OBJECTIVE To observe the efficacy and safety of ceftazidime and avibactam sodium （CAZ/AVI） in the treatment of carbapenem-resistant organism （CRO） infection. METHODS The information of patients with CRO infection admitted to the Second Affiliated Hospital of Soochow University from September 2019 to March 2022 was collected， and the patients were retrospectively divided into observation group （48 cases） and control group （48 cases） according to the treatment plan. The control group was given Polycolistin B sulfate for injection intravenously at a dose of 500 000 U every 12 hours； no dose adjustment was performed in patients with renal insufficiency or receiving continuous renal replacement therapy （CRRT）. The observation group was given continuous micropump of CAZ/AVI for injection intravenously at a dose of 2.5 g every 8 hours for 2 continous hours； among them， the patients with renal insufficiency received an adjusted dose based on creatinine clearance， and no dose adjustment was performed in patients receiving CRRT. The clinical efficacy and microbiological efficacy as well as body temperature， white blood cell （WBC）， C-reactive protein （CRP） and procalcitonin （PCT） before and after treatment were compared between 2 groups. The prognosis and the occurrence of adverse drug reactions were recorded. The factors influencing the clinical efficacy were screened by Logistic regression analysis. RESULTS The effective rate and microbial clearance rate of the observation group were significantly higher than the control group （P＜0.05）. After treatment， body temperature， PCT and CRP of 2 groups were significantly lower than before treatment， and CRP of the observation group was significantly lower than the control （No.SDFEYJLC2105） group （P＜0.05）. There was no statistically significant differencebetween the two groups in terms of rehabilitation discharge rate， the proportion of patients transferred to general wards，the proportion of dead patients， and the total incidence ofadverse drug reactions （P＞0.05）. CAZ/AVI and prolonging therapy duration were more likely to achieve clinical benefits （odds ratios of 1.146， 7.707，P＜0.05）， while lung infection and CRRT may be independent risk factors for treatment failure （odds ratios of 0.182， 0.236， P＜0.05）. CONCLUSIONS CAZ/AVI has good efficacy and safety in the treatment of CRO infection， the appropriate extension of antibacterial treatment time can achieve a higher clinical response rate， while lung infection or CRRT may lead to treatment failure.

Nonalcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis and insulin resistance and there are currently no approved drugs for its treatment. Hyperactivation of mTOR complex 1 (mTORC1) and subsequent impairment of the transcription factor EB (TFEB)-mediated autophagy-lysosomal pathway (ALP) are implicated in the development of NAFLD. Accordingly, agents that augment hepatic TFEB transcriptional activity may have therapeutic potential against NAFLD. The objective of this study was to investigate the effects of nuciferine, a major active component from lotus leaf, on NAFLD and its underlying mechanism of action. Here we show that nuciferine activated ALP and alleviated steatosis, insulin resistance in the livers of NAFLD mice and palmitic acid-challenged hepatocytes in a TFEB-dependent manner. Mechanistic investigation revealed that nuciferine interacts with the Ragulator subunit hepatitis B X-interacting protein and impairs the interaction of the Ragulator complex with Rag GTPases, thereby suppressing lysosomal localization and activity of mTORC1, which activates TFEB-mediated ALP and further ameliorates hepatic steatosis and insulin resistance. Our present results indicate that nuciferine may be a potential agent for treating NAFLD and that regulation of the mTORC1-TFEB-ALP axis could represent a novel pharmacological strategy to combat NAFLD.

Objective:To preliminarily discuss the difference of ovary anti-miillerian hormone ( AMH) when cyclophosphamide is used in different time during menstrual cycle .Methods:Totally 30 young female patients with average age of (36 ±6.39) diagnosed as glomerular disease were treated with cyclophosphamide .According to the medication time , the patients were divided into follicular phase group and secretory phase group based on the property of menstrual cycle .Follicular phase group was treated with cyclophospha-mide during the first day and the eighth day of menstrual cycle .Secretory phase group was treated with cyclophosphamide after ovulato-ry time, namely the 14th day-the 16th day of menstrual cycle.AMH was detected before the drug treatment and 1st, 3rd, 6th and 10th cycles after cyclophosphamide treatment in the two groups .Results: AMH in the five periods had no statistic difference between the groups (P>0.05).There was significant difference in AMH before the treatment and after one-month treatment in the same group(P<0.05).AMH in different age groups showed statistic difference (P<0.05).Conclusion:There is no significant difference in AMH when cyclophosphamide is administrated in different time of menstrual cycle .However , ovarian function is impaired just by low dose cyclophosphamide (0.8g) with the first administration and will be recovered slowly at least half a year after the drug withdrawal .

