Objective To explore the effects of plantamajoside on the proliferation and invasion of human gastric cancer cell line BGC823.Methods BGC823 cells were randomly separated into a control group,a plantamajoside group,an AAV-NC(transfection of empty plasmids packaged with lentivirus)group and a plantamajoside+AAV-HIF-1α(transfection of HIF-1α overexpression plasmid packaged with lentivirus)group.Cell proliferation,inva-sion,apoptosis,the numbers of vascular mimicry(VM)lumens and vascular branches,the expression of prolifera-tion,apoptosis,epithelial mesenchymal transition(EMT)related proteins,HIF-1α/VEGF pathway proteins of cells were all examined.Results Compared with control group,the BGC823 cell viability,colony formation num-ber,invasion number,VM lumen number,vascular branch number,and expression of Ki-67,PCNA,vimentin,MMP9,Snail,VEGFA,VE-cadhering,HIF-1α and VEGF protein were all lower in plantamajoside group(P＜0.05).The apoptosis rate,the cleaved Caspase-3,Bax,and E-cadherin protein expression were significantly increased(P＜0.05).Compared with plantamajoside group,the BGC823 cell viability,colony formation number,invasion number,VM lumen number,vascular branch number,and expression of Ki-67,PCNA,vimentin,MMP9,Snail,VEGFA,VE-cadherin,HIF-1α and VEGF protein were higher in the plantamajoside+AAV-HIF-1α group(P＜0.05).The apoptosis rate,the cleaved caspase-3,Bax,and E-cadherin protein expression were lower(P＜0.05).Conclusions Plantamajoside inhibits proliferation,EMT,invasion,and VM of human gastric cancer cell line and induce its apoptosis.

Objective To investigate the effect of intravenous injection of remifentanil on the comfort level of birth-giving women with scarred uterus undergoing cesarean section.Methods A total of 82 birth-giving women with scarred uterus who underwent cesarean section in the Suqian Hospital of Jiangsu Provincial People's Hospital from October 2021 to September 2023 were selected and randomly divided into the observation group and the control group(with 41 cases in each group).Before skin resection of cesarean section,the birth-giving women of the observation group were injected with 0.05 μg·kg-1·min-1 remifentanil intravenously until the end of the operation,and these in the control group was injected with the same amount of normal saline.The vital signs and pain at different time points,traction reaction and occurrence of maternal and infant complications were compared between the two groups.Results The mean arterial pressure(MAP),heart rate(HR),pain visual analogue scale(VAS)score and incidence of traction reactions at abdominal exploration in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the neonatal umbilical vein pH value,umbilical vein blood pulse oximetry saturation(SPO2),Apgar scores 1 minute and 5 minutes after birth of newborn,or nausea,vomiting and respiratory depression of birth-giving women between the two groups(P>0.05).Conclusion For birth-giving women with scar uterus who underwent cesarean section,intravenous injection of 0.05 μg·kg-1·min-1 of reifentanil can reduce the fluctuation of vital signs,significantly relieve the traction reaction at abdominal exploration,with a few maternal and infant complications,which is conducive to improving the comfort level of the birth-giving women.

