Objective To investigate the attributable risk(AR)of Acinetobacter baumannii(AB)infection in criti-cally ill patients.Methods A multicenter retrospective cohort study was conducted among adult patients in inten-sive care unit(ICU).Patients with AB isolated from sterile body fluid and confirmed with AB infection in each cen-ter were selected as the infected group.According to the matching criteria that patients should be from the same pe-riod,in the same ICU,as well as with similar APACHE Ⅱ score(±5 points)and primary diagnosis,patients who did not infect with AB were selected as the non-infected group in a 1:2 ratio.The AR was calculated.Results The in-hospital mortality of patients with AB infection in sterile body fluid was 33.3％,and that of non-infected group was 23.1％,with no statistically significant difference between the two groups(P=0.069).The AR was 10.2％(95％CI:-2.3％-22.8％).There is no statistically significant difference in mortality between non-infected pa-tients and infected patients from whose blood,cerebrospinal fluid and other specimen sources AB were isolated(P＞0.05).After infected with AB,critically ill patients with the major diagnosis of pulmonary infection had the high-est AR.There was no statistically significant difference in mortality between patients in the infected and non-infec-ted groups(P＞0.05),or between other diagnostic classifications.Conclusion The prognosis of AB infection in critically ill patients is highly overestimated,but active healthcare-associated infection control for AB in the ICU should still be carried out.

Chronic atrophic gastritis(CAG)is a common intractable gastric disease in clinic,which belongs to the gastric precancerous lesions.Professor LIU Feng-Bin and his team have performed the exploration and practice in the field of CAG for more than 30 years,and they proposed that the evolution of the traditional Chinse medicine(TCM)pathogenesis of inflammation-to-tumor transition(ITT)in CAG was characterized by spleen deficiency being the root cause,qi stagnation,blood stasis and dampness retention being the branch cause,and stasis and toxin being the aggravating factors.Deificiency of the spleen and stomach is the initial factor of CAG,which influences the whole process of the disease.Qi stagnation,blood stasis and dampness retention are the triggering and aggravating factors for the ITT in CAG.The formation of blood stasis and toxin is the key to the progression and transition of CAG.Treatment of ITT in CAG should be based on the results of syndrome differentiation and gastroscopic findings by staging therapy.Before treatment,disease dianosis and syndrome differentiation should be made,and macro and micro syndrome differentiation should be carried out for assistance.Therapy of strengthening the spleen and supporting healthy qi should be implemented throughout the whole process of the disease.The early stage of CAG has the features of gastric mucosa with mild to moderate atrophy and with or without mild intestinal epithelial hyperplasia,the pathogenesis of early CAG is characterized by weakness of the spleen and stomach and is accompanied with the pathological factors of qi stagnation,damp-retention and blood stasis,and the basic treatment should adopt the therapies of strengthening the spleen and clearing heat,regulating qi and activating blood stasis.The advanced stage of CAG has the features of severe atrophic gastric mucosa with or without moderate to severe intestinal epithelial and/or mild to moderate intraepithelial neoplasia,the pathogenesis is characterized by weakness of the spleen and stomach,phlegm blended with blood stasis,and stasis-toxin in the gastric collaterals,and the basic treatment should adopt the therapies of supporting healthy qi and dissipating masses,and unblocking the collaterals and removing toxin,so as to construct an intact line to blocking the ITT in CAG with traditional Chinese medicine.

