Objective To analyze the clinical characteristics,laboratory test,imaging examination,and treatment outcome of invasive Klebsiella pneumoniae liver abscess syndrome(IKPLAS)in the elderly,and improve clinicians' understanding on this disease.Methods Clinical data of 7 elderly patients who were diagnosed with IKPLAS in a hospital from January 2020 to February 2024 were analyzed retrospectively.Results Among the 7 elderly patients with IKPLAS,there were 3 males and 4 females,ranging in age from 60 to 78 years old.All 7 patients were with community-acquired infection.The main clinical symptoms were fever(n=7),chills(n=6),upper abdominal pain(n=4),fatigue and poor appetite(n=3),cough and expectoration(n=5),vomiting(n=3),vision decrease(n=2),and disturbance of consciousness(n=1).All 7 patients had pathogenic evidence of Klebsiella pneumoniae(KP),including 4 cases with KP isolated from liver puncture pus,3 from blood culture,and 1 from both liver puncture pus and intraocular pus.Among the 7 patients,there were 5,2,1,3,1,1 cases combined with pulmonary abscess,endophthalmitis,brain abscess,bloodstream infection,urinary system infection,and pelvic infection,re-spectively.Conclusion Elderly patients with IKPLAS have a variety of underlying diseases and diverse clinical symptoms,showing no specificity.Once IKPLAS was suspected,timely testing for pathogen and screening for other metastatic infection sites outside the liver should be performed.Timely drainage of liver abscess and selection of ap-propriate antimicrobial agents for treatment based on antimicrobial susceptibility testing result can improve patients' survival rate.

Objective:To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) in the treatment of severe acute pancreatitis (SAP) with infected pancreatic necrosis (IPN).Methods:A retrospective analysis was conducted on the clinical data of 113 patients with SAP and IPN admitted to Qingdao Municipal Hospital between January 2018 and June 2023. The cohort included 66 males and 47 females, aged (46.2±13.6) years. Based on the treatment approach, patients were divided into two groups: those who underwent percutaneous catheter drainage (PCD) alone were assigned to the PCD group ( n=60), and those who received PCNL were assigned to the PCNL group ( n=53). Clinical parameters such as age, sex, number of debridement procedures, and postoperative complications were recorded. Results:Compared with the PCD group, the PCNL group had a higher CT severity index [8(6, 9) vs. 7(6, 8)], a greater proportion of patients with multiloculated abscesses [71.7%(38/53) vs. 41.7%(25/60)], and a higher percentage of patients with IPN involving >50% necrosis [56.6%(30/53) vs. 33.3%(20/60)]. These differences were statistically significant (all P<0.05). The PCNL group also showed a higher proportion of patients with post-treatment IPN necrosis involving <30% [91.4%(49/53) vs. 70.8%(42/60)], a lower rate of requiring step-up laparoscopic or open surgery [3.8%(2/53) vs. 10.0%(6/60)], fewer debridement sessions [2(1, 4) vs. 4(2, 6)], and a shorter total hospital stay [45(35, 58) d vs. 54(23, 72) d]. These differences were statistically significant (all P<0.05). Additionally, the PCNL group had lower rates of postoperative complications, including enteric fistula [3.8%(2/53) vs. 11.7%(7/60)], intra-abdominal bleeding [5.7%(3/53) vs. 13.3%(8/60)], and pancreatic fistula [15.1%(8/53) vs. 20.0% (12/60)]. These differences were also statistically significant (all P<0.05). The recurrence rate of abscesses was significantly lower in the PCNL group [11.3%(6/53) vs. 16.7%(10/60), χ2=4.14, P=0.042]. Conclusion:PCNL is an effective treatment for SAP complicated by IPN. Compared with PCD, it improves the clearance of necrotic tissue, reduces the number of debridement procedures, shortens the total hospital stay, and lowers the risk of postoperative complications.

Objective To analyze the clinical characteristics,laboratory test,imaging examination,and treatment outcome of invasive Klebsiella pneumoniae liver abscess syndrome(IKPLAS)in the elderly,and improve clinicians' understanding on this disease.Methods Clinical data of 7 elderly patients who were diagnosed with IKPLAS in a hospital from January 2020 to February 2024 were analyzed retrospectively.Results Among the 7 elderly patients with IKPLAS,there were 3 males and 4 females,ranging in age from 60 to 78 years old.All 7 patients were with community-acquired infection.The main clinical symptoms were fever(n=7),chills(n=6),upper abdominal pain(n=4),fatigue and poor appetite(n=3),cough and expectoration(n=5),vomiting(n=3),vision decrease(n=2),and disturbance of consciousness(n=1).All 7 patients had pathogenic evidence of Klebsiella pneumoniae(KP),including 4 cases with KP isolated from liver puncture pus,3 from blood culture,and 1 from both liver puncture pus and intraocular pus.Among the 7 patients,there were 5,2,1,3,1,1 cases combined with pulmonary abscess,endophthalmitis,brain abscess,bloodstream infection,urinary system infection,and pelvic infection,re-spectively.Conclusion Elderly patients with IKPLAS have a variety of underlying diseases and diverse clinical symptoms,showing no specificity.Once IKPLAS was suspected,timely testing for pathogen and screening for other metastatic infection sites outside the liver should be performed.Timely drainage of liver abscess and selection of ap-propriate antimicrobial agents for treatment based on antimicrobial susceptibility testing result can improve patients' survival rate.