Objective:To explore the differences of cortical responses to unilateral upper limb training (UULT) in subacute stroke patients with different motor-evoked potentials (MEPs).Methods:A cross-sectional study was performed; 33 subacute stroke patients accepted UULT were recruited from Center of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University from August 2023 to August 2024. Transcranial magnetic stimulation was used to assess MEPs, and functional near-infrared spectroscopy (fNIRS) was used to record hemodynamic changes in bilateral primary motor cortex (M1), pre-motor cortex/supplementary motor area (PMC/SMA), and posterior parietal cortex (PPC) during the resting state and UULT task state. Wavelet coherence analysis and Granger causality analysis were used to determine the strengths of functional connectivity (FC) and effective connectivity (EC) between brain regions.Results:Among the 33 patients, 16 were assigned to an absent MEP (MEP -) group and 17 into a present MEP (MEP +) group (MEP amplitude: [310±200] μV). In the MEP - group, compared with those during the resting state, FC of ipsilesional M1 with contralesional PPC, contralesional M1, ipsilesional PPC, contralesional PMC/SMA and ipsilesional PMC/SMA during the task state (0.64±0.14 vs. 0.48±0.12, 0.63±0.14 vs. 0.45±0.10, 0.70±0.14 vs. 0.56±0.12, 0.56±0.13 vs. 0.39±0.15, 0.61±0.13 vs. 0.44±0.14), and FC between the ipsilesional PMC/SMA and ipsilesional PPC during the task state (0.71±0.12 vs. 0.61±0.09) were significantly decreased ( P<0.0033); compared with that during the resting state, EC from the ipsilesional PPC to the ipsilesional PMC/SMA during the task state (0.15±0.07 vs. 0.25±0.18) was significantly increased ( P<0.05). In the MEP + group, compared with that during the resting state, FC of the ipsilesional M1 with contralesional M1 and ipsilesional PPC during the task state (0.81±0.08 vs. 0.70±0.14, 0.78±0.08 vs. 0.68±0.13) was significantly decreased ( P<0.0033); compared with that during the resting state, EC from contralesional M1 to ipsilesional M1 during the task state (0.11±0.10 vs. 0.15±0.10) was significantly increased ( P<0.05). No significant differences were noted in changes of FC strength between resting state and UULT task state across brain regions when comparing the MEP - and MEP + groups ( P>0.0033). Conclusion:MEP - subacute stroke patients exhibit extensive bilateral cortical response during the UULT task state, whereas MEP + patients show limited cortical response, which indicate that rehabilitation training strategy in MEP + patients needs to be adjusted.

AIM:To investigate the effects of the neutrophil elastase(NE)inhibitor sivelestat on the pathologi-cal changes of cardiac tissues in mice with heart failure with preserved ejection fraction(HFpEF).METHODS:Eight-week-old C57BL/6J mice were randomly divided into 3 groups:control group(n=5),model group(n=6),and treatment group(n=18).The HFpEF mouse model was established using a combined approach of high-fat diet and NG-nitro-L-argi-nine methyl ester(L-NAME).The mice in treatment group received intraperitoneal injection of sivelestat at doses of 12.5,25 and 50 mg·kg-1·d-1(n=6),while those in control and model groups were injected with the same volume of nor-mal saline.After 12 weeks,small animal ultrasound was employed to assess changes in cardiac function,and the lung weight-to-tibia length(LW/TL)ratio was calculated to evaluate pulmonary edema.An exercise fatigue test was conducted to assess exercise intolerance.Histological evaluations were performed using HE,wheat germ agglutinin,dihydroethidium and Sirius red staining to examine overall heart morphology,cross-sectional area of cardiomyocytes,levels of oxidative stress,and the extent of cardiac fibrosis.The expression of fibrosis-related proteins was analyzed using Western blot.RE-SULTS:Compared with model group,sivelestat at various concentrations significantly improved cardiac diastolic function in HFpEF mice,indicated by an increased E/A ratio and a decreased E/e'ratio(P＜0.05).The LW/TL ratio decreased,alleviating lung congestion and exercise intolerance(P＜0.05).The heart weight-to-tibia length(HW/TL)ratio,overall heart cross-sectional area,and cardiomyocyte cross-sectional area all decreased,indicating attenuation in cardiac hypertro-phy(P＜0.05).Additionally,cardiac fibrosis and reactive oxygen species levels were significantly reduced(P＜0.05).CONCLUSION:Inhibition of NE exerts a protective effect against diastolic dysfunction and cardiac fibrosis induced by HFpEF in mice.

