ObjectiveTo understand the infection characteristics of multidrug-resistant organisms (MDROs) in hospitalized patients in a tertiary sentinel hospital in Shanghai, so as to provide an evidence for the development of targeted prevention and control measures. MethodsData of MDROs strains and corresponding medical records of some hospitalized patients in a hospital in Shanghai from 2021 to 2023 were collected, together with an analysis of the basic information, clinical treatment, underlying diseases and sources of sample collection. ResultsA total of 134 strains of MDROs isolated from hospitalized patients in this hospital were collected from 2021 to 2023 , including 63 strains of methicillin-resistant Staphylococcus aureus (MRSA), 57 strains of carbapenem-resistant Acinetobacter baumannii (CRAB), and 14 strains of carbapenem-resistant Klebsiella pneumoniae (CRKP). Of the 134 strains, 30 strains were found in 2021, 47 strains in 2022 and 57 strains in 2023. The male-to-female ratio of patients was 2.05∶1, with the highest percentage (70.90%) in the age group of 60‒<90 years. The primary diagnosis was mainly respiratory disease, with lung and respiratory tract as the cheif infection sites. There was no statistically significant difference in the distribution of strains between different genders and infection sites (P>0.05). However, the differences in the distribution of strains between different ages and primary diagnosis were statistically significant (P<0.05). Patients who were admitted to the intensive care unit (ICU), had urinary tract intubation, were not artery or vein intubated, were not on a ventilator, were not using immunosuppresants or hormones, and were not applying radiotherapy or chemotherapy were in the majority. There was no statistically significant difference in the distribution of strains for whether received radiotherapy or chemotherapy or not (P>0.05), while the differences in the distribution of strains with ICU admission history, urinary tract intubation, artery or vein intubation, ventilator use, and immunosuppresants or hormones use or not were statistically significant (all P<0.05). The type of specimen was mainly sputum, the hospitalized ward was mainly comprehensive ICU, the sampling time was mainly in the first quarter throughout the year, the number of underlying diseases was mainly between 1 to 2 kinds, the application of antibiotics ≥4 kinds, and those who didn’t receive any surgery recently accounted for the most. There were statistically significant differences in the distribution of strains between different specimen types, wards occupied and history of ICU stay (P<0.05), but no statistically significant difference in the distribution of strains between different sampling times, number of underlying diseases and types of antibiotics applied (P>0.05). ConclusionThe situation of prevention and control on MDROs in this hospital is still serious. Focus should be placed on high-risk factors’ and infection monitoring and preventive measures should be strengthened to reduce the incidence rate of MDROs infection.

Objective:To investigate the effects of overexpression of Nkx2.5 gene on the anti apoptotic ability of bone marrow mesenchymal stem cells (BMSCs) and cardiac function after myocardial infarction.Methods:A cell ischemia model was established by culturing cells under oxygen glucose deprivation/reoxygenat (OGD/R) conditions. The experiment was divided into four groups: bone marrow mesenchymal stem cells cultured under normal conditions (BMSC group), BMSC group cultured under glucose and oxygen deprivation (BMSC+OGD/R group), overexpressed empty vector BMSC group cultured under glucose and oxygen deprivation(BMSC NC+OGD/R group), and overexpressed Nkx2.5 BMSC group cultured under glucose and oxygen deprivation (BMSC Nkx2.5+OGD/R group). The apoptosis rate of BMSCs in each group was detected via flow cytometry, and BMSC protein was extracted. The expression of caspase-3 and pro-caspase-3, caspase-8 and pro-caspase-8, caspase-9, and cytochrome C protein and expression of Nkx2.5 in the BMSCs of each group were detected by Western blot to determine the anti-apoptotic pathway in vitro. The model of myocardial infarction in mice was established by ligating the left anterior descending branch of coronary artery. The experiment was divided into five groups: sham surgery group, myocardial infarction untreated group, myocardial infarction tail vein injection of BMSC group, myocardial infarction tail vein injection of BMSC empty body group, myocardial infarction tail vein injection of BMSC overexpression Nkx2.5 group. The changes of cardiac function in mice were evaluated by echocardiography. Normal distribution econometric data were compared between groups using convenient analysis, and pairwise comparisons were conducted using LSD-t test. Results:The apoptosis rate of the BMSC+OGD/R group (12.98±1.24)% was higher than that of the BMSC group (7.82±0.42)%, and the difference was statistically significant ( P<0.001). The apoptosis rate of the BMSC NKx2.5+OGD/R group (11.26±0.22)% was lower than that of the BMSC+OGD/R group (12.98±1.24)% and the BMSC NC+OGD/R group (13.14±0.70)%, with statistically significant differences ( P<0.05). Compared to BMSC group ((0.36±0.08), (1.13±0.04), (0.36±0.06), (1.12±0.13), (1.23±0.08), (0.60±0.05), (0.67±0.14)), BMSC+OGD/R group ((1.05±0.10), (0.62±0.04), (1.07±0.09), (0.57±0.07), (0.55±0.08), (1.25±0.09), (0.71±0.04)) and BMSC NC+OGD/R group ((1.16±0.16), (0.64±0.06), (1.19±0.16), (0.56±0.06), (0.50±0.06), (1.28±0.06), (0.73±0.04)), the expression of Caspase-3 (0.72±0.08) and pro-caspase-3(0.89±0.09), Caspase-8 (0.63±0.08) and pro-caspase-8(0.85±0.12), Caspase-9 (0.87±0.09), cytochrome C (0.91±0.10), and Nkx2.5 (1.54±0.16) in BMSC Nkx2.5+OGD/R group was statistically significant (all P<0.05). In vivo experiments showed that the heart ejection fraction (29.05±7.07)% of mice treated with BMSC Nkx2.5 after myocardial infarction was significantly improved compared to the BMSC group (16.57±2.09)% and BMSC NC group (18.08±3.27)% (all P<0.05). Conclusion:BMSC Nkx2.5 may enhance the anti-apoptosis ability of BMSCs and improve cardiac function after myocardial infarction by inhibiting the death receptor pathway and the mitochondrial signal pathway .