Objective:To explore the impact of baseline remnant cholesterol levels at a single time point and cumulative remnant cholesterol exposure on the progression trajectories of arterial stiffness.Methods:This prospective cohort study included 2 401 eligible participants from the Beijing Health Management Cohort who consecutively attended health examinations in 2010-2011, 2012-2013, and 2014-2015. The remnant cholesterol value measured in 2014-2015 served as the baseline remnant cholesterol level at a single time point. The cumulative exposure indices were calculated based on remnant cholesterol values from three health examinations from 2010 to 2015, including cumulative exposure, cumulative exposure burden, and duration of high remnant cholesterol exposure. Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV). The follow-up continued until December 31, 2019, with annual check-ups. During the follow-up period, a group-based trajectory model was employed to construct the progression trajectories of baPWV. The associations between the baseline remnant cholesterol level, cumulative exposure indices of remnant cholesterol and baPWV trajectories were examined using ordinal logistic regression models, adjusting for traditional cardiovascular risk factors and low-density lipoprotein cholesterol (LDL-C) levels.Results:The age of the 2 401 participants was 61 (54, 69) years, with 1 801 (75.01%) being male. The group-based trajectory model indicated that the best-fit model categorized the participants into three subgroups: low-rising group (1 036 individuals, 43.15%), moderate-rising group (1 137 individuals, 47.36%), and high-rising group (228 individuals, 9.50%). After adjusting for traditional cardiovascular risk factors, baseline remnant cholesterol levels at a single point ( OR=1.170, 95% CI: 1.074-1.274), cumulative remnant cholesterol exposure ( OR=1.194, 95% CI: 1.096-1.303), cumulative remnant cholesterol exposure burden ( OR=1.270, 95% CI: 1.071-1.507), and high-remnant cholesterol exposure duration (6 years: OR=1.351, 95% CI: 1.077-1.695) were significantly associated with the risk of developing a poor baPWV progression trajectory. These results remained significant after adjusting for cumulative average LDL-C levels. The association between baseline remnant cholesterol levels and baPWV progression became insignificant after adjusting for cumulative remnant cholesterol levels ( OR=1.053, 95% CI: 0.923-1.197), while the association between cumulative remnant cholesterol exposure and baPWV progression remained significant after adjusting for baseline remnant cholesterol levels ( OR=1.145, 95% CI: 1.008-1.305). Conclusions:Higher levels of baseline remnant cholesterol and cumulative remnant cholesterol are independent risk factors for the progression of arterial stiffness. These associations remain significant even after adjusting for traditional cardiovascular risk factors and LDL-C levels. Furthermore, the effect of cumulative remnant cholesterol levels on the progression of arterial stiffness was stronger than the effect of baseline remnant cholesterol levels.

Objective To explore the effect of shikonin on the recovery of nerve function after acute spinal cord injury(SCI)in rats.Methods 96 male Sprague-Dawley(SD)rats were divided into 4 groups randomly:sham operation group(Group A),sham operation+shikonin group(Group B),SCI+DMSO(Group C),SCI+shikonin group(Group D).The acute SCI model of rats was made by clamp method in groups C and D.After subdural catheterization,no drug was given in group A.rats in groups B and D were injected with 100 mg·kg-1 of shikonin through catheter 30 min after modeling,and rats in group C were given with the same amount of DMSO,once a day until the time point of collection tissue.Basso-Beattie-Bresnahan(BBB)scores were performed on 8 rats in each group at 6,12,and 3 d after moneling,and oblique plate tests were performed on 1,3,7 and 14 d after modeling,and then spinal cord tissues were collected.Eight rats were intraperitoneally injected with propidine iodide(PI)1 h before sacrificed to detection PI positive cells at 24 h in each group.Eight rats were sacrificed in each group at 24 h after modeling,the spinal cord injury was observed by HE staining.The Nissl staining was used to observe survivor number of nerve cells.Western-blot technique was used to detect the expression levels of Bcl-2 protein and apoptosis related protein RIPK1.Results After modeling,BBB scores were normal in group A and B,but in group C and D were significantly higher than those in group A and B.And the scores in group D were higher than those in group C in each time point(P＜0.05).At 12 h after modeling,the PI red stained cells in group D were significantly reduced compared with that in group C,and the disintegration of neurons was alleviated(P＜0.05).HE and Nissl staining showed nerve cells with normal morphology in group A and B at 24h after operation.The degree of SCI and the number of neuronal survival in group D were better than those in group C,the differ-ence was statistically significant at 24h(P＜0.05).The expression of Bcl-2 and RIPK1 proteins was very low in group A and B;The expression of RIPK1 was significantly increased in Group C and decreased in Group D,with a statistically significant dif-ference(P＜0.05);The expression of Bcl-2 protein in group D was significantly higher than that in group C(P＜0.05).Conclu-sion Shikonin can alleviate the pathological changes after acute SCI in rats,improve the behavioral score,and promote the re-covery of spinal nerve function.The specific mechanism may be related to the inhibition of TNFR/RIPK1 signaling pathway mediated necrotic apoptosis.

