Objective To explore the effects of tripterygium glycosides(TGs)on adipocyte differentiation,inflam-mation,and fibrosis of orbital fibroblasts(OFs)in thyroid associated ophthalmopathy(TAO).Methods OFs isolated from 12 TAO patients were cultured and identified.CCK-8 experiment was used to detect the effect of different concentra-tions of TGs(0,12.5,25.0,50.0,100.0 mg·L-1)on the activity of OFs.Then,adipocyte differentiation phenotypes of OFs were induced and divided into a control group,an adipocyte differentiation group(DM),and TG groups(12.5,25.0,and 50.0 mg·L-1 TGs).Inflammation phenotypes of OFs were induced and divided into a control group,an IL-1 β group,and TG groups(12.5,25.0,and 50.0 mg·L-1 TGs).Fibrosis phenotypes of OFs were induced and divided into a control group,a TGF-βi group,and TG groups(12.5,25.0,and 50.0 mg·L-1 TGs).Oil red O staining was used to detect the formation of lipid droplets in OFs of adipocyte differentiation phenotype.ELISA was used to measure IL-6 and TNF-α levels in OFs of inflammation phenotype and HA levels in OFs of fibrosis phenotype.Transwell experiment was used to detect the cell migration rate of OFs of fibrosis phenotype.Real time quantitative polymerase chain reaction(RT-qPCR)and Western blot were used to detect the expression levels of PPAR-γ,c/EBP-α,FABP-4,perilipin-1,and adiponectin mRNAs and pro-teins in OFs of adipocyte differentiation phenotype,the expression levels of IL-6,TNF-α,COX-2,MCP-1 and ICAM-1 mR-NAs and proteins in OFs of inflammation phenotype,and the expression levels of Vimentin,Fibronectin,COL1A1,COL1A2 and ACTA2 mRNAs and proteins in OFs of fibrosis phenotype.Results The cells were identified as OFs.12.5,25.0,and 50.0 mg·L-1 of TGs had no significant effect on OF activity and these three concentrations were used in the subsequent ex-periment.In OFs of adipocyte differentiation phenotype,the number of orange red lipid droplets greatly decreased after TG treatment.The expression levels of PPAR-γ,c/EBP-α,FABP-4,perilipin-1,and adiponectin mRNAs and proteins in cells of TG groups were significantly lower than those of the DM group(all P＜0.05).In OFs of inflammation phenotype,IL-6 and TNF-α levels in supernatant and cells of TG groups were significantly decreased,compared with those of the IL-1βgroup(all P＜0.05).The expression levels of COX-2,MCP-1,and ICAM-1 mRNAs and proteins in cells of TG groups were significantly lower than those of the IL-1 β group(all P＜0.05).In OFs of fibrosis phenotype,the cell migration rates,HA levels in cell culture supernatant,and the expression levels of Vimentin,Fibronectin,COL1A1,COL1A2,and ACTA2 mR-NAs and proteins in cells of TG groups were significant lower than those of the TGF-β1 group(all P＜0.05).Conclusion TGs can inhibit the adipocyte differentiation,IL-1 β-induced inflammatory responses and TGF-β1-induced fibrosis of TAO-OFs.

