Objective:To construct a prediction model for postoperative poor in-hospital prognosis in patients with traumatic brain injury (TBI) and evaluate its predictive performance.Methods:A retrospective case control study was conducted to analyze the clinical data of 1 120 TBI patients admitted to Changde Hospital Affiliated to Xiangya Medical College of Central South University from May 2019 to December 2024. The patients were divided into the training set ( n=784) and verification set ( n=336) at a ratio of 7∶3. Based on the Glasgow outcome scale-extended (GOS-E) at discharge, the training set was stratified into favorable prognosis group ( n=335, GOS-E 5-8 points) and poor prognosis group ( n=449, GOS-E 1-4 points). The two groups in the training set were compared in terms of general baseline indicators, TBI-related clinical indicators, and admission laboratory blood test results. Univariate analysis and Lasso regression analysis were employed to screen risk factors associated with postoperative poor in-hospital prognosis in TBI patients. Multivariate Logistic regression analysis was used to determine independent risk factors and construct a regression equation. The regression equation was presented using R language to create a visual nomogram for predicting postoperative poor in-hospital prognosis in TBI patients. In both the training set and verification set, the predictive performance of the model was evaluated by calculating the area under the receiver operating characteristic (ROC) curve (AUC), plotting calibration curves, and performing decision curve analysis (DCA). Results:The results of the univariate analysis indicated that the age, Charlson complication index (CCI), time from trauma to admission, time from trauma to operation, cause of injury, abbreviated injury scale (AIS) (head and neck), injury severity score (ISS), admission Glasgow coma scale (GCS), admission pupil responsiveness, multiple craniocerebral injuries, subdural hematoma, intracerebral hematoma, intraventricular hemorrhage, subarachnoid hemorrhage, decompressive craniotomy, intraoperative blood loss, intraoperative blood transfusion, traumatic cerebral infarction, postoperative delayed bleeding, epilepsy seizures, as well as the following admission tested results including red blood cell count, white blood cell count, platelet count, neutrophil percentage, percentage of lymphocytes, albumin, total bilirubin, urea nitrogen, thrombin time (TT), prothrombin time (PT), international standardized ratio (INR), glutamic aminotransferase, alanine aminotransferase, creatinine, and blood glucose were statistically different between the two groups in the training set ( P<0.05). Lasso regression analysis suggested 14 risk factors of age, CCI, cause of injury, head and neck AIS, ISS, admission GCS, admission pupil responsiveness, multiple craniocerebral injuries, subdural hematoma, intracerebral hematoma, intraoperative blood loss, admission platelet count, admission albumin, admission blood glucose for postoperative poor in-hospital prognosis. The results of the multivariate Logistic regression analysis showed that age ( OR=1.02, 95% CI 1.00, 1.03, P<0.01), CCI ( OR=1.46, 95% CI 1.02, 2.09, P<0.05), head and neck AIS ( OR=1.43, 95% CI 1.11, 1.85, P<0.01), ISS ( OR=2.16, 95% CI 1.39, 3.35, P<0.01), admission GCS ( OR=1.59, 95% CI 1.19, 2.13, P<0.01), intracerebral hematoma ( OR=4.41, 95% CI 2.15, 9.44, P<0.01), intraoperative blood loss ( OR=1.05, 95% CI 1.00, 1.09, P<0.05), admission platelet count ( OR=0.98, 95% CI 0.97, 0.99, P<0.01), admission blood glucose ( OR=1.08, 95% CI 1.02, 1.15, P<0.05) could be the main risk factors to construct a prediction model for postoperative poor in-hospital prognosis in TBI patients. Meanwhile, a regression equation was constructed: Logit[ P/(1- P)]=-2.4+ 0.02×"age"+0.38×"CCI"+0.36×"head and neck AIS"+0.77×"ISS"+0.47×"admission GCS"+1.48×"intracerebral hematoma"+0.05×intraoperative blood loss-0.02×admission platelet count+0.08×admission blood glucose. In the training set, the predictive model for poor postoperative in-hospital prognosis in TBI patients achieved an AUC of 0.87 (95% CI 0.84, 0.89), with a Youden′s index of 0.57, sensitivity of 73.70%, and specificity of 83.00%. In the verification set, the model showed an AUC of 0.80 (95% CI 0.76, 0.85), with a Youden′s index of 0.63, sensitivity of 65.20%, and specificity of 77.90%. In the training set, the Brier score for the calibration curve was 0.14 (95% CI 0.13, 0.16). In the verification set, the Brier score for the calibration curve was 0.18 (95% CI 0.15, 0.20). The DCA diagram indicated that the nomogram prediction model provided high clinical net benefit for predicting postoperative poor in-hospital prognosis in TBI patients. Conclusion:The prediction model for postoperative poor in-hospital prognosis in TBI patients, constructed based on age, CCI, head and neck AIS, ISS, admission GCS, intracerebral hematoma, intraoperative blood loss, admission platelet count, and admission blood glucose, exhibits good predictive performance.

