Objective To analyze the epidemiological and clinical characteristics of scrub typhus in Liuyang People's Hospital Hunan Province for better diagnosis,treatment,prevention and control of scrub typhus.Methods A retrospective study was conducted on 159 confirmed cases of scrub typhus.The demographic data of patients,clinical manifestations of scrub typhus,laboratory tests,and chest CT findings,complications,treatment,and outcomes were analyzed.Results The 159 patients with scrub typhus included 142 males and 17 females.The average age of patients was(53.8±11.9)(18-82)years old.The peak incidence of scrub typhus was in the period from July to September(87.42％).The common clinical manifestations included fever(97.48％),headache(41.51％),and fatigue(23.90％).The most common signs were eschar(92.45％)on the lower limbs(25.16％),scrotum(15.72％),and buttocks(11.32％).Laboratory test results upon admission showed decreased platelet count(64.15％),elevated creatinine(38.36％),elevated AST(90.57％),ALT(80.50％),and LDH(90.57％).Pulmonary imaging study revealed pulmonary inflammation(22.64％),pleural effusion(13.21％),and pericardial effusion(6.29％).The common complications included liver impairment(69.81％)and decreased platelet count(50.94％),as well as other complications such as renal dysfunction,myocardial injury,sepsis,respiratory failure,and disseminated intravascular coagulation(DIC).Doxycycline-based therapies resulted in cure rate of 98.11％(156/159).Three patients died due to severe complications.Conclusions The peak incidence of scrub typhus was in the period from July to September in Hunan Province.Eschar is a key feature for clinical diagnosis.Scrub typhus can affect multiple organ systems,leading to various systemic complications.The cure rate is high with doxycycline treatment,but some patients may die from severe complications due to delayed medical treatment.

Objective To analyze the epidemiological and clinical characteristics of scrub typhus in Liuyang People's Hospital Hunan Province for better diagnosis,treatment,prevention and control of scrub typhus.Methods A retrospective study was conducted on 159 confirmed cases of scrub typhus.The demographic data of patients,clinical manifestations of scrub typhus,laboratory tests,and chest CT findings,complications,treatment,and outcomes were analyzed.Results The 159 patients with scrub typhus included 142 males and 17 females.The average age of patients was(53.8±11.9)(18-82)years old.The peak incidence of scrub typhus was in the period from July to September(87.42％).The common clinical manifestations included fever(97.48％),headache(41.51％),and fatigue(23.90％).The most common signs were eschar(92.45％)on the lower limbs(25.16％),scrotum(15.72％),and buttocks(11.32％).Laboratory test results upon admission showed decreased platelet count(64.15％),elevated creatinine(38.36％),elevated AST(90.57％),ALT(80.50％),and LDH(90.57％).Pulmonary imaging study revealed pulmonary inflammation(22.64％),pleural effusion(13.21％),and pericardial effusion(6.29％).The common complications included liver impairment(69.81％)and decreased platelet count(50.94％),as well as other complications such as renal dysfunction,myocardial injury,sepsis,respiratory failure,and disseminated intravascular coagulation(DIC).Doxycycline-based therapies resulted in cure rate of 98.11％(156/159).Three patients died due to severe complications.Conclusions The peak incidence of scrub typhus was in the period from July to September in Hunan Province.Eschar is a key feature for clinical diagnosis.Scrub typhus can affect multiple organ systems,leading to various systemic complications.The cure rate is high with doxycycline treatment,but some patients may die from severe complications due to delayed medical treatment.

Delirium is an acute brain dysfunction syndrome characterized by confusion and difficulty concentrating,which mainly affects intensive care unit patients and elderly inpatients.Treatment is expensive and may also lead to increased risks of serious complications and death.The complex etiology and unknown pathological mechanisms of delirium mean that clinical drug treatment is largely ineffective.Animal models therefore provide a powerful tool to help understand the mechanism of delirium,screen new drugs,and study potential intervention measures.We review experimental research related to delirium animal models worldwide,and summarize the latest progress in the construction and evaluation of these models from the aspects of animal selection,model construction method,and model evaluation,to provide a reference for further experimental research based on delirium animal models.

Severe infection is a significant threat to patient safety and survival.As the main treat-ment for hospital acquired infections,meropenem is limited in its effectiveness due to the emergence of drug resistance,especially after long-term use of antibiotics.Therefore,optimizing the efficacy of an-tibiotics such as meropenem and avoiding microbi-al resistance has become an urgent issue to be ad-dressed.Therapeutic drug monitoring(TDM),as an important tool for achieving personalized drug ad-ministration,is increasingly recognized as an impor-tant strategy for optimizing antibiotic concentra-tion,avoiding treatment failure and toxicity in criti-cally ill patients and patients with renal insufficien-cy.By reviewing the current application status,pharmacokinetics,and TDM guidance of meropen-em,clinical references are provided for the treat-ment of critically ill patients and patients with renal insufficiency,and guidance and support are provid-ed for optimizing antibiotic treatment.

