ObjectiveTo observe the clinical efficacy of Anshen Buxin Gao in patients with coronary artery disease （CAD） complicated with somatization disorder after percutaneous coronary intervention （PCI）， as well as its effect on heart rate variability （HRV）. MethodsA total of 96 patients with somatization disorder after PCI were selected and randomized into control and treatment groups （48 cases）. On the basis of standardized Western medical treatment for CAD， the control group received Dailixin， while the treatment group received Dailixin combined with Anshen Buxin Gao. The somatic symptom scale （SSS）， generalized anxiety disorder 7-item scale （GAD-7）， patient health questionnaire-9 （PHQ-9）， and self-rating scale of sleep （SRSS） scores in both groups were recorded before and after treatment. The traditional Chinese medicine symptom efficacy， HRV， and incidence of adverse drug reactions were observed. ResultsA total of 90 patients completed the trial， encompassing 45 patients in the control group and 45 patients in the treatment group. Baseline characteristics between the two groups showed no statistically significant differences， indicating comparability. After treatment， both groups exhibited reductions in SSS， GAD-7， and PHQ-9 scores （P<0.05）， and the treatment group outperformed the control group in alleviating somatic symptoms and anxiety-depression symptoms （P<0.05）. The control group did not achieve a significant reduction in SRSS score， whereas the treatment group effectively lowered the SRSS score （P<0.05）. Regarding traditional Chinese medicine symptom efficacy， the total response rate in the treatment group was 91.1% （41/45）， which was higher than that （71.1%， 32/45） in the control group （Z=-2.663， P<0.05）. Both groups improved HRV in patients with somatization disorder， and the treatment group showed greater improvement （P<0.05）. There were no serious clinical adverse events during the study period. The incidence of adverse reactions in the treatment group was 6.7% （3/45）， which was lower than that （14/45， 31.10%） in the control group （χ²=7.252， P<0.05）. ConclusionThe addition of Anshen Buxin Gao to Dailixin therapy significantly alleviates the clinical symptoms and improves the sleep quality， treatment efficacy， and HRV in patients with CAD complicated with somatization disorder after PCI， while reducing the adverse effects associated with Dailixin alone. This approach demonstrates considerable clinical value and warrants further promotion.

Objective To evaluate the protective effect of Schistosoma japonicum cystatin(rSj-Cystatin)in a mouse mode of"two-hit"sepsis.Methods Sixty male C57BL/6 mice randomized equally into sham-operated group,protein group,"two-hit"modeling group,and protein intervention group.In the former two groups,the mice received an intraperitoneal injection of 100 μL PBS followed by exposure of the cecum and then by intraperitoneal injection of 100 μL PBS or 25 μg rSj-Cystatin 30 min later;In the latter two groups,100 μL PBS containing LPS(5 mg/kg)was injected intraperitoneally 24 h before cecal ligation and puncture(CLP),and 100 μL PBS or 25 μg rSj-Cystatin were injected 30 min after CLP.At 12 h after rSj-Cystatin treatment,6 mice from each group were sacrificed for detection of TNF-α,IL-6,IL-10,TGF-β,iNOS and Arg-1 in the serum,spleen,liver,lung and kidney tissues using ELISA,for examinations of liver,lung and kidney pathologies with HE staining,and for analysis of CD3+CD4+CD25+Foxp3+T cell percentage in the spleen using flow cytometry.The remaining mice were observed for general condition and 72-h survival.Results The 72-h survival rates in the 4 groups were 100％,100％,0％and 20％,respectively,showing significant differences between the latter two groups.The mouse models of"two-hit"sepsis exhibited obvious tissue pathologies and significant elevations of TNF-α and IL-6 in both the serum and tissue homogenate,which were significantly ameliorated by rSj-Cystatin treatment.Treatment with rSj-Cystatin also increased IL-10 and TGF-β levels and spleen CD3+CD4+CD25+Foxp3+T cell percentage.The septic mouse models also showed increased iNOS levels in all the detected tissues and a decreased Arg-1 level in the kidney,and these changes were obviously improved by rSj-Cystatin treatment.Conclusion rSj-Cystatin has a protective effect against"two-hit"sepsis in mice by regulating the inflammatory microenvironment.