Objective To fabricate nanosilicate functionalized polycaprolactone(PCL/LAP)electrospun membrane and evaluate its role in bone marrow mesenchymal stem cells(BMSCs)-induced bone repairing.Methods The PCL/LAP electrospun membranes were fabricated via electrospinning technology and co-cultured with rat BMSCs.The cytocompatibility of the membranes was evaluated through cytoskeleton staining,live/dead cell staining and CCK-8 assay.The migration capacity of BMSCs was assessed using scratch assay,Transwell migration experiments and expression of migration-related genes(Pdgf and Tgfβ)was evaluated by qRT-PCR.The os-teogenic differentiation and pro-angiogenesis potential were determined by alkaline phosphatase(ALP)staining,alizarin red staining,expression levels of osteogenesis-related genes(Alp,Col1a1,Runx2,Bglap and Bmp2)and angiogenesis-related genes(Angpt1,Fgf2 and Vegfa)along with RUNX2 protein expression.PCL and PCL/LAP electrospun membranes conditioned medium was subsequently used to stimulate vascular endothelial cells(EAhy926).The expression of angiogenesis-associated genes(KDR,ENOS and HIF1A)was quantified by qRT-PCR.Results BMSCs adhered well to the surface of the PCL/LAP membranes,with no significant impact on cell viability(P＞0.05).PCL/LAP membranes not only promoted the proliferation(P＜0.05),migration(P＜0.05),but also enhanced ALP activity and mineralized nodule formation(P＜0.05),increased osteogenic differentiation gene and protein expression(P＜0.05)of BMSCs.Moreover,PCL/LAP promoted the expression of angiogenic genes of BMSCs(P＜0.05),to indirectly regulate angiogenesis-related gene expression in vascular endothelial cells(P＜0.05).Conclusion PCL/LAP electrospun membranes exhibit excellent biocompatibility and can promote proliferation,migration,osteogenic differentiation and BMSC-mediated angiogenic differentiation,showing great potential for bone defect repairing as barrier membrane.

Objective To fabricate nanosilicate functionalized polycaprolactone(PCL/LAP)electrospun membrane and evaluate its role in bone marrow mesenchymal stem cells(BMSCs)-induced bone repairing.Methods The PCL/LAP electrospun membranes were fabricated via electrospinning technology and co-cultured with rat BMSCs.The cytocompatibility of the membranes was evaluated through cytoskeleton staining,live/dead cell staining and CCK-8 assay.The migration capacity of BMSCs was assessed using scratch assay,Transwell migration experiments and expression of migration-related genes(Pdgf and Tgfβ)was evaluated by qRT-PCR.The os-teogenic differentiation and pro-angiogenesis potential were determined by alkaline phosphatase(ALP)staining,alizarin red staining,expression levels of osteogenesis-related genes(Alp,Col1a1,Runx2,Bglap and Bmp2)and angiogenesis-related genes(Angpt1,Fgf2 and Vegfa)along with RUNX2 protein expression.PCL and PCL/LAP electrospun membranes conditioned medium was subsequently used to stimulate vascular endothelial cells(EAhy926).The expression of angiogenesis-associated genes(KDR,ENOS and HIF1A)was quantified by qRT-PCR.Results BMSCs adhered well to the surface of the PCL/LAP membranes,with no significant impact on cell viability(P＞0.05).PCL/LAP membranes not only promoted the proliferation(P＜0.05),migration(P＜0.05),but also enhanced ALP activity and mineralized nodule formation(P＜0.05),increased osteogenic differentiation gene and protein expression(P＜0.05)of BMSCs.Moreover,PCL/LAP promoted the expression of angiogenic genes of BMSCs(P＜0.05),to indirectly regulate angiogenesis-related gene expression in vascular endothelial cells(P＜0.05).Conclusion PCL/LAP electrospun membranes exhibit excellent biocompatibility and can promote proliferation,migration,osteogenic differentiation and BMSC-mediated angiogenic differentiation,showing great potential for bone defect repairing as barrier membrane.

