Liver fibrosis is caused by various factors such as viral infection， alcohol intake， and metabolism-related damage， leading to the replacement of normal tissue by fibrous scars. As a regulatory factor for cell proliferation， insulin-like growth factor 1 （IGF-1） participates in the regulation of cell cycle， the promotion of cell proliferation and differentiation， and the inhibition of cell apoptosis by binding to its receptor insulin-like growth factor-1 receptor （IGF-1R）. Studies have shown that the IGF-1/IGF-1R signaling pathway can regulate the process of liver fibrosis by affecting the senescence and apoptosis of hepatocytes， the activation and proliferation of hepatic stellate cells， and the dysfunction of endothelial cells. In addition， the IGF-1/IGF-1R signaling system can also regulate multiple mechanisms such as DNA damage repair， cell proliferation， lipid metabolism， cell senescence， and oxidative stress， thereby providing new strategies and potential targets for the prevention and treatment of liver fibrosis. This article summarizes the mechanism of action of IGF-1/IGF-1R and its signal transduction system in mediating liver fibrosis by regulating DNA damage repair in different cells， in order to provide a theoretical basis for the treatment of liver fibrosis.

Metabolic associated fatty liver disease （MAFLD） is a highly prevalent chronic liver disease worldwide， and the mechanism underlying its progression to metabolic associated steatohepatitis and liver fibrosis remain unclear. Endoplasmic reticulum stress （ERS） and ferroptosis （Fer） are deeply involved in the pathological evolution of MAFLD. This article systematically reviews the core regulatory mechanisms of ERS and its role in regulating lipid metabolism， inflammation response， and cell apoptosis in MAFLD. It also analyzes the core mechanism of Fer and discusses the predisposing factors for Fer in the pathological microenvironment of MAFLD， as well as the role of Fer in exacerbating hepatocyte death and activating the progression of liver fibrosis. This article proposes that the crosstalk between ERS and Fer is a key driver for the progression of MAFLD， which provides new references and ideas for the clinical intervention of MAFLD.

Objective To analyze the clinical distribution characteristics and changing trend of postoperative pneu-monia(POP),and provide basis for further monitoring and management of POP.Methods Clinical data of POP patients in the First Affiliated Hospital with Nanjing Medical University from 2014-2023 were collected.The inci-dence of POP,the changing trend of proportion of ventilator-associated pneumonia(VAP),the occurrence time,pathogen distribution,and incidence of POP in various departments were analyzed retrospectively.Results From 2014 to 2023,a total of 653 609 patients in the hospital received surgery,with 676 245 times of operations,out of which 2 934 cases had POP,and the incidence of POP was 0.43％.The average age of POP patients was(59.76±16.53)years old,with 68.58％being male.The incidence of POP decreased from 2.00％in 2014 to 0.10％in 2023,and the proportion of VAP increased from 9.92％in 2014 to 99.10％in 2023,with statistically significant differences(all P＜0.001).POP occurred within 7,10,and 30 days after surgery accounted for 65.81％,78.80％,and 95.64％,respectively.The top three departments with the highest incidences were cardiovascular surgery(5.277％),neurosurgery(2.114％),and thoracic surgery(1.130％).The main pathogen of infection was Gram-negative bacteria(77.58％).Conclusion The incidence of POP shows a downward trend.VAP patients should be the focus of follow-up improvement work.Departments of cardiovascular surgery,neurosurgery,and tho-racic surgery are the key departments of POP,and 10 days after surgery should be the critical period of POP.

