OBJECTIVE To explore the clinical characteristics of the neonates with early-onset sepsis caused by Listeria monocytogenes and analyze the risk factors for adverse treatment outcomes.METHODS A total of 16 neo-nates with early-onset sepsis caused by L.monocytogenes who were treated in neonatology department of the Affili-ated Suzhou Hospital of Nanjing Medical University from Jan.2012 to Dec.2023 were recruited as the research subjects.The clinical data and the results of laboratory test and drug susceptibility testing were collected from the neonates,and the risk factors for the adverse prognosis were analyzed.RESULTS Totally 14 neonates were born in the hospital,and the incidence rate was 6.7/100,000;13 cases were preterm infants,accounting for 81.25％.The peak of the onset ranged between May and November.Most of the 16 neonates showed clinical symptoms instantly after the birth,and the major manifestations included gasping and moaning(12 cases),hypotonia(11 cases),pale skin(10 cases)and poor response(9 cases).Totally 14 neonates showed the rise of C-reactive protein(CRP)in varying degree within 6 hours after the birth.In terms of the treatment outcomes,9 cases were cured and dis-charged,2 cases were improved and discharged,and 4 cases died.One of another cases was improved and died due to poor prognosis after against-advice discharge.There were significant differences in the decline of base excess,septic shock,use of sensitive antibiotics in early stage,invasive mechanical ventilation and peak value of CRP be-tween the survival group and the death group(P＜0.05).All of the L.monocytogenes were tested resistant to ce-foxitin,6 to ampicillin,6 to vancomycin,8 to linezolid.CONCLUSIONS The early-onset sepsis caused by L.mono-cytogenes is common among the preterm neonates and is prevalent in summer and autumn.Most of the cases show the symptoms instantly after the birth,the clinical manifestations are usually severe,and the mortality rate is high.The pregnant women who are suspected for L.monocytogenes infection before the delivery can be treated with penicillin,the neonates can be treated with the first choice of penicillin or ampicillin,and the severe cases can be treated with combination of vancomycin and linezolid.

Sepsis poses a significant threat to hu-man health due to its widespread prevalence,high mortality rate,substantial treatment costs,and the absence of effective life-saving therapies.Melato-nin,a primary hormone regulating the circadian rhythm,has demonstrated potential as a promising therapeutic agent against sepsis.Its anti-inflamma-tory,antioxidant,immunomodulatory,mitochondri-al protective,and multi-organ protective effects are noteworthy.In this review,we summarize current research on the mechanisms of action and clinical efficacy of melatonin in sepsis treatment and multi-organ function preservation,aiming to offer new perspectives and support for sepsis research and therapy.

Delirium is an acute brain dysfunction syndrome,mainly manifested by cognitive impairment and mental abnormalities.It is the most common manifestation of brain dysfunction associated with severe diseases.Critically ill patients with delirium often have poor prognosis,but there is currently no"miracle drug"for the prevention and treatment of delirium in clinical practice.Melatonin is an endogenous neurohormone secreted by the pineal gland,which has the functions of regulating sleep circadian rhythm,anti-inflammatory,antioxidant,and neuroprotective.When delirium occurs in critically ill patients,the serum melatonin level often changes,indicating that melatonin may be involved in the occurrence and development of delirium.Current research suggests that exogenous supplementation of melatonin may have a preventive and therapeutic effect on delirium.This article reviews researches on the mechanism and clinical efficacy of melatonin in the prevention and treatment of delirium in critically ill patients,with the aim of providing reference for basic and clinical research on the prevention and treatment of delirium in critically ill patients.

OBJECTIVE To explore the clinical characteristics of the neonates with early-onset sepsis caused by Listeria monocytogenes and analyze the risk factors for adverse treatment outcomes.METHODS A total of 16 neo-nates with early-onset sepsis caused by L.monocytogenes who were treated in neonatology department of the Affili-ated Suzhou Hospital of Nanjing Medical University from Jan.2012 to Dec.2023 were recruited as the research subjects.The clinical data and the results of laboratory test and drug susceptibility testing were collected from the neonates,and the risk factors for the adverse prognosis were analyzed.RESULTS Totally 14 neonates were born in the hospital,and the incidence rate was 6.7/100,000;13 cases were preterm infants,accounting for 81.25％.The peak of the onset ranged between May and November.Most of the 16 neonates showed clinical symptoms instantly after the birth,and the major manifestations included gasping and moaning(12 cases),hypotonia(11 cases),pale skin(10 cases)and poor response(9 cases).Totally 14 neonates showed the rise of C-reactive protein(CRP)in varying degree within 6 hours after the birth.In terms of the treatment outcomes,9 cases were cured and dis-charged,2 cases were improved and discharged,and 4 cases died.One of another cases was improved and died due to poor prognosis after against-advice discharge.There were significant differences in the decline of base excess,septic shock,use of sensitive antibiotics in early stage,invasive mechanical ventilation and peak value of CRP be-tween the survival group and the death group(P＜0.05).All of the L.monocytogenes were tested resistant to ce-foxitin,6 to ampicillin,6 to vancomycin,8 to linezolid.CONCLUSIONS The early-onset sepsis caused by L.mono-cytogenes is common among the preterm neonates and is prevalent in summer and autumn.Most of the cases show the symptoms instantly after the birth,the clinical manifestations are usually severe,and the mortality rate is high.The pregnant women who are suspected for L.monocytogenes infection before the delivery can be treated with penicillin,the neonates can be treated with the first choice of penicillin or ampicillin,and the severe cases can be treated with combination of vancomycin and linezolid.

