The Burkholderia cepacia complex (Bcc) comprises a group of genetically related yet phenotypically diverse Gram-negative opportunistic pathogens. These organisms demonstrate significant pathogenicity in immunocompromised populations, particularly cystic fibrosis (CF) and chronic granulomatous disease (CGD) patients, causing severe infections including pneumonia, bacteremia, and urinary tract infections. Notably, Bcc infection in CF patients may progress to acute respiratory failure or the life-threatening "cepacia syndrome". Of particular concern is the widespread nosocomial colonization by Bcc strains coupled with their sophisticated multidrug resistance mechanisms, which contribute substantially to clinical treatment failures. This review systematically examines the epidemiological characteristics, clinical manifestations and resistance mechanisms of Bcc. The review aims to provide evidence-based references for improving accurate diagnosis and enhancing infection control measures against this challenging pathogen.

【Objective】 To evaluate the clinical efficacy and safety of platelet-rich plasma(PRP) in acute achilles tendon injury by meta-analysis. 【Methods】 Literature on clinical randomized controlled trial of PRP in the treatment of acute achilles tendon injury from Wanfang database, CNKI, VIP database, The Chinese Biological Literature Database, The Chinese Clinical Trials Registry, PubMed, Embase, Cochrane and The US Clinical Trials Registry as of August 2023 were retrieved. The control group received conventional treatment for acute achilles tendon injury, while PRP treatment group received additional PRP treatment. The primary outcome measure was visual analogue pain scale, and the secondary outcome measures were the achilles tendon fracture score, maximum heel rise height, calf circumference and ankle range of motion. The quality of the literature was assessed using the Cochrane manual, and a meta-analysis of qualified literature was performed using RevMan 5.3 software. 【Results】 Seven articles were finally included, involving 421 patients with acute achilles tendon injury, including 212 patients in the PRP treatment group, and 209 patients in the conventional treatment group. The results of meta-analysis showed that there was no difference between the conventional treatment group and the PRP treatment group in terms of the visual analogue pain scale(SMD=-0.44, 95%CI: -0.94~0.06, P>0.05), calf circumference (MD=1.14, 95% CI: -1.56-3.84, P>0.05), ankle joint toe flexion range of motion (SMD=1.85, 95%CI: -1.38-5.09, P>0.05), ankle dorsiflexion range of motion(SMD=2.61, 95%CI: -0.95-6.17, P>0.05), achilles tendon fracture score (MD=-5.60, 95%CI: -15.36-4.16, P>0.05) and the maximum heel rise height (MD=-2.48, 95%CI: -5.30-0.33, P>0.05). And there was no difference in the incidence of adverse reactions between the two groups (X²=2. 455, P>0.05). 【Conclusion】 PRP injection for acute achilles tendon injury does not improve the biomechanical and clinical outcomes of patients, and the use of PRP does not increase the occurrence of adverse reactions.

Objective:To evaluate the effect of controlled low central venous pressure (CLCVP) induced by milrinone on intraoperative cerebral blood flow in the patients undergoing laparoscopic hepatectomy.Methods:Eighty American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, regardless of gender, scheduled for elective laparoscopic hepatectomy, with body mass index of 18-30 kg/m 2, aged 18-64 yr, were divided into 2 groups ( n=40 each) by a random number table method: nitroglycerin group (X group) and milrinone group (M group). After the start of surgery, milrinone 0.5 μg·kg -1·min -1 was continuously infused in group M and nitroglycerin 0.5-1.5 μg·kg -1·min -1 was continuously infused in group X to maintain central venous pressure (CVP)<5 cmH 2O. Norepinephrine 0.01-0.10 μg·kg -1·min -1 was intravenously injected during operation to maintain mean arterial pressure at 60-90 mmHg. Norepinephrine 8-16 μg was intravenously injected when necessary. At 10 min after tracheal intubation (T 1), after establishment of pneumoperitoneum (T 2), at 5 and 30 min after CVP reached the target value (T 3, T 4), at 5 min after CVP returned to normal value (T 5) and at the end of surgery (T 6), the internal carotid artery mean blood flow velocity, internal carotid artery blood flow, cardiac output, and cardiac index were recorded. The surgical field score, consumption of intraoperative norepinephrine, fluid input and output, and occurrence of adverse reactions at 7 days after operation were recorded. Results:Compared with group X, the cardiac output, cardiac index, internal carotid artery mean blood flow velocity and internal carotid artery blood flow were significantly increased, the consumption of intraoperative norepinephrine was decreased, and the surgical field score was increased at T 3-5 in group M ( P<0.05). There was no significant difference in the intraoperative fluid intake and output and incidence of postoperative adverse reactions at each time point between the 2 groups ( P>0.05). Conclusions:Compared with nitroglycerin-induced CLCVP, milrinone-induced CLCVP can improve the reduction in intraoperative cerebral blood flow in the patients undergoing laparoscopic hepatectomy to some extent.

To prepare a lipid nanoparticle (LNP)-based subunit vaccine of Mycobacterium tuberculosis (Mtb) antigen EsxV and study its immunological characteristics, the LNP containing EsxV and c-di-AMP (EsxV: C: L) was prepared by thin film dispersion method, and its encapsulation rate, LNP morphology, particle size, surface charge and polyphase dispersion index were measured. BALB/c mice were immunized with EsxV: C: L by nasal drops. The levels of serum and mucosal antibodies, transcription and secretion of cytokines in lung and spleen, and the proportion of T cell subsets were detected after immunization. EsxV: C: L LNPs were obtained with uniform size and they were spherical and negatively charged. Compared with EsxV: C immunization, EsxV: C: L mucosal inoculation induced increased sIgA level in respiratory tract mucosa. Levels of IL-2 secreted from spleen and ratios of memory T cells and tissue-resident T cells in mice were also elevated. In conclusion, EsxV: C: L could induce stronger mucosal immunity and memory T cell immune responses, which may provide better protection against Mtb infection.
Animals ; Mice ; Mycobacterium tuberculosis ; Antigens, Bacterial ; Immunization ; Nanoparticles ; Vaccines, Subunit ; Mice, Inbred BALB C

Humans ; Pulmonary Disease, Chronic Obstructive ; Smoke/adverse effects* ; Tobacco ; Tobacco Smoke Pollution

Objectve:To study the effect of gabexate mesylate (GM) on acute lung injury (ALI) in septic rats based on metabonomics.Methods:Fifty-seven SD rats were randomly(random number) divided into three groups: sham operation group (SC group), cecal ligation puncture induced septic ALI group (CLP group), and intraperitoneal administration of GM at 1 h after CLP (CLP-GM group). Twenty-four h after the experiment, the survival of rats in the SC, CLP and CLP-GM groups was observed, the lung tissue was collected for HE staining to observe the pathological changes, and the plasma was collected for metabonomics detection to analyze the characteristics of metabolites.Results:Compared with the SC group, the infiltration of inflammatory cells in the lung tissue of rats in the CLP groupincreased significantly, and the metabolic profile of plasma changed significantly. However, the pathological and metabonomic characteristics of the CLP-GM group showed that the above changes were reversed after the application of GM. Twelve major differential metabolites were found in plasma. The metabolic pathways involved in the disorder included biosynthesis of phenylalanine, tyrosine and tryptophan, phenylalanine metabolism and sphingolipid metabolism.Conclusions:GM may improve septic ALI by regulating amino acid metabolism, sphingolipid metabolism and other metabolic pathways.

Clinicopathological data of 15 patients with pyloric early cancer and precancerous lesions, who received endoscopic submucosal dissection (ESD) in Zhejiang Cancer Hospital from March 2011 to January 2020 were retrospectively analyzed. Postoperative pathology showed 7 cases of low-grade intraepithelial neoplasia, 3 cases of high-grade intraepithelial neoplasia, and 5 cases of early gastric cancer. R0 complete resection was achieved in all patients. The mean operation time was 55.2 min (35-78 min). One patient had delayed postoperative bleeding, and no other complications such as bleeding, perforation or abdominal pain occurred in other 14 patients. No recurrence, metastasis or pyloric stenosis was found during the follow-up of 31.3 months (1-106 months). ESD is safe and effective for early cancer and precancerous lesions in the pylorus.

Objective:To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy.Methods:A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO′s recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results:A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P<0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR=1.42, 95% CI: 1.07-1.88, P=0.015), 46% ( OR=1.46, 95% CI: 1.13-1.88, P=0.004), and 64% ( OR=1.64, 95% CI: 1.13-2.38, P=0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P>0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR=2.87, 95% CI: 1.41-5.83, P=0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR=1.59, 95% CI: 1.04-2.43, P=0.032). Both the risk of premature rupture of membranes ( OR=1.58, 95% CI: 1.18-2.13, P=0.002) and premature delivery ( OR=1.52, 95% CI: 1.07-2.17, P=0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR=5.34, 95% CI: 1.45-19.70, P=0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR=1.44, 95% CI: 1.10-1.90, P=0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR=4.11, 95% CI: 1.18-14.27, P=0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR=1.46, 95% CI: 1.12-1.89, P=0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR=1.47, 95% CI: 1.13-1.92, P=0.004). Conclusions:Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.

The simulator testing in vitro and computational simulation of the artificial knee joint wear are important methods to evaluate the wear performance of the prosthesis in vitro and to predict the clinical performance of knee joint products. Based on the method of literature search, this paper compares the mechanical and kinematic loading input curves carried out by Chinese scholars in recent years, standard curves, and Chinese measurement curves of two typical movements of gait. Data of vitro simulator test and computational simulation model are compared, summarized, and analyzed. The results show that the measured data of motion and load cannot be directly used as the loading conditions for the simulator wear test and computational simulation. The mechanics and kinematics data of Chinese people are different from the international standards. The domestic artificial knee joint in vitro simulator wear test methods are similar but the results of different test institutions are somewhat different. The computation wear prediction research is basically synchronized with foreign countries, but the problem that the calculated wear results are lower than that in vitro test is still unsolved. The artificial knee joint wear performance evaluation system based on Chinese knee joint mechanics and kinematics data is the forward direction of the research.

OBJECTIVE：To pro vide reference for rational use of antibiotics in pediatric department. METHODS ：Clinical bacterial strains isolated from children outpatients and inpatients were collected from West China Guang ’an Hospital of Sichuan University（called“our hospital ”for short ）during Jan. 2014 to Jun. 2019. Distribution and drug resistance of bacteria were analyzed retrospectively. RESULTS ：During 2014-2019，total of 4 692 strains were detected ，accounting for 29.56％ of total ；those were mainly from sputum （3 749 strains，79.90％），blood（203 strains，4.33％）and secretion （137 strains，2.92％）specimen. Among them ，1 488 strains of Gram-positive bacteria （31.71％）were mainly Streptococcus pneumoniae （711 strains，15.15％） and Staphylococcus aureus （574 strains，12.23％）；3 204 strains of Gram-negative bacteria （68.29％）were mainly 2 466 strains of Haemophilus influenza （52.56％）. Totally 172 strains of methicillin-resistant S. aureus and 1 517 strains of β-lactamase producing H. influenzae were detected ；the detection rates were 29.97％ and 61.52％ ，respectively. Resistance rates of H. influenza to ampicillin，cefaclor and cefuroxime were higher than 50％，and the overall trend was on the rise ，resistance rates of cefotaxime ， rifampin and ofloxacin were all lower than 6％. Resistance rates of S. pneumoniae to erythromycin and tetracycline were more than 70％，and the resistance rate to erythromycin was increasing year by year. Resistance rates of S. pneumoniae to β-lactams and quinolones were generally lower than 20％. No resistant strains of linezolid and vancomycin were found. Resistance rate of S. aureus to penicillin G was more than 90％. S. aureus was relarively sensitive to aminoglycosides ，macrolides and tetracyclines ；no furantoin，linezolid and vancomycin-resistant strains were found. CONCLUSIONS ：Gram-negative bacteria are the main pathogens isolated from children in our hospital ，and most of them are H. influenza e，S. pneumon iae and other caustic bacteria. The detection rate of drug-resistant and enzyme producing strains is high ， and the resistance rate of several pathogens to commonly used 0826-2600251。E-mail：wenxiaozheng269@sina.com antibiotics is increasing year by year. Drug resistance is severe. In order to delay the emergence and spread of drug-resistant pathogens in real time and further standardize the use of pediatric antibiotics.