Objective To explore the effects of tripterygium glycosides(TGs)on adipocyte differentiation,inflam-mation,and fibrosis of orbital fibroblasts(OFs)in thyroid associated ophthalmopathy(TAO).Methods OFs isolated from 12 TAO patients were cultured and identified.CCK-8 experiment was used to detect the effect of different concentra-tions of TGs(0,12.5,25.0,50.0,100.0 mg·L-1)on the activity of OFs.Then,adipocyte differentiation phenotypes of OFs were induced and divided into a control group,an adipocyte differentiation group(DM),and TG groups(12.5,25.0,and 50.0 mg·L-1 TGs).Inflammation phenotypes of OFs were induced and divided into a control group,an IL-1 β group,and TG groups(12.5,25.0,and 50.0 mg·L-1 TGs).Fibrosis phenotypes of OFs were induced and divided into a control group,a TGF-βi group,and TG groups(12.5,25.0,and 50.0 mg·L-1 TGs).Oil red O staining was used to detect the formation of lipid droplets in OFs of adipocyte differentiation phenotype.ELISA was used to measure IL-6 and TNF-α levels in OFs of inflammation phenotype and HA levels in OFs of fibrosis phenotype.Transwell experiment was used to detect the cell migration rate of OFs of fibrosis phenotype.Real time quantitative polymerase chain reaction(RT-qPCR)and Western blot were used to detect the expression levels of PPAR-γ,c/EBP-α,FABP-4,perilipin-1,and adiponectin mRNAs and pro-teins in OFs of adipocyte differentiation phenotype,the expression levels of IL-6,TNF-α,COX-2,MCP-1 and ICAM-1 mR-NAs and proteins in OFs of inflammation phenotype,and the expression levels of Vimentin,Fibronectin,COL1A1,COL1A2 and ACTA2 mRNAs and proteins in OFs of fibrosis phenotype.Results The cells were identified as OFs.12.5,25.0,and 50.0 mg·L-1 of TGs had no significant effect on OF activity and these three concentrations were used in the subsequent ex-periment.In OFs of adipocyte differentiation phenotype,the number of orange red lipid droplets greatly decreased after TG treatment.The expression levels of PPAR-γ,c/EBP-α,FABP-4,perilipin-1,and adiponectin mRNAs and proteins in cells of TG groups were significantly lower than those of the DM group(all P＜0.05).In OFs of inflammation phenotype,IL-6 and TNF-α levels in supernatant and cells of TG groups were significantly decreased,compared with those of the IL-1βgroup(all P＜0.05).The expression levels of COX-2,MCP-1,and ICAM-1 mRNAs and proteins in cells of TG groups were significantly lower than those of the IL-1 β group(all P＜0.05).In OFs of fibrosis phenotype,the cell migration rates,HA levels in cell culture supernatant,and the expression levels of Vimentin,Fibronectin,COL1A1,COL1A2,and ACTA2 mR-NAs and proteins in cells of TG groups were significant lower than those of the TGF-β1 group(all P＜0.05).Conclusion TGs can inhibit the adipocyte differentiation,IL-1 β-induced inflammatory responses and TGF-β1-induced fibrosis of TAO-OFs.

Objective:In critical care medicine, extubation is a pivotal step in the management of mechanically ventilated patients. Accurately determining the optimal timing for extubation is essential for minimizing complications and improving patient survival rates. However, reliable indicators to predict clinical outcomes following extubation remain scarce. This study aims to identify a novel and robust predictor of extubation success in critically ill patients, thereby providing clinicians with more precise decision-making support.Methods:This retrospective study analyzed data from adult patients who underwent mechanical ventilation and were evaluated for extubation across six intensive care units (ICUs) at Xiangya Third Hospital of Central South University between January 2019 and December 2021. Patients with a history of difficult airway, upper airway obstruction, or neuromuscular disorders affecting respiratory function were excluded. The primary outcome was the reintubation rate within 24 hours post-extubation. Categorical variables were analyzed using the chi-square test or Fisher’s exact test, while between-group differences were assessed with the Mann-Whitney U test. Significant predictors identified in univariate analysis were further evaluated via multivariate logistic regression. The diagnostic accuracy of the maximum inspiratory pressure/body mass index (MIP/BMI) ratio was determined using receiver operating characteristic (ROC) curve analysis, with the Youden index employed to establish the optimal cutoff value. Kaplan-Meier analysis and log-rank tests were used to compare extubation success rates between groups. Statistical analyses were performed using SPSS V28.0 and Stata v.16.0. Results:Diabetes comorbidity ( OR: 8.181, 95% CI: 1.659–40.338) and MIP/BMI ( OR: 0.140, 95% CI: 0.042–0.469) were identified as independent predictors of reintubation. The area under the ROC curve (AUROC) for MIP/BMI was 0.753, demonstrating good predictive accuracy. The optimal cutoff value for MIP/BMI was 1.26 cmH 2O/(kg·m 2), with a sensitivity of 55.3% and specificity of 92.3%. Kaplan-Meier analysis revealed a significantly higher reintubation rate in the low MIP/BMI group compared to the high MIP/BMI group ( P = 0.009), further validating its predictive utility. Conclusions:This study establishes MIP/BMI as a novel and clinically valuable predictor of extubation outcomes in critically ill patients. A cutoff value of 1.26 cmH 2O/(kg·m 2) was found to best predict successful extubation.