Most patients with differentiated thyroid cancer have a good prognosis after radioiodine-131 therapy,but a small number of patients are insensitive to radioiodine-131 therapy and even continue to develop disease.At present,some targeted drugs can improve progression-free survival in patients with radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC),such as sorafenib and levatinib,have been approved for the treatment of RAIR-DTC.However,due to the presence of primary and acquired drug resistance,drug efficacy in these patients is unsatisfactory.This review introduces the acquired drug resistance mechanism of sorafenib in the regulation of mitogen-activated protein kinase(MAPK)and phosphatidylinositol-3-kinase(PI3K)pathways and proposes related treatment strategies,in order to provide a reference for similar drug resistance mechanism of sorafenib and effective treatment of RAIR-DTC.

Objective:To investigate the safety and anti-reflux effect of a highly bionic modi-fied esophagogastric anastomosis in the reconstruction of the digestive tract after proximal gas-trectomy,with the aim of providing a safe and simple new option with good anti-reflux effect for the reconstruction of the digestive tract after proximal gastrectomy.Methods:In this retrospec-tive study,30 patients(Study group)who underwent modified esophagogastric anastomosis after proximal gastrectomy in the Department of Gastrointestinal Surgery of Shandong Provincial Hospi-tal Affiliated to Shandong First Medical University from January 2022 to September 2023 were compared with 27(Control group)patients who underwent double-tract reconstruction which is currently recognized as having good anti-reflux effect during the same period,the main compari-sons were made between the surgery-related indexes,the quality of life after the surgery,the postoperative complications,and the anti-reflux effect of the surgery.Results:The study group was significantly better than the control group in terms of operation time and postoperative hospi-talization time,with statistically significant differences(P＜0.05),and the difference between the two groups was comparable in terms of intraoperative bleeding and the anti-reflux effect of the opera-tion,with no statistically significant differences(P＞0.05);in terms of postoperative complications,the incidence of anastomotic fistula and intestinal obstruction was slightly lower in the study group compared with the control group,but in terms of total incidence,the difference was not statistically significant;in terms of quality of life,the difference was not statistically significant when comparing the quality of life of the two groups after treatment(P＜0.05).Conclusion:Highly bionic modified esophagogastric anastomosis is safe and feasible in the treatment of adenocarcinoma of the esophagogastric junction with excellent anti-reflux effect,but the procedure needs further high-quality randomized controlled studies and in-depth exploration.

In November 2023, the seventh National Nucleic Acid Vaccine Conference was held to deeply discuss the immune mechanism, safety risks, advantages, and disadvantages of nucleic acid vaccines, and review the safety and effectiveness of COVID-19 vaccines developed by nucleic acid vaccine technology. Some prospectives were formed in the meeting that in the post-pandemic era, nucleic acid vaccine technology will play a role in the following areas: dealing with pathogens that are difficult to be prevented by traditional vaccines, promoting the upgrading of traditional live attenuated vaccines, contributing to the development of multivalent and combined vaccines, and rapid response to emerging and re-emerging infectious diseases. These views point out the direction for the future development of nucleic acid vaccine technology.

AIM To study the chemical constituents from the leaves of Ziziphus jujuba Mill.var.spinosa (Bunge) Hu ex H.F.Chou and their in vitro anti-inflammatory activities.METHODS The 70％ ethanol extract from the leaves of Z.jujuba var.spinosa was isolated and purified by various modern chromatographic methods,then the structures of obtained compounds were identified by physicochemical properties and spectral data.Their in vitro anti-inflammatory activities were evaluated by RAW264.7 model.RESULTS Fourteen compounds were isolated and identified as ampelopsisionoside (1),(3S,6S)-cis-linalool-3,7-oxide-β-D-glucopyranoside (2),alangionoside L (3),2-{(2S,5R)-5-[(1E)-4-hydroxy-4-methylhexa-1,5-dien-1-yl]-5-methyltetra-hydrofuran-2-yl} propan-2-yl β-D-glucopyranoside (4),(-)-nectandrin B-β-D-glucopyranoside (5),nikoenoside (6),kiwiionoside (7),dendranthemoside A (8),tormentic acid (9),2α,3β,19α-trihydroxy-urs-12-en-28 oic acid (10),2α-hydroxybetulinic acid (11),2α-hydroxylursolic acid (12),ceanothanolic acid (13),and maslinic acid (14).Compounds 10,11,13 and 14 could inhibit the production of NO in RAW264.7 cells.CONCLUSION Compounds 1,2,4 are first isolated from Rhamnaceae family,and 3,5,6,8 are first isolated from this plant.Compounds 10,11,13 and 14 have significant anti-inflammatory activities.