Objective To investigate the effect of intravenous injection of remifentanil on the comfort level of birth-giving women with scarred uterus undergoing cesarean section.Methods A total of 82 birth-giving women with scarred uterus who underwent cesarean section in the Suqian Hospital of Jiangsu Provincial People's Hospital from October 2021 to September 2023 were selected and randomly divided into the observation group and the control group(with 41 cases in each group).Before skin resection of cesarean section,the birth-giving women of the observation group were injected with 0.05 μg·kg-1·min-1 remifentanil intravenously until the end of the operation,and these in the control group was injected with the same amount of normal saline.The vital signs and pain at different time points,traction reaction and occurrence of maternal and infant complications were compared between the two groups.Results The mean arterial pressure(MAP),heart rate(HR),pain visual analogue scale(VAS)score and incidence of traction reactions at abdominal exploration in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the neonatal umbilical vein pH value,umbilical vein blood pulse oximetry saturation(SPO2),Apgar scores 1 minute and 5 minutes after birth of newborn,or nausea,vomiting and respiratory depression of birth-giving women between the two groups(P>0.05).Conclusion For birth-giving women with scar uterus who underwent cesarean section,intravenous injection of 0.05 μg·kg-1·min-1 of reifentanil can reduce the fluctuation of vital signs,significantly relieve the traction reaction at abdominal exploration,with a few maternal and infant complications,which is conducive to improving the comfort level of the birth-giving women.

AIM:To investigate the effects of the neutrophil elastase(NE)inhibitor sivelestat on the pathologi-cal changes of cardiac tissues in mice with heart failure with preserved ejection fraction(HFpEF).METHODS:Eight-week-old C57BL/6J mice were randomly divided into 3 groups:control group(n=5),model group(n=6),and treatment group(n=18).The HFpEF mouse model was established using a combined approach of high-fat diet and NG-nitro-L-argi-nine methyl ester(L-NAME).The mice in treatment group received intraperitoneal injection of sivelestat at doses of 12.5,25 and 50 mg·kg-1·d-1(n=6),while those in control and model groups were injected with the same volume of nor-mal saline.After 12 weeks,small animal ultrasound was employed to assess changes in cardiac function,and the lung weight-to-tibia length(LW/TL)ratio was calculated to evaluate pulmonary edema.An exercise fatigue test was conducted to assess exercise intolerance.Histological evaluations were performed using HE,wheat germ agglutinin,dihydroethidium and Sirius red staining to examine overall heart morphology,cross-sectional area of cardiomyocytes,levels of oxidative stress,and the extent of cardiac fibrosis.The expression of fibrosis-related proteins was analyzed using Western blot.RE-SULTS:Compared with model group,sivelestat at various concentrations significantly improved cardiac diastolic function in HFpEF mice,indicated by an increased E/A ratio and a decreased E/e'ratio(P＜0.05).The LW/TL ratio decreased,alleviating lung congestion and exercise intolerance(P＜0.05).The heart weight-to-tibia length(HW/TL)ratio,overall heart cross-sectional area,and cardiomyocyte cross-sectional area all decreased,indicating attenuation in cardiac hypertro-phy(P＜0.05).Additionally,cardiac fibrosis and reactive oxygen species levels were significantly reduced(P＜0.05).CONCLUSION:Inhibition of NE exerts a protective effect against diastolic dysfunction and cardiac fibrosis induced by HFpEF in mice.