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(±)-Talapyrones A-F (1-6), six pairs of dimeric polyketide enantiomers featuring unusual 6/6/6 and 6/6/6/5 ring systems, were isolated from the fungus Talaromyces adpressus. Their structures were determined by spectroscopic analysis and HR-ESI-MS data, and their absolute configurations were elucidated using a modified Mosher's method and electronic circular dichroism (ECD) calculations. (±)-Talapyrones A-F (1-6) possess a 6/6/6 tricyclic skeleton, presumably formed through a Michael addition reaction between one molecule of α-pyrone derivative and one molecule of C₈ poly-β-keto chain. In addition, compounds 2/3 and 4/5 are two pairs of C-18 epimers, respectively. Putative biosynthetic pathways of 1-6 were discussed.
Polyketides/isolation & purification* ; Talaromyces/chemistry* ; Stereoisomerism ; Molecular Structure ; Circular Dichroism ; Pyrones/chemistry*

ObjectiveTo observe the effectivenss and safety of Yiqi Huoxue Formula （益气活血方） combined with surgery and sequential therapy of estrogen and progesterone for the treatment of intrauterine adhesion with syndrome of qi deficiency and blood stasis. MethodsSixty-four patients with intrauterine adhesions were recruited in Guang'anmen Hospital， China Academy of Chinese Medical Sciences during 1st June 2021 to 31st December 2022， and they were randomly divided into two groups， with 32 patients in each group， all receiving transcervical resection of adhesions （TCRA）. The control group was treated with sequential therapy of estrogen and progesterone after surgery， taking 1 tablet orally daily， estradiol tablets for the first 14 days， and estradiol dydrogesterone tablets for the last 14 days. In the treatment group， the postoperative treatment was combined with Yiqi Huoxue Formula on the basis of the treatment in the control group， and 1 dose was taken daily. The treatment course of both groups was 3 months. We observed the clinical effectiveness， syndrome scores of traditional Chinese Medicine （TCM）， endometrial thickness， uterine adhesion score， menstrual flow points， and the re-adhesion rate and pregnancy rate 3 months after the end of treatment of the two groups， and conducted evaluation on safety. ResultsThe total clinical effectiveness rates of the treatment group and the control group were 90.63% and 75.00%， respectively， significantly better in the treatment group （P＜0.05）. The endometrial thickness and menstrual flow of patients in both groups increased after treatment， and the scores of uterine adhesion and TCM syndrome scores decreased significantly （P＜0.05 or P＜0.01）. After treatment， the uterine adhesion score and TCM syndrome scores of the treatment group decreased significantly compared with the control group （P＜0.05）. The 6-month postoperative pregnancy rate in the treatment group was 37.50%， higher than the 12.50% in the control group （P＜0.05）. The re-adhesion rate was 3.13% in the treatment group and 9.38% in the control group， and the difference between the two groups was not statistically significant （P＞0.05）. No adverse events occurred in both groups. ConclusionYiqi Huoxue Formula combined with surgery and sequential therapy of estrogen and progesterone for treating intrauterine adhesion patients with syndrome of qi deficiency and blood stasis can promote endometrial recovery， increase menstrual flow， improve patients' clinical symptoms， and improve pregnancy rate， showing certain clinical effectiveness and safety.

