Immune suppression in the tumor microenvironment (TME) is closely related to abnormal glycolysis. Tumor cells gain metabolic advantages and suppress immune responses through the "Warburg effect". Traditional Chinese medicine (TCM) has been shown to regulate key glycolysis enzymes (such as HK2 and PKM2), metabolic signaling pathways (such as PI3K/AKT/mTOR, HIF-1α) and non-coding RNAs at multiple targets, thus synergistically inhibiting lactate accumulation, improving vascular abnormalities, and relieving metabolic inhibition of immune cells. Studies have shown that TCM monomers and formulas can promote immune cell infiltration and functions, improve metabolic microenvironment, and with the assistance by the nano-delivery system, enhance the precision of treatment. However, the dynamic mechanism of the interaction between TCM-regulated glycolysis and TME has not been fully elucidated, for which single-cell sequencing and other technologies provide important technical support to facilitate in-depth analysis and clinical translational research. Future studies should be focused on the synergistic strategy of "metabolic reprogramming-immune activation" to provide new insights into the mechanisms of tumor immunotherapy.
Humans ; Tumor Microenvironment/immunology* ; Glycolysis/drug effects* ; Neoplasms/drug therapy* ; Medicine, Chinese Traditional ; Signal Transduction ; Drugs, Chinese Herbal/pharmacology*

Objective To explore serum periostein,interleukin (IL)-5,IL-8 and IL-13 expression levels in patients with allergic bronchopulmonary aspergillosis (ABPA) and their correlation with lung function. Methods 73 patients with ABPA admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2019 to December 2022 were selected as the case group,and 60 asthma patients during the same period were selected as the control group. ELISA was used to detect serum levels of Periodin,IL-5,IL-8 and IL-13. Pearson analysis was used to investigate the correlation between serum Periodin and lung function indicators. Multivariate Logistic regression analysis was used to investigate the effect of serum period on the occurrence of ABPA in patients with bronchial asthma,and the diagnostic value of serum Periodin for ABPA was evaluated by ROC curves. Results Compared with the control group,the serum levels of Periostin(97.64±28.05 ng/ml vs 57.39±22.78 ng/ml),IL-5(1.62±0.35 ng/L vs 0.59±0.31 ng/L),IL-8(79.22±10.26 ng/L vs 51.04±8.26 ng/L )and IL-13(1.59±0.43 ng/L vs 1.02±0.51 ng/L)in the case group increased(t=6.997～17.776),the total serum IgE,specific IgE positivity rate,eosinophil count and fractional exhaled nitric oxide (FeNO) levels in the case group increased(t=9.341～131.469),the percentage of forced expiratory volume in the first second to the expected value (FEV1％pred),and forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) levels decreased(t=2.652,3.126),the differences were statistically significant(all P<0.05),respectively. Serum Periodin in ABPA patients was positively correlated with IL-5,IL-8,IL-13 and FeNO (r=0.539～0.695,all P<0.05),and negatively correlated with FEV1％ pred,FVC％ pred and FEV1/FVC (r=-0.657,-0.506,-0.582,all P<0.05). Compared with serum Periosin>68.35 ng/ml,bronchial asthma patients with serum Periodin 97.83～131.02 ng/ml and>131.02 ng/ml had a higher risk of ABPA,and the differences were statistically significant (all P<0.05),respectively .The area under the curve of combined diagnosis of ABPA with serum Periodin+IL-5+IL-8+IL-13+total IgE+specific IgE+eosinophils was better than that of single periodin and periodin combined with inflammatory factor diagnosis,the difference was statistically significant(Z=3.562,2.931,all P<0.05).Conclusion Serum Periostin is abnormally elevated in ABPA patients,which is closely related to lung function. Early detection can assist in clinical diagnosis of ABPA.