Mild cognitive impairment(MCI)is an intermediate state between normal aging and dementia,and there is a risk of conversion to dementia if left untreated.Repetitive transcranial magnetic stimulation(rTMS)is a physical treatment for neuropsychiatric disorders that noninvasively acts on target area to upregulate neurotrophic substance expression,modulate cortical physiological activity,affect regional connectivity,and induce synaptic plasticity.On this basis,rTMS can realize targeted-regulation of damaged neural circuits,thereby improving cognitive dysfunction and becoming an effective method to intervene in MCI.This paper summarizes the theoretical background of this technology and further discusses the brain network that may be affected by target-specific rTMS in ameliorating MCI,in order to provide reference for clinical translation.

Objective:To improve the diagnosis and treatment of thyroid carcinoma in flying personnel by analyzing the clinical characteristics of thyroid carcinoma.Methods:The clinical and pathological data of flying personnel with thyroid carcinoma diagnosed and treated by Air Force Medical Center of PLA from January of 2010 to December of 2022 were retrospectively analyzed. Clinical characteristics such as age, flying hours, aircraft types, thyroid function at diagnosis, and pathological characteristics such as tumor site, tumor size, lymph node metastasis, calcification and sand and Ki-67 positive ratio were collected, and the clinical and pathological characteristics were statistically analyzed.Results:Thyroid nodule was found as the first diagnosis of thyroid carcinoma in 57 flying personnel. The age of onset was 22-58 years old, the median age was 37 years old, the flying hours was 4-18 000 h, and the median flying hours was 2 000 h. Thyroid carcinoma was detected in both thyroid glands, and the histological type was papillary thyroid carcinoma. Thyroid function was normal in most cases when thyroid carcinoma was detected. Lymph node metastasis of thyroid carcinoma was low positively correlated with tumor size ( r=0.304, P=0.021), and was low positively correlated with the positive proportion of Ki-67 ( r=0.360, P=0.006). Other clinical and pathological characteristics did not show clear correlation. With the extension of flying hours, the incidence of lymph node metastasis of thyroid carcinoma increased, and the difference was statistically significant ( χ2=6.32, P=0.012). There was no statistical difference among the clinical characteristics of flying personnel with different age and aircraft types ( P>0.05). Conclusions:The thyroid carcinoma is usually diagnosed without clinical symptoms and the thyroid function is basically normal. The thyroid ultrasound examination should be emphasized during physical examination, and further examination should be conducted for the flying personnel with thyroid nodules.

