OBJECTIVE To analyze the influential factors for clinical efficacy of polymyxin B combined with other antibiotics in the treatment of carbapenem-resistant Acinetobacter baumannii （CRAB） pulmonary infection. METHODS A retrospective analysis was conducted on the clinical data of patients with CRAB pulmonary infection in our hospital from May 2021 to October 2024. Information such as age， gender， admitting department， infection status， underlying medical conditions， mechanical ventilation time， combination anti-infective treatment regimens， and the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE-Ⅱ） score 24 h before medication was compiled. Based on the effectiveness of the treatment， patients were divided into treatment-effective group and treatment-ineffective group. Univariate analysis and multivariate Logistic regression analysis were employed to identify independent factors influencing clinical efficacy. RESULTS A total of 156 patients were included， and 108 patients were treated effectively， with an effective rate of 69.23%. The results of univariate analysis indicated that there were statistically significant differences between 2 groups in terms of the duration of mechanical ventilation time， APACHE-Ⅱ score 24 h before medication， the number of complication types， the proportion of abnormal coagulation function， anti-infective treatment course， and hospital stay before medication （P＜0.05）. The results of multivariate Logistic regression analysis showed that APACHE-Ⅱ score≥15 points 24 h before medication [OR＝2.965， 95%CI （1.284， 6.845）， P＝0.020]， mechanical 20251606） ventilation time≥10 d [OR＝3.577， 95%CI （1.185， 10.793）， P＝0.037] and hospital stay≥14 d before medication [OR＝2.422， 95%CI （1.036， 5.654）， P＝0.041] were independent 15120420253@139.com risk factors， and anti-infective treatment course＞7 d was a protective factor [OR＝0.445， 95%CI （0.221， 0.895）， P＝0.043]. CONCLUSIONS This study shows that the effective rate of polymyxin B combined with other antibiotics in the treatment of CRAB pulmonary infection is less than 70%. The mechanical ventilation time≥10 d， APACHE-Ⅱ score≥15 points 24 h before medication， and hospital stay≥14 d before medication may lead to treatment failure， whereas anti-infective treatment course＞7 d may be associated with treatment success.

Objective To explore the diagnosis of clinically suspicious von Willebrand disease(vWD)in a family and its pathogene-sis.Methods The pedigree information and the biological specimen were collected from the clinically suspected VWD patient and her family members(4 persons in total)in Peking University First Hospital.The levels of platelet count(PLT),activated partial thrombo-plastin time(APTT),vWF antigen(vWF:Ag),vWF activity(vWF:Ac)and FⅧ activity(FⅧ:C)were detected,and vWF risto-cetin cofactor(vWF:RCo)assay,ristocetin-induced platelet aggregation assay(RIPA)and vWF collagen binding(vWF:CB)assay were performed for phenotype diagnosis.The peripheral blood genomic DNAs were extracted from the proband and her family members to perform whole-exome sequencing for identifying the mutation of vWF gene,The mutation site was analyzed by using bioinformation tools to explore the pathogenesis of the proband.Results The APTT of proband(m 1)was slightly prolonged and her vWF:Ag,vWF:Ac,vWF:RCo and vWF:CB were significantly decreased.There was no obvious aggregation in RIPA assay(1.0 mg/mL and 1.25 mg/mL).In her father(Ⅱ3),APTT,FⅧ:C,vWF:Ag,vWF:Ac and vWF:CB were normal,but vWF:RCo was slightly decreased.In her mother(Ⅱ4),APTT,FⅧ:C,vWF:Ag,vWF:RCo and vWF:CB were all normal,but vWF:Ac significantly decreased.In her brother(Ⅲ2),APTT and FⅧ:C were normal,but vWF:Ag,vWF:Ac,vWF:RCo and vWF:CB were reduced to varying degrees.In all the family members(father,mother and brpther),no apparent aggregation in RIPA(1.0 mg/mL)was shown.Genetic analysis showed that the proband(Ⅲ1)carried a compound heterozygous mutation of vWF gene c.7288-9T＞G and c.1117C＞T,her father(Ⅱ3)carried vWF gene c.7288-9T＞G heterozygous mutation,and vWF gene c.1117C＞T heterozygous mutation was presented in both mother(Ⅱ4)and brother(Ⅲ2).Conclusion According to the results of laboratory tests,the proband was diagnosed as type 2A vWD.The hetero-zygous mutation in vWF gene c.1117C＞T and c.7288-9T＞G may be the molecular mechanism leading to type 2A vWD in the proband.

Objective:To explore the association of hemoglobin(HGB) levels with bone mineral density(BMD) and osteoporosis in patients with type 2 diabetes mellitus(T2DM).Methods:A cross-sectional study was conducted in 364 patients with T2DM who were hospitalized in the Department of Endocrinology and Geriatrics of the Affiliated Huaian No. 1 People′s Hospital of Nanjing Medical University from September 2019 to September 2020. Participants were stratified into tertiles(lower, middle, and upper) according to femoral BMD determined by dual-energy X-ray absorptiometry. Demographic characteristics, medical history, chronic diabetes complications, and comorbid conditions were compared among the 3 groups. The association between hemoglobin levels and BMD/osteoporosis was examined using multivariable logistic regression analyses. Interaction and stratified analyses were conducted according to age, body mass index(BMI), duration of diabetes, estimated glomerular filtration rate(eGFR), glycosylated hemoglobin(HbA 1C), total cholesterol(TC), triglycerides(TG), high-density lipoprotein-cholesterol(HDL-C), low-density lipoprotein-cholesterol(LDL-C) and uric acid(UA). Results:After adjusting for age, BMI, and duration of diabetes, there were no significant differences observed in the association between hemoglobin levels and BMD or osteoporosis among postmenopausal women with T2DM(all P>0.05). After adjusting for age, BMI, duration of diabetes, and eGFR, men aged≥50 years with hemoglobin≥130 g/L showed a positive association between hemoglobin level and femoral neck BMD compared to those with hemoglobin<130 g/L( β=0.057, 95% CI 0.014-0.100, P=0.011). However, no significant associations were observed between hemoglobin level and BMDs at the total hip or lumbar spine(L1-L4), nor the risk of osteoporosis(all P>0.05). Stratified analyses revealed no significant differences in the subgroups classified based on age, BMI, diabetes duration, eGFR, HbA 1C, TC, TG, HDL-C, LDL-C, and UA(all interaction P>0.05). Conclusion:In males aged 50 and above with T2DM, elevated hemoglobin levels may be a protective factor for femoral neck bone density.

AIM:To explore the roles and associations of hepatocyte nuclear factor 4 alpha(HNF4A)and mu-protocadherin(MUCDHL)in the kidney of diabetic mice.METHODS:(1)A cohort of six 12-week-old db/m mice and six db/db mice were selected and maintained on a standard diet until 16 weeks.The protein levels of fibronectin(FN),collagen type III(Col-III),E-cadherin,α-smooth muscle actin(α-SMA),HNF4A,Snail and MUCDHL in renal tissues were scrutinized using Western blot.Immunohistochemical staining was conducted to observe the distribution and expres-sion of FN,HNF4A and MUCDHL.(2)Mouse renal tubular epithelial cells(mRTEC)were cultured in vitro and catego-rized into groups:normal glucose(NG)group,high glucose(HG)group,overexpression control groups(NG+vector and HG+vector),overexpression groups(NG+OE-MUCDHL,HG+OE-MUCDHL,NG+OE-HNF4A and HG+OE-HNF4A),knockdown control groups(NG+control and HG+control),and knockdown groups(NG+si-MUCDHL,HG+si-MUCDHL,NG+si-HNF4A and HG+si-HNF4A).The relevant protein levels were also detected by Western blot.RESULTS:(1)In db/db group,elevated body weight,blood glucose and urine albumin-to-creatinine ratio(UACR)indicated significant re-nal injury.Compared with db/m group,the mice in db/db group exhibited increased expression of FN,Col-III,α-SMA and Snail,and decreased expression of E-cadherin,HNF4A and MUCDHL.MUCDHL was predominantly expressed in the apical membrane of renal tubular epithelial cells,FN in the tubular mesenchyme,and HNF4A in the plasma and nu-cleus of renal tubular cells.(2)In HG group,there was an up-regulation in the expression of fibrosis-related proteins and a down-regulation in the expression of E-cadherin,HNF4A and MUCDHL compared with NG group.Overexpression of MUCDHL led to a decrease in the expression of FN,Col-III,α-SMA and Snail proteins,an increase in the expression of E-cadherin and MUCDHL proteins,and unaltered expression of HNF4A.Knockdown of MUCDHL resulted in a reversal of the aforementioned effects,with HNF4A expression remaining unaltered.Overexpression of HNF4A led to an increased ex-pression of MUCDHL,and the expression changes of the remaining indicators were consistent with the overexpression of MUCDHL.Knockdown of HNF4A reversed the aforementioned effects.MUCDHL may represent a downstream target gene of HNF4A.CONCLUSION:The diminished expression of HNF4A and MUCDHL in the renal tubules of diabetic mice implies their involvement in the progression of renal fibrosis in diabetic kidney disease(DKD).HNF4A may potentially impede the progression of renal fibrosis in DKD by up-regulating the expression of MUCDHL.

African swine fever(ASF),caused by the African swine fever virus(ASFV),is a highly contagious infectious disease of pigs.This disease has been spread rapidly in China since 2018,po-sing a huge threat to China's pig farming industry.To rapid detect the ASFV,a loop-mediated iso-thermal amplification(LAMP)combined with the disposable nucleic acid visualization test strip was established for visual detection of the nucleic acid of ASFV B646L gene.The method was easy to operate without special instruments and equipment,while it effectively avoided the disadvantage of false positives caused by aerosol contamination.The method was able to detect 1.16 copies/μL of the recombinant plasmid in 50 min at 65 ℃.In addition,the method was specific with no cross-re-action with classical swine fever virus,porcine reproductive and respiratory syndrome virus,por-cine parvovirus,transmissible gastroenteritis virus.The results in this study provides a rapid,con-venient,sensitive and reliable method for early diagnosis and screening for ASFV suspected infec-tion cases.

Objective:To explore the effect of motivational enhancement group intervention conducted by nur-ses on the motivation of self-improvement,relapse tendency and self-esteem in the recovering male amphetamine addicts.Methods:Ninety-eight recovering male amphetamine addicts in the Compulsory Detoxification Center were randomly divided into control group(n=54)and motivational enhancement group(n=44).The addicts in the con-trol group received routine education while those in the motivational enhancement group received routine education combined with a 12-week motivational enhancement group intervention conducted by nurses.The Stages of Change Readiness and Treatment Eagerness Scale(SOCRATES),Relapse Tendency Questionnaire,and Rosenberg Self-es-teem Scale(RSES-T)were applied to measure the effect,before and after the intervention.Results:In both two groups,the scores of RSEST,questionnaire of relapse tendency,and self-confidence of detoxification were lower af-ter 12-week intervention than at the baseline(Ps＜0.05).After 12-week intervention,all the above scores were lower in the motivational enhancement group than in the control group(Ps＜0.05).Conclusion:Compared with routine education,the motivational enhancement group intervention conducted by nurses may be more effective to improve their self-confidence in drug rehabilitation and prevention of relapse in recovering male amphetamine ad-dicts,however,the improvement on self-esteem is limited.

Objective To investigate the distribution of B cells in both tumor and non-tumor tissues of gastric cancer patients,analyze their phenotypic characteristics and explore the impact on T cell proliferation.Methods Immunohistochemical staining was utilized to detect the expression of B cell surface marker CD 19 in tumor and non-tumor tissues from 33 gastric cancer patients.The expression levels of chemokine receptors and immunoglobulin molecules on B cells in both tumor and non-tumor tissues were measured using flow cytometry.Chemotaxis experiments were conducted to examine the role of the CXCL12-CXCR4 axis in B cell chemotaxis.B cells isolated and purified from both tissue types were co-cultured with autologous peripheral T cells to assess their effect on T cell proliferation.Results There were significantly more B cells infiltrated in tumor tissues than those infitrated in the non-tumor tissues of gastric cancer patients(P＜0.01),and CXCR4 was highly expressed on tumor-infiltrating B cells compared with B cells derived from non-tumor tissues(P＜0.05).The Cancer Genome Atlas(TCGA)analysis indicated that the expression level of CXCL12 in tumor tissues was positively correlated with the expression level of CD19 in gastric cancer patients(r=0.15,P＜0.01).And the expression level of CXCL12 in tumor tissues of the gastric cancer patients was also positively correlated with the number of B cells infiltrated in tumor tissues.Chemotaxis experiments confirmed that the CXCL12-CXCR4 axis was involved in promoting B cell chemotaxis(P＜0.05).Although B cells in tumor and non-tumor tissues had similar levels of IgM,IgG,and IgA expression,tumor-infiltrating B cells significantly inhibited the proliferation of T cells when compared with B cells derived from non-tumor tissues(P＜0.01).Conclusion There are more B cells infiltrated in gastric cancer tissues,which may be recruited to tumor tissues through the CXCL12-CXCR4 axis,and then inhibit T cell proliferation to promote the progression of gastric cancer.

Surgery is the mainstay of lung cancer treatment options.Traditionally,lobectomy has held its place as the gold standard for treating localized lung cancer,while sublobar resection,including wedge resection and segmentectomy,was primarily considered as an alternative,often reserved for patient ineligible to sustain a radical intervention.However,with the widespread application of computed tomography(CT)to clinical practice,the increasing detection rate of pulmonary ground glass nodules(GGNs)has reshaped this landscape.Ground glass opacity(GGO)in persistent lung nodules is an indicative factor of a favorable prognosis