Delirium is an acute brain dysfunction syndrome,mainly manifested by cognitive impairment and mental abnormalities.It is the most common manifestation of brain dysfunction associated with severe diseases.Critically ill patients with delirium often have poor prognosis,but there is currently no"miracle drug"for the prevention and treatment of delirium in clinical practice.Melatonin is an endogenous neurohormone secreted by the pineal gland,which has the functions of regulating sleep circadian rhythm,anti-inflammatory,antioxidant,and neuroprotective.When delirium occurs in critically ill patients,the serum melatonin level often changes,indicating that melatonin may be involved in the occurrence and development of delirium.Current research suggests that exogenous supplementation of melatonin may have a preventive and therapeutic effect on delirium.This article reviews researches on the mechanism and clinical efficacy of melatonin in the prevention and treatment of delirium in critically ill patients,with the aim of providing reference for basic and clinical research on the prevention and treatment of delirium in critically ill patients.

Sepsis poses a significant threat to hu-man health due to its widespread prevalence,high mortality rate,substantial treatment costs,and the absence of effective life-saving therapies.Melato-nin,a primary hormone regulating the circadian rhythm,has demonstrated potential as a promising therapeutic agent against sepsis.Its anti-inflamma-tory,antioxidant,immunomodulatory,mitochondri-al protective,and multi-organ protective effects are noteworthy.In this review,we summarize current research on the mechanisms of action and clinical efficacy of melatonin in sepsis treatment and multi-organ function preservation,aiming to offer new perspectives and support for sepsis research and therapy.

Objective    To propose a path planning method for precise robot-assisted bronchial intervention. Methods    In the MuJoCo dynamic simulation environment, a simulation model and a simulated bronchus model which could accurately represent the motion process of the robot were built. Based on the Informed RRT* algorithm, the known spatial information was used to improve the path planning method and the motion characteristics of the robot were simulated to verify the ability of the robot algorithm to reach the target position. Results    In the dynamic simulation environment, the robot could move as required, and could explore the target point of the planning task in a short time, and the position accuracy was improved by more than 50% compared with the existing electromagnetic navigation and other methods. Conclusion    The established simulation model can restore the motion of the robot, and the robot has the ability to move in the bronchial environment. The proposed method can precisely control the simulated robot to enter the more peripheral airway position. It has the advantages of accuracy and faster speed than traditional manual interventional surgery, and can be used for the human-machine coordinated control task of robot-assisted bronchoscopy.

Objective:To establish a drug-related problems (DRPs) classification system for outpatients and home patients and provide healthcare staff with tools for standardized recording of DRPs.Methods:DRPs classification systems-related literature were collected by searching foreign databases. The selected DRPs classification systems were compared and analyzed, and the initial DRPs classification system was formed by integrating the characteristics of pharmaceutical care for outpatients and home patients in China. The expert consultation form of DRPs classification system was made, expert consultation was performed for 2 rounds using Delphi method, and the final DRPs classification system was formed through modification and adjustment according to expert opinions.Results:A total of 25 DRPs classification systems were obtained, of which 16 were selected and then integrated to form the initial version of the DRPs classification system. The primary structure of the initial DRPs classification system consisted of 5 parts: problem state, problem type, problem cause, problem intervention, and intervention result. Each part had different number of items, among which there were different number of secondary structure items in problem cause, problem intervention, and intervention result. In the first round of consultation, 32 experts were invited and 30 consultation forms were collected, with a recovery rate of 94%. In the second round of consultation, 30 experts were invited and 30 consultation forms were collected, with a recovery rate of 100%. After 2 rounds of consultation, the acceptance rates of experts for the question state, problem type, problem cause, question intervention, and intervention result in the primary structure were 100%, 90%, 83%, 83%, and 97%, respectively. For the evaluation of 5 categories of drug treatment (indications, effectiveness, safety, economy, and compliance) in DRPs classification system, except for that the expert authority coefficient of economics was 0.79, the expert authority coefficient of the other 4 categories of issues was all >0.8. In the first and second round of consultation, the coordination coefficient of expert opinions was 0.386 ( χ2=995.258, P<0.001) and 0.364 ( χ2=971.232, P<0.001), respectively. After modifying with expert opinions, a final version of DRPs classification system was formed, which included 38 primary structure items in 5 categories and 90 secondary structure items in 3 categories. Conclusion:A DRPs classification system for outpatients and home patients suitable for China′s national conditions has been initially established, which can be used as a standardized recording tool for DRP.