Objective:To explore the application effect of biofeedback functional electrical stimulation (BF-FES) combined with vaginal hysterectomy (TVH) in elderly patients with pelvic organ prolapse (POP) .Methods:A prospective study was conducted on 92 elderly POP patients admitted to the hospital from Jul. 2020 to Dec. 2022. They were divided into a study group (45 cases) and a control group (47 cases) using a random number table method. The control group received TVH treatment and underwent routine pelvic floor rehabilitation training after surgery; The research group received BF-FES treatment on the basis of the control group. All patients were treated continuously for 4 weeks and followed up for 6 months. The surface electromyographic values, three-dimensional pelvic floor ultrasound parameters, and urodynamic indicators between the two groups were compared before treatment and at 4 weeks of treatment. The results of the 1-hour urinary pad test before treatment, at 4 weeks of treatment, and at 3 and 6 months of follow-up were compared.Results:The surface electromyographic values of the two groups of patients at each stage of treatment for 4 weeks were higher than those before treatment. The surface electromyographic values of the study group at rest, rapid contraction, tense contraction, endurance contraction, and post rest stages were higher than those of the control group ( P<0.05). After 4 weeks of treatment, the mobility of the bladder neck in both groups was higher than those before treatment, while the posterior angle and rotation angle of the urethra and bladder were lower than those before treatment; The mobility of the bladder neck in the study group was higher than that in the control group, while the posterior angle of the urethra and bladder, as well as the rotation angle of the urethra were lower than those of the control group ( P<0.05). The maximum urine flow rate, maximum bladder volume, and average urine flow rate of the two groups after 4 weeks of treatment were higher than those before treatment, while residual urine volume was lower than that before treatment; The maximum urine flow rate, maximum bladder volume, and average urine flow rate in the study group were were higher than those in the control group. The residual urine volume in the observation group was lower than that in the control group ( P<0.05). After 4 weeks of treatment, 3 months of follow-up, and 6 months of follow-up, the increase in 1-hour urine pad weight of patients in the two groups gradually decreased compared to that before treatment, and the study group was lower than the control group ( P<0.05) . Conclusion:BF-FES combined with TVH can significantly enhance pelvic muscle strength, improve pelvic floor ultrasound parameters and urodynamic indicators in elderly POP patients, and have a significant effect on treating urinary incontinence in patients.

Objective:To explore the application effect of biofeedback functional electrical stimulation (BF-FES) combined with vaginal hysterectomy (TVH) in elderly patients with pelvic organ prolapse (POP) .Methods:A prospective study was conducted on 92 elderly POP patients admitted to the hospital from Jul. 2020 to Dec. 2022. They were divided into a study group (45 cases) and a control group (47 cases) using a random number table method. The control group received TVH treatment and underwent routine pelvic floor rehabilitation training after surgery; The research group received BF-FES treatment on the basis of the control group. All patients were treated continuously for 4 weeks and followed up for 6 months. The surface electromyographic values, three-dimensional pelvic floor ultrasound parameters, and urodynamic indicators between the two groups were compared before treatment and at 4 weeks of treatment. The results of the 1-hour urinary pad test before treatment, at 4 weeks of treatment, and at 3 and 6 months of follow-up were compared.Results:The surface electromyographic values of the two groups of patients at each stage of treatment for 4 weeks were higher than those before treatment. The surface electromyographic values of the study group at rest, rapid contraction, tense contraction, endurance contraction, and post rest stages were higher than those of the control group ( P<0.05). After 4 weeks of treatment, the mobility of the bladder neck in both groups was higher than those before treatment, while the posterior angle and rotation angle of the urethra and bladder were lower than those before treatment; The mobility of the bladder neck in the study group was higher than that in the control group, while the posterior angle of the urethra and bladder, as well as the rotation angle of the urethra were lower than those of the control group ( P<0.05). The maximum urine flow rate, maximum bladder volume, and average urine flow rate of the two groups after 4 weeks of treatment were higher than those before treatment, while residual urine volume was lower than that before treatment; The maximum urine flow rate, maximum bladder volume, and average urine flow rate in the study group were were higher than those in the control group. The residual urine volume in the observation group was lower than that in the control group ( P<0.05). After 4 weeks of treatment, 3 months of follow-up, and 6 months of follow-up, the increase in 1-hour urine pad weight of patients in the two groups gradually decreased compared to that before treatment, and the study group was lower than the control group ( P<0.05) . Conclusion:BF-FES combined with TVH can significantly enhance pelvic muscle strength, improve pelvic floor ultrasound parameters and urodynamic indicators in elderly POP patients, and have a significant effect on treating urinary incontinence in patients.

Severe infection is a significant threat to patient safety and survival.As the main treat-ment for hospital acquired infections,meropenem is limited in its effectiveness due to the emergence of drug resistance,especially after long-term use of antibiotics.Therefore,optimizing the efficacy of an-tibiotics such as meropenem and avoiding microbi-al resistance has become an urgent issue to be ad-dressed.Therapeutic drug monitoring(TDM),as an important tool for achieving personalized drug ad-ministration,is increasingly recognized as an impor-tant strategy for optimizing antibiotic concentra-tion,avoiding treatment failure and toxicity in criti-cally ill patients and patients with renal insufficien-cy.By reviewing the current application status,pharmacokinetics,and TDM guidance of meropen-em,clinical references are provided for the treat-ment of critically ill patients and patients with renal insufficiency,and guidance and support are provid-ed for optimizing antibiotic treatment.

