Objective To investigate the anti-inflammatory effects of Ophiopogon japonicus polysaccharides(OJP)on submandibular gland inflammation in a mouse model of Sj?gren's syndrome(SS)and its impact on the tumor necrosis factor-α(TNF-α)/nuclear factor kappa-B(NF-κB)/NOD-like receptor family pyrin domain containing 3(NLRP3)signaling pathway.Methods ① Eight C57BL/6J mice served as the control group(Control group),while 32 C57BL/6J mice were subjected to immune induction to establish the SS model and then randomly divided into 4 groups(n=8 each):model group(SS group),low-dose OJP group[OJP(10 mg/kg)group],high-dose OJP group[OJP(20 mg/kg)group],and hydroxychloroquine group(Hyd group).The Control and SS groups received intragastric administration of saline,the OJP(10 mg/kg)and OJP(20 mg/kg)groups received 0.2 mL of OJP solution at 10 mg/kg or 20 mg/kg,respectively,and the Hyd group received 0.2 mL of hydroxychloroquine solution at 100 mg/kg,once daily for 4 weeks.Water consumption and salivary flow rate were measured.Serum levels of inflammatory cytokines interleukin-6(IL-6),interleukin-1β(IL-1β),and TNF-α were detected by ELISA.Pathological changes in submandibular gland tissue were observed by HE staining.Protein expression related to the TNF-α/NF-κB/NLRP3 pathway was assessed by Western blot,and TNF-α and NLRP3 protein expression was detected by immunofluorescence.② RAW264.7 macrophages were divided into blank control group(Control group),model group(SS group),low-dose OJP group(OJP1 group),medium-dose OJP group(OJP2 group),and high-dose OJP group(OJP4 group).After 24 hours of culture,the medium was removed;the Control group received 2 mL of complete DMEM medium,the SS group received 2 mL of complete DMEM medium containing 16 μg LPS,and the different OJP dose groups received 2 mL of complete DMEM medium containing 16 μg LPS plus OJP at concentrations of 1,2,or 4 mg/mL,respectively.Inflammatory cytokine levels were measured by ELISA,TNF-α/NF-κB/NLRP3 pathway-related protein expression was detected by Western blot,and TNF-α protein expression was detected by immunofluorescence.Results ① Compared with the Control group,the SS group showed increased water consumption and decreased salivary flow rate(P<0.05),elevated serum levels of IL-1β,IL-6,and TNF-α(P<0.01),aggravated pathological damage observed by HE staining in submandibular glands,and increased expression of NLRP3,apoptosis-associated speck-like protein containing a CARD(ASC),cysteinyl aspartate specific proteinase(Caspase-1),IL-1β,TNF-α,TNF receptor type 1(TNFR1)/glyceraldehyde-3-phosphate dehydrogenase(GAPDH),and phosphorylated NF-κB p65(p-NF-κB p65)/NF-κB p65(P<0.01),with immunofluorescence also showing elevated TNF-α and NLRP3 protein expression.Compared with the SS group,the Hyd group and both OJP dose groups exhibited decreased water consumption,increased salivary flow rate(P<0.01),reduced serum levels of IL-1β,IL-6,and TNF-α,alleviated submandibular gland pathological damage,decreased expression of NLRP3,ASC,Caspase-1,IL-1β,TNF-α,TNFR1/GAPDH,and p-NF-κB p65/NF-κB p65 proteins by Western blotting(P<0.01),and reduced TNF-α and NLRP3 protein expression by immunofluorescence.② Compared with macrophages treated solely with LPS,those treated with OJP intervention showed reduced levels of inflammatory cytokines and decreased expression of NLRP3,ASC,Caspase-1,IL-1β,TNF-α,TNFR1/GAPDH,and p-NF-κB p65/NF-κB p65(P<0.01).Conclusion OJP may exert anti-inflammatory effects by inhibiting the activation of the TNF-α/NF-κB/NLRP3 signaling pathway,thereby alleviating the inflammatory response in SS mice.