Objective To explore the value of free anterolateral thigh flaps in the reconstruction of maxillofacial defects after resection.Methods Patients were recruited from January,2008 to March,2016 in the Department of Oral and Maxillofacial Surgery of Nanjing University.All patients sunder when reconstructive surgery employing anterolateral thigh myocutaneous flaps follow-up of 3 months to 84 months after operation.Results Among 422 cases,survived completely with satisfied configuration,the survival rate was 98.6％.Postoerative vessel thrombosis occurred in flaps,21 patients required operative exploration in the perioperative period including 10 flaps with thrombotic events and 11 flaps with venous thrombosis were complete survival after the salvages,and 6 flaps were failure.The mean follow-up was 36.5 months (range:3 to 84 months).Conclusion The free anterolateral thigh flap is an ideal choice for reconstruction of maxillofacial defects,as it has many advantages such as abundance volume,easily molding and adjusting the thickness,possessing,long vascular pedicle,composition need to be adjusted according to defects,easily concealed donor site,and little donor site complications and malformation.

Objective: To evaluate the effects of application of vancomycin in the early stage of patients with extremely severe burn, in order to provide reference to drug for anti-infection treatment in the early stage of patients with extremely severe burn. Methods: Data of 15 patients of Kunshan explosion on August 2nd, 2014, admitted to the Department of Intensive Care in our hospital were retrospectively analyzed. The clinical efficacy of continuously intravenous dripping of vancomycin (combined with imipenem) in the early stage of burns (before and on post burn day 14) was analyzed. (1) The steady state plasma concentration of vancomycin was monitored respectively 30 min before the third, sixth, and tenth medication with direct chemiluminescent imaging method. (2) The distribution of Gram-positive bacteria of patients during hospitalization and their drug resistance to 14 antibiotics commonly used in clinic were analyzed. (3) Serum level of procalcitonin (PCT), white blood cell count, percentage of neutrophils before and after treatment, and efficacy grade of anti-infection treatment in the early stage of burns were analyzed. (4) Serum levels of aspartate transaminase (AST), alanine aminotransferase (ALT), creatinine before and after treatment, and the adverse effects during medication were analyzed. The WHONET 5.5 statistical software was used to analyze the distribution of Gram-positive bacteria in all the pathogens, and the status of drug resistance of Gram-positive bacteria to 14 antibiotics. Data were processed with Wilcoxon rank sum test. Results: (1) Twenty-nine times of steady state plasma concentration monitoring were performed in the patients in total, with the steady state plasma concentration of vancomycin from 4.3 to 42.1 μg/mL. In the monitoring before third, sixth, and tenth medication, the percentages of result reaching the standard were respectively 1, 3/14, and 2/7. (2) A total of 79 Gram-positive bacteria were isolated, including 49 (62.03%) strains of Staphylococcus aureus, 9 (11.39%) strains of Staphylococcus haemolyticus, 7 (8.86%) strains of Staphylococcus epidermidis, 12 (15.19%) strains of Enterococcus faecium, and 2 (2.53%) strains of Enterococcus faecalis. The above-mentioned Staphylococcus strains were with high drug resistance to antibiotics including penicillins, erythromycin, ciprofloxacin, and low drug resistance to linezolid, teicoplanin, and nitrofurantoin. The above-mentioned Enterococcus strains were with high drug resistance to antibiotics including erythromycin, ciprofloxacin, gentamicin, and low drug resistance to linezolid and teicoplanin. The above-mentioned Staphylococcus strains were all sensitive to vancomycin. Two strains of vancomycin-resistant Enterococcus were detected in the above-mentioned Enterococcus strains. (3) Serum level of PCT, white blood cell count, percentage of neutrophils of patients were (8.1±7.5) ng/mL, (24±10)×10⁹/L, and 0.898±0.029 before treatment, which were significantly higher than (3.0±2.8) ng/mL, (12±5)×10⁹/L, and 0.867±0.016 after treatment (with Z values respectively -2.103, -3.237, and -3.068, P<0.05 or P<0.01). After the early treatment, excellence, progess, and invalid results were achieved in 7, 5, and 3 patients, with the effective percentage of 4/5 in clinic. (4) There were no statistically significant differences in serum levels of AST, ALT, and creatinine of patients between before and after treatment (with Z values respectively-0.057, -1.508, and -1.363, P values above 0.05). Only one patient had liver and renal dysfunction during treatment. Conclusions The positive and reasonable use of vancomycin can remove most of the Gram-positive bacteria, and control the development of sepsis combined with imipenem in the early stage of patients with extremely severe burn. However, the dose of vancomycin should be individualized and the steady state plasma concentration should be monitored to maintain the blood concentration within the safe and effective range, so as to improve the rational use of vancomycin.