Objective : To analyze the influencing factors associated with the coexistence of multidrug-resistantEscherichia coli(MDR-ECO) infection and active tuberculosis(ATB) in patients with lung infections. Methods: A total of 204 hospitalized patients with lung infections caused by MDR-ECO were enrolled. Among them, patients with coexisting ATB were identified and assigned to the observation group. Univariate and multivariate Logistic regression analysis were performed to identify the risk factors for the coexistence of MDR-ECO lung infection and ATB. Results : Factors such as patient age, neutrophil count, hemoglobin level, malignancy, rheumatoid arthritis, history of antibiotic exposure, and history of surgery within the past year were found to be influencing factors for the coexistence of MDR-ECO lung infection and ATB(allP<0.05). Specifically, advanced age(95%CI: 0.949-0.992,P=0.008), decreased neutrophils(95%CI: 0.750-0.922,P<0.001), and a history of antibiotic exposure(95%CI: 1.202-2.596,P=0.004) were identified as risk factors. Conclusion Some patients with MDR-ECO lung infections are prone to coexisting with ATB. Therefore, it is recommended to strengthen ATB screening among high-risk patients, including those at peak ages for susceptibility, with low neutrophil counts, and with a history of antibiotic exposure.

OBJECTIVES: To evaluate the protective effect of Schistosoma japonicum cystatin (rSj-Cystatin) in a mouse mode of "two-hit" sepsis. METHODS: Sixty male C57BL/6 mice randomized equally into sham-operated group, protein group, "two-hit" modeling group, and protein intervention group. In the former two groups, the mice received an intraperitoneal injection of 100 μL PBS followed by exposure of the cecum and then by intraperitoneal injection of 100 μL PBS or 25 μg rSj-Cystatin 30 min later; In the latter two groups, 100 μL PBS containing LPS (5 mg/kg) was injected intraperitoneally 24 h before cecal ligation and puncture (CLP), and 100 μL PBS or 25 μg rSj-Cystatin were injected 30 min after CLP. At 12 h after rSj-Cystatin treatment, 6 mice from each group were sacrificed for detection of TNF-α, IL-6, IL-10, TGF-β, iNOS and Arg-1 in the serum, spleen, liver, lung and kidney tissues using ELISA, for examinations of liver, lung and kidney pathologies with HE staining, and for analysis of CD3⁺CD4⁺CD25⁺Foxp3⁺ T cell percentage in the spleen using flow cytometry. The remaining mice were observed for general condition and 72-h survival. RESULTS: The 72-h survival rates in the 4 groups were 100%, 100%, 0% and 20%, respectively, showing significant differences between the latter two groups. The mouse models of "two-hit" sepsis exhibited obvious tissue pathologies and significant elevations of TNF-α and IL-6 in both the serum and tissue homogenate, which were significantly ameliorated by rSj-Cystatin treatment. Treatment with rSj-Cystatin also increased IL-10 and TGF-β levels and spleen CD3⁺CD4⁺CD25⁺Foxp3⁺ T cell percentage. The septic mouse models also showed increased iNOS levels in all the detected tissues and a decreased Arg-1 level in the kidney, and these changes were obviously improved by rSj-Cystatin treatment. CONCLUSIONS rSj-Cystatin has a protective effect against "two-hit" sepsis in mice by regulating the inflammatory microenvironment.