Objective To evaluate the clinical characteristics and risk factors of healthcare-associated urinary tract infection(HA-UTI)due to vancomycin-resistant Enterococcus(VRE),and provide basis for clinical prevention and control.Methods Patients with VRE HA-UTI in a tertiary first-class hospital in Guangdong Province from January 2021 to October 2023 were selected as the VRE group.A 1∶2 case-control study method was conducted to select pa-tients with vancomycin-sensitive Enterococcus(VSE)UTI as the VSE group.Clinical characteristics of two groups of patients were compared and analyzed.Risk factors for VRE HA-UTI were analyzed using univariate regression and logistic multivariate regression.Results A total of 32 patients in the VRE group and 64 patients in the VSE group were included in the analysis.In VRE group,most patients were female(68.75％),aged≥60 years(71.88％),and from intensive care unit(ICU,56.25％).The main detected pathogen was vancomycin-resistant Enterococcus faecium(VREfm,96.87％).The proportion of clinical symptoms such as fever and lumbago as well as the levels of procalcitonin(PCT)and C-reactive protein(CRP)in patients in the VRE group were all higher than those in the VSE group(all P＜0.05).Logistic regression analysis results showed that concomitant pulmonary infection(OR=6.890,95％CI:1.098-43.218,P=0.039),history of hypertension(OR=4.240,95％CJ:1.084-16.581,P=0.038),and cephalosporin antibiotic exposure before infection(OR=4.642,95％CI:1.270-16.967,P=0.020)were independent risk factors for VRE HA-UTI.There were 32 and 64 strains of Enterococcus detected from VRE group and VSE group,respectively.VRE had higher resistance rates to ciprofloxacin,amoxicillin,ampicillin,peni-cillin G,tetracycline,high concentration gentamicin,and levofloxacin than VSE(all P＜0.05).Conclusion Pa-tients with VRE HA-UTI often have multiple underlying diseases and poor nutritional status,and are highly resis-tant to multiple antimicrobial agents.Clinical attention should be focused on patients with concomitant pulmonary infection,history of hypertension,and exposure to cephalosporin antibiotics.

Objective:To analyze the risk factors of contralateral central lymph node metastasis in papillary thyroid carcinoma (PTC) patients with established ipsilateral central lymph node metastasis, and to provide a basis for clinical decision-making on whether to perform contralateral central lymph node dissection.Method:The clinical data of 348 PTC patients who underwent surgery at Jiangsu Provincial People's Hospital from Jun 2018 to Aug 2024 were retrospectively analyzed. Univariate analysis and multivariate Logistic regression analysis were used to determine the independent risk factors affecting the contralateral central lymph node metastasis of PTC with existing ipsilateral central lymph node metastasis.Results:Tumor size was positively correlated with the risk of metastasis. For every one-unit increase in the metastasis rate of the ipsilateral central lymph nodes, the risk of metastasis in the contralateral central region increases by 13.31 times ( P<0.001). Patients with ipsilateral lateral cervical metastasis have a higher risk of contralateral central metastasis ( P=0.026). The contralateral lymph node metastasis rate of patients with Hashimoto was 24%, while that of patients without Hashimoto was 76%( P<0.001). When the tumor was located at the upper pole, the metastasis rate of the contralateral central lymph nodes was 18%; when it was located at the middle pole, it was 29.6%; and when it was located at the lower pole, it was 42.6%( P=0.016). Conclusions:Tumor size, contralateral lateral cervical lymph node metastasis, and the intensity of ipsilateral central lymph node metastasis are independent risk factors for contralateral central lymph node metastasis in PTC patients with existing ipsilateral central lymph node metastasis. Tumor location at the upper pole and the presence of Hashimoto are protective factors.

Objective To evaluate the clinical characteristics and risk factors of healthcare-associated urinary tract infection(HA-UTI)due to vancomycin-resistant Enterococcus(VRE),and provide basis for clinical prevention and control.Methods Patients with VRE HA-UTI in a tertiary first-class hospital in Guangdong Province from January 2021 to October 2023 were selected as the VRE group.A 1∶2 case-control study method was conducted to select pa-tients with vancomycin-sensitive Enterococcus(VSE)UTI as the VSE group.Clinical characteristics of two groups of patients were compared and analyzed.Risk factors for VRE HA-UTI were analyzed using univariate regression and logistic multivariate regression.Results A total of 32 patients in the VRE group and 64 patients in the VSE group were included in the analysis.In VRE group,most patients were female(68.75％),aged≥60 years(71.88％),and from intensive care unit(ICU,56.25％).The main detected pathogen was vancomycin-resistant Enterococcus faecium(VREfm,96.87％).The proportion of clinical symptoms such as fever and lumbago as well as the levels of procalcitonin(PCT)and C-reactive protein(CRP)in patients in the VRE group were all higher than those in the VSE group(all P＜0.05).Logistic regression analysis results showed that concomitant pulmonary infection(OR=6.890,95％CI:1.098-43.218,P=0.039),history of hypertension(OR=4.240,95％CJ:1.084-16.581,P=0.038),and cephalosporin antibiotic exposure before infection(OR=4.642,95％CI:1.270-16.967,P=0.020)were independent risk factors for VRE HA-UTI.There were 32 and 64 strains of Enterococcus detected from VRE group and VSE group,respectively.VRE had higher resistance rates to ciprofloxacin,amoxicillin,ampicillin,peni-cillin G,tetracycline,high concentration gentamicin,and levofloxacin than VSE(all P＜0.05).Conclusion Pa-tients with VRE HA-UTI often have multiple underlying diseases and poor nutritional status,and are highly resis-tant to multiple antimicrobial agents.Clinical attention should be focused on patients with concomitant pulmonary infection,history of hypertension,and exposure to cephalosporin antibiotics.

