Objective:To summarize the clinical characteristics and management experience of complications in patients with cervical necrotizing fasciitis （CNF） with or without descending necrotizing mediastinitis （DNM）, in order to provide a basis for optimizing diagnosis and treatment strategies. Methods:A retrospective analysis was conducted on the clinical data of 31 patients diagnosed with CNF and DNM at Shandong Provincial Hospital Affiliated to Shandong First Medical University between October 2019 and March 2024. A comprehensive evaluation was performed based on the patients' clinical characteristics, metagenomic next-generation sequencing （mNGS） pathogen detection results, imaging assessments, surgical interventions, management approaches for specific complications, and prognostic outcomes. Results:Among the 31 patients, 10 had severe diabetes mellitus. Etiological analysis was summarized as follows: 5 cases were odontogenic, 3 were of tonsillar origin, 3 were due to endogenous esophageal injury, 2 were due to exogenous cervical trauma, 2 originated from a congenital branchial cleft fistula, and 16 cases had an unknown etiology. Among them, 29 patients underwent surgery via an external cervical approach, 1 patient underwent surgery via an intraoral approach, and 1 patient received ultrasound-guided puncture and drainage therapy. Ultimately, 29 patients were cured and discharged （including 1 patient who experienced two instances of major neck vessel rupture and successfully underwent two interventional embolization procedures for hemostasis）; 2 patients died after failed rescue efforts due to concurrent sepsis and multiple organ dysfunction. The treatment success rate was 93%, and the mortality rate was 7%. In this cohort of CNF and DNM cases, only a minority had a clearly identified odontogenic cause; although the etiology was unknown in most cases, imaging consistently showed oropharyngeal lymph node necrosis, suggesting a possible pharyngeal origin of infection in adults. The mNGS pathogen profile was predominantly Gram-positive bacteria, accompanied by anaerobic bacilli and fungi. Conclusion:CNF and DNM are severe and rapidly progressive conditions that can lead to life-threatening complications within hours. Timely recognition can reduce unnecessary examinations and expedite treatment.
Humans ; Retrospective Studies ; Fasciitis, Necrotizing/therapy* ; Mediastinitis/complications* ; Neck/pathology* ; Male ; Female ; Middle Aged ; Adult ; Aged ; Prognosis

Objective:To explore the clinical effect of precise intraepiphyseal wedge osteotomy for the treatment of congenital hypertrophic epiphysis of the distal phalanx of the thumbs in children.Methods:A retrospective analysis was conducted on the data of children with congenital hypertrophic epiphysis deformity of the distal phalanx of the thumb treated by precisely located intraepiphyseal wedge osteotomy in Dongguan Integrated Traditional Chinese and Western Medicine Hospital from January 2020 to January 2023. Preoperative X-ray films all showed asymmetric thickening of the secondary ossification centers, presenting as triangular, elliptical, unequal trapezoidal, and bipartite epiphyseal fusion shapes respectively. During the operation, precise localization was performed, and wedge osteotomy was conducted at 1.5 mm from the articular surface. The osteotomy angle and volume were adjusted according to the morphology of the hypertrophic epiphysis and the comprehensive condition of the distal and proximal phalanges, with axial over-correction of approximately 10° for fixation. Six months after surgery, the ulnar deviation angle of the distal phalanx with the interphalangeal joint of the thumb, the maximum passive flexion angle, and the thickness of the distal epiphyseal plate on X-ray were followed up. Statistical analysis was conducted using paired t-tests before and after surgery, and P<0.05 was considered statistically significant. Results:A total of 32 children with 34 thumbs were included, aged from 6 months to 8 years old, with an average age of 2.1 years old. There were 27 thumbs accompanied by radial polydactyly, the main and accessory thumbs were clear, and the epiphysis of the distal phalanx of the main thumb was thickened. The lateral deviation angle of the distal phalanx of the thumb before surgery was (35.6±13.2)° (15.0°-67.0°), the maximum