Objective:To explore the differences of cortical responses to unilateral upper limb training (UULT) in subacute stroke patients with different motor-evoked potentials (MEPs).Methods:A cross-sectional study was performed; 33 subacute stroke patients accepted UULT were recruited from Center of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University from August 2023 to August 2024. Transcranial magnetic stimulation was used to assess MEPs, and functional near-infrared spectroscopy (fNIRS) was used to record hemodynamic changes in bilateral primary motor cortex (M1), pre-motor cortex/supplementary motor area (PMC/SMA), and posterior parietal cortex (PPC) during the resting state and UULT task state. Wavelet coherence analysis and Granger causality analysis were used to determine the strengths of functional connectivity (FC) and effective connectivity (EC) between brain regions.Results:Among the 33 patients, 16 were assigned to an absent MEP (MEP -) group and 17 into a present MEP (MEP +) group (MEP amplitude: [310±200] μV). In the MEP - group, compared with those during the resting state, FC of ipsilesional M1 with contralesional PPC, contralesional M1, ipsilesional PPC, contralesional PMC/SMA and ipsilesional PMC/SMA during the task state (0.64±0.14 vs. 0.48±0.12, 0.63±0.14 vs. 0.45±0.10, 0.70±0.14 vs. 0.56±0.12, 0.56±0.13 vs. 0.39±0.15, 0.61±0.13 vs. 0.44±0.14), and FC between the ipsilesional PMC/SMA and ipsilesional PPC during the task state (0.71±0.12 vs. 0.61±0.09) were significantly decreased ( P<0.0033); compared with that during the resting state, EC from the ipsilesional PPC to the ipsilesional PMC/SMA during the task state (0.15±0.07 vs. 0.25±0.18) was significantly increased ( P<0.05). In the MEP + group, compared with that during the resting state, FC of the ipsilesional M1 with contralesional M1 and ipsilesional PPC during the task state (0.81±0.08 vs. 0.70±0.14, 0.78±0.08 vs. 0.68±0.13) was significantly decreased ( P<0.0033); compared with that during the resting state, EC from contralesional M1 to ipsilesional M1 during the task state (0.11±0.10 vs. 0.15±0.10) was significantly increased ( P<0.05). No significant differences were noted in changes of FC strength between resting state and UULT task state across brain regions when comparing the MEP - and MEP + groups ( P>0.0033). Conclusion:MEP - subacute stroke patients exhibit extensive bilateral cortical response during the UULT task state, whereas MEP + patients show limited cortical response, which indicate that rehabilitation training strategy in MEP + patients needs to be adjusted.

Objective To observe the clinical efficacy of Xingnao Kaiqiao Acupuncture(with the functions of awakening the brain and opening the orifices)combined with acupuncture at pericardium meridian points in the treatment of post-stroke sleep reversal(PSSR).Methods Sixty patients with PSSR were randomly divided into observation group and control group,30 patients in each group.Both groups were given conventional treatment,the control group was given oral use of Alprazolam,and the observation group was given the combination of acupuncture a at pericardial meridian points,and 10 days of treatment was one course of treatment.After 10 days of treatment,the clinical efficacy of the two groups was evaluated.The changes in the Pittsburgh Sleep Quality Index(PSQI)and Ascens Insomnia Scale(AIS)scores,as well as the Hamilton Depression Scale(HAMD)scores were observed before and after treatment in the two groups.The changes in cortisol levels at 0,8,and 16 o'clock were compared before and after treatment between the two groups.Results(1)After treatment,the PSQI scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving PSQI scores,and the difference was statistically significant(P＜0.05).(2)After treatment,the AIS and HAMD scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the AIS and HAMD scores,and the difference was statistically significant(P＜0.05).(3)After treatment,the cortisol level of patients in the two groups at 0,8,and 16 o'clock was significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the cortisol level at 0,8,and 16 o'clock was significantly superior to the control group,and the difference was statistically significant(P＜0.05).(4)The total effective rate was 86.67%(26/30)in the observation group and 80.00%(24/30)in the control group.The efficacy of the observation group was slightly superior to that of the control group,but the difference was not statistically significant(P＞0.05).Conclusion Xingnao Kaiqiao Acupuncture combined with acupuncture at pericardium meridian points for the treatment of PSSR can significantly improve the clinical symptoms of the patients,so as to improve the quality of life of the patients,and the therapeutic efficacy is remarkable.