Objective:To construct a prediction model for postoperative poor in-hospital prognosis in patients with traumatic brain injury (TBI) and evaluate its predictive performance.Methods:A retrospective case control study was conducted to analyze the clinical data of 1 120 TBI patients admitted to Changde Hospital Affiliated to Xiangya Medical College of Central South University from May 2019 to December 2024. The patients were divided into the training set ( n=784) and verification set ( n=336) at a ratio of 7∶3. Based on the Glasgow outcome scale-extended (GOS-E) at discharge, the training set was stratified into favorable prognosis group ( n=335, GOS-E 5-8 points) and poor prognosis group ( n=449, GOS-E 1-4 points). The two groups in the training set were compared in terms of general baseline indicators, TBI-related clinical indicators, and admission laboratory blood test results. Univariate analysis and Lasso regression analysis were employed to screen risk factors associated with postoperative poor in-hospital prognosis in TBI patients. Multivariate Logistic regression analysis was used to determine independent risk factors and construct a regression equation. The regression equation was presented using R language to create a visual nomogram for predicting postoperative poor in-hospital prognosis in TBI patients. In both the training set and verification set, the predictive performance of the model was evaluated by calculating the area under the receiver operating characteristic (ROC) curve (AUC), plotting calibration curves, and performing decision curve analysis (DCA). Results:The results of the univariate analysis indicated that the age, Charlson complication index (CCI), time from trauma to admission, time from trauma to operation, cause of injury, abbreviated injury scale (AIS) (head and neck), injury severity score (ISS), admission Glasgow coma scale (GCS), admission pupil responsiveness, multiple craniocerebral injuries, subdural hematoma, intracerebral hematoma, intraventricular hemorrhage, subarachnoid hemorrhage, decompressive craniotomy, intraoperative blood loss, intraoperative blood transfusion, traumatic cerebral infarction, postoperative delayed bleeding, epilepsy seizures, as well as the following admission tested results including red blood cell count, white blood cell count, platelet count, neutrophil percentage, percentage of lymphocytes, albumin, total bilirubin, urea nitrogen, thrombin time (TT), prothrombin time (PT), international standardized ratio (INR), glutamic aminotransferase, alanine aminotransferase, creatinine, and blood glucose were statistically different between the two groups in the training set ( P<0.05). Lasso regression analysis suggested 14 risk factors of age, CCI, cause of injury, head and neck AIS, ISS, admission GCS, admission pupil responsiveness, multiple craniocerebral injuries, subdural hematoma, intracerebral hematoma, intraoperative blood loss, admission platelet count, admission albumin, admission blood glucose for postoperative poor in-hospital prognosis. The results of the multivariate Logistic regression analysis showed that age ( OR=1.02, 95% CI 1.00, 1.03, P<0.01), CCI ( OR=1.46, 95% CI 1.02, 2.09, P<0.05), head and neck AIS ( OR=1.43, 95% CI 1.11, 1.85, P<0.01), ISS ( OR=2.16, 95% CI 1.39, 3.35, P<0.01), admission GCS ( OR=1.59, 95% CI 1.19, 2.13, P<0.01), intracerebral hematoma ( OR=4.41, 95% CI 2.15, 9.44, P<0.01), intraoperative blood loss ( OR=1.05, 95% CI 1.00, 1.09, P<0.05), admission platelet count ( OR=0.98, 95% CI 0.97, 0.99, P<0.01), admission blood glucose ( OR=1.08, 95% CI 1.02, 1.15, P<0.05) could be the main risk factors to construct a prediction model for postoperative poor in-hospital prognosis in TBI patients. Meanwhile, a regression equation was constructed: Logit[ P/(1- P)]=-2.4+ 0.02×"age"+0.38×"CCI"+0.36×"head and neck AIS"+0.77×"ISS"+0.47×"admission GCS"+1.48×"intracerebral hematoma"+0.05×intraoperative blood loss-0.02×admission platelet count+0.08×admission blood glucose. In the training set, the predictive model for poor postoperative in-hospital prognosis in TBI patients achieved an AUC of 0.87 (95% CI 0.84, 0.89), with a Youden′s index of 0.57, sensitivity of 73.70%, and specificity of 83.00%. In the verification set, the model showed an AUC of 0.80 (95% CI 0.76, 0.85), with a Youden′s index of 0.63, sensitivity of 65.20%, and specificity of 77.90%. In the training set, the Brier score for the calibration curve was 0.14 (95% CI 0.13, 0.16). In the verification set, the Brier score for the calibration curve was 0.18 (95% CI 0.15, 0.20). The DCA diagram indicated that the nomogram prediction model provided high clinical net benefit for predicting postoperative poor in-hospital prognosis in TBI patients. Conclusion:The prediction model for postoperative poor in-hospital prognosis in TBI patients, constructed based on age, CCI, head and neck AIS, ISS, admission GCS, intracerebral hematoma, intraoperative blood loss, admission platelet count, and admission blood glucose, exhibits good predictive performance.