passive flexion range was (62.8±7.7)° (38.0°-80.0°), and the maximum thickness of the distal phalanx epiphysis in the X-ray was (3.7±0.9) mm (2.3-5.9 mm). All surgeries of all children were successfully completed, the wounds healed well without redness, swelling or infection. Patients were discharged smoothly. The average follow-up time after surgery was 13 month (rang from 6-22 months), with an average deviation angle of (7.6±5.6)° (1.8°-13.4°) in the distal phalanx with the interphalangeal joint, compared with before surgery, the difference was statistically significant ( t=10.36, P=0.012). Five thumbs had residual ulnar deviation after surgery, with an average deviation of (16.6±2.3)° (12.0°-20.0°), two cases had corrected positive radial deviation (15°, 18°), while the other cases had no significant ulnar deviation in the distal phalanx of the thumb. The average maximum angle of passive flexion of the distal thumb after surgery was (62.9±7.5)° (35.0°-80.0°), compared with before surgery, the difference was not statistically significant ( t=0.16, P=0.359). The average maximum thickness of the distal epiphyses on postoperative X-rays was (1.9±0.5) mm (1.2-3.1 mm), compared with before surgery, the difference was statistically significant ( t=17.04, P=0.012). The epiphyses were flat and round, and the growth lines were normal. Conclusion:Using precise intraepiphyseal wedge osteotomy, combined with postoperative fixation with mild overcorrection for the treatment of congenital hypertrophic epiphysis at distal phalanx of the thumb in children, can achieve satisfactory correction of deviation, significantly shorten and improve the morphology of the epiphysis without affecting the growth plate, and cause minimal impact on joint flexion activity.

OBJECTIVE To investigate a suspected hospital-acquired infection cluster of Enterococcus faecium(Efm)in a neonatal intensive care unit(NICU)of the First Medical Center of Chinese PLA General Hospital,identify the source of infection and transmission routes,and provide a reference for precise prevention and control of hospital-acquired infections.METHODS Epidemiological investigations and environmental microbiological sam-pling were conducted for two neonates with Efm bloodstream infections in the NICU in Jul.2024 to detect Efm in the ward environment.Whole-genome average nucleotide identity(ANI)and multilocus sequence typing(MLST)were used to analyze the homology,drug resistance,and virulence factors of Efm isolates from patients and envi-ronments.Targeted intervention measures were proposed.RESULTS Two cases of Efm bloodstream infection were detected.A total of 37 environmental specimens were collected,and 2 were cultured Efm(the wipe dispenser o-pening and incubator handle of the patients).The drug susceptibility testing results of 2 environmental specimens were consistent with those of the two patient specimens.Genomic analysis confirmed high homology(ANI＞99.99％)among the four Efm isolates.After implementing a series of measures including centralized isolation,strict hand hygiene,thorough environmental cleaning and disinfection,strict disinfection and management of inva-sive devices,enhanced grouping of medical staff for diagnosis and treatment,the incident was effectively con-trolled.CONCLUSIONS This incident can be determined as cluster of hospital-acquired infection with Enterococcus faecium in the neonatal intensive care unit.The wet wipes are the source or transmission medium of contamina-tion.Inadequate disinfection of items and the environment,and insufficient hand hygiene of medical staff are the main reasons for this infection outbreak.Early identification of abnormal cluster of infection,investigation of the source of infection and transmission routes and timely implementation of targeted measures are the keys for preventing infection outbreaks.

Krüppel-like factor 5 (KLF5) has been confirmed as a key transcription factor in the occurrence and development of tumors, which is closely related to the malignant biological behaviors such as the proliferation and migration of tumor cells. This article summarizes the latest progress of KLF5 in tumor research, explores the mechanism and role of KLF5 in promoting tumor progression, aiming to further explore the potential of KLF5 as a therapeutic target and bring new thinking to the research in this field.