AIM To study the chemical constituents from the leaves of Ziziphus jujuba Mill.var.spinosa (Bunge) Hu ex H.F.Chou and their in vitro anti-inflammatory activities.METHODS The 70％ ethanol extract from the leaves of Z.jujuba var.spinosa was isolated and purified by various modern chromatographic methods,then the structures of obtained compounds were identified by physicochemical properties and spectral data.Their in vitro anti-inflammatory activities were evaluated by RAW264.7 model.RESULTS Fourteen compounds were isolated and identified as ampelopsisionoside (1),(3S,6S)-cis-linalool-3,7-oxide-β-D-glucopyranoside (2),alangionoside L (3),2-{(2S,5R)-5-[(1E)-4-hydroxy-4-methylhexa-1,5-dien-1-yl]-5-methyltetra-hydrofuran-2-yl} propan-2-yl β-D-glucopyranoside (4),(-)-nectandrin B-β-D-glucopyranoside (5),nikoenoside (6),kiwiionoside (7),dendranthemoside A (8),tormentic acid (9),2α,3β,19α-trihydroxy-urs-12-en-28 oic acid (10),2α-hydroxybetulinic acid (11),2α-hydroxylursolic acid (12),ceanothanolic acid (13),and maslinic acid (14).Compounds 10,11,13 and 14 could inhibit the production of NO in RAW264.7 cells.CONCLUSION Compounds 1,2,4 are first isolated from Rhamnaceae family,and 3,5,6,8 are first isolated from this plant.Compounds 10,11,13 and 14 have significant anti-inflammatory activities.

Objective To investigate the clinical correlation of Naomai Jiejing decoction with cerebrovascular hemodynamics,thromboelastography(TEG)and rehabilitation outcome in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 160 patients with aSAH admitted to Zhongshan Traditional Chinese Medicine Hospital from January 2020 to December 2022 were selected as the study objects,and were divided into study groupand control group according to whether the patients used Naomai Jiejing decoction.The control group was treated with basic therapy combined with nimodipine,the study group was treated with basic therapy combined with nimodipine and Naomai Jiejing decoction(No.1)before surgery,and was treated with basic therapy combined with Nimodipine and naomai Jiejing decoction(No.2)after surgery.Chinese medicine symptom score,cerebrovascular hemodynamics indexes[systolic peak velocity(Vs),mean blood velocity(Vm),end-diastolic peak velocity(Vd),pulsatile index(PI)and resistance index(RI)]and TEG parameters[maximum amplitude(MA),α angle and coagulation index(CI)]were compared between the two groups before and after treatment.Finally,the short-term prognosis of the two groups was evaluated by glasgow prognostic score,and the short-term prognosis of the two groups was compared.Results A total of 160 aS AH patients were included,with 85 in the study group and 75 in the control group.After treatment,the Chinese medicine symptom scores in the study group were significantly lower than those in the control group(P＞0.05).After treatment,the indexes of cerebrovascular hemodynamics in the study group were better than those in the control group(P＜0.05).After treatment,the TEG parameters in the study group were significantly lower than those in the control group(P＜0.05).The overall prognosis of the study group was better than that of the control group,and the proportion of patients with good recovery was significantly higher than that of the control group(P＜0.05).Conclusion Naomai Jiejing decoction has a good treatment effect on aSAH patients,can improve cerebrovascular hemodynamics and TEG parameters,relieve clinical symptoms,and improve the short-term prognosis of patients.