Objective:To analyze the risk factors of contralateral central lymph node metastasis in papillary thyroid carcinoma (PTC) patients with established ipsilateral central lymph node metastasis, and to provide a basis for clinical decision-making on whether to perform contralateral central lymph node dissection.Method:The clinical data of 348 PTC patients who underwent surgery at Jiangsu Provincial People's Hospital from Jun 2018 to Aug 2024 were retrospectively analyzed. Univariate analysis and multivariate Logistic regression analysis were used to determine the independent risk factors affecting the contralateral central lymph node metastasis of PTC with existing ipsilateral central lymph node metastasis.Results:Tumor size was positively correlated with the risk of metastasis. For every one-unit increase in the metastasis rate of the ipsilateral central lymph nodes, the risk of metastasis in the contralateral central region increases by 13.31 times ( P<0.001). Patients with ipsilateral lateral cervical metastasis have a higher risk of contralateral central metastasis ( P=0.026). The contralateral lymph node metastasis rate of patients with Hashimoto was 24%, while that of patients without Hashimoto was 76%( P<0.001). When the tumor was located at the upper pole, the metastasis rate of the contralateral central lymph nodes was 18%; when it was located at the middle pole, it was 29.6%; and when it was located at the lower pole, it was 42.6%( P=0.016). Conclusions:Tumor size, contralateral lateral cervical lymph node metastasis, and the intensity of ipsilateral central lymph node metastasis are independent risk factors for contralateral central lymph node metastasis in PTC patients with existing ipsilateral central lymph node metastasis. Tumor location at the upper pole and the presence of Hashimoto are protective factors.

Objective To discuss the application of mind map in self-management of elderly patients after receiving mitral valve transcatheter edge-to-edge repair(M-TEER).Methods A total of 66 patients,who underwent M-TEER at Nanjing Hospital of Nanjing Medical University from August 2021 to October 2022,were enrolled in this study.Using the envelope concealment method,a total of 66 data analysis samples were included in the analysis.There were 33 patients each in the study group and control group.Routine health education was adopted for the patients of the control group,while the responsible nurse conducted health education for the patients of the study group under the guidance of the mind map that was designed by a multidisciplinary specialized nurses.Results There was a significant difference in postoperative medication compliance between the study group and the control group(P＜0.05),i.e.the degree of compliance,including taking medicine on time,insisting on taking medicine and taking medicine as prescribed,in the study group was obviously higher than that in the control group.The postoperative 6-min walking test,which was regarded as one of the indicators of cardiac functions,in the study group was remarkably better than that in the control group,the difference was statistically significant(P＜0.05).The postoperative quality of life(including daily activity ability,frailty degree,social support,and incidence of hospitalization for heart failure within one year after treatment)in the study group was strikingly better than that in the control group(P＜0.05).Conclusion The use of mind map in self-management of elderly patients after receiving M-TEER can effectively improve the medication compliance of the patients after discharge,improve the quality of life of patients,and reduce the incidence of hospitalization due to heart failure.