Animals ; Mice ; Sepsis/drug therapy* ; Male ; Schistosoma japonicum/chemistry* ; Mice, Inbred C57BL ; Cystatins/therapeutic use* ; Interleukin-10/metabolism* ; Interleukin-6/blood* ; Tumor Necrosis Factor-alpha/blood* ; Disease Models, Animal ; Transforming Growth Factor beta/metabolism*

Objective:To explore application value of a constructed predictive model of quantitative parameters of contrast-enhanced ultrasound(CEUS)combined with immunohistochemical indicators in assessing the curative efficacy of neoadjuvant chemotherapy(NAC)for breast cancer,so as to provide objective basis for clinically individual treatment decisions.Methods:The CEUS quantitative parameters were used to combine with immunohistochemical indicators to construct predictive model,and this study adopted prospective cohort design.A total of 93 patients who were preliminarily diagnosed as breast cancer at Affiliated Hospital of Jiangnan University during June 2022 and June 2023 were included in this study.According to the pathologically relieve condition,they were divided into significant response group(41 cases)and non-significant response group(52 cases).All of them received NAC with docetaxel/doxorubicin/cyclophosphamide(TAC).Before treatment,the peak intensity(PI),time-to-peak(TTP),and wash-in rate(WIR)of them were obtained through CEUS,and all of patients underwent immunohistochemical examination to detect the expressions of immunohistochemical indicators included estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER2)and Ki-67 proliferation index.The Miller-Payne grade G4-G5 was used as the standard of pathological complete response(pCR).Multivariate logistic regression was adopted to screen independent predictors,and construct a jointly predictive model,and verify effectiveness by Bootstrap resampling method.Results:The PI value of significant response group was(22.7±4.1)dB,which was significantly higher than(18.3±3.6)dB of non-significant response group,and the difference was significant(t=5.437,P<0.001).The TTP of significant response group was(14.2±2.8)s,which was shorter than(18.6±3.1)s of non-significant response group,and the difference was significant(t=7.152,P<0.05).The wash-in rate(WIR)of significant response group was(1.61±0.43)dB/s,which was significantly higher than(0.98±0.37)dB/s of non-significant response group,and the difference was significant(t=7.893,P<0.001).In the immunohistochemical indicators,the positive HER2 and high Ki-67 expression significantly correlated with pathological response.In the results of positive HER2,there were 17 cases(41.5%)in 41 patients of significant response group,and there were 9 cases(17.3%)in non-significant response group,and the positive HER2 of significant response group was higher than that of non-significant response group,and the difference was significant(x2=7.326,P<0.05).For patients whose Ki-67 were larger or equal to 20%,the positive rate of significant response group was 75.6%(31 cases),which was higher than 57.7%(30 cases)of non-significant response group.For patients whose Ki-67 were less than 20%,the positive rate of significant response group was 24.4%(10 cases),which was significantly higher than 42.3%(22 cases)of non-significant response group,and the difference was significant(x2=3.921,P<0.05).Multivariate analysis indicated that TTP≤15 s,WIR≥1.5 dB/s,and positive HER2 were respectively independent predictors(OR=4.23,3.76,2.91,P<0.05).The area under curve(AUC)value of receiver operating characteristic(ROC)curve of joint model was 0.89(95%CI:0.83-0.95),and the sensitivity and specificity of that were respectively 92.7%and 80.8%,which were significantly better than each single parameter.Decision curve analysis indicated that the net benefit value of joint model increased by 21.3%-28.6%than conventional strategy when threshold probabilities was 15%-60%.Conclusion:CEUS quantitative parameters(TTP,WIR)that combine with HER2 status can construct predictive model with high-precision and low-cost for NAC curative efficacy,which synergistic effect in dynamic perfusion assessment and molecularly pathological characteristic can provide new paradigm for precision treatment in breast cancer.This mode has excellent clinical applicability,and can effectively identify chemosensitive populations and optimize decision-making process of treatment.