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 tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％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)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed 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 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the changing distribution and antibiotic resistance profiles of clinical isolates of Staphylococcus in hospitals across China from 2015 to 2021.Methods Antimicrobial susceptibility testing was conducted for the clinical isolates of Staphylococcus according to the unified protocol of CHINET(China Antimicrobial Surveillance Network)using disk diffusion method and commercial automated systems.The CHINET antimicrobial resistance surveillance data from 2015 to 2021 were interpreted according to the 2021 CLSI breakpoints and analyzed using WHONET 5.6.Results During the period from 2015 to 2021,a total of 204,771 nonduplicate strains of Staphylococcus were isolated,including 136,731(66.8％)strains of Staphylococcus aureus and 68,040(33.2％)strains of coagulase-negative Staphylococcus(CNS).The proportions of S.aureus isolates and CNS isolates did not show significant change.S.aureus strains were mainly isolated from respiratory specimens(38.9±5.1)％,wound,pus and secretions(33.6±4.2)％,and blood(11.9±1.5)％.The CNS strains were predominantly isolated from blood(73.6±4.2)％,cerebrospinal fluid(12.1±2.5)％,and pleural effusion and ascites(8.4±2.1)％.S.aureus strains were mainly isolated from the patients in ICU(17.0±7.3)％,outpatient and emergency(11.6±1.7)％,and department of surgery(11.2±0.9)％,whereas CNS strains were primarily isolated from the patients in ICU(32.2±9.7)％,outpatient and emergency(12.8±4.7)％,and department of internal medicine(11.2±1.9)％.The prevalence of methicillin-resistant strains was 32.9％in S.aureus(MRSA)and 74.1％in CNS(MRCNS).Over the 7-year period,the prevalence of MRSA decreased from 42.1％to 29.2％,and the prevalence of MRCNS decreased from 82.1％to 68.2％.MRSA showed higher resistance rates to all the antimicrobial agents tested except trimethoprim-sulfamethoxazole than methicillin-susceptible S.aureus(MSSA).Over the 7-year period,MRSA strains showed decreasing resistance rates to gentamicin,rifampicin,and levofloxacin,MRCNS showed decreasing resistance rates to gentamicin,erythromycin,rifampicin,and trimethoprim-sulfamethoxazole,but increasing resistance rate to levofloxacin.No vancomycin-resistant strains were detected.The prevalence of linezolid-resistant MRCNS increased from 0.2％to 2.3％over the 7-year period.Conclusions Staphylococcus remains the major pathogen among gram-positive bacteria.MRSA and MRCNS were still the principal antibiotic-resistant gram-positive bacteria.No S.aureus isolates were found resistant to vancomycin or linezolid,but linezolid-resistant strains have been detected in MRCNS isolates,which is an issue of concern.

Purpose: This study aimed to explore the application of Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS US) combined with MV-Flow (Samsung Medison Co., Ltd.) to diagnose ovarian-adnexal masses. Methods: A total of 112 ovarian-adnexal masses (81 benign and 31 malignant) from 105 consecutive patients were analyzed. The O-RADS US and vascular index from MV-Flow (VIMV) were measured and compared with the reference standard. O-RADS US and MV-Flow were tested for consistency. Results: Receiver operating characteristic curves were drawn for O-RADS US, MV-Flow, and their combination. The combined methods had the largest area under the curve (0.955), followed by O-RADS US (0.929) and MV-Flow (0.923). A mass was considered malignant when the O-RADS US classification was 5 and VIMV was ≥7.15. With this definition, MV-Flow had the highest sensitivity (87.10%), with consistent findings for the combined diagnostic methods and O-RADS US (83.87%). The specificity of the combined diagnostic methods (93.83%) was higher than that of MV-Flow (91.36%). O-RADS US had the lowest specificity (90.12%). The combined diagnostic methods had the highest coincidence rate (91.07%), and MV-Flow (90.18%) had a significantly higher coincidence rate than O-RADS US (88.39%). Both O-RADS US and MV-Flow showed good consistency among different physicians (former kappa, 0.974; latter intraclass correlation coefficient [ICC], 0.986). MV-Flow had a high consistency for the same physician (ICC, 1). Conclusion O-RADS US and MV-Flow exhibited good diagnostic efficacy, and their combined diagnostic efficacy was higher than that of each individually. O-RADS US and MV-Flow can improve the diagnosis of benign and malignant ovarian-adnexal masses.