Objective:To construct model of risk factors for follicular thyroid carcinoma.Methods:Clinical, ultrasound, and pathological data of 196 patients with single thyroid follicular neoplasm who underwent initial surgical treatment at the First Affiliated Hospital of Nanjing Medical University from Apr 2018 to Oct 2023 were collected as a training cohort. The clinical, ultrasound, and pathological data of 48 patients with the same condition at the Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine were used as a validation cohort.Results:Among the training cohort, 63 cases (32.1%) were diagnosed with follicular thyroid carcinoma. Univariate analysis showed that patients with higher preoperative thyroglobulin levels [390.1(106.7-500.0)ng/ml vs. 42.6(27.7-139.2)ng/ml, Z=-5.612, P<0.001], solid internal structure on ultrasound (81.0% vs. 54.1%, χ2=13.154, P<0.001), low internal echogenicity (68.3% vs.15.0%, χ2=55.507, P<0.001), irregular tumor morphology (39.7% vs.3.0%, χ2=45.612, P<0.001), uneven tumor margins (20.6% vs. 1.5%, χ2=19.515, P<0.001), internal tumor calcification (52.4% vs.16.5%, χ2=27.201, P<0.001), absence of acoustic halo or the acoustic halo is uneven in thickness (85.7% vs. 24.8%, χ2=64.235, P<0.001), and uneven echogenicity of solid tumor portions (74.6% vs. 19.5%, χ2=55.437, P<0.001) were characteristics of follicular thyroid carcinoma. Multivariate logistic analysis demonstrated that preoperative serum thyroglobulin levels ( OR=1.001, 95% CI: 1.000-1.002, P=0.046), solid internal echogenicity of the tumor ( OR=4.967, 95% CI: 1.602-15.405, P=0.006), tumor with calcification ( OR=4.238,95% CI:1.550-11.588, P=0.005), absence of halo around the tumor ( OR=4.225,95% CI:1.353-13.192, P=0.013), uneven thickness of the halo ( OR=21.240, 95% CI: 3.242-139.160, P=0.001), and uneven echogenicity of solid tumor portions ( OR=4.580, 95% CI: 1.678-12.505, P=0.003) were independent risk factors for follicular thyroid carcinoma . A nomogram model was constructed based on these variables, and the ROC curve showed AUC values of 0.931. Conclusion:Higher preoperative serum thyroglobulin levels, solid internal echogenicity of the tumor, tumor with calcification, absence of halo around the tumor, uneven thickness of the halo, and uneven echogenicity of solid tumor portions are independent risk factors for follicular thyroid carcinoma.

Objective:To construct model of risk factors for follicular thyroid carcinoma.Methods:Clinical, ultrasound, and pathological data of 196 patients with single thyroid follicular neoplasm who underwent initial surgical treatment at the First Affiliated Hospital of Nanjing Medical University from Apr 2018 to Oct 2023 were collected as a training cohort. The clinical, ultrasound, and pathological data of 48 patients with the same condition at the Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine were used as a validation cohort.Results:Among the training cohort, 63 cases (32.1%) were diagnosed with follicular thyroid carcinoma. Univariate analysis showed that patients with higher preoperative thyroglobulin levels [390.1(106.7-500.0)ng/ml vs. 42.6(27.7-139.2)ng/ml, Z=-5.612, P<0.001], solid internal structure on ultrasound (81.0% vs. 54.1%, χ2=13.154, P<0.001), low internal echogenicity (68.3% vs.15.0%, χ2=55.507, P<0.001), irregular tumor morphology (39.7% vs.3.0%, χ2=45.612, P<0.001), uneven tumor margins (20.6% vs. 1.5%, χ2=19.515, P<0.001), internal tumor calcification (52.4% vs.16.5%, χ2=27.201, P<0.001), absence of acoustic halo or the acoustic halo is uneven in thickness (85.7% vs. 24.8%, χ2=64.235, P<0.001), and uneven echogenicity of solid tumor portions (74.6% vs. 19.5%, χ2=55.437, P<0.001) were characteristics of follicular thyroid carcinoma. Multivariate logistic analysis demonstrated that preoperative serum thyroglobulin levels ( OR=1.001, 95% CI: 1.000-1.002, P=0.046), solid internal echogenicity of the tumor ( OR=4.967, 95% CI: 1.602-15.405, P=0.006), tumor with calcification ( OR=4.238,95% CI:1.550-11.588, P=0.005), absence of halo around the tumor ( OR=4.225,95% CI:1.353-13.192, P=0.013), uneven thickness of the halo ( OR=21.240, 95% CI: 3.242-139.160, P=0.001), and uneven echogenicity of solid tumor portions ( OR=4.580, 95% CI: 1.678-12.505, P=0.003) were independent risk factors for follicular thyroid carcinoma . A nomogram model was constructed based on these variables, and the ROC curve showed AUC values of 0.931. Conclusion:Higher preoperative serum thyroglobulin levels, solid internal echogenicity of the tumor, tumor with calcification, absence of halo around the tumor, uneven thickness of the halo, and uneven echogenicity of solid tumor portions are independent risk factors for follicular thyroid carcinoma.