Objective:To analyze the iodine nutrition status and its related factors among adults aged 18 years and above in Zhejiang Province in 2022.Methods:A multistage stratified sampling method was used to select 4 320 adults aged 18 years and above from 16 on-site survey sites in Zhejiang Province for the study. A questionnaire was used to investigate the general demographic information and personal dietary characteristics of the study participants. Household edible salt and urine samples were collected to detect salt iodine content and urinary iodine level by using direct titration and cerium arsenate-catalyzed spectrophotometry, respectively, to evaluate the iodine nutritional status according to the standard. The multiple-ordered logistic regression model was used to analyze the factors influencing the urinary iodine concentration.Results:The age of the 4 320 study participants was (51.19±15.33) years, with males accounting for 44.44% (1 920). About 40.16% of adults (1 735) were from coastal areas and 56.37% (2 435) from urban areas. The salt iodine content, M ( Q1, Q3), of the 4 320 household edible salt samples was 21.10 (0.00, 24.16) mg/kg, including 1 662 non-iodized salt samples, 182 unqualified iodized salt samples and 2 476 qualified iodized salt samples. The rate of iodized salt coverage was 61.53%, and the rate of qualified iodized salt consumption was 57.31%. There was a statistically significant difference in the proportion of qualified iodized salt in adult households among different regions ( P<0.001), with the proportion of non-iodized salt gradually decreasing from coastal to inland areas ( χ 2trend=618.458, P<0.001). The urinary iodine concentration M ( Q1, Q3) was 137.60 (86.85, 210.60) μg/L in 4 320 adult urine samples, with the urinary iodine levels of<100, 100-199, 200-299, and≥300 μg/L accounting for 31.64% (1 367), 40.56% (1 752), 17.66% (763), and 10.14% (438), respectively. There was a nonlinear positive correlation between household salt iodine content and urinary iodine level in adults aged 18 years and above by using the χ 2 test for trend ( χ 2regression=231.10, P<0.001 and χ 2skew=28.81, P<0.001). Urinary iodine concentrations were higher in men than in women ( P=0.029) and higher in adults in rural areas than in urban areas ( P<0.001). There were statistically significant differences in the distribution of iodine nutritional status among adults of different ages, regions, and urban and rural areas (all P<0.001). The proportion of those with urinary iodine levels<100 μg/L gradually increased with age ( χ 2trend=37.493, P<0.001), and gradually decreased from coastal areas to inland areas ( χ 2trend=71.381, P<0.001). The results of the multiple-ordered logistic regression model analysis showed that compared with adults aged 18 to 44 years and male adults, those aged 45 to 59 years and female adults had lower urinary iodine levels, with OR (95% CI) of 0.75 (0.68-0.83) and 0.85 (0.76-0.95), respectively. Compared with adults in coastal and urban adults, those in sub-coastal, inland and rural adults had higher levels of urinary iodine, with OR (95% CI) of 1.89 (1.63-2.19), 2.02 (1.72-2.37) and 1.46 (1.28-1.66), respectively. Conclusion:The overall iodine nutrition level of adults aged 18 years and above in Zhejiang Province in 2022 is generally appropriate. However, there is a potential risk of iodine deficiency among adults in coastal areas.