In recent years,the isolation rate of carbapenem-resistant Klebsiella pneunoniae(CRKP)in China has increased year by year.Due to its multidrug resistance and high mortality in patients,CRKP brings severe challen-ges to the clinical treatment.The major mechanism of drug resistance in CRKP is the production of carbapenemases,with Ambler A,B,and D being the common types while Ambler type C comparativly rare.Klebsiella pneumoniae carbapenemase(KPC)is the most common carbapenemase,which belongs to type A.KPC-producing Klebsiella pneumoniae(KPC-KP)widely spreads in the world,with very limited number of effective clinical drugs.In this re-view,advances in the treatment KPC-KP were summarized to provide reference for clinical treatment.

Objective:To investigate the distribution characteristics of urinary tract pathogens in patients with community-acquired urinary tract infection and their sensitivity to nenoxacin and levofloxacin.Methods:This prospective, multicenter clinical trial included patients with community-acquired urinary tract infection who were admitted to urological clinics at 9 clinical research centers from November 2021 to August 2022.Inclusion criteria: Patients aged 18-70 years with community-acquired acute uncomplicated cystitis(AUC), recurrent acute episodes of urinary tract infection(rUTI), and non-febrile complicated urinary tract infection(cUTI) with signs of urinary tract irritation and abnormal elevation of routine white blood cells in urine. Exclusion criteria: ①Patients who received effective antimicrobial therapy within 72 h before enrollment and lasted for more than 24 h. ②Fever (>37.3℃) or symptoms of upper urinary tract infection such as low back pain, tapping pain in the kidney area, etc. ③Indwelling urinary catheter. At the first visit, clean midstream urine samples were taken for bacterial culture, and the distribution characteristics of urinary pathogens of different types of urinary tract infections were analyzed. Extended spectrum β-lactamases (ESBLs) were measured for Gram-negative bacteria. The susceptibility of nenoxacin and levofloxacin to urinary tract pathogens was determined by disk diffusion method. Drug resistance rate, sensitivity rate were analyzed between different disease groups.Results:There were 404 enrolled patients from 9 hospitals, including 364 (90.1%) females and 40 (9.9%) males. A total of 177 strains of pathogenic bacteria were isolated, among which the highest proportion of Escherichia coli was 66.1% (117/177).Klebsiella pneumoniae was followed by 6.8% (12/177) and Streptococcus agalactis 5.1% (9/177). The bacterial spectrum distribution of AUC and rUTI were similar, and the proportions of Escherichia coli were 70.6% (85/119) and 65.9% (29/44), respectively. However, the proportions of Escherichia coli isolated from cUTI patients were only 28.6% (4/14) and Enterococcus faecalis 7.1%(1/14). The overall detection rate of ESBLs in Gram-negative bacteria was 30.9%(43/139). The sensitivity rate of nenoxacin was 74.6%(91/122), and the resistance rate was 25.4%(31/122). The overall sensitivity rate of levofloxacin was 44.9%(70/156) and the resistance rate was 36.5%(57/156). The rate of resistance of urinary tract pathogens to levofloxacin was 48.2% (27/56) in patients with previous urinary tract infection history, and 30.0% (30/100) in patients with no previous urinary tract infection history, the difference was statistically significant( P=0.023).The sensitivity rate of Gram-negative bacteria to nenofloxacin was 70.7% (65/92) and that to levofloxacin was 50.0% (46/92, P<0.001). The sensitivity of Gram-positive bacteria to nenofloxacin was 80.0% (16/20), and that to levofloxacin was 70.0% (14/20, P=0.009). Conclusions:The bacterial profile of out-patient community acquired urinary tract infection varies greatly according to different diseases. The proportion of Escherichia coli in AUC and rUTI patients is higher than that in cUTI. The detection rate of ESBLs in Gram-negative bacteria was lower than the domestic average.Patients with a history of urinary tract infection had a high risk of treatment failure with levofloxacin. The sensitivity of common urinary tract pathogens to nenofloxacin was higher than levofloxacin.