Objective:To explore the relationship between bullying and depressive symptoms in college students,the mediating role of mobile phone addiction and the moderating role of gender.Methods:Totally 1 499 college students in Nantong City were selected to evaluate bullying experience,mobile phone addiction tendency and depressive symptoms with the Revised Adolescent Peer Relations Instrument-Bully and Target(RAPRI-T),Smart-phone Addiction Scale-Short Version(SAS-SV),Patient Health Questionnaire Depression 9-item(PHQ-9).SPSS macro program PROCESS 3.2 was used to examine the mediating role of mobile phone addiction and the modera-ting role of gender.Results:Different forms of bullying,traditional verbal bullying had the highest detection rate.There were positive correlations among bullying and the scores of SAS-SV and PHQ-9(r=0.17-0.42,Ps＜0.001).In the relationship between bullying scores and PHQ-9 scores,SAS-SV scores played a partial mediating role,and the mediating effect accounts for 26.70％of the total effect.The interaction terms between bullying and genders had statistical significance with PHQ-9 scores(β=0.09,P＜0.001),as the bullying scores increased,the PHQ-9 scores were higher in girls than in boys.Conclusion:Mobile phone addiction plays a partial mediating role in the association between bullying and depressive symptomsin college students,and the association between bull-ying and depressive symptoms is moderated by gender factors.

Objective To predict the target and molecular mechanism of Huayu Xiaopi decoction in the intervention of Precancerous lesions of gastric cancer(PLGC)based on network pharmacology and molecular docking technology,and to conduct experimental verification.Methods A total of 60 SPF SD male rats were randomly selected as blank control,and the other rats were replicated in PLGC model.After successful modeling,the rats were randomly divided into model group,folic acid group(2 mg·kg-1·d-1),Huayu Xiaopi decoction high,medium and low dose groups(24.8,12.4,6.2 g·kg-1·d-1),which were continuously administered for 90 days.The body mass and food intake of rats at 3 h were recorded,and the gastric histopathology was observed by HE staining.Network pharmacology and molecular docking techniques were used to predict the potential targets of Huayu Xiaopi decoction in PLGC intervention,and the core targets were verified by Western blot technique.Results Compared with the blank group,the body mass and 3 h food intake of rats in the model group were significantly decreased(P<0.05),the gastric mucosa of rats was significantly thinner,the glands were significantly reduced and disordered,and the intestinal metaplasia goblet cells and a large number of inflammatory cells were visible in some areas.Compared with the model group,the body mass and 3 h food intake of rats in each administration group were improved to varying degrees.Huayu Xiaopi Decoction improved significantly in medium and high doses(P<0.05),the gastric mucosa was repaired in different degrees,the glandular arrangement tended to be orderly,and the inflammatory cells in the interstitial were gradually reduced.The results of network pharmacology and molecular docking showed that TP53,JUN and MAPK3/1(ERK1/2)were the core targets of Huayu Xiaopi decoction in the intervention of PLGC.Molecular biological detection results showed that compared with blank group,the protein phosphorylation levels of TP53,c-Jun and ERK1/2 in gastric tissue of model group were significantly increased(P<0.05).Compared with model group,the protein phosphorylation levels of TP53,c-Jun and ERK1/2 in gastric tissue of rats in all administration groups were decreased to different degrees,and significantly decreased in Huayu Xiaopi decoction high-dose and medium-dose groups(P<0.05).Conclusion Huayu Xiaopi Decoction can significantly improve the survival condition of PLGC rats and promote gastric mucosal repair,the specific mechanism of which may be related to the decrease of ERK1/2,c-Jun and TP53 protein phosphorylation levels in gastric tissue of PLGC rats,and then regulate the downstream signaling molecular response.