Objective To investigate the diversity and composition of gut fungi microbiota in patients with polycystic kidney disease(PKD)and its correlation with clinical indicators.Methods A total of 44 PKD patients,44 patients with non-polycystic chronic kidney disease(NPCKD)and 22 healthy controls(HC)admitted to our hospital from February 2023 to February 2024 were recruited.ITS1 DNA sequencing was applied to analyze the gut fungal composition.Bioinformatics analysis was used to compare the diversity and structural differences of fungi among the 3 groups.Pearson correlation analysis was performed to analyze the relationship between gut fungi and clinical indicators.Results There were no significant differences in baseline characteristics(gender,age,body mass index,etc.)among the 3 groups,but statistical differences were seen in terms of serum indicators(such as serum creatinine,blood urea nitrogen,uric acid,estimated glomerular filtration rate,etc.)(P<0.01).Alpha diversity analysis showed no significant difference was seen between the PKD and HC groups,but the PKD group had significant differences to the NPCKD group(P<0.01).Beta diversity analysis revealed significant differences among the 3 groups and in pairwise comparisons(P=0.001).Fungi composition analysis found that the abundance of Candida was significantly higher in the PKD group than the other 2 groups(P<0.01),while the abundances of Aspergillus and Cladosporium were significantly lower in the PKD group than the HC group(P<0.05).Linear discriminant analysis(LEFSe)indicated that Candida was significantly enriched,while Aspergillus and Cladosporium were significantly reduced in the PKD group.Correlation analysis revealed that the abundance of Cladosporium was negatively correlated with cyst diameter and immunoglobulin light chain Kappa/Lambda ratio in the PKD group(P<0.05),while the abundance of Candida was positively correlated with liver/kidney cyst diameter(P<0.01).Conclusion PKD patients exhibit characteristic changes in gut fungi diversity and composition.The abundances of Cladosporium and Candida are closely associated with clinical indicators of PKD patients.

Objective To study the effect and duration of point-of-use filters on the improvement of endoscopic fi-nal rinse water quality.Methods The final rinse water end at the gastroscope manual cleaning workstation in the Endoscopy Centre of the First Affiliated Hospital with Nanjing Medical University was selected to install a tap ter-minal filter;five specimens of final rinse water were collected consecutively before the installation,immediately after the installation,and 1-11 weeks after the installation.At each sampling time,the staff responsible for clea-ning and disinfecting were asked whether the flow rate of discharged water could satisfy the working demand;the final rinse water was inoculated on R2A culture medium with membrane filter method,bacterial colony forming unit(CFU)was calculated after 30℃ incubation for 5 days.Results The qualified rates of endoscopic final rinse water before point-of-use filter installation was 0,immediately after and 1-9 weeks after installation were both 100％,10 and 11 weeks after installation were 80.0％and 20.0％,respectively.The mean CFU of endoscopic final rinse wa-ter before point-of-use filter installation was 102 CFU/100 mL,immediately after and 1-9 weeks after installation were both ≤2 CFU/100 mL,10 and 11 weeks after installation were 8 and 18 CFU/100 mL,respectively.The feedback from the cleaning and disinfection staff before installation,immediately after installation,and 1-11 weeks after installation indicated that the flow rate of discharged water gradually slowed down over time,but could still meet the work requirements.Conclusion The point-of-use filter can quickly and effectively improve the quality of endoscopic final rinse water,with use duration of up to 9 weeks after installation;Its biggest advantage is that it can serve as the final barrier to all integrated measures,playing a supplementary role in case of any problems occu-rring in the front-end process,and ensuring the microbial quality of the final rinse water to the greatest extent possible.