OBJECTIVE To separate and identify the chemical constituents of the n-butanol fraction from the stems of Clerodendrum trichotomum ，and to investigate their antitumor activities in vitro . METHODS The ethanol extracts were obtained with 85% ethanol from dried stems of C. trichotomum. After dispersed with water ，ethanol extracts were distributed by petroleum ether，ethyl acetate and n-butanol in turn ，then concentrated under reduced pressure to obtain the fractions of each extraction part . The n-butanol fraction from the stems of C. trichotomum was isolated and purified by macroporous resin D 101 column chromatography and various chromatographic techniques including silica gel ，hydroxypropyl glucan gel and Toyopearl HW -40F macroporous resin and so on . The structures of them were identified by physical and chemical properties ，MS and NMR . All these compounds were evaluated for cytotoxic activities against 4 kinds of human tumor cells such as cultured K 562，MCF-7，A549 and HepG2，using the MTT assay . RESULTS Fourteen chemical constituents were isolated and identified as teuvincenone B （1）， uncinatone（2），villosin C （3），syringaresinol（4），syringaresinol-4ʹ-O-β-glucopyranoside（5），3，12-O-β-D-diglucopyranosyl-11，16- dihydroxyabieta-8，11，13-triene（6），glypentoside C （7），martynoside（8），isomartynoside（9），2-（4-hydroxyphenyl）ethanol-O-β-D- glucopyranosyl-（1→2）-O- β -D-glucopyranoside（10），3，4-dimethoxyphenyl-1-O- β -D-apiofuranosyl （1→2） - β -D- glucopyranoside（11）， 2，6-dimethoxy-4-hydroxy-1-O- β -D- glucopyranoside（12），adenosine（13）and cistanoside F （14）. In vitro anti-tumor activity studies showed that compounds 1-3 showed certa in inhibitory activities against tumor cellproliferation，among which compound 2 displayed the strongest inhibitory activity against MCF -7，A549 and HepG 2 cells，and their IC 50 values were 25.00，22.34 and 12.50 μmol/L respectively ；only compound 3 showed stronger inhibitory activity against K562 cell with IC 50 of 28.41 μmol/L. CONCLUSIONS Among them ，compounds 10 to 13 are isolated from genus Clerodendrum for the first time ，compounds 4，5，14 were isolated from C. trichotomum for the first time . The abietane diterpenoids （compounds 1-3）have better inhibitory activities against above four tumor cell lines .

Objective:To investigate hospital acquired infection (HAI) in hospitalized patients who were mainly treated with hyperbaric oxygen (HBO) during the period when the whole society and the hospital were in level one public health emergency response to COVID-19.Methods:The HAI incidence and infectious pathogen test results of 138 patients (the observation group) who were given HBO therapy in Nanjing Zijin Hospital in February 2020, the period of level one public health emergency response to COVID-19, were collected, and they were analyzed in year-on-year comparison with the corresponding data of the 133 patients (the control group I) admitted to the hospital in February 2019, and in month-on-month comparison with the corresponding data of the 213 patients (the control group II) admitted to the hospital in December 2019.Results:The HAI incidence of the observation group (10.87%) was about 5% lower than that (15.04%) in the control group I and that (15.02%) in the control group II, but there was no statistical difference ( χ2=1.43, P=0.49). The pathogens detected in the observation group were pseudomonas aeruginosa, acinetobacter baumannii, and serratia marcescens, which were less than those detected in the control group II. Conclusion:Strict social isolation and ward infection control measures can effectively reduce HAI incidence in patients given HBO therapy, but the reliability of such measures needs further demonstration by multi-center and large-sample data.

Objective:To investigate hospital acquired infection (HAI) in hospitalized patients who were mainly treated with hyperbaric oxygen (HBO) during the period when the whole society and the hospital were in level one public health emergency response to COVID-19.Methods:The HAI incidence and infectious pathogen test results of 138 patients (the observation group) who were given HBO therapy in Nanjing Zijin Hospital in February 2020, the period of level one public health emergency response to COVID-19, were collected, and they were analyzed in year-on-year comparison with the corresponding data of the 133 patients (the control group I) admitted to the hospital in February 2019, and in month-on-month comparison with the corresponding data of the 213 patients (the control group II) admitted to the hospital in December 2019.Results:The HAI incidence of the observation group (10.87%) was about 5% lower than that (15.04%) in the control group I and that (15.02%) in the control group II, but there was no statistical difference ( χ2=1.43, P=0.49). The pathogens detected in the observation group were pseudomonas aeruginosa, acinetobacter baumannii, and serratia marcescens, which were less than those detected in the control group II. Conclusion:Strict social isolation and ward infection control measures can effectively reduce HAI incidence in patients given HBO therapy, but the reliability of such measures needs further demonstration by multi-center and large-sample data.