Objective:To improve the diagnosis and treatment of thyroid carcinoma in flying personnel by analyzing the clinical characteristics of thyroid carcinoma.Methods:The clinical and pathological data of flying personnel with thyroid carcinoma diagnosed and treated by Air Force Medical Center of PLA from January of 2010 to December of 2022 were retrospectively analyzed. Clinical characteristics such as age, flying hours, aircraft types, thyroid function at diagnosis, and pathological characteristics such as tumor site, tumor size, lymph node metastasis, calcification and sand and Ki-67 positive ratio were collected, and the clinical and pathological characteristics were statistically analyzed.Results:Thyroid nodule was found as the first diagnosis of thyroid carcinoma in 57 flying personnel. The age of onset was 22-58 years old, the median age was 37 years old, the flying hours was 4-18 000 h, and the median flying hours was 2 000 h. Thyroid carcinoma was detected in both thyroid glands, and the histological type was papillary thyroid carcinoma. Thyroid function was normal in most cases when thyroid carcinoma was detected. Lymph node metastasis of thyroid carcinoma was low positively correlated with tumor size ( r=0.304, P=0.021), and was low positively correlated with the positive proportion of Ki-67 ( r=0.360, P=0.006). Other clinical and pathological characteristics did not show clear correlation. With the extension of flying hours, the incidence of lymph node metastasis of thyroid carcinoma increased, and the difference was statistically significant ( χ2=6.32, P=0.012). There was no statistical difference among the clinical characteristics of flying personnel with different age and aircraft types ( P>0.05). Conclusions:The thyroid carcinoma is usually diagnosed without clinical symptoms and the thyroid function is basically normal. The thyroid ultrasound examination should be emphasized during physical examination, and further examination should be conducted for the flying personnel with thyroid nodules.

A 71-year-old male patient with advanced lung adenocarcinoma received pemetrexed (0.8 g, IV infusion on the first day) and carboplatin (500 mg, IV infusion on the first day) combined with pembrolizumab (200 mg, IV infusion on the second day) and 21 days was a cycle. Before the third cycle of treatment, the patient developed palpitations, irritability, increased appetite, and emaciation. Laboratory tests showed triiodothyronine (T 3) 2.88 nmol/L, thyroxine (T 4) 247.90 nmol/L, free triiodothyronine (FT 3) 10.57 pmol/L, free thyroxine (FT 4) 39.63 pmol/L, thyroid stimulating hormone (TSH) 0.014 mU/L, anti-thyroglobulin antibody (TGAb) 15.9 μg/L, thyroid peroxidase antibody (TPOAb) >1 300.0 kU/L. Immunerelated hyperthyroidism was considered, which may be related to pembrolizumab. The above-mentioned treatment was continued due to the patient′s condition, and thiamazole and metoprolol were given orally at the same time. One month later, laboratory tests showed T 3 2.50 nmol/L, T 4 153.40 nmol/L, FT 3 7.70 pmol/L, FT 4 33.61 pmol/L, TSH 0.007 mU/L, TGAb 15.7 μg/L and TPOAb >1 300.0 kU/L; 2 months later, laboratory tests showed T 3 1.84 nmol/L, T 4 81.20 nmol/L, FT 3 3.86 pmol/L, FT 4 11.56 pmol/L, TSH 1.979 mU/L, TGAb 15.7 μg/L, and TPOAb >1 300.0 kU/L. His symptoms of palpitation and irritability were alleviated.

A 71-year-old male patient with advanced lung adenocarcinoma received pemetrexed (0.8 g, IV infusion on the first day) and carboplatin (500 mg, IV infusion on the first day) combined with pembrolizumab (200 mg, IV infusion on the second day) and 21 days was a cycle. Before the third cycle of treatment, the patient developed palpitations, irritability, increased appetite, and emaciation. Laboratory tests showed triiodothyronine (T 3) 2.88 nmol/L, thyroxine (T 4) 247.90 nmol/L, free triiodothyronine (FT 3) 10.57 pmol/L, free thyroxine (FT 4) 39.63 pmol/L, thyroid stimulating hormone (TSH) 0.014 mU/L, anti-thyroglobulin antibody (TGAb) 15.9 μg/L, thyroid peroxidase antibody (TPOAb) >1 300.0 kU/L. Immunerelated hyperthyroidism was considered, which may be related to pembrolizumab. The above-mentioned treatment was continued due to the patient′s condition, and thiamazole and metoprolol were given orally at the same time. One month later, laboratory tests showed T 3 2.50 nmol/L, T 4 153.40 nmol/L, FT 3 7.70 pmol/L, FT 4 33.61 pmol/L, TSH 0.007 mU/L, TGAb 15.7 μg/L and TPOAb >1 300.0 kU/L; 2 months later, laboratory tests showed T 3 1.84 nmol/L, T 4 81.20 nmol/L, FT 3 3.86 pmol/L, FT 4 11.56 pmol/L, TSH 1.979 mU/L, TGAb 15.7 μg/L, and TPOAb >1 300.0 kU/L. His symptoms of palpitation and irritability were alleviated.

