Objective To investigate the relationship between cerebrospinal fluid albumin/serum albumin(C-ALB/S-Alb)and the systemic immune inflammatory index(SII)and postoperative delirium(POD)in elderly patients with general anesthesia combined with epidural anesthesia.Methods Elderly patients who un-derwent elective hip replacement surgery and received general anesthesia combined with epidural anesthesia in this hospital from October 2023 to June 2024 were selected.According to the assessment results of the Chi-nese version of the 3-Minute Delirium Diagnostic Scale(3D-CAM),the patients were divided into the POD group(68 cases)and the non-POD group(76 cases).The general information of the patients was collected,the cerebrospinal fluid and venous blood specimens were detected.The levels of cerebrospinal fluid albumin(C-Alb),serum albumin(S-Alb),α-synuclein(α-syn),β-amyloid protein(Aβ)1-42,Aβ1-40,total Tau protein(t-Tau),phosphorylated Tau protein(p-Tau)were detected by enzyme-linked immunosorbent assay(ELISA).The neutrophil count,platelet count and lymphocyte count of the patients were detected by the fully automatic blood analyzer,and the SII was calculated.Results Compared with the non-POD group,the levels of C-Alb,α-syn,t-Tau,p-tau,SII and C-Alb/S-Alb in the POD group increased,while Aβ1-42 and Aβ1-40 were significantly decreased,and the differences were statistically significant(P＜0.05).C-Alb,t-Tau,SII and C-Alb/S-Alb were all independent risk factors for the occurrence of POD.The results of the receiver operating characteristic(ROC)curve analysis showed that the areas under the curve(AUC)of the ROC curves of SII,t-Tau,C-Alb,C-Alb/S-Alb and C-Alb/S-Alb combined with SII for predicting delirium were 0.824,0.818,0.723,0.862 and 0.926,respectively.The AUC predicted by C-Alb/S-Alb combined with SII was the highest(all P＜0.05).Conclusion High SII and C-Alb/S-Alb are independent risk factors for POD occurrence in eld-erly patients with general anesthesia combined with epidural anesthesia.Both have good predictive efficacy for POD,and the combined use has better predictive efficacy.

Objective:To evaluate the changes of carotid intima thickness（CIT）and stiffness parameters in ankylosing spondylitis（AS）patients by 24 MHz ultra-high frequency ultrasound probe and RF-data based quantitative analysis on vessel stiffness（R-VQS），and to explore its influencing factors.Methods:Sixty patients with AS who underwent consultation at Henan Provincial People's Hospital from November 2023 to May 2024 were prospectively collected as AS group，54 healthy volunteers matched for sex，age，and body mass index were collected as control group. CIT were measured using a 24 MHz ultra-high frequency ultrasound probe，hardness coefficien（HC）and pulse wave velocity（PWV）were measured by R-VQS，the differences of the parameters between the two groups were compared. The changes of carotid artery elasticity and intima thickness and their influencing factors in patients with AS were explored by univariate and multivariate linear regression analysis.Results:①C-reactiveprotein，erythrocyte sedimentation rate（ESR），neutrophil count and neutrophil to lymphocyte ratio（NLR）were elevated in the AS group compared with the control group，and the differences were statistically significant（all P < 0.05）. ②CIT，carotid intima-media thickness（CIMT），HC，PWV and epicardial adipose tissue thickness（EATT）were all increased in the AS group compared with the control group，and the differences were statistically significant（all P < 0.05）. ③Multifactorial linear regression analysis showed that EATT，ESR were the main influencing factors of HC，PWV and CIT（ β=2.192，0.031；1.792，0.002；0.097，0.001；all P＜0.05）. Conclusions:Carotid CIT，CIMT，HC，PWV and EATT are all higher in the AS patients，and ESR and EATT are the main influencing factors of HC，PWV，and CIT，suggesting that more attention should be paid to the detection of ESR and EATT in patients with AS when interventions are performed clinically.