Objective:To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) in the treatment of severe acute pancreatitis (SAP) with infected pancreatic necrosis (IPN).Methods:A retrospective analysis was conducted on the clinical data of 113 patients with SAP and IPN admitted to Qingdao Municipal Hospital between January 2018 and June 2023. The cohort included 66 males and 47 females, aged (46.2±13.6) years. Based on the treatment approach, patients were divided into two groups: those who underwent percutaneous catheter drainage (PCD) alone were assigned to the PCD group ( n=60), and those who received PCNL were assigned to the PCNL group ( n=53). Clinical parameters such as age, sex, number of debridement procedures, and postoperative complications were recorded. Results:Compared with the PCD group, the PCNL group had a higher CT severity index [8(6, 9) vs. 7(6, 8)], a greater proportion of patients with multiloculated abscesses [71.7%(38/53) vs. 41.7%(25/60)], and a higher percentage of patients with IPN involving >50% necrosis [56.6%(30/53) vs. 33.3%(20/60)]. These differences were statistically significant (all P<0.05). The PCNL group also showed a higher proportion of patients with post-treatment IPN necrosis involving <30% [91.4%(49/53) vs. 70.8%(42/60)], a lower rate of requiring step-up laparoscopic or open surgery [3.8%(2/53) vs. 10.0%(6/60)], fewer debridement sessions [2(1, 4) vs. 4(2, 6)], and a shorter total hospital stay [45(35, 58) d vs. 54(23, 72) d]. These differences were statistically significant (all P<0.05). Additionally, the PCNL group had lower rates of postoperative complications, including enteric fistula [3.8%(2/53) vs. 11.7%(7/60)], intra-abdominal bleeding [5.7%(3/53) vs. 13.3%(8/60)], and pancreatic fistula [15.1%(8/53) vs. 20.0% (12/60)]. These differences were also statistically significant (all P<0.05). The recurrence rate of abscesses was significantly lower in the PCNL group [11.3%(6/53) vs. 16.7%(10/60), χ2=4.14, P=0.042]. Conclusion:PCNL is an effective treatment for SAP complicated by IPN. Compared with PCD, it improves the clearance of necrotic tissue, reduces the number of debridement procedures, shortens the total hospital stay, and lowers the risk of postoperative complications.

OBJECTIVE To explore the improvement effect and mechanism of petroleum ether extract of Saposhnikovia divaricata on rheumatoid arthritis （RA） rats by regulating neutrophil extracellular traps （NETs）. METHODS Establishment of rat RA model using bovine type Ⅱ collagen and Freund’s complete adjuvant. The model rats were randomly divided into model group and low-dose， middle-dose and high-dose groups （55， 110， 220 mg/kg） of petroleum ether extract of S. divaricata； the normal group without modeling was also established， with 10 rats in each group. Each group was given corresponding drugs or constant volume of 2% Tween-80 solution intragastrically， once a day， for consecutive 28 days. The toe swelling degree in rats was observed， and the arthritis index （AI） was scored. The serum levels of interleukin-1β （IL-1β）， IL-10， IL-17， tumor necrosis factor-α （TNF-α）， 25-hydroxyvitamin D3 [25（OH）D3]， myeloperoxidase （MPO）， neutrophil elastase （NE） and NETs in rats were detected. The histopathological changes in ankle joint were observed. The expression of citrullinated histone H3 （CitH3） in ankle joint as well as the expressions of cytochrome P450 24A1 （CYP24A1）， cytochrome P450 27B1 （CYP27B1），vitamin D receptor （VDR） and peptidyl arginine deiminase 4 疾病。E-mail：zhongyao626@126.com （PAD4） in synovium were all determined. RESULTS Compared with the model group， the toe swelling degree and AI score in the middle-dose and high-dose groups of petroleum ether extract of S. divaricata decreased significantly from day 14 to day 28 after administration （P＜0.05 or P＜0.01）. The serum levels of IL-1β， IL-17， TNF-α， MPO， NE and NETs decreased significantly， while the levels of IL-10 and 25（OH）D3 increased significantly （P＜0.05 or P＜0.01）. The widened ankle joint space and the improved structure were found； the expression of CitH3 in ankle joint， and the expressions of CYP24A1 and PAD4 in synovium were down-regulated significantly， while the expressions of CYP27B1 and VDR were up-regulated significantly in synovium （P＜0.05 or P＜0.01）. CONCLUSIONS The petroleum ether extract of S. divaricata may inhibit the production of NETs and improve the symptoms of RA by regulating the vitamin D system.

