88.6% (31/35) of ST11-KL64 K. pneumoniae strains co-harbored IncFII, IncFIB, and IncR plasmids simultaneously. Between 2016 and 2022, the dominant subtype among Klebsiella spp. isolates was bla KPC-2+bla NDM-1 (56.2%, 36/64). In 2023, the bla KPC-2+bla NDM-13 subtype (29.5%, 19/64) emerged and exhibited clonal transmission (single nucleotide polymorphism 2?74 bp) in Hebei, Beijing, and Jilin. Susceptibility testing showed widespread resistance to β-lactams (90.2%-100%). Aztreonam-avibactam, tigecycline, and colistin retained high activity, with susceptibility rates of 90.16%-98.36%. Conclusions:In China, the majority of clinical Enterobacteriaceae strains that harbor multiple carbapenemases are Klebsiella spp. co-producing KPC and NDM enzymes. Dissemination is driven by both clonal expansion of ST11-KL64 and horizontal transfer of IncFII, IncFIB, and IncR plasmids. The recent emergence and regional clonal spread of the bla KPC-2+bla NDM-13 genotype underscore the urgent need for strengthened surveillance and containment measures.

Objective:To investigate the immuno-inflammatory regulatory effects of the Qing Gan San Jie Xiao Ying Formula(QGSJXYF)on Hashimoto's thyroiditis(HT)by modulating thyroid cell-derived exosomes to provide experi-mental evidence for its immunomodulatory mechanisms.Methods:Nthy-ori-3-1 thyroid cells were treated with QGSJXYF-medicated serum,with untreated cells serving as controls.Exosomes from both groups were extracted and analyzed using nanoparticle tracking analysis(NTA),transmission electron microscopy(TEM),and Western blot to assess concentration,size distribution,morphology,and the expression of characteristic exosomal markers.An inflammatory model of human T lymphocytes(H9)was established and co-incubated with normal exosomes(EXO-C group)or QGSJXYF-treated exosomes(EXO-T group).The levels of inflammatory cytokines in H9 cells were measured using Western blot(WB)and ELISA.Results:Exosome characterization showed that the particle concentration of Nthy-ori-3-1 cell-derived exosomes in both the control and QGSJXYF groups ranged from 1×109 to 1×1011/mL,with particle diameters between 80～300 nm.The exosomes exhibited a typical spherical or cup-shaped morphology with positive expression of TSG101,CD63,and HSP70.Compared with the inflammation model group and the EXO-C group,the EXO-T group significantly reduced the intracellular expression of IL-17A protein in H9 cells(P<0.05)and suppressed IL-17 and IL-6 levels in the cell supernatant(P<0.01).Conclusion:QGSJXYF may exert its anti-inflammatory and thyroid-protective effects by modulating the functional state of thyroid cell-derived exosomes,regulating the inflamma-tory microenvironment,and inhibiting the expression of inflammatory cytokines associated with Hashimoto's thyroiditis.