Objective:To investigate the relationship between the expression of CD103 +CD8 +T cells in locally advanced oral squamous cell carcinoma (LA-OSCC), and the response to neoadjuvant chemoimmunotherapy (NACI). Methods:Thirty LA-OSCC patients from the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, who underwent NACI from June 2020 to December 2022 were analyzed, including 16 responders and 14 non-responders. Using multiple immunofluorescence technique to stain sections of patients to verify the correlation between the expression of CD103 +CD8 +T cells and the efficacy of NACI. CD103 +CD8 +T cell density was counted using Inform and HALO software. The Spearman correlation coefficient in rank correlation is used to describe the correlation between CD103 +CD8 +T cell and neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-lymphocyte ratio (PLR), systemic immune inflammation index (SII) It′s effectiveness as a predictive marker to NACI was analyzed by receiver operator characteristic (ROC) curve analysis and decision curve analysis (DCA). Two-tailed t-test or Mann-Whitney U-test was used to compare data between two groups, and one-way ANOVA was used to compare data between multiple groups. SPSS 22.0 and GraphPad prism 9.0 software were used for statistical analysis and plotting of relevant statistical graphs such as histograms. P<0.05 was considered a statistically significant difference. Results:The density of CD103 +CD8 +T cells has expanded in advanced OSCC patients who are responsive to NACI. The CD103 +CD8 +T cell densities in the responsive and nonresponsive groups were 118.30(41.92, 197.80) pcs/mm 2 and 21.63(4.91, 71.92) pcs/mm 2 respectively, with statistically significant differences( U=52.00, P=0.012). CD103 +CD8 +T cell abundance was negatively correlated with NLR, dNLR, PLR, and SII ( P<0.05). ROC curve analysis showed that the AUC for predicting efficacy of NLR, dNLR, PLR, and SII were 0.781 ( P=0.009, 95% CI: 0.5715-0.9910), 0.671 ( P=0.105, 95% CI: 0.467-0.881), 0.679 ( P=0.020 95% CI: 0.549-0.951), 0.750 ( P=0.096, 95% CI: 0.461-0.896), respectively. The AUC for CD103 +CD8 +T cells alone was 0.861 ( P=0.013, 95% CI: 0.585-0.950), and the AUC of combining CD103 +CD8 +T cells with NLR was 0.896 ( P=0.025, 95% CI: 0.454-0.938). Conclusions:The density of CD103 +CD8 +T cells is expanded in advanced OSCC patients who are responsive to NACI. CD103 +CD8 +T cells positively predict favorable responses as a strong indicator to NACI in advanced OSCC patients. Co-interpretation of CD103 +CD8 +T cells and NLR value enhances the predictive accuracy of NACI in advanced OSCC patients.

Objective:To investigate the serum antibody level in children with pertussis in Hangzhou city, and to evaluate the incidence of pertussis in children and the immunization effect of vaccine.Methods:A retrospective study was conducted.The pertussis toxin IgG antibody levels in 1 486 children aged 0-14 who received physical exa-mination in Hangzhou Children′s Hospital from January to December 2018 of were collected and analyzed.Serum antibody level ≥30 IU/mL was considered seropositive.The children enrolled were divided into the 0-3-year-old, 4-6-year-old, 7-9-year-old and 10-14-year-old groups; then the children under 3 years old were subdivided into groups of 0-<3 months, 3-<6 months, 6-<9 months, 9-<12 months, 12-<18 months, and 18-≤ 36 months; finally, the children were grouped according to their vaccination times, the pertussis toxin IgG antibody level and the infection rate of pertussis were compared among different groups by Mann- Whitney U, Kruskal- Wallis and χ2 tests. Results:The overall positive rate of the pertussis toxin IgG antibody was 23.62% (351/1 486), and the median antibody concentration was 6.60 IU/mL.Among children aged 0-14, the 0-3-year-old children had the highest positive rate of the pertussis toxin IgG antibody and the highest median antibody concentration, which were 24.58% (29/118) and 6.95 IU/mL, respectively.There was no significant difference in the antibody positive rate and the median antibody concentration among different age groups (all P>0.05). Among different subgroups of children aged 0-3, the pertussis toxin IgG antibody positive rate and the median antibody concentration were statistically significant (all P<0.05). It was predicted that the pertussis infection rate in children over 3 years old in Hangzhou was about 45.99%.The patients receiving more than 3 doses of vaccination accounted for 87.48% (1 300/1 486), and their antibody positive rate was 25.46% (331/1 300). After excluding unvaccinated children, the comparison results suggested that there was statistical significance in the antibody positive rate and median antibody concentration among different vaccination groups ( χ2=24.467, 67.438, all P<0.001). Conclusions:The serum pertussis toxin IgG antibody positive rate in children aged 0-14 in Hangzhou is low, but their predicted pertussis infection rate is higher.Children aged 0-14 are easy to become a main source of infection.Therefore, it is necessary to pay attention to and strengthen the vaccination plan and research, enhance the monitoring of the infection source, and prevent the " recurrence of pertussis" .