Objective:To report cases of multiple mitochondrial dysfunction syndrome 2 (MMDS2) caused by BOLA3 gene mutation, hoping to help clinical diagnosis. Methods:The medical records of a child with MMDS2 admitted to the Department of Neurology, Guangzhou Women and Children′s Medical Center in November 2021 were analyzed, and the clinical, imaging characteristics and prognosis of MMDS2 were summarized by literature review.Results:This 1 year and 9 months old male had a disease that started in childhood, with motor function regression and hyperlactatemia. Head magnetic resonance imaging indicated white matter lesions, and gene examination indicated the homozygous variation of BOLA3 gene c.295C>T(p.Arg99Trp). The diagnosis of MMDS2 was clear for the child. After treatment, the clinical symptoms and imaging of the child recovered significantly. Through literature review, 13 children with MMDS2 reported in 7 English literatures were reviewed. These cases had similar manifestations with the case reported in this study. Among them, 1 case recovered and 8 cases died in infancy. Conclusions:MMDS2 patients often show nervous system dysfunction such as motor regression, elevated lactate and white matter lesions, which often cause multiple system disorders. Some children die early, but some of them can be recovered.

Objective:To investigate the feasibility of early treatment of congenital giant melanocytic nevus (CGMN).Methods:From October 2013 to December 2021, the clinical data of children with giant nevus treated with skin soft tissue expansion in the Plastic Surgery Department of Sun Yat-sen Memorial Hospital were analyzed retrospectively. A renal expander was implanted in the first stage, including single and repeated expansion. The giant nevus was removed and repaired in the second stage with an expanded skin flap. The occurrence of complications, such as wound infection, expander exposure, expander rupture, and flap congestion, were recorded. Children’s mental health problems and their parents’ satisfaction were also analyzed. The χ2 between children of different ages and the infection rate between children with an internal and external pot. Results:A total of 58 children, 24 males and 34 females, aged from 3 months to 3 years, with an average age of 1.45 years, were enrolled. A total of 190 expanders were implanted. The patients were followed for 5 to 106 months, averaging 42.43 months. In the first stage, 29 cases of wound infection, 41 cases of expander exposure, two cases of flap congestion, and 6 cases of expander rupture occurred. The flap transfers were not affected by these complications after appropriate treatment. The comparison of complication rates among 3 months~<1 year、1~<2 years、2~<3 years、3 years was 37.34%(31/83)、56.75% ((21/37) ), 33.33% (13/39) and 41.94%(13/31), respectively, No statistically significant difference ( χ2=5.21, P=0.157). The incidence of wound infection was 16.67% (6/36) and 14.94% (23/154), respectively, for the internal and external dilators. There was no significant difference in the location of the dilator pot and the incidence of wound infection ( χ2=0.07, P=0.795). The appearance of all children has been significantly improved. Thirty-nine children’s families are particularly satisfied, and 20 are generally satisfied with the treatment effect, and no mental health problems were found. Conclusions:Skin and soft tissue expansion is a reliable method for early treatment of congenital giant nevus.