Objective:To investigate the operation opportunity for vascular rings in infants and assess the impact of prenatal and postnatal integrated management strategies on treatment outcomes.Methods:A retrospective analysis was conducted on the clinical data of 75 infants with vascular rings who underwent surgical treatment at the Third Affiliated Hospital of Zhengzhou University from January 2016 to December 2023. Among them, 54 were males and 21 were females, with a median age at surgery of 1.7 (0.7-6.9) months and a median weight of 5.3 (3.5-8.0) kg. Vascular rings malformation was diagnosed by real-time three-dimensional color doppler echocardiography during pregnancy in 51 cases. Preoperatively, 28 cases presented with respiratory or digestive system-related symptoms, and 26 cases had a history of hospitalization due to related symptoms. All patients underwent preoperative cardiac CTA+ CTVE and three-dimensional reconstruction examinations, and 56 cases showed varying degrees of airway compression and stenosis on imaging. Among them, 10 patients presented with preoperative stridor and respiratory distress; fiberoptic bronchoscopy performed after anesthesia induction confirmed significant tracheal compression/stenosis. One patient was ventilator-dependent preoperatively, and bronchoscopy revealed main bronchomalacia. The cohort included: Complete vascular rings (62 cases of double aortic arch, 10 cases of right aortic arch with aberrant left subclavian artery and left-sided ductus arteriosus/ligamentum) and incomplete vascular rings (3 cases of pulmonary artery sling). Additionally, 5 cases had associated Kommerell’s diverticulum, and 12 had intracardiac malformation. All patients successfully completed surgery, and those with intracardiac malformation underwent extracorporeal circulation and primary radical surgery concurrently. Based on prenatal diagnosis and implementation of prenatal and postnatal integrated management, patients were divided into an observation group (prenatal and postnatal integrated management group) and a control group (postnatally diagnosed group). The perioperative data of the two groups were compared to analyze the surgical outcomes and the advantages of prenatal and postnatal integrated treatment.Results:All 75 patients successfully completed surgery. Preoperatively, 56 cases (74.66%) presented with varying degrees of tracheal stenosis. Except for 1 case that died after abandoning treatment and 1 case that underwent tracheal surgery due to repeated failed ventilator weaning, all other patients were successfully discharged from the hospital. The overall mortality rate was 1.33%, and the rate of tracheal surgery was 1.35%. The age and weight at surgery in the observation group were lower than those in the control group ( P<0.05), and the proportion of preoperative hospitalization history was lower in the observation group ( P<0.05). No significant differences were observed between the two groups in terms of tracheal compression and stenosis, postoperative monitoring time, operation time, ventilator time, and risk of postoperative complications ( P>0.05). Conclusion:Tracheal stenosis is a common complication in children with vascular rings. Early surgical intervention is recommended for complete vascular rings and pulmonary artery slings (as an incomplete ring). Timely prenatal diagnosis of vascular ring anomalies combined with the implementation of an integrated prenatal-postnatal management strategy can significantly reduce the risk of preoperative hospitalization due to related symptoms and may lower the risk of subsequent tracheal surgery, potentially improving long-term prognosis.

Objective:To investigate the risk factors influencing mortality in neonates undergoing continuous renal replacement therapy (CRRT).Methods:This retrospective study included 34 neonates with a corrected age of≤28 days who received CRRT at the Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, from January 2019 to December 2023. The neonates were divided into a mortality group ( n=16) and a survival group ( n=18) based on whether they died during CRRT. Pre-CRRT blood biochemical indices, general condition, CRRT treatment modes, parameters, and related complications were analyzed using t-tests, Wilcoxon signed-rank tests, and Chi-square tests. Logistic stepwise regression analysis was used to screen for risk factors associated with CRRT mortality. Results:The mortality rate among the 34 neonates was 48.6% (16/34), with a median CRRT age of 17 days (range: 2-33 days). Eleven neonates (32.3%) were preterm, with the youngest gestational age being 27 weeks and the lowest weight before CRRT initiation being 1 700 g. The mortality group had lower urine output 6-12 hours before CRRT initiation and lower critical illness scores compared to the survival group [0.05 (0.02-1.00) ml/(kg·h) vs. 0.50 (0.20-1.05) ml/(kg·h), (64.50±7.10) scores