Objective:To establish a drug-related problems (DRPs) classification system for outpatients and home patients and provide healthcare staff with tools for standardized recording of DRPs.Methods:DRPs classification systems-related literature were collected by searching foreign databases. The selected DRPs classification systems were compared and analyzed, and the initial DRPs classification system was formed by integrating the characteristics of pharmaceutical care for outpatients and home patients in China. The expert consultation form of DRPs classification system was made, expert consultation was performed for 2 rounds using Delphi method, and the final DRPs classification system was formed through modification and adjustment according to expert opinions.Results:A total of 25 DRPs classification systems were obtained, of which 16 were selected and then integrated to form the initial version of the DRPs classification system. The primary structure of the initial DRPs classification system consisted of 5 parts: problem state, problem type, problem cause, problem intervention, and intervention result. Each part had different number of items, among which there were different number of secondary structure items in problem cause, problem intervention, and intervention result. In the first round of consultation, 32 experts were invited and 30 consultation forms were collected, with a recovery rate of 94%. In the second round of consultation, 30 experts were invited and 30 consultation forms were collected, with a recovery rate of 100%. After 2 rounds of consultation, the acceptance rates of experts for the question state, problem type, problem cause, question intervention, and intervention result in the primary structure were 100%, 90%, 83%, 83%, and 97%, respectively. For the evaluation of 5 categories of drug treatment (indications, effectiveness, safety, economy, and compliance) in DRPs classification system, except for that the expert authority coefficient of economics was 0.79, the expert authority coefficient of the other 4 categories of issues was all >0.8. In the first and second round of consultation, the coordination coefficient of expert opinions was 0.386 ( χ2=995.258, P<0.001) and 0.364 ( χ2=971.232, P<0.001), respectively. After modifying with expert opinions, a final version of DRPs classification system was formed, which included 38 primary structure items in 5 categories and 90 secondary structure items in 3 categories. Conclusion:A DRPs classification system for outpatients and home patients suitable for China′s national conditions has been initially established, which can be used as a standardized recording tool for DRP.

Objective: To assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity(DU). Methods: A prospective and self-controlled trail was conducted from August 2012 to October 2017. Male patients with nerve injury, dysuria more than 6 months, DU(bladder contractility index less than 100) were enrolled in this study. Exclusion criteria included patients with acute urinary tract infection, bladder stone, benign prostate hyperplasia, urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline, and the solution of BTX- A was injected into 4 different points(3-o’clock, 6-o’clock, 9-o’clock, and 12-o’clock) in external urinary sphincter with each point of 1ml solution. Patients were evaluated at baseline and 12 weeks after injection. The outcomes included post void residual (PVR), maximum flow rate (Q_max), maximum detrusor pressure during voiding phases (P_det.max), maximum urethral closure pressure (MUCP), the case number of intermittent catheterization (IC)and the score of quality of life (QOL score). Adverse events were also recorded. Results: A total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital)with mean age 28.6 years suffered from cerebral palsy (n=2), cerebrovascular accident(n=19)and spinal cord injury(n=37) were included into the study. Compared to baseline data, significant difference were observed at week 12 in PVR (56.68 ml vs. 280.11 ml, P<0.001), P_det.max(23.95 cmH₂O vs. 30.01 cmH₂O, P=0.019), Q_max(6.74 ml/s vs. 3.28 ml/s, P=0.042), MUCP(48.25 cmH₂O vs. 79.34 cmH₂O, P<0.001), the case number of IC(40 vs. 58, P<0.001) and QOL score(3.63 vs.5.22, P<0.001) respectively. 5 cases developed perineal pain and 16 cases developed mild transient haematuria. These adverse events were disappeared by medical symptomatic treatment during 3-5 days. Conclusions BTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity.