Objective:Periprosthetic joint infection (PJI) is one of the most severe complications following hip and knee arthroplasty and is a leading cause of revision surgery. Pathogens and their antibiotic susceptibility are key factors in the successful treatment of PJI. This study retrospectively analyzes the pathogen characteristics and antimicrobial susceptibility of PJI patients treated at our center, aiming to establish an empirical antibiotic regimen for PJI in the region, providing a reference for empirical antibiotic therapy in the clinical management of PJI.Methods:This study retrospectively reviewed PJI patients treated at our center from January 2018 to October 2024. In each case, preoperative arthrocentesis fluid, and synovium tissue from at least three sites during surgery were collected for aerobic and anaerobic blood culture. The positive culture rate, distribution of pathogens based on Gram staining, methicillin resistance, mixed infections, and multidrug resistance were analyzed. Effective coverage parameters were constructed based on antimicrobial sensitivity and coverage rates, and appropriate empirical antimicrobial regimens were proposed.Results:A total of 233 PJI patients were included in the analysis. There were 99 males and 134 females with an average age of 67.0±10.1 years (ranging from 32 to 93 years). The study included 130 hip and 103 knee arthroplasty patients. Among the patients, 202 (86.7%) had positive cultures, with a total of 301 pathogen strains isolated: 268 Gram-positive bacteria (89.4%), 25 Gram-negative bacteria (8.3%), and 7 fungal strains (2.3%). The most common Gram-positive bacteria were coagulase-negative staphylococci (196 strains, 65.1%), epidermal staphylococci (77 strains, 25.6%), Staphylococcus aureus (39 strains, 13.0%), and Streptococcus spp. (19 strains, 6.3%). The most common Gram-negative bacteria were Enterobacteriaceae (14 strains, 4.7%). In hip joint infections, the most prevalent pathogens were epidermal Staphylococci (48 strains, 28.1%) and Staphylococcus aureus (27 strains, 15.8%), while in knee joint infections, epidermal Staphylococci (29 strains, 22.3%) were most common. Regarding antibiotic resistance, 48.5% of staphylococcal strains were methicillin-resistant Staphylococcus, and 51.5% were multidrug-resistant strains. Staphylococci were 100% susceptible to vancomycin, teicoplanin, daptomycin, linezolid, and tigecycline, but exhibited high resistance to β-lactams and quinolone antibiotics. Analysis of empirical antibiotic regimens revealed that vancomycin combined with meropenem, linezolid combined with meropenem, vancomycin combined with imipenem, vancomycin combined with piperacillin/tazobactam, and vancomycin combined with ceftriaxone had effective coverage rates of 97.0%, 97.0%, 96.0%, 94.9%, and 90.9%, respectively.Conclusion:The main pathogens in PJI in this region are Gram-positive bacteria, with high rates of methicillin resistance and multidrug resistance. Based on antimicrobial susceptibility data, we recommend vancomycin combined with meropenem as the empirical treatment regimen for culture-negative PJI in this region, with linezolid combined with meropenem as an alternative.

Objective:Periprosthetic joint infection (PJI) is one of the most severe complications following hip and knee arthroplasty and is a leading cause of revision surgery. Pathogens and their antibiotic susceptibility are key factors in the successful treatment of PJI. This study retrospectively analyzes the pathogen characteristics and antimicrobial susceptibility of PJI patients treated at our center, aiming to establish an empirical antibiotic regimen for PJI in the region, providing a reference for empirical antibiotic therapy in the clinical management of PJI.Methods:This study retrospectively reviewed PJI patients treated at our center from January 2018 to October 2024. In each case, preoperative arthrocentesis fluid, and synovium tissue from at least three sites during surgery were collected for aerobic and anaerobic blood culture. The positive culture rate, distribution of pathogens based on Gram staining, methicillin resistance, mixed infections, and multidrug resistance were analyzed. Effective coverage parameters were constructed based on antimicrobial sensitivity and coverage rates, and appropriate empirical antimicrobial regimens were proposed.Results:A total of 233 PJI patients were included in the analysis. There were 99 males and 134 females with an average age of 67.0±10.1 years (ranging from 32 to 93 years). The study included 130 hip and 103 knee arthroplasty patients. Among the patients, 202 (86.7%) had positive cultures, with a total of 301 pathogen strains isolated: 268 Gram-positive bacteria (89.4%), 25 Gram-negative bacteria (8.3%), and 7 fungal strains (2.3%). The most common Gram-positive bacteria were coagulase-negative staphylococci (196 strains, 65.1%), epidermal staphylococci (77 strains, 25.6%), Staphylococcus aureus (39 strains, 13.0%), and Streptococcus spp. (19 strains, 6.3%). The most common Gram-negative bacteria were Enterobacteriaceae (14 strains, 4.7%). In hip joint infections, the most prevalent pathogens were epidermal Staphylococci (48 strains, 28.1%) and Staphylococcus aureus (27 strains, 15.8%), while in knee joint infections, epidermal Staphylococci (29 strains, 22.3%) were most common. Regarding antibiotic resistance, 48.5% of staphylococcal strains were methicillin-resistant Staphylococcus, and 51.5% were multidrug-resistant strains. Staphylococci were 100% susceptible to vancomycin, teicoplanin, daptomycin, linezolid, and tigecycline, but exhibited high resistance to β-lactams and quinolone antibiotics. Analysis of empirical antibiotic regimens revealed that vancomycin combined with meropenem, linezolid combined with meropenem, vancomycin combined with imipenem, vancomycin combined with piperacillin/tazobactam, and vancomycin combined with ceftriaxone had effective coverage rates of 97.0%, 97.0%, 96.0%, 94.9%, and 90.9%, respectively.Conclusion:The main pathogens in PJI in this region are Gram-positive bacteria, with high rates of methicillin resistance and multidrug resistance. Based on antimicrobial susceptibility data, we recommend vancomycin combined with meropenem as the empirical treatment regimen for culture-negative PJI in this region, with linezolid combined with meropenem as an alternative.

Objective:To investigate the incidence and prothrombotic risk factors of postoperative venous thromboembolism(VTE) in Cushing′s disease and to further develop an assessment model to identify those at high risk of postoperative VTE events.Methods:A retrospective study was performed in 82 patients who were admitted to Huashan Hospital, Fudan University during January 2019 and January 2020 and diagnosed with Cushing′s disease. These patients underwent the evaluation about their clinical, hormonal, and coagulation parameters, as well as ultrasonography and pulmonary angio-CT when necessary. The least absolute shrinkage and selection operator(LASSO) regression analysis was used to screen independent risk factors, and a nomogram model for postsurgical VTE risk assessment in Cushing′s disease was initially established, and Bootstrap method was used for internal verification. Finally, the predictive model was evaluated for calibration and clinical applicability in the study cohort.Results:Nineteen patients(23.17%) developed VTE events, with 14 cases occurring after endoscopic transsphenoidal surgery. Compared to patients without VTE, those in the VTE group were older( P<0.001), had longer postoperative bed rest, higher rates of current infection, higher HbA 1C levels, and more severe glucose tolerance impairment(all P<0.05). Through LASSO regression analysis, two independent risk factors for postoperative VTE were identified: Age and current infection. Then a VTE risk assessment nomogram model was established to predict the patients at high risk of VTE. In the nomogram model for VTE risk assessment, the area under the receiver operating characteristic curve was 0.868(95% CI 0.787-0.949), with the calibration curve closely aligning with the ideal diagonal line and the clinical decision curve exceeding the two extreme curves. Conclusions:Advanced perioperative assessment needs to be taken to screen those with high VTE risks in patients diagnosed with Cushing′s disease. Additionally, during the perioperative period, patients with Cushing′s disease should undergo mandatory physical activity or prophylactic anticoagulant therapy.

Objective To evaluate the concurrent validity and predictive validity of the patient-reported outcome measure for chronic heart failure(CHF-PROM).Methods A prospective cohort of 1128 patients with chronic heart failure who met the inclusion and exclusion criteria was followed.To analyze the correlation between the concurrent validity criterion and the CHF-PROM each field score and total score using Pearson and Spearman.As a predictive validity criterion,readmission and death from heart failure were used.Analyze the effects of CHF-PROM each field score and total score on the risk of readmission and death using univariate and multivariate two-level Cox regression models.Results The results of concurrent validity analysis showed that the physiological field score,psychological field score and total score were negatively correlated with the New York Heart Association(NYHA)class.Physiological field scores were inversely correlated with N-terminal pro-B type natriuretic peptide(NT-proBNP)levels.The results of predictive validity analysis showed that the physiological field score was a predictor of readmission and death in patients with heart failure,and the psychological field score was only related to patient readmission.Conclusion CHF-PROM is a valid tool to evaluate in patients with chronic heart failure.The scale has good concurrent validity and predictive power.

Objective To evaluate the concurrent validity and predictive validity of the patient-reported outcome measure for chronic heart failure(CHF-PROM).Methods A prospective cohort of 1128 patients with chronic heart failure who met the inclusion and exclusion criteria was followed.To analyze the correlation between the concurrent validity criterion and the CHF-PROM each field score and total score using Pearson and Spearman.As a predictive validity criterion,readmission and death from heart failure were used.Analyze the effects of CHF-PROM each field score and total score on the risk of readmission and death using univariate and multivariate two-level Cox regression models.Results The results of concurrent validity analysis showed that the physiological field score,psychological field score and total score were negatively correlated with the New York Heart Association(NYHA)class.Physiological field scores were inversely correlated with N-terminal pro-B type natriuretic peptide(NT-proBNP)levels.The results of predictive validity analysis showed that the physiological field score was a predictor of readmission and death in patients with heart failure,and the psychological field score was only related to patient readmission.Conclusion CHF-PROM is a valid tool to evaluate in patients with chronic heart failure.The scale has good concurrent validity and predictive power.

ETS-1 is a transcription factor that is a member of the E26 transformation-specific (ETS) family. Galanin receptor 2 (GalR2), a subtype of receptors of the neuropeptide galanin, has been shown to have an antidepressant-like effect after activation in rodents. Our previous study has shown that overexpression of ETS-1 increases the expression of GalR2 in PC12 phaeochromocytoma cells. However, whether ETS-1 has an antidepressant-like effect is still unclear. In this study, we found that chronic mild stress (CMS) decreased the expression of both ETS-1 and GalR2 in the ventral hippocampus of rats. Meanwhile, we demonstrated that overexpression of ETS-1 increased the expression of GalR2 in primary hippocampal neurons. Importantly, we showed that overexpression of ETS-1 in the ventral hippocampus counteracted the depression-like behaviors of CMS rats. Furthermore, we found that overexpression of ETS-1 increased the level of downstream phosphorylated extracellular signal-regulated protein kinases 1 and 2 (p-ERK1/2) of GalR2 in the ventral hippocampus of CMS rats. Taken together, our findings suggest that ETS-1 has an antidepressant-like effect in rats, which might be mediated by increasing the level of GalR2 and its downstream p-ERK1/2 in the ventral hippocampus.

OBJECTIVE: Regional nodal metastasis in nasopharyngeal carcinoma plays an important role in the definition of radiotherapy area and clinical stage. It is also one of the main factors influencing prognosis. This study was designed to explore the pattern of metastatic lymph nodes for patients with nasopharyngeal carcinoma, which might provide a basis for clinical treatment and research. METHOD: From Jan. 2009 to Jul. 2011, 1 298 histologically diagnosed nasopharyngeal carcinoma patients had routine MRI scan before radiotherapy in The First Affiliated Hospital of Guangxi Medical University. Diagnostic radiologists and radiation oncologists together assessed the nodal distribution according to the guideline CT-based delineation of lymph node levels. Then,Chi-square test was used to analyze the correlations between T stage and nodal metastasis rate and between nodal diameter and nodal extracapsular invasion. RESULT: Of 1298 patients, 1067 (82.2%) had nodal involvement. The distributions were as: 20 in level I b,604 in level II a,883 in level II b,330 in level III, 78 in level IV, 162 in level Va,49 in level Vb,967 in retropharynx. Leap metastasis rate was 0.69%. In these patients, a total of 2464 positive nodes,including 1589 (64.52%) extra capsular spread nodes, were detected. The rate of nodal extracapsular invasion was higher when the axial diameter increased. No significant correlation was found between T stage and nodal involvement. CONCLUSION The level II and retropharyngeal node are the most frequently involved regions. They have similar metastatic rate and are both the first echo node to metastases of nasopharyngeal carcinoma. Level I metastasis is very low. There is a positive correlation between the proportion of extracapsular spread of metastatic lymph nodes and the axial diameter of lymph nodes. The cervical node involvement of nasopharyngeal carcinoma spread orderly down the neck, and the incidence of skip metastasis is rare. There is no significant difference between T stage and nodal involvement.
Adolescent ; Adult ; Aged ; Carcinoma ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; pathology ; Young Adult