【Objective】 To observe the effects of mirror neuron system theory(MNST) on hand dexterity and fine motor function in preschool children with developmental coordination disorder(DCD), so as to provide reference for the rehabilitation of children with DCD. 【Methods】 A total of 51 children with DCD treated at Nantong Maternal and Child Health Care Hospital from June 2021 to April 2023 were enrolled in this study, and were randomly assigned to treatment group (n=26) and control group (n=25) except for 5 cases who missed in the follow-up. Both groups received conventional rehabilitation training, while the treatment group received MNST additionally. The hand dexterity and fine motor function of both groups were assessed using the hand dexterity subscale of the Movement Assessment Battery for Children-Second Edition (MABC-2), Peabody Developmental Motor Scale-Fine Motor (PDMS-FM), and Function Independence Measure for Children (WeeFIM) before and after 12 weeks of treatment. 【Results】 Before treatment, there were no significant differences in hand dexterity subscale of MABC-2, PDMS-FM, and WeeFIM scores between the two groups (P>0.05). After treatment, both groups showed improvements in hand dexterity subscale of MABC-2, PDMS-FM, and WeeFIM scores (treatment group: t=35.620, 42.084, 40.072; control group: t=14.000, 12.017, 14.054, P<0.001), with the treatment group showing significantly greater improvements compared to the control group (t=2.611, 3.120, 2.331, P<0.05). 【Conclusion】 MNST combined with conventional rehabilitation training can enhance hand dexterity and fine motor function in children with DCD, thereby improving children′s activities of daily living.

Objective:To observe the effects of transcutaneous auricular vagus nerve stimulation(taVNS)matched with re-habilitation training on upper limb function in children with spastic hemiplegic cerebral palsy. Method:A total of 50 children with spastic hemiplegic cerebral palsy were randomly divided into treatment group(n=25)and control group(n=25).The treatment group received conventional rehabilitation training com-bined with taVNS,while the control group received conventional rehabilitation training combined with sham-taVNS.The upper limb flexor muscle tension and upper limb function of the two groups were analyzed by the modified Ashworth scale(MAS),Carroll Upper Extremities Functional Test(UEFT),Peabody Developmen-tal Motor Scales-Fine Motor(PDMS-FM)and Function Independence Measure for Children(WeeFIM)before and after 12 weeks of treatment respectively.In addition,any adverse reactions that occurred during the treat-ment process was closely monitored and recorded. Result:A total of 5 subjects dropped out,including 3 subjects in the treatment group and 2 subjects in the control group.After treatment,there was no significant difference in MAS classification of hemiplegic side in the two groups(P＞0.05),and there was no significant difference between the treatment group and the control group(P=0.065).However,both groups showed significant improvements in UEFT score,PDMS-FM and WeeFIM scores compared to before treatment(P＜0.05),with the treatment group scoring better than the con-trol group(P＜0.05). Conclusion:Conventional rehabilitation training combined with taVNS can effectively improve the affected up-per limb motor function in children with spastic hemiplegic cerebral palsy,without significant adverse effects.

Objective:To help flying personnel prevent flight fatigue risk and ensure flight safety by investigating the fatigue and countermeasures of flying personnel during long-haul flight.Methods:Air Force flying personnel were randomly selected from a cluster. They were divided into 21-30, 31-40 and 41-50 years group according to age. According to the post, they were divided into fighter pilots, bomber pilots, air navigation commander/air communication controller/aerial machinist and other groups. The self-made "questionnaire of aeromedical support to long-haul flight safety" was used to collect the fatigue condition and countermeasures of flying personnel in long-haul flight for the comparison among age and post groups.Results:Out of 156 questionnaires, 150 were valid, with a response rate of 96.2%. For the comparisons among age groups, the significant differences were observed in 3 fatigue symptoms such as drowsiness/sleepiness, discomfort on neck, waist, and shoulders, and degraded reaction ( χ2=12.62, 11.77, 12.23, P=0.002, 0.003, 0.002), 2 fatigue countermeasures such as talking with teammates and engaging in physical activity ( χ2=6.37, 16.70, P=0.041,<0.001), and 4 measures of maintaining flight ability such as sleep management, comprehensive physical training, functional food intake and simulation training ( χ2=8.81, 11.48, 9.59, 7.32, P=0.012, 0.003, 0.008, 0.026). For the comparisons among post groups, the significant differences were observed in 3 fatigue symptoms as visual fatigue, drowsiness/sleepiness, and discomfort on neck, waist, and shoulders ( χ2=10.39, 17.89, 8.42, P=0.016, 0.001, 0.038), as well as in fatigue countermeasures chosen like taking in water or food ( χ2=19.06, P<0.001) and in improving flight ability chosen like relieving eye fatigue ( χ2=12.09, P=0.007). Conclusions:The age and post factors influence the fatigue conditions and countermeasures chosen in the flying personnel during long-haul flight. The targeted and comprehensive interventions are suggested.