Objective: To investigate the characteristics and clinical significance of the immunomicroenvironment typing based on the expression of programmed death-ligand 1 (PD-L1) and the infiltration of CD8+ T cells in the stroma in patients with non-small cell lung cancer (NSCLC). Methods: Paraffin tissue specimens and relevant clinicopathological data of 74 NSCLC patients admitted to our hospital from January 2016 to July 2018 were collected.All patients received EGFR gene test, and none received radiotherapy, chemotherapy or targeted therapy. Immunohistochemistry was used to detect the expression of PD-L1 in tissues and the infiltration of CD8+T cells in interstitium, and the relationship between PD-L1, CD8+T cells, and the immune microenvironment typing based on both, and the pathological parameters and the survival of patients was analyzed. Results: PD-L1 expression in the primary tumor of NSCLC patients showed statistical differences in gender, pathological type, smoking history, EFGR gene mutation status ( P <0.05). The infiltration of CD8+ T lymphocytes in tumor microenvironment showed statistically significant differences in different TNM stage and lymph node metastasis ( P <0.05), PD-L1 expression was significantly correlated with EGFR mutation ( P =0.000), while CD8+T lymphocyte infiltration was not correlated with EGFR mutation ( P =0.605). The immunomicroenvironment of EGFR wild-type patients was mainly (CD8+ PD-L1+) (type I), and the mutants were mainly (CD8-PD-L1-) (type II) and (CD8+PD-L1-) (type IV). The distribution of immune microenvironmental typing in each group with different EGFR mutation, smoking history and pathological differentiation degree was significantly different ( P <0.05) and significantly correlated with EGFR mutation ( P <0.05). Follow-up showed that the patients with disease free survival, recurrence and metastasis and death were the most in type I, type II and type I, respectively. Conclusions: In this study, the distribution of tumor immunomicroenvironmental typing in NSCLC patients was mainly the highest in type I and the lowest in type Ⅲ, which was related to EGFR mutation, smoking history and pathological differentiation. Patients with EGFR mutations were mainly of type Ⅱand type Ⅳ, and were associated with low expression of PD-L1. ··

Ablation Techniques ; adverse effects ; methods ; Humans ; Lung Neoplasms ; diagnostic imaging ; radiotherapy ; surgery ; Postoperative Complications ; prevention & control ; therapy ; Radio Waves ; therapeutic use ; Radiotherapy, Image-Guided ; adverse effects ; methods ; Treatment Outcome

Objective To investigate the performance of MSCT in the diagnosis of metanephric adenoma.Methods The imaging data of 5 cases of metanephric adenoma confirmed by operation and pathology in our hospital were collected and analyzed retrospectively.The location, size, shape, density and enhancement of the lesion were further retrospectively analyzed.Results In the incorporated 5 cases of metanephric adenoma, the male to female ratio of cases was 1:4, all were unilateral, including 2 cases of the right kidney,3 cases of the left kidney,2 cases were located in the upper pole, 2 cases in the polar region, 1 case in the lower pole of the kidney.Maximum diameter of the metanephric adenoma ranged from 2.9 cm to 8.4 cm, with an average value of 4.8 cm.The shape of metanephric adenoma was classified into: round (3 cases) and oval (2 cases).On plain scanning slightly lower density was found in 2 cases, equidensity in 2 cases and slightly higher density in 1 case.Furthermore,1 case had small punctatel calcification in the edge of the lesion,1 case with renal papillary carcinoma.4 cases underwent plain and enhanced scanning,and 1 case plain scanning,in which slight density increase after intravenous enhancement was showed in 3 cases,moderate enhancement in 1 case,more uniform enhancement in 3 cases,uneven enhancement in 1 case,delayed enhancement in 4 cases.Conclusion The characteristic MSCT features of metanephric adenoma have a certain specificity.Preoperative correct understanding is helpful to guide the operation scheme.