To investigate the risk factors for acute kidney injury (AKI) following the use of amphotericin B deoxycholate and to develop a predictive model to guide clinical monitoring and intervention.

Irritable bowel syndrome （IBS） is a functional bowel disorder characterized primarily by abdominal pain and altered defecation habits. In recent years， traditional Chinese medicine （TCM） has made progress in multiple aspects of IBS research and treatment， including syndrome distribution， development of TCM formulas， clinical efficacy evaluation， external therapies， and psychosocial regulation. However， it still faces challenges such as over-reliance on symptomatic manifestations rather than biomarkers for diagnostic criteria， and the lack of high-quality evidence-based data supporting the efficacy of TCM formulas in treating IBS. This paper proposed that TCM diagnosis and treatment of IBS should adhere to the strategy of integrating the holistic concept with syndrome differentiation and treatment， combining TCM external therapies such as acupuncture， moxibustion and acupoint application）， and emphasizing individualized diagnosis and treatment for psychosomatic abnormalities. Future research should integrate multi-omics technologies， artificial intelligence and other methods to deepen the understanding of the pathogenesis of IBS and the mechanisms of TCM formulas， so as to promote the standardization and internationalization of TCM in the diagnosis and treatment of IBS.

Objective:To measure pancreatic fat deposition by magnetic resonance chemical shift imaging (CSI), and analyze the correlation between pancreatic fat deposition and pancreatic fistula after pancreaticoduodenectomy (PD).Methods:A retrospective analysis was conducted on the data of 55 patients who underwent PD in the Affiliated Hospital of Xuzhou Medical University from September 2021 to April 2024. Among them, 34 were male (61.8%) and 21 were female (38.2%), with the age of (63.5±12.0) years. The 55 patients included 17 cases (30.9%) of pancreatic ductal adenocarcinoma, 1 case (1.8%) of pancreatic serous cystadenoma, 2 cases (3.6%) of pancreatic mucinous cystadenoma, 1 case (1.8%) of pancreatic solid pseudopapillary tumor, 11 cases (20.0%) of ampullary carcinoma, 10 cases (18.2%) of common bile duct carcinoma, and 13 cases of other pathological types (such as high-grade intraepithelial neoplasia of the ampullary gland, duodenal adenocarcinoma, etc.) (23.6%). Before the operation, pancreatic fat deposition was measured by CSI and the fat fraction was calculated. With a fat fraction of 6.2% as the cut-off value, 55 patients were divided into the normal pancreas group (fat fraction ≤ 6.2%, n=29) and the fat pancreas group (fat fraction > 6.2%, n=26). The total hospitalization cost, postoperative hospital stay, biochemical leakage, grade B pancreatic fistula of the two groups were compared, and the correlation between pancreatic fat fraction and pancreatic fistula was analyzed. Result:The total hospitalization cost in the normal pancreas group was (91 527.3±19 118.4) yuan, and the postoperative hospital stay was 9.0 (8.0, 13.0) days, both of which were lower than those in the fatty pancreas group (107 772.4 ± 27 055.6) yuan and 11.0 (8.0, 22.0) days, and the differences were statistically significant ( t=-2.59, P=0.012; Z=-2.08, P=0.038). In the normal pancreas group, 8 cases (27.6%) of biochemical leakage and 1 case (3.4%) of grade B pancreatic fistula occurred after the operation. In the fat pancreas group, 10 cases (38.5%) of biochemical leakage and 8 cases (30.8%) of grade B pancreatic fistula occurred after the operation. There was no statistically significant difference in the incidence of biochemical leakage between the two groups ( χ2=0.74, P=0.391). The incidence of grade B pancreatic fistula after surgery in the adipose pancreas group was significantly higher than that in the normal pancreas group, and the difference was statistically significant ( χ2=5.61, P=0.018). The relationship between pancreatic body fat fraction and the occurrence of pancreatic fistula is correlated (the correlation coefficient was 0.334, 95% CI: 0.127-0.515, P=0.013) The relationship between the overall fat fraction of the pancreas and the occurrence of pancreatic fistula is correlated (the correlation coefficient was 0.472, 95% CI: 0.235-0.689, P<0.001). Conclusions:The incidence of grade B pancreatic fistula after PD in patients with a low fat fraction of the pancreas measured by CSI was lower than that in patients with a high fat fraction. Fat deposition in the pancreatic body and the pancreas as a whole is associated with the incidence of pancreatic fistula.

Objective:To measure pancreatic fat deposition by magnetic resonance chemical shift imaging (CSI), and analyze the correlation between pancreatic fat deposition and pancreatic fistula after pancreaticoduodenectomy (PD).Methods:A retrospective analysis was conducted on the data of 55 patients who underwent PD in the Affiliated Hospital of Xuzhou Medical University from September 2021 to April 2024. Among them, 34 were male (61.8%) and 21 were female (38.2%), with the age of (63.5±12.0) years. The 55 patients included 17 cases (30.9%) of pancreatic ductal adenocarcinoma, 1 case (1.8%) of pancreatic serous cystadenoma, 2 cases (3.6%) of pancreatic mucinous cystadenoma, 1 case (1.8%) of pancreatic solid pseudopapillary tumor, 11 cases (20.0%) of ampullary carcinoma, 10 cases (18.2%) of common bile duct carcinoma, and 13 cases of other pathological types (such as high-grade intraepithelial neoplasia of the ampullary gland, duodenal adenocarcinoma, etc.) (23.6%). Before the operation, pancreatic fat deposition was measured by CSI and the fat fraction was calculated. With a fat fraction of 6.2% as the cut-off value, 55 patients were divided into the normal pancreas group (fat fraction ≤ 6.2%, n=29) and the fat pancreas group (fat fraction > 6.2%, n=26). The total hospitalization cost, postoperative hospital stay, biochemical leakage, grade B pancreatic fistula of the two groups were compared, and the correlation between pancreatic fat fraction and pancreatic fistula was analyzed. Result:The total hospitalization cost in the normal pancreas group was (91 527.3±19 118.4) yuan, and the postoperative hospital stay was 9.0 (8.0, 13.0) days, both of which were lower than those in the fatty pancreas group (107 772.4 ± 27 055.6) yuan and 11.0 (8.0, 22.0) days, and the differences were statistically significant ( t=-2.59, P=0.012; Z=-2.08, P=0.038). In the normal pancreas group, 8 cases (27.6%) of biochemical leakage and 1 case (3.4%) of grade B pancreatic fistula occurred after the operation. In the fat pancreas group, 10 cases (38.5%) of biochemical leakage and 8 cases (30.8%) of grade B pancreatic fistula occurred after the operation. There was no statistically significant difference in the incidence of biochemical leakage between the two groups ( χ2=0.74, P=0.391). The incidence of grade B pancreatic fistula after surgery in the adipose pancreas group was significantly higher than that in the normal pancreas group, and the difference was statistically significant ( χ2=5.61, P=0.018). The relationship between pancreatic body fat fraction and the occurrence of pancreatic fistula is correlated (the correlation coefficient was 0.334, 95% CI: 0.127-0.515, P=0.013) The relationship between the overall fat fraction of the pancreas and the occurrence of pancreatic fistula is correlated (the correlation coefficient was 0.472, 95% CI: 0.235-0.689, P<0.001). Conclusions:The incidence of grade B pancreatic fistula after PD in patients with a low fat fraction of the pancreas measured by CSI was lower than that in patients with a high fat fraction. Fat deposition in the pancreatic body and the pancreas as a whole is associated with the incidence of pancreatic fistula.

Purpose To explore the expression level of let-7b-5p in glioma and its effects and potential mecha-nisms on U251 cell growth.Methods The expression of let-7b-5p in glioma was detected using qRT-PCR.Data from the CGGA database were analyzed to examine the relationship between the let-7b-5p expression levels,WHO grade and overall survival rates of glioma patients.Transient transfection was used to downregulate the expression of let-7b-5p and IGF1R in U251 cells.The role and potential mechanism of let-7b-5p in the U251 cell were evaluated using qRT-PCR,CCK8 assays,clone formation assays,Western blotting,and double luciferase reporter assays.Results The expres-sion of let-7b-5p in glioma cells(A172:3.64±0.64,V251:4.56±0.52,U87-MG:3.31±0.50)and tissues(2.18±0.22)was significantly higher than that in astrocytes(HMC3:1.00±0.21,P＜0.05 or P＜0.01)and nor-mal brain tissues(1.01±0.19,P＜0.05).Let-7b-5p expression was negatively correlated with WHO grades but pos-itively correlated with survival rates in primary and recurrent glioma patients(P＜0.000 1 and P=0.028,respective-ly).Knockdown of let-7b-5p in U251 cells significantly promoted the growth of glioma cells(CCK8:knockdown group 126.00±12.09 vs miR-NC group 90.93±5.13,P＜0.05)and activated PI3K/AKT signal pathway.Suppressing IGF1R expression in U251 cells reversed the effects of let-7b-5p knockdown on glioma cell growth[CCK8:let-7b-5p knockdown+IGF1R knockdown group(92.08±6.14)vs let-7b-5p knockdown+sh-NC group(116.67.08±8.50)]and PI3K/AKT signal pathway activation.Conclusion Let-7b-5p functions as a tumor suppressor gene in glioma.It may regulate glioma cell growth by targeting IGF1R and modulating PI3K/AKT signal pathway.

Objective:To examine the impact of the"outpatient+inpatient"bundled integrated payment reform on the utilization of health services for patients with ordinary tuberculosis,and to evaluate its effectiveness in resource allocation and cost containment.Methods:Based on the Andersen model,clinical and health insurance data from a city in Hebei Province were analyzed.An empirical study was conducted on 5 656 patients using Ordinary Least Squares(OLS)regression and Propensity Score Matching(PSM)to assess outpatient and inpatient service utilization and related costs.Results:Patients in the post-reform group showed a significant increase in outpatient visits and outpatient costs(an average increase of approximately 4.809 visits and 266.368 yuan,respectively,P<0.001),while inpatient visits,inpatient costs,and total medical costs significantly decreased(reductions of approximately 0.302 visits,3 638.647 yuan,and 3 372.279 yuan,respectively,P<0.001).Conclusion:The bundled integrated payment model effectively promotes outpatient service utilization,optimizes inpatient resource allocation,and reduces medical costs.However,the sharp increase in outpatient workload may pose a risk of overutilization.Recommendations:Future initiatives should establish a dynamic monitoring and evaluation system that emphasizes both service quality and clinical outcomes in outpatient and inpatient settings.Furthermore,refining incentive and regulatory mechanisms is essential to ensure that cost control measures do not compromise medical quality and patient safety.

OBJECTIVE To explore the clinical characteristics of the nontuberculous Mycobacteria pulmonary dis-ease(NTMPD)patients with previous pulmonary tuberculosis(PPTB)and analyze the clinical difference from the recurrence of pulmonary tuberculosis.METHODS By means of retrospective survey,the patients who were diag-nosed with NTMPD and recurrent pulmonary tuberculosis in Wuhan Pulmonary Hospital from Mar.2021 to Oct.2023 were recruited as the research subjects,a total of 395 patients with NTMPD were enrolled in the study and were divided into the PPTB-NTMPD group with 92 cases and the NPPTB-NTMPD group with 303 cases according to the history of PPTB.The baseline data,clinical symptoms,imaging findings,underlying diseases,pulmonary diseases,and species of nontuberculous Mycobacteria(NTM)were observed and compared.Totally 92 patients with recurrent pulmonary tuberculosis were randomly screened and assigned as the recurrent pulmonary tuberculo-sis group in a 1:1 ratio by matching the PPTB-NTMPD group with the gender and age.The major clinical charac-teristics were compared between the two groups.The 92 patients with PPTB-NTMPD were divided into the 1-10 years group with 40 cases,the 10-30 years group with 37 cases,and the more than 30 years group with 15 cases according to the interval between the initial diagnosis of pulmonary tuberculosis and the diagnosis of NTMPD.The major clinical characteristics were compared among the groups.RESULTS The age was(64.21±10.71)years old in the PPTB-NTMPD group,(60.26±11.83)years old in the NPPTB-NTMPD group(t=3.020,P=0.003).The proportion of patients with body mass index less than 18.5 kg/m2 was 59.78％in the PPTB-NTMPD group,41.25％in the NPPTB-NTMPD group(x2=6.155,P=0.013);the proportion of patients with cough was 77.17％in the PPTB-NTMPD group,65.68％in the NPPTB-NTMPD group(x2=4.313,P=0.038);the inci-dence of cavitary shadow was 50.00％in the PPTB-NTMPD group,35.31％in the NPPTB-NTMPD group(x2=6.414,P=0.011);the incidence of emphysema and pulmonary bullae was 29.35％in the PPTB-NTMPD group,12.87％in the NPPTB-NTMPD group(x2=13.766,P＜0.001);the incidence of chronic obstructive pulmonary disease(COPD)was 22.83％in the PPTB-NTMPD group,14.19％in the NPPTB-NTMPD group(x2=3.875,P=0.049);the incidence of damaged lung was 9.78％in the PPTB-NTMPD group,2.97％in the NPPTB-NT-MPD group(x2=7.530,P=0.014);there were significant differences.Mycobacterium intracellulare and Myco-bacterium abscessus were the predominant species of NTM in both the PPTB-NTMPD group and the NPPTB-NT-MPD group,there was no significant difference in the distribution of NTM species between the two groups of pa-tients.The incidence of patch shadow of the PPTB-NTMPD group was lower than that of the recurrent pulmonary tuberculosis group(P＜0.05),the incidence of bronchiectatic shadow of the PPTB-NTMPD group was higher than that of the recurrent pulmonary tuberculosis group(P＜0.05).There were significant differences in the age,incidence of pleural thickening and incidence of COPD among the patients with different time intervals between ini-tial diagnosis of pulmonary tuberculosis and the diagnosis of NTMPD in the PPTB-NTMPD group(P＜0.05).CONCLUSIONS The previous pulmonary tuberculosis mainly affect the body mass index less than 18.5 kg/m2 and the post-tuberculosis pulmonary diseases such as cough,pulmonary cavity,emphysema,pulmonary bullae,COPD and damaged lung of the NTMPD patients.The NTMPD patients with previous pulmonary tuberculosis are more likely to have bronchiectasia than the patients with recurrent tuberculosis.It is necessary for the clinicians to attach great importance.

OBJECTIVE To observe the intervention effect of puerarin on the rats with bacterial periodontitis by reg-ulating nucleotide-binding oligomeric domain-like receptor protein 3/Caspase-1(NLRP3/Caspase-1)signaling pathways.METHODS Totally 44 male SPF rats were chosen as subjects and were divided into the blank group,the model group,the puerarin group and the puerarin plus inhibitor group.The models of rats with bacterial periodon-titis were successfully established.The periodontal indexes and alveolar resorption were observed and compared a-mong the groups.RESULTS The sulcus bleeding index(SBI)and plaque index(PLI)scores of the model group and the puerarin plus inhibitor group were higher than those of the blank group;the NLRP3 level was 0.87±0.09 in the model group,0.85±0.08 in the puerarin plus inhibitor group,higher than 0.18±0.03 in the blank group;the Caspase-1 level was 1.15±0.11 in the model group,1.03±0.10 in the puerarin plus inhibitor group,higher than 0.35±0.04 in the blank group.The trabecular separation spacing(Tb.Sp),cemento-enamel junction-facial bone crest(CEJ-FBC),interleukin--1β(IL-1β)level,interleukin-6(IL-6)level,tumor necrosis factor-α(TNF-α)level and osteoclast counts of the model group and the puerarin plus inhibitor group were higher than those of the blank group;while the trabecular thickness(Tb.Th),bone volume/tissue volume(BV/TV)and bone mineral density(BMD)of the model group and the puerarin plus inhibitor group were lower than those of the blank group.The SBI and PLI scores of the puerarin group were lower than those of the model group;the NLRP3 level of the puerarin group was 0.20±0.04,lower than 0.87±0.09 of the model group;the Caspase-1 level of the puerarin group was 0.37±0.05,lower than 1.15±0.11 of the model group.The Tb.Sp,CEJ-FBC,IL-1βlevel,IL-6 lev-el,TNF-α level and osteoclast counts of the puerarin group were lower than those of the model group;while the Tb.Th,V/V and BMD of the puerarin group were higher than those of the model group.The SBI and PLI score of the puerarin plus inhibitor group were higher than those of the puerarin group;the NLRP3 level of the puerarin plus inhibitor group was 0.85±0.08,higher than 0.20±0.04 of the puerarin group;the Caspase-1 level of the pu-erarin plus inhibitor group was 1.03±0.10,higher than 0.37±0.05 of the puerarin group.The Tb.Sp,CEJ-FBC,IL-1β level,IL-6 level,TNF-α level and osteoclast counts of the puerarin plus inhibitor group were higher than those of the puerarin group,while the Tb.Th,V/V and BMD of the puerarin plus inhibitor group were low-er than those of the puerarin group,there were significant differences in the above comparisons(P＜0.05).CONCLUSIONS Puerarin can effectively reduce the periodontal plaque index and bleeding index of the rats with bacterial,reduce the levels of inflammatory factors and alleviate the damage of tissue.The action mechanisms may be associated with the NLRP3/Caspase-1 signaling pathways.

OBJECTIVE To investigate and analyze the current situation and problems of the advanced personnel en-gaging in the hospital-acquired infection control during their training period and explore the existing countermeas-ures and future development.METHODS The literatures regarding to the advanced study in China were retrieved from databases,the subjects of the literatures covered infection control-related advanced study practice,discipline construction,position competence,talent cultivation,scientific research innovation,professional title evaluation,laws,regulations and development plans.From Aug.2024 to Nov.2024,a questionnaire survey and face-to-face interviews were conducted among 36 advanced study personnel from 9 provinces of China who engaged in hos-pital-acquired infection control in the First Medical Center of Chinese PLA General Hospital.Eventually,36 ques-tionnaires were retrieved,all of which were valid with a questionnaire recovery rate of 100.00％.RESULTS Among the 36 advanced study personnel of hospital-acquired infection control,58.33％were medium-grade professional ti-tle;preventive medicine(41.67％),clinical medicine(25.00％)and nursing(16.67％)ranked the top 3 majors.The personnel engaged in the infection control for more than 6 years,and the duration of the advanced study was generally 3 or 6 months.In reality,the personnel faced the choices in terms of the purposes of further education,learning approaches and learning contents.The advanced study personnel also encountered the problems of challenges from promotion,improvement of position competency,integration with clinical training,supervision and practice,as well as physiological,psychological and family pressure.CONCLUSION Aiming at the problems that the advanced study personnel are generally concerned about,such as how to scientifically and effectively carry out hospital-acquired infection control advanced study and preset and solve the problems that may encounter,it is necessary to formulate targeted training programmes so as to provide bases and enlightenment for establishment of a long-term mechanism for advanced study of infection control in China.

Objective To investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.