Objective:To explore the clinical characteristics of biliary system diseases complicated by severe acute pancreatitis(SAP) and the risk factors.Methods:This is a retrospective cohort study. A retrospective analysis was conducted on the clinical data of 159 SAP patients admitted to the Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University from January 2019 to October 2024. There were 105 male cases, 54 female cases;aged (42.3±10.8)years (range:20 to 71 years). Grouping was performed according to the presence or absence of concurrent acute acalculous cholecystitis (AAC) and biliary stricture. There were 58 cases in the AAC group,including 40 males and 18 females;aged (43.8±10.6) years (range:28 to 71 years);101 cases in the non-AAC group,including 64 males and 37 females;aged (41.5±10.8) years (range:20 to 64 years);there were statistically significant differences between the two groups in terms of admission total bilirubin,Balthazar-CTSI score,fasting time,and the proportions of concurrent shock and sepsis (all P<0.05);the time from onset of SAP to diagnosis of AAC( M (IQR)) was 10.5 (13.3) days (range: 3 to 34 days). There were 15 cases in the biliary stricture group,including 13 males and 2 females;age (46.5±10.0) years (range:33 to 63 years);141 cases in the non-biliary stricture group,including 89 males and 52 females;age (41.9±10.8) years (range: 20 to 71 years); there were statistically significant differences between the two groups in the proportions of infected pancreatic necrosis,pancreatic head necrosis,and lower extremity venous thrombosis (all P<0.05);the time from the onset of SAP to the diagnosis of biliary stenosis in patients with biliary stenosis was 2.0 (3.0) months (range: 1 to 19 months). Univariate analysis was performed using independent sample t-test, Mann-Whitney U test, χ 2 test,or Fisher′s exact probability method,and variables with P<0.05 in univariate analysis were included in multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic and predictive value of the multivariate logistic regression model for AAC and biliary stricture. Results:There were statistically significant differences in fasting time,Balthazar-CTSI score,admission total bilirubin,and the proportions of concurrent shock and sepsis between the AAC group and non-AAC group ( P<0.05). Multivariate logistic analysis showed that admission total bilirubin ( OR=1.033,95% CI: 1.010 to 1.058, P=0.004),Balthazar-CTSI score ( OR=1.276,95% CI: 1.036 to 1.572, P=0.022),fasting time ( OR=1.127,95% CI: 1.044 to 1.216, P=0.002), and sepsis ( OR=4.033, 95% CI: 1.419 to 11.462, P=0.009) were independent risk factors for AAC complicated by SAP. The area under the curve (AUC) of the ROC curve was 0.820 (95% CI: 0.752 to 0.888). There were statistically significant differences in the proportions of infected pancreatic necrosis,pancreatic head necrosis,and lower extremity venous thrombosis between the biliary stricture group and non-biliary stricture group ( P<0.05). Multivariate logistic analysis showed that infected pancreatic necrosis ( OR=7.376,95% CI:1.566 to 37.750, P=0.012) and pancreatic head necrosis ( OR=3.898,95% CI:1.180 to 12.877, P=0.026) were independent risk factors for biliary stricture complicated by SAP. The AUC of the ROC curve was 0.806 (95% CI:0.715 to 0.898). Conclusions:AAC typically occurs in the early stage of SAP,and biliary stricture usually occurs in the late stage of SAP. Admission total bilirubin,Balthazar-CTSI score,fasting duration,and concurrent sepsis are independent risk factors for AAC complicating SAP. Infected pancreatic necrosis and pancreatic head necrosis are independent risk factors for biliary stricture complicating SAP.

Objective To explore serum periostein,interleukin (IL)-5,IL-8 and IL-13 expression levels in patients with allergic bronchopulmonary aspergillosis (ABPA) and their correlation with lung function. Methods 73 patients with ABPA admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2019 to December 2022 were selected as the case group,and 60 asthma patients during the same period were selected as the control group. ELISA was used to detect serum levels of Periodin,IL-5,IL-8 and IL-13. Pearson analysis was used to investigate the correlation between serum Periodin and lung function indicators. Multivariate Logistic regression analysis was used to investigate the effect of serum period on the occurrence of ABPA in patients with bronchial asthma,and the diagnostic value of serum Periodin for ABPA was evaluated by ROC curves. Results Compared with the control group,the serum levels of Periostin(97.64±28.05 ng/ml vs 57.39±22.78 ng/ml),IL-5(1.62±0.35 ng/L vs 0.59±0.31 ng/L),IL-8(79.22±10.26 ng/L vs 51.04±8.26 ng/L )and IL-13(1.59±0.43 ng/L vs 1.02±0.51 ng/L)in the case group increased(t=6.997～17.776),the total serum IgE,specific IgE positivity rate,eosinophil count and fractional exhaled nitric oxide (FeNO) levels in the case group increased(t=9.341～131.469),the percentage of forced expiratory volume in the first second to the expected value (FEV1％pred),and forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) levels decreased(t=2.652,3.126),the differences were statistically significant(all P<0.05),respectively. Serum Periodin in ABPA patients was positively correlated with IL-5,IL-8,IL-13 and FeNO (r=0.539～0.695,all P<0.05),and negatively correlated with FEV1％ pred,FVC％ pred and FEV1/FVC (r=-0.657,-0.506,-0.582,all P<0.05). Compared with serum Periosin>68.35 ng/ml,bronchial asthma patients with serum Periodin 97.83～131.02 ng/ml and>131.02 ng/ml had a higher risk of ABPA,and the differences were statistically significant (all P<0.05),respectively .The area under the curve of combined diagnosis of ABPA with serum Periodin+IL-5+IL-8+IL-13+total IgE+specific IgE+eosinophils was better than that of single periodin and periodin combined with inflammatory factor diagnosis,the difference was statistically significant(Z=3.562,2.931,all P<0.05).Conclusion Serum Periostin is abnormally elevated in ABPA patients,which is closely related to lung function. Early detection can assist in clinical diagnosis of ABPA.