Objective:To help flying personnel prevent flight fatigue risk and ensure flight safety by investigating the fatigue and countermeasures of flying personnel during long-haul flight.Methods:Air Force flying personnel were randomly selected from a cluster. They were divided into 21-30, 31-40 and 41-50 years group according to age. According to the post, they were divided into fighter pilots, bomber pilots, air navigation commander/air communication controller/aerial machinist and other groups. The self-made "questionnaire of aeromedical support to long-haul flight safety" was used to collect the fatigue condition and countermeasures of flying personnel in long-haul flight for the comparison among age and post groups.Results:Out of 156 questionnaires, 150 were valid, with a response rate of 96.2%. For the comparisons among age groups, the significant differences were observed in 3 fatigue symptoms such as drowsiness/sleepiness, discomfort on neck, waist, and shoulders, and degraded reaction ( χ2=12.62, 11.77, 12.23, P=0.002, 0.003, 0.002), 2 fatigue countermeasures such as talking with teammates and engaging in physical activity ( χ2=6.37, 16.70, P=0.041,<0.001), and 4 measures of maintaining flight ability such as sleep management, comprehensive physical training, functional food intake and simulation training ( χ2=8.81, 11.48, 9.59, 7.32, P=0.012, 0.003, 0.008, 0.026). For the comparisons among post groups, the significant differences were observed in 3 fatigue symptoms as visual fatigue, drowsiness/sleepiness, and discomfort on neck, waist, and shoulders ( χ2=10.39, 17.89, 8.42, P=0.016, 0.001, 0.038), as well as in fatigue countermeasures chosen like taking in water or food ( χ2=19.06, P<0.001) and in improving flight ability chosen like relieving eye fatigue ( χ2=12.09, P=0.007). Conclusions:The age and post factors influence the fatigue conditions and countermeasures chosen in the flying personnel during long-haul flight. The targeted and comprehensive interventions are suggested.

BACKGROUND: Immune-related adverse events (irAEs) are commonly occurred in patients treated with immune checkpoint inhibitors. However, evidence of irAEs derived from the Chinese population is relatively lacking. The aim of this study was to investigate the incidence and outcomes of irAEs in Chinese patients with lung cancer after receiving immune checkpoint inhibitors (ICIs). METHODS: Clinical and follow-up data from lung cancer patients who received at least one time of ICIs from January 2018 to September 2021 at Huadong Hospital, Fudan University were included. Statistical descriptions and Kaplan-Meier method were used to analyze the overall incidence of irAEs, as well as the incidence and outcomes of each type of irAEs. RESULTS: 135 patients were included in the study. 106 patients (78.5%) presented at least one type of irAEs, and the median time to first irAEs onset was 28 d. Most irAEs occurred at early time after treatment, and most irAEs were mild-moderate and reversible. 57 patients (42.2%) died at the study cutoff. The mortality rate of severe irAEs was 12.6% (n=17), and among them 7 patients (41.2%) died of pneumonitis. The median progression-free survival (PFS) and overall survival (OS) time of the total population was 505 d (95%CI: 352-658) and 625 d (95%CI: 491-759), respectively. Patients who presented any irAEs achieved a longer PFS than those who did not (median PFS: 533 d vs 179 d, P=0.037, HR=0.57), while patients who presented skin toxicities achieved a longer OS than patients who did not (median OS: 797 d vs 469 d, P=0.006, HR=0.70). CONCLUSIONS In real-world settings, irAEs in lung cancer patients were commonly observed, with pneumonitis as the most common fatal irAEs. In addition, patients who presented any irAEs may tend to achieve a longer PFS.
Humans ; Lung Neoplasms ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Immune Checkpoint Inhibitors/therapeutic use* ; Incidence ; Antineoplastic Agents, Immunological/therapeutic use* ; Drug-Related Side Effects and Adverse Reactions/drug therapy* ; Retrospective Studies