Objective:To analyze the characteristics of drug resistance genes in a Klebsiella pneumoniae strain coproducing carbapenemases KPC-2 and NDM-5. Methods:Klebsiella pneumoniae KPN-hnqyy was separated from the stool specimen of a patient in the Hematology Department of Affiliated Cancer Hospital of Zhengzhou University. The strain was identified with a BD Phenix-M50 automated microbiology system and the minimum inhibitory concentration against the strain was measured as well. The genotypes of the carbapenemases were tested by enzyme immunochromatographic assay and PCR method. The transferability of related plasmids was analyzed by conjugation test. Whole-genome sequencing of the strain was conducted using PacBio and Illumina platforms. The MLST type, resistance gene and plasmid type of the strain were retrieved in BacWGSTdb. The genome and open reading frame sequence of the strain were compared using Easyfig_2.2.3. Visual cycle graphs were generated using BRIG v0.95. Results:Klebsiella pneumoniae KPN-hnqyy was resistant to carbapenem antibiotics. It belonged to ST11 and carried two carbapenemase genes of blaKPC-2 and blaNDM-5. The conjugant only harbored the blaKPC-2 gene. Whole-genome sequencing revealed that the strain contained one chromosome and three plasmids. Its chromosome genome shared more than 99.9% similarity with that of Klebsiella pneumonia KP69 and KP19-2029. Moreover, a similar IncR and IncFⅠ resistance gene fusion region was contained in different types of plasmids carried by them: the blaKPC-2 gene was located in a structure—which evolved from the Tn3-△Tn4401-Tn1721/Tn1722 sequence—inside this fusion region with its ends inserted into the transposase IS26 gene; the blaNDM-5 gene was located on a transposon containing the special plasmids of the insertion fragment in phages, with its ends inserted into the transposase IS26 gene too. Conclusions:The IncR and IncFⅡ resistance gene fusion region of blaKPC-2 carried by Klebsiella pneumoniae ST11 might be widely coexistent with the chromosomal genome. The blaNDM-5 gene carried by special plasmids might be accidentally obtained through gene recombination mediated by transposable element IS26. The wide transmission of Klebsiella pneumoniae ST11 carrying the blaKPC-2 gene in China and its ability to obtain other carbapenemase genes through transposable element IS26 were well worth attention.

Objective:To investigate the feasibility of early treatment of congenital giant melanocytic nevus (CGMN).Methods:From October 2013 to December 2021, the clinical data of children with giant nevus treated with skin soft tissue expansion in the Plastic Surgery Department of Sun Yat-sen Memorial Hospital were analyzed retrospectively. A renal expander was implanted in the first stage, including single and repeated expansion. The giant nevus was removed and repaired in the second stage with an expanded skin flap. The occurrence of complications, such as wound infection, expander exposure, expander rupture, and flap congestion, were recorded. Children’s mental health problems and their parents’ satisfaction were also analyzed. The χ2 between children of different ages and the infection rate between children with an internal and external pot. Results:A total of 58 children, 24 males and 34 females, aged from 3 months to 3 years, with an average age of 1.45 years, were enrolled. A total of 190 expanders were implanted. The patients were followed for 5 to 106 months, averaging 42.43 months. In the first stage, 29 cases of wound infection, 41 cases of expander exposure, two cases of flap congestion, and 6 cases of expander rupture occurred. The flap transfers were not affected by these complications after appropriate treatment. The comparison of complication rates among 3 months~<1 year、1~<2 years、2~<3 years、3 years was 37.34%(31/83)、56.75% ((21/37) ), 33.33% (13/39) and 41.94%(13/31), respectively, No statistically significant difference ( χ2=5.21, P=0.157). The incidence of wound infection was 16.67% (6/36) and 14.94% (23/154), respectively, for the internal and external dilators. There was no significant difference in the location of the dilator pot and the incidence of wound infection ( χ2=0.07, P=0.795). The appearance of all children has been significantly improved. Thirty-nine children’s families are particularly satisfied, and 20 are generally satisfied with the treatment effect, and no mental health problems were found. Conclusions:Skin and soft tissue expansion is a reliable method for early treatment of congenital giant nevus.