Objective:To explore the clinical characteristics of biliary system diseases complicated by severe acute pancreatitis(SAP) and the risk factors.Methods:This is a retrospective cohort study. A retrospective analysis was conducted on the clinical data of 159 SAP patients admitted to the Department of Pancreatic and Biliary Surgery,the First Affiliated Hospital of Harbin Medical University from January 2019 to October 2024. There were 105 male cases, 54 female cases;aged (42.3±10.8)years (range:20 to 71 years). Grouping was performed according to the presence or absence of concurrent acute acalculous cholecystitis (AAC) and biliary stricture. There were 58 cases in the AAC group,including 40 males and 18 females;aged (43.8±10.6) years (range:28 to 71 years);101 cases in the non-AAC group,including 64 males and 37 females;aged (41.5±10.8) years (range:20 to 64 years);there were statistically significant differences between the two groups in terms of admission total bilirubin,Balthazar-CTSI score,fasting time,and the proportions of concurrent shock and sepsis (all P<0.05);the time from onset of SAP to diagnosis of AAC( M (IQR)) was 10.5 (13.3) days (range: 3 to 34 days). There were 15 cases in the biliary stricture group,including 13 males and 2 females;age (46.5±10.0) years (range:33 to 63 years);141 cases in the non-biliary stricture group,including 89 males and 52 females;age (41.9±10.8) years (range: 20 to 71 years); there were statistically significant differences between the two groups in the proportions of infected pancreatic necrosis,pancreatic head necrosis,and lower extremity venous thrombosis (all P<0.05);the time from the onset of SAP to the diagnosis of biliary stenosis in patients with biliary stenosis was 2.0 (3.0) months (range: 1 to 19 months). Univariate analysis was performed using independent sample t-test, Mann-Whitney U test, χ 2 test,or Fisher′s exact probability method,and variables with P<0.05 in univariate analysis were included in multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic and predictive value of the multivariate logistic regression model for AAC and biliary stricture. Results:There were statistically significant differences in fasting time,Balthazar-CTSI score,admission total bilirubin,and the proportions of concurrent shock and sepsis between the AAC group and non-AAC group ( P<0.05). Multivariate logistic analysis showed that admission total bilirubin ( OR=1.033,95% CI: 1.010 to 1.058, P=0.004),Balthazar-CTSI score ( OR=1.276,95% CI: 1.036 to 1.572, P=0.022),fasting time ( OR=1.127,95% CI: 1.044 to 1.216, P=0.002), and sepsis ( OR=4.033, 95% CI: 1.419 to 11.462, P=0.009) were independent risk factors for AAC complicated by SAP. The area under the curve (AUC) of the ROC curve was 0.820 (95% CI: 0.752 to 0.888). There were statistically significant differences in the proportions of infected pancreatic necrosis,pancreatic head necrosis,and lower extremity venous thrombosis between the biliary stricture group and non-biliary stricture group ( P<0.05). Multivariate logistic analysis showed that infected pancreatic necrosis ( OR=7.376,95% CI:1.566 to 37.750, P=0.012) and pancreatic head necrosis ( OR=3.898,95% CI:1.180 to 12.877, P=0.026) were independent risk factors for biliary stricture complicated by SAP. The AUC of the ROC curve was 0.806 (95% CI:0.715 to 0.898). Conclusions:AAC typically occurs in the early stage of SAP,and biliary stricture usually occurs in the late stage of SAP. Admission total bilirubin,Balthazar-CTSI score,fasting duration,and concurrent sepsis are independent risk factors for AAC complicating SAP. Infected pancreatic necrosis and pancreatic head necrosis are independent risk factors for biliary stricture complicating SAP.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective:To explore the characteristics of intestinal flora in children with asthma from the theory of "lung and large intestine being interior-exterior" , and to provide an experimental basis for the study of "lung and intestine axis" .Methods:Based on 16S rDNA high-throughput sequencing technology, stool samples from children with 30 asthma and 28 healthy children were enrolloed and sequenced. All patients are from january 2018 to April 2018, Shanghai Children's Medical Center affiliated to Shanghai Jiaotong University Medical College and Oriental Hospital Affiliated to Tongji University. Statistical methods such as Principal component analysis (PCA), LEfSe analysis, linear discriminant analysis (LDA), and non-metric multidimensional scale analysis (NMDS) were used to analyze intestinal flora characteristics of asthma children.Results:The number of Intestinal flora operating taxon unit (OTU) in asthmatic group (141.96 ± 27.42 vs. 164.54 ± 50.58, P=0.048), Shannon index (2.49 ± 0.51 vs. 2.80 ± 0.56, P=0.044) were significantly lower than those of healthy children group, and Simpson index (0.18 ± 0.06 vs. 0.13 ± 0.07, P=0.010) was significantly higher than that of healthy children. There was no significant difference in intestinal flora abundance between asthmatic children and healthy children ( P>0.05), but there was a decreasing trend. Further differential intestinal flora analysis showed that there were differences in bacterial abundance between children with asthma and healthy children. Conclusion:Children with asthma showed high related with intestinal flora disorders, referring that asthma maybe treated when intestinal flora is treated, which provides a reference for the study of the relationship between lung and intestine from the perspective of intestinal flora.

With the rapid development of computing methods and computing power, the ability of artificial intelligence in problem modelling and analysis has been improved rapidly. Artificial intelligence has been gradually introduced into the field of medical care and nursing, and played an important role in assisting medical care and nursing. This paper mainly discusses the progress of artificial intelligence technology in nursing, and analyzes the existing problems and challenges, in order to provide new ideas for artificial intelligence in supporting the development of nursing more effectively.