OBJECTIVE To observe the impact of hospital-associated infections(HAIs)on length of hospital stay and medical costs of the patients with 10 single diseases included in the Performance Assessment of Tertiary Public Hospitals in China(referred to as the National Assessment)and evaluate the significance of infection control in the'National Assessment'.METHODS The data were collected from the patients with 10 single diseases covered by the National Assessment who were treated in The First Affiliated Hospital of Nanjing Medical University from Jan.2022 to Dec.2022.The incidence of HAIs and the infection sites of the patients with the single diseases were analyzed.Multivariate analysis was performed for the assessment of impact of the HAIs on the length of hospital stay and medical costs.RESULTS Among the patients with the single diseases,the incidence of HAIs was the highest(12.41％)in the patients undergoing coronary artery bypass grafting(CABG),followed by adult pneumo-nia(4.70％)and heart failure(2.25％).There was gathering of infection sites among the patients with the differ-ent single diseases:lower respiratory tract was the major infection site among the patients undergoing CABG,and the urinary tract was the major infection site among the patients undergoing hip replacement.Ther result of multi-variate analysis showed that the HAIs could extend the length of hospital stay of the patients with all the single diseases except for chronic obstructive pulmonary disease(COPD)and adult pneumonia(P＜0.05);the lengths of hospital stay of the patients undergoing hip replacement(with the increase of 22.05 days),the patients with heart failure(with the increase of 18.39 days)and those with myocardial infarction(with the increase of 17.15 days)in-creased most remarkably.The medical costs of the patients with CABG,COPD,hip replacement,cerebral infarc-tion,myocardial infarction and heart failure were increased due to the HAIs(P＜0.05),and the medical costs of the patients with heart failure increased most remarkably(with the increase of 251,662.92 yuan).CONCLUSIONS The HAIs have remarkable negative effects on the length of hospital stay and medical costs of most of the patients with single diseases.It is necessary to strengthen the prevention and control of HAIs so as to improve the medical quality,guarantee the safety of patients,effectively improve the performance assessment indexes for tertiary pub-lic hospitals and facilitate the high-quality development of medical institutions.

Hepatocellular carcinoma （HCC）， as the sixth most common malignant tumor worldwide， poses a serious threat to human health due to its insidious onset and high mortality rate. This article reviews the molecular mechanisms and intervention strategies of gut microbiota （GM） homeostasis in the development and progression of HCC， in order to provide new ideas for the intervention and treatment of HCC. Studies have shown that GM dysbiosis， intestinal leakage， microbial-associated molecular pattern， bacterial translocation， and metabolic products play key roles in the progression of HCC. GM imbalance may lead to immune escape， thereby promoting tumor cell proliferation and metastasis. This article elaborates on the association between GM and HCC， deeply analyzes the mechanism of action of GM in the development and progression of HCC， investigates the role of bile acid-related metabolites， short-chain fatty acid-related metabolites， and other metabolites in HCC， and explores the strategies for targeting GM in the treatment of HCC， including probiotics， prebiotics， antibiotics， Toll-like receptor 4 antagonists， and fecal microbiota transplantation. This article emphasizes that maintaining the integrity of the intestinal barrier and GM homeostasis is of great significance in the prevention and treatment of HCC， which provides a direction for developing new diagnosis and treatment strategies.

Objective To analyze the clinical distribution characteristics and changing trend of postoperative pneu-monia(POP),and provide basis for further monitoring and management of POP.Methods Clinical data of POP patients in the First Affiliated Hospital with Nanjing Medical University from 2014-2023 were collected.The inci-dence of POP,the changing trend of proportion of ventilator-associated pneumonia(VAP),the occurrence time,pathogen distribution,and incidence of POP in various departments were analyzed retrospectively.Results From 2014 to 2023,a total of 653 609 patients in the hospital received surgery,with 676 245 times of operations,out of which 2 934 cases had POP,and the incidence of POP was 0.43％.The average age of POP patients was(59.76±16.53)years old,with 68.58％being male.The incidence of POP decreased from 2.00％in 2014 to 0.10％in 2023,and the proportion of VAP increased from 9.92％in 2014 to 99.10％in 2023,with statistically significant differences(all P＜0.001).POP occurred within 7,10,and 30 days after surgery accounted for 65.81％,78.80％,and 95.64％,respectively.The top three departments with the highest incidences were cardiovascular surgery(5.277％),neurosurgery(2.114％),and thoracic surgery(1.130％).The main pathogen of infection was Gram-negative bacteria(77.58％).Conclusion The incidence of POP shows a downward trend.VAP patients should be the focus of follow-up improvement work.Departments of cardiovascular surgery,neurosurgery,and tho-racic surgery are the key departments of POP,and 10 days after surgery should be the critical period of POP.