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective To investigate the effects of Demodex infection on clinical symptoms,signs,and tear MMP-9 levels in patients with meibomian gland dysfunction(MGD).Methods A total of 680 patients with MGD were selected from our hospital,including 162 males and 518 females,with an average age of(45.05±15.41)years old.The patients were divided into two groups based on the presence of Demodex mite infestation:the Demodex positive group(340 cases)and the Demodex negative group(340 cases).All patients underwent evaluations using the OSDI questionnaire,SPEED questionnaire,eyelid margin alteration score,corneal fluorescein staining score,tear MMP-9 measurement,meibomian gland orifice score,meibomian gland excretion ability score,meibomian gland secretion score,meibomian gland loss score,tear film breakup time(BUT),and Schirmer I tear secretion test.The differences in these indicators between the two groups were compared.Results SPEED questionnaire score:Demodex positive group:(7.68±2.80),Demodex negative group:(6.28±1.99).There was a statistically significant difference between the two groups(t=2.582,P=0.012).Eyelid margin alteration score:Demodex positive group:(3.63±1.53),Demodex negative group:(2.85±0.77).A statistically significant difference was observed(t=2.861,P=0.006).Corneal fluorescein staining score:Demodex positive group:(2.25±1.86),Demodex negative group:(1.08±1.33).There was a statistically significant difference(t=3.247,P=0.002).Tear MMP-9 content:Demodex positive group:(30.76±43.14)ng/mL,Demodex negative group:(12.36±12.10)ng/mL.A statistically significant difference was found(t=2.598,P=0.013).No statistically significant differences were observed between the Demodex positive and negative groups in meibomian gland orifice score,meibomian gland excretion ability score,meibomian gland secretion score,meibomian gland loss score,BUT,tear secretion examination,and age comparison(P>0.05).Conclusions Demodex mite infestation in patients with MGD exhibits significant differ-ences across various clinical indicators,notably in SPEED questionnaire scores,eyelid margin alterations,corneal fluorescein staining,and tear MMP-9 levels.These changes are associated with mechanisms including inflammatory responses,cellular damage,and immune dysregulation.Demodex mite infestation may significantly influence the clinical progression of MGD by exacerbating inflammation and symptom severity,potentially playing a crucial role in disease development.

Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.

Objective To investigate the effects of Demodex infection on clinical symptoms,signs,and tear MMP-9 levels in patients with meibomian gland dysfunction(MGD).Methods A total of 680 patients with MGD were selected from our hospital,including 162 males and 518 females,with an average age of(45.05±15.41)years old.The patients were divided into two groups based on the presence of Demodex mite infestation:the Demodex positive group(340 cases)and the Demodex negative group(340 cases).All patients underwent evaluations using the OSDI questionnaire,SPEED questionnaire,eyelid margin alteration score,corneal fluorescein staining score,tear MMP-9 measurement,meibomian gland orifice score,meibomian gland excretion ability score,meibomian gland secretion score,meibomian gland loss score,tear film breakup time(BUT),and Schirmer I tear secretion test.The differences in these indicators between the two groups were compared.Results SPEED questionnaire score:Demodex positive group:(7.68±2.80),Demodex negative group:(6.28±1.99).There was a statistically significant difference between the two groups(t=2.582,P=0.012).Eyelid margin alteration score:Demodex positive group:(3.63±1.53),Demodex negative group:(2.85±0.77).A statistically significant difference was observed(t=2.861,P=0.006).Corneal fluorescein staining score:Demodex positive group:(2.25±1.86),Demodex negative group:(1.08±1.33).There was a statistically significant difference(t=3.247,P=0.002).Tear MMP-9 content:Demodex positive group:(30.76±43.14)ng/mL,Demodex negative group:(12.36±12.10)ng/mL.A statistically significant difference was found(t=2.598,P=0.013).No statistically significant differences were observed between the Demodex positive and negative groups in meibomian gland orifice score,meibomian gland excretion ability score,meibomian gland secretion score,meibomian gland loss score,BUT,tear secretion examination,and age comparison(P>0.05).Conclusions Demodex mite infestation in patients with MGD exhibits significant differ-ences across various clinical indicators,notably in SPEED questionnaire scores,eyelid margin alterations,corneal fluorescein staining,and tear MMP-9 levels.These changes are associated with mechanisms including inflammatory responses,cellular damage,and immune dysregulation.Demodex mite infestation may significantly influence the clinical progression of MGD by exacerbating inflammation and symptom severity,potentially playing a crucial role in disease development.