vs. (77.67±3.65) scores, Z or t values were 10.97 and 3.91, respectively]. However, the vasoactive inotropic score (VIS), proportion of coma, and levels of blood potassium, alanine aminotransferase, aspartate aminotransferase, blood ammonia, blood lactic acid, and activated partial thromboplastin time (APTT) were higher in the mortality group compared to the survival group [ (86.88±15.80) scores vs. (55.56±24.31) scores, 11/16 vs. 1/18, (7.02±1.73) mmol/L vs. (5.88±1.53) mmol/L, 274.55(132.50-664.98) U/L vs. 31.10(19.03-110.70) U/L, 688.20 (449.73-3 618.13) U/L vs. 96.65 (44.15-439.00) U/L, 232.75 (70.33-1 310.85) μmol/L vs.77.70 (49.78-919.05) μmol/L, (11.17±3.36) U/L vs. (7.99±2.67) U/L, and (99.57±39.74) s vs. (60.97±31.25) s, with t, χ2, or Z values of－4.39, 14.81,－2.03,－2.72,－11.81,－3.89,－3.06, and－3.17, respectively] (all P<0.05). Logistic regression analysis revealed that pre-treatment VIS value ( OR=1.150, 95% CI: 1.035-1.278), and blood ammonia level ( OR=1.004, 95% CI: 1.002-1.009) were independent risk factors for mortality (both P<0.05). Conclusions:Neonatal CRRT mortality is associated with pre-treatment VIS scores and blood ammonia levels. Attention should be paid to a rapid decreases in urine output, the intensity of vasopressor support, and elevated levels of blood ammonia, blood lactic acid, transaminases, and APTT at the initiation of treatment.

Objective:To develop and explore the clinical value of a nomogram model for the preoperative diagnosis of proliferative hepatocellular carcinoma (HCC) based on gadoxetate disodium (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI).Methods:The preoperative Gd-EOB-DTPA-enhanced MRI data and clinical pathological data of patients with pathologically confirmed proliferative (178 cases) and non-proliferative type HCC (378 cases) from September 2017 to November 2022 were retrospectively collected. The MRI features and clinicopathological features of proliferative and non-proliferative type HCC were evaluated. Multivariate logistic regression analysis was used to determine the independent predictive factors of proliferative-type HCC. The nomogram prediction model was constructed using R software. The receiver operating characteristic curve (ROC) was used to evaluate its diagnostic efficacy. The calibration curve and decision curve analysis (DCA) were drawn to evaluate the calibration performance and clinical application value of the nomogram model. The optimal threshold for distinguishing high-risk from low-risk was determined using the Youden index. The survival prognosis of proliferative and non-proliferative type HCC was analyzed and compared using the Kaplan-Meier survival curve and the log-rank test. The measurement data were analyzed using the independent sample t-test or the Mann-Whitney U test. The count data were compared using the χ2 test. Results:There were statistically significant differences in alpha-fetoprotein (AFP) levels ( χ2=17.244, P<0.001), tumor morphology ( χ2=13.669, P<0.001), intratumoral fatty degeneration ( χ2=10.495, P=0.001), abnormal enhancement of peritumoral abnormalities during arterial phase ( χ2=37.662, P<0.001), tumor capsule ( χ2=23.961, P<0.001), intratumoral necrosis ( χ2=77.184, P<0.001), intratumoral hemorrhage ( χ2=4.892, P=0.027), peritumoral hypointense in hepatobiliary phase ( χ2=47.675, P<0.001), rim arterial phase hyperenhancement ( χ2=115.976, P<0.001), intratumoral artery ( χ2=15.528, P<0.001) and intravenous tumor thrombus ( χ2=10.532, P=0.001) between proliferative and non-proliferative type HCC groups. Multivariate logistic regression analysis showed that AFP>200 μg/L ( OR=1.561, P=0.044), no intratumoral fatty degeneration ( OR=1.947, P=0.033), intratumoral necrosis ( OR=2.084, P=0.003), peritumoral hypointensity in the hepatobiliary phase ( OR=2.314, P=0.001), and annular hyperenhancement in the arterial phase ( OR=5.557, P<0.001) were independent predictors for preoperative diagnosis of proliferative-type HCC. A nomogram model for preoperative prediction of proliferative type HCC was constructed based on the independent predictors. The area under the ROC curve model for predicting proliferative-type HCC was 0.772 (95% CI: 0.735-0.807), with a sensitivity of 69.1% and a specificity of 75.4%. The calibration curve and DCA curve showed superior calibration performance and clinical applicability of the nomogram model. The Kaplan-Meier curve showed that the recurrence free survival rate after liver resection was significantly lower in patients with proliferative-type HCC than that of non-proliferative-type HCC ( P<0.001), and the high-risk group was significantly lower than the low-risk group ( P<0.001). Conclusions:The construction of a nomogram model based on Gd-EOB-DTPA-enhanced MRI features combined with AFP >200μg/L can accurately diagnose proliferative-type HCC and predict its preoperative prognosis.