Objective To study the effect and duration of point-of-use filters on the improvement of endoscopic fi-nal rinse water quality.Methods The final rinse water end at the gastroscope manual cleaning workstation in the Endoscopy Centre of the First Affiliated Hospital with Nanjing Medical University was selected to install a tap ter-minal filter;five specimens of final rinse water were collected consecutively before the installation,immediately after the installation,and 1-11 weeks after the installation.At each sampling time,the staff responsible for clea-ning and disinfecting were asked whether the flow rate of discharged water could satisfy the working demand;the final rinse water was inoculated on R2A culture medium with membrane filter method,bacterial colony forming unit(CFU)was calculated after 30℃ incubation for 5 days.Results The qualified rates of endoscopic final rinse water before point-of-use filter installation was 0,immediately after and 1-9 weeks after installation were both 100％,10 and 11 weeks after installation were 80.0％and 20.0％,respectively.The mean CFU of endoscopic final rinse wa-ter before point-of-use filter installation was 102 CFU/100 mL,immediately after and 1-9 weeks after installation were both ≤2 CFU/100 mL,10 and 11 weeks after installation were 8 and 18 CFU/100 mL,respectively.The feedback from the cleaning and disinfection staff before installation,immediately after installation,and 1-11 weeks after installation indicated that the flow rate of discharged water gradually slowed down over time,but could still meet the work requirements.Conclusion The point-of-use filter can quickly and effectively improve the quality of endoscopic final rinse water,with use duration of up to 9 weeks after installation;Its biggest advantage is that it can serve as the final barrier to all integrated measures,playing a supplementary role in case of any problems occu-rring in the front-end process,and ensuring the microbial quality of the final rinse water to the greatest extent possible.

OBJECTIVE To observe the impact of hospital-associated infections(HAIs)on length of hospital stay and medical costs of the patients with 10 single diseases included in the Performance Assessment of Tertiary Public Hospitals in China(referred to as the National Assessment)and evaluate the significance of infection control in the'National Assessment'.METHODS The data were collected from the patients with 10 single diseases covered by the National Assessment who were treated in The First Affiliated Hospital of Nanjing Medical University from Jan.2022 to Dec.2022.The incidence of HAIs and the infection sites of the patients with the single diseases were analyzed.Multivariate analysis was performed for the assessment of impact of the HAIs on the length of hospital stay and medical costs.RESULTS Among the patients with the single diseases,the incidence of HAIs was the highest(12.41％)in the patients undergoing coronary artery bypass grafting(CABG),followed by adult pneumo-nia(4.70％)and heart failure(2.25％).There was gathering of infection sites among the patients with the differ-ent single diseases:lower respiratory tract was the major infection site among the patients undergoing CABG,and the urinary tract was the major infection site among the patients undergoing hip replacement.Ther result of multi-variate analysis showed that the HAIs could extend the length of hospital stay of the patients with all the single diseases except for chronic obstructive pulmonary disease(COPD)and adult pneumonia(P＜0.05);the lengths of hospital stay of the patients undergoing hip replacement(with the increase of 22.05 days),the patients with heart failure(with the increase of 18.39 days)and those with myocardial infarction(with the increase of 17.15 days)in-creased most remarkably.The medical costs of the patients with CABG,COPD,hip replacement,cerebral infarc-tion,myocardial infarction and heart failure were increased due to the HAIs(P＜0.05),and the medical costs of the patients with heart failure increased most remarkably(with the increase of 251,662.92 yuan).CONCLUSIONS The HAIs have remarkable negative effects on the length of hospital stay and medical costs of most of the patients with single diseases.It is necessary to strengthen the prevention and control of HAIs so as to improve the medical quality,guarantee the safety of patients,effectively improve the performance assessment indexes for tertiary pub-lic hospitals and facilitate the high-quality development of medical institutions.