OBJECTIVE:To analyze the blood concentration monitoring data of 4 commonly used antiepileptic drugs(AEDs, sodium phenytoin,carbamazepine,sodium valproic acid,oxcarbazepine)in order to provide reference for rational use of drugs in the clinic. METHODS:415 patients underwent 4 AEDs blood concentration monitoring were selected from our hospital during 2014-2015,and the results of blood concentration monitoring were analyzed statistically. RESULTS:There were 680 cases of AE-Ds blood concentration monitoring in total. The main objects of serum concentration monitoring were young and middle-aged(range from 19 to 60),involving 449 cases in total(66.03%). 360 cases were in the normal range(52.94%). Among 361 patients receiving single drug therapy,the rates of serum concentration in the normal range were 80.77%for carbamazepine,which was higher than oth-er 3 AEDs(30.00% for sodium phenytoin,47.40% for sodium valproic acid and 40.38% for oxcarbazepine),with statistical signifi-cance(P<0.05). Among 54 patients receiving combination therapy,the serum concentration monitoring data of 67.65%patients treat-ed with double-combination therapy and 100%patients treated with triple-combination therapy deviated from normal range. CONCLU-SIONS:The rate of AEDs blood concentration reaching the normal range are in low level in our hospital. It’s necessary to strengthen medication education for patients to improve the compliance of patients;clinical efficacy of AEDs is evaluated on the basis of blood concentration monitoring and clinical symptom,and combination therapy should be avoided as much as possible.

5 patients with chronic prolonged mandibular dislocations(CPMD)were examined by CT scan.The patients were treated by manual reduction under general anaesthesia and muscle relaxants.Traction was performed with ligaturing steel wires on fixation titanium screws intermaxillaryly and wrapping up the skull-jaw bone with elastic bandages for 3 weeks.After 1 month,a maximal mouth opening of o-ver 30 mm was noted and no episode of redislocation occurred in 3 -34 month follow-up.

Objective To analyze the predictive factors of anti-androgen withdrawal in the treatment of androgen independent prostate cancer. Methods 347 cases of advanced metastatic prostate cancer in our prostate cancer database were filtered. All the cases were treated with maximal androgen blockade and had full pathological and clinical information. 237 cases developed to the androgen independent stage during the maximal androgen blockade treatment. Among them, 90 cases were treated with anti-androgen withdrawal. This 90 cases were followed up and the last follow-up date was 30 September 2009. The Logistic regression of univariate and multivariate analysis were used to find the predictive factors for the effectiveness of anti-androgen withdrawal, which including baseline PSA, Gleason score, clinical stage, way of castration, kind of anti-androgen, PSA nadir during maximal androgen blockade, time to PSA nadir, PSAV at the time of AIPC, PSADT at the time of AIPC, the effective duration of maximal androgen blockade, age at the time of AIPC and PSA at the initiation of anti-androgen withdrawal. Results Of the 90 cases treated with anti-androgen withdrawal, 3 cases were excluded for analysis because of the incomplete information. Among the 87 cases, 17 cases were effective with the anti-androgen withdrawal treatment while the other 70 cases were ineffective. At the last follow-up, 3 cases were still effective. The median effective duration of anti-androgen withdrawal was 4 months. The univariate analysis indicated that PSAV at the time of AIPC (P=0.033), PSADT at the time of AIPC (P=0.009) and PSA at the initiation of anti-androgen withdrawal (P=0.002)were predictive factors. The multivariate analysis indicated that PSAV (P=0.042) and PSADT at the time of AIPC (P= 0.036) were independent predictive factors for the effectiveness of anti-androgen withdrawal. Conclusions Among the androgen independent advanced metastatic prostate cancer patient, there were about 19. 5% cases effective with the anti-androgen withdrawal treatment and the median effective duration was 4 months. PSAV and PSADT at the time of AIPC were independent predictive factors for the effectiveness of anti-androgen withdrawal.

Objective The value of using partial spleen embolization (PSE) in the treatment of hyper-splenism. Methods Using mixed antibiotic 60% meglucamine diatrizoate, we injected tiny gelatinsponges as embolus to 34 cases of hypersplenism for making spleen artery embolization between 1989 and 2001. Results In the 34 cases of hypersplenism who used PSE, the 26 cases had gained CR(76.5%)and the 6 cases had gained PR(17.6%). The overall effective rate was 94.1%. Tracing the 26 cases who had gained CR, there were 7 cases relapsed. And the recurrence rate was 26.9%. Conclusion The using areas of PSE are wide. And the curative effect is exact. PSE can completely replace the operation of splenectomy with mastering skill and attending complication.

0.05). Conclusions The choice of Miles opereration or ARP in the treatment of LRC is mainly according to patients condition. However, if a radical treatment can be assured. ARP is the best choice for LRC.