Objective:To explore application value of a constructed predictive model of quantitative parameters of contrast-enhanced ultrasound(CEUS)combined with immunohistochemical indicators in assessing the curative efficacy of neoadjuvant chemotherapy(NAC)for breast cancer,so as to provide objective basis for clinically individual treatment decisions.Methods:The CEUS quantitative parameters were used to combine with immunohistochemical indicators to construct predictive model,and this study adopted prospective cohort design.A total of 93 patients who were preliminarily diagnosed as breast cancer at Affiliated Hospital of Jiangnan University during June 2022 and June 2023 were included in this study.According to the pathologically relieve condition,they were divided into significant response group(41 cases)and non-significant response group(52 cases).All of them received NAC with docetaxel/doxorubicin/cyclophosphamide(TAC).Before treatment,the peak intensity(PI),time-to-peak(TTP),and wash-in rate(WIR)of them were obtained through CEUS,and all of patients underwent immunohistochemical examination to detect the expressions of immunohistochemical indicators included estrogen receptor(ER),progesterone receptor(PR),human epidermal growth factor receptor 2(HER2)and Ki-67 proliferation index.The Miller-Payne grade G4-G5 was used as the standard of pathological complete response(pCR).Multivariate logistic regression was adopted to screen independent predictors,and construct a jointly predictive model,and verify effectiveness by Bootstrap resampling method.Results:The PI value of significant response group was(22.7±4.1)dB,which was significantly higher than(18.3±3.6)dB of non-significant response group,and the difference was significant(t=5.437,P<0.001).The TTP of significant response group was(14.2±2.8)s,which was shorter than(18.6±3.1)s of non-significant response group,and the difference was significant(t=7.152,P<0.05).The wash-in rate(WIR)of significant response group was(1.61±0.43)dB/s,which was significantly higher than(0.98±0.37)dB/s of non-significant response group,and the difference was significant(t=7.893,P<0.001).In the immunohistochemical indicators,the positive HER2 and high Ki-67 expression significantly correlated with pathological response.In the results of positive HER2,there were 17 cases(41.5%)in 41 patients of significant response group,and there were 9 cases(17.3%)in non-significant response group,and the positive HER2 of significant response group was higher than that of non-significant response group,and the difference was significant(x2=7.326,P<0.05).For patients whose Ki-67 were larger or equal to 20%,the positive rate of significant response group was 75.6%(31 cases),which was higher than 57.7%(30 cases)of non-significant response group.For patients whose Ki-67 were less than 20%,the positive rate of significant response group was 24.4%(10 cases),which was significantly higher than 42.3%(22 cases)of non-significant response group,and the difference was significant(x2=3.921,P<0.05).Multivariate analysis indicated that TTP≤15 s,WIR≥1.5 dB/s,and positive HER2 were respectively independent predictors(OR=4.23,3.76,2.91,P<0.05).The area under curve(AUC)value of receiver operating characteristic(ROC)curve of joint model was 0.89(95%CI:0.83-0.95),and the sensitivity and specificity of that were respectively 92.7%and 80.8%,which were significantly better than each single parameter.Decision curve analysis indicated that the net benefit value of joint model increased by 21.3%-28.6%than conventional strategy when threshold probabilities was 15%-60%.Conclusion:CEUS quantitative parameters(TTP,WIR)that combine with HER2 status can construct predictive model with high-precision and low-cost for NAC curative efficacy,which synergistic effect in dynamic perfusion assessment and molecularly pathological characteristic can provide new paradigm for precision treatment in breast cancer.This mode has excellent clinical applicability,and can effectively identify chemosensitive populations and optimize decision-making process of treatment.