Objective:To investigate the effects of Zhuanggu Zhitong Capsules on JNK signaling molecules and their phosphorylated proteins in postmenopausal osteoporosis model female mice.Methods:The rats were divided into sham-operation group, blank group, model group, positive drug group, and Zhuanggu Zhitong Capsules group according to the random number table method, with 10 rats in each group. The model group, the positive drug group and the Zhuanggu Zhitong Capsules group were prepared by bilateral ovarian detomy to prepare a female mouse model of postmenopausal osteoporosis. The positive drug group was given 0.9 mg/kg of alendronate sodium, the Zhuanggu Zhitong Capsules group was given was Zhuanggu Zhitong Capsules 1.944 g/kg for gavage, and the blank group, sham-operation group, and model group were given the same volume of normal saline for gavage, once a day for a total of 13 weeks. Rat vaginal exfoliated cells were stained with Wright's staining; serum Omentin-1 and 25(OH)D 3 levels were determined by ELISA; renal tissue and femoral structure were observed by HE staining; JNK and p-JNK protein expressions were detected by immunohistochemical staining; JNK mRNA levels were detected by PCR. Results:Compared with the model group, the serum levels of 25(OH)D3 and Omentin-1 in the Zhuanggu Zhitong Capsules group and the positive drug group increased ( P<0.01), the mean gray values of JNK and p-JNK protein in bone and kidney tissues decreased ( P<0.01), and the mRNA levels of JNK in bone and kidney tissues decreased ( P<0.01). Conclusion:Zhuanggu Zhitong Capsules can effectively improve the bone microstructure of postmenopausal osteoporotic rats, and its mechanism may be related to the regulation of JNK signaling pathway.

Objective To explore the role of dapansutrile(OLT1177)in radiation-induced intestinal injury and the mechanism.Methods C57BL/6J mice were locally irradiated in the abdomen with 60Co to induce a model of radiation-induced intestinal injury.OLT1177 was intraperitoneally injected at a dose of 100 mg/kg 2 hours before irradiation and 6 hours after irradiation before the drug was administered once a day.At 12 hours after irradiation,intestinal tissues were taken for terminal deoxynucleotidyl transferase mediated nick end labeling(TUNEL)staining to detect apoptosis in intestinal tissues.At 4 days after irradiation,mouse serum was collected to detect the levels of inflammatory factors in the serum.Hematoxylin-eosin(HE)stainingwas used for the evaluation of the damage to the intestinal villus structure.Immunohistochemical staining was adopted to detect the changes in crypt proliferation in intestinal tissues.Finally,proteins were isolated from intestinal tissues,and Western blotting was employed to evaluate the activation of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome.Results After irradiation,the intestinal villi in mice were shortened.Meanwhile,there was a notable declinein the number of cells that were proliferating in the crypts,a surge in the number of apoptotic cells,and a significant spike in the overall inflammatory level.However,administration of OLT1177 inhibited the activation of the NLRP3 inflammasome,reduced apoptosis and pyroptosis,decreased the inflammatory level,and thus improved radiation-induced intestinal injury.Conclusion Administration of OLT1177 can significantly mitigate radiation-induced intestinal injury.