Objective:To compare the clinical characteristics of patients with cryptogenic cirrhosis and hepatitis B cirrhosis in order to provide a basis for the diagnosis of cryptogenic cirrhosis.Methods:A retrospective study was performed. The clinical data of inpatients with cryptogenic cirrhosis from 2010 to 2020 were collected from Peking University First Hospital. The clinical baseline data were analyzed. Patients with hepatitis B cirrhosis hospitalized during the same period were used as the control group, and 1:1 matching was performed according to the age range (±5 years) and the same year of admission. The basic clinical data between the groups were analyzed. The t-test, X2-test or Mann-Whitney U test was used for intergroup comparison.Results:A total of 232 cases with cryptogenic cirrhosis were collected. A total of 207 cases were collected after excluding cases with missing data, including 95 males (45.9%) and 112 females (54.1%), with a median age of 66 (57-76) years. A total of 182 pairs were matched according to the matching criteria for the control study. Compared with the hepatitis B cirrhosis group, the patients with cryptogenic cirrhosis had higher blood triglycerides (0.89 mmol/L vs. 0.80 mmol/L, P=0.002)and total cholesterol (3.73 mmol/L vs. 3.55 mmol/L, P=0.048), alanine transaminase (21.0 U/L vs. 24.5 U/L, P=0.003) and aspartate transaminase (29.5 U/L vs. 33.0 U/L, P=0.008) were lower, the prothrombin time was shorter (12.4 s vs. 13.0 s, P=0.003), and the INR was lower (1.18 vs. 1.21, P=0.015) with statistically significant differences ( P<0.05). The proportion of patients with cryptogenic cirrhosis combined with hepatocellular carcinoma (15.9% vs. 35.7%, P<0.001), hepatic encephalopathy (2.7% vs. 7.7%, P=0.034), and hepatorenal syndrome (1.6% vs. 5.5%, P=0.048),were relatively low, and the differences were statistically significant ( P<0.05). Conclusions:Cryptogenic cirrhosis at our hospital may be associated with metabolic syndrome and cannot be excluded as a cause of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis in some of these patients.

BACKGROUND:In recent years,the application of surgical robots has become a research hotspot in the field of spinal surgery,but there is still a lack of literature visualization analysis of spinal surgical robots in China.OBJECTIVE:To conduct literature visualization analysis on the research hotspots of spinal surgical robots for the treatment of spinal diseases to provide a useful reference for the research and development of spinal surgical robots in China.METHODS:The Web of Science core set database was applied to search for relevant literature on spinal surgical robots for the treatment of spinal diseases,and 900 articles were finally included. Visualization analysis was conducted on number of publications,journals,institutions,countries,keywords,co-cited documents and highly cited documents of the included literature using VOSviewer 1.6.19 software.RESULTS AND CONCLUSION:(1) The literature in the field of spinal surgical robots for the treatment of spinal diseases has been increasing year by year,especially in 2023,when the number of publications reached a peak. United States,China,and Germany are the research hotspots in this field. National Natural Science Foundation of China is the main fund in this field. (2) Beijing Jishuitan Hospital,China and Hospital for Special Surgery in United States have made great publications to the research in this field. (3) World Neurosurgery,Spine,and Operative Neurosurgery are the main publication journals in this field. (4) Keyword analysis showed that the research mainly focused on the accuracy of robot-assisted spinal surgery,minimally invasive surgery,robotic spinal surgery,and navigation technology. (5) The results of the co-citation analysis of the literature exhibit that robot-assisted technology has significant advantages in spinal surgery. Compared with traditional surgery,spinal surgical robots such as ROSA? Spine,ExcelsiusGPS,Mazor X,and TiRobot have the advantages of high-precision navigation,precise pedicle screw placement,and real-time feedback. They reduce X-ray radiation exposure during surgery,diminish the risk of complications for patients,and improve the success rate of surgery,showing their application prospects in the field of spinal surgery. (6) Despite this,the application and accuracy of related technologies still need to accumulate experience for improvement. Robotic surgery technology has shown cost-effectiveness in reducing surgical radiation exposure and enhancing surgical accuracy. However,it is needed to explore its accuracy in pedicle screw placement surgery,the impact of surgical time,and economic benefits. (7) The results of the analysis of highly cited literature from 2021 to 2024 further show that the latest research hotspots in this field are currently focused on the application of virtual reality and augmented reality technologies,the improvement of the accuracy of robot-assisted pedicle screw placement,and the application of navigation robot spinal surgery platforms. For example,innovative technologies such as organic electrochemical neurons provide new integrated solutions for brain-computer interfaces,prosthetics,and intelligent soft robotics. Simultaneously,virtual reality and augmented reality technologies have shown broad application prospects in areas such as spinal deformity correction.

Alzheimer's disease (AD), characterized by β-amyloid (Aβ) aggregation and neuroinflammation, remains a formidable clinical challenge. Herein, we present an innovative nose-to-brain delivery platform utilizing lactoferrin (Lf)-functionalized lipid nanoparticles (LNPs) co-encapsulating α-mangostin (α-M) and β-site APP cleaving enzyme 1 (BACE1) siRNA (siB). This dual-modal therapeutic system synergistically combines the neuroprotective and microglia-reprogramming capabilities of α-M with the transcriptional silencing of BACE1 via siB, thereby simultaneously inhibiting Aβ production and enhancing its clearance. Fabricated via a microfluidic approach, the LNPs exhibited uniform particle size distribution, great encapsulation efficiency, and robust colloidal stability. Upon intranasal administration, Lf-functionalization enabled superior brain-targeting efficacy through receptor-mediated transcytosis. In vitro studies demonstrated that α-M reversed Aβ-induced low-density lipoprotein receptor downregulation, promoting microglial phagocytosis and autophagic degradation of Aβ, while siB effectively suppressed BACE1 expression, abrogating Aβ synthesis. In vivo investigations in APP/PS1 transgenic mice revealed remarkable cognitive recovery, substantial Aβ plaque reduction, and alleviation of neuroinflammation and oxidative stress. This intricately designed LNP system, exploiting a non-invasive and efficient nose-to-brain delivery route, provides a biocompatible, synergistic, and transformative therapeutic strategy for the multifaceted management of AD.

BACKGROUND: The primary limitation to kidney transplantation is organ shortage. Recent progress in gene editing and immunosuppressive regimens has made xenotransplantation with porcine organs a possibility. However, evidence in pig-to-human xenotransplantation remains scarce, and antibody-mediated rejection (AMR) is a major obstacle to clinical applications of xenotransplantation. METHODS: We conducted a kidney xenotransplantation in a brain-dead human recipient using a porcine kidney with five gene edits (5GE) on March 25, 2024 at Xijing Hospital, China. Clinical-grade immunosuppressive regimens were employed, and the observation period lasted 22 days. We collected and analyzed the xenograft function, ultrasound findings, sequential protocol biopsies, and immune surveillance of the recipient during the observation. RESULTS: The combination of 5GE in the porcine kidney and clinical-grade immunosuppressive regimens prevented hyperacute rejection. The xenograft kidney underwent delayed graft function in the first week, but urine output increased later and the single xenograft kidney maintained electrolyte and pH homeostasis from postoperative day (POD) 12 to 19. We observed AMR at 24 h post-transplantation, due to the presence of pre-existing anti-porcine antibodies and cytotoxicity before transplantation; this AMR persisted throughout the observation period. Plasma exchange and intravenous immunoglobulin treatment mitigated the AMR. We observed activation of latent porcine cytomegalovirus toward the end of the study, which might have contributed to coagulation disorder in the recipient. CONCLUSIONS 5GE and clinical-grade immunosuppressive regimens were sufficient to prevent hyperacute rejection during pig-to-human kidney xenotransplantation. Pre-existing anti-porcine antibodies predisposed the xenograft to AMR. Plasma exchange and intravenous immunoglobulin were safe and effective in the treatment of AMR after kidney xenotransplantation.
Transplantation, Heterologous/methods* ; Kidney Transplantation/methods* ; Heterografts/pathology* ; Immunoglobulins, Intravenous/administration & dosage* ; Graft Survival/immunology* ; Humans ; Animals ; Sus scrofa ; Graft Rejection/prevention & control* ; Kidney/pathology* ; Gene Editing ; Species Specificity ; Immunosuppression Therapy/methods* ; Plasma Exchange ; Brain Death ; Biopsy ; Male ; Aged

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.

Objective: To explore the association between vitamin D levels and sleep in children and adolescents，so as to provide a reference for promoting the sleep health of children and adolescents. Methods: From October to December, 2021, 4 827 primary and middle school students aged 6-17 in Shenzhen were selected by multistage cluster random sampling method, and their demographic information, family background, lifestyle and sleep status were obtained by facetoface questionnaire survey, and their fasting venous blood in the morning was collected to detect the serum 25(OH)D level. The relationship between serum vitamin D level and sleep characteristics was analyzed by binary Logistic regression, and stratified analysis was carried out according to gender. Results: The proportion of vitamin D deficiency was 41.1%, and the proportion of sleep deficiency was 19.4%. With the increase of vitamin D level, daily sleep duration of children and adolescents tended to increase (r=0.10,P<0.01). After adjusting for covariates such as gender and age, it was found that children and adolescents with insufficient vitamin D levels were more likely to experience sleep insufficiency, social jetlag, and late sleep on weekdays, with ORs being 1.32(95%CI=1.12-1.56), 1.35(95%CI=1.19-1.54), and 1.26(95%CI=1.05-1.52)(P<0.05). Sexstratified analysis showed that, among boys, vitamin D deficiency was associated with sleep deficiency, social jetlag, and late bedtime on weekdays and weekends[OR(95%CI)=1.42(1.14-1.77),1.25(1.04-1.49),1.39(1.06-1.82),1.86(1.19-2.92),P<0.05]. In girls, however, serum vitamin D levels were only associated with social jetlag with OR being 1.47 (95%CI=1.21-1.79, P<0.05). Conclusion Vitamin D levels are associated with various sleep characteristics in children and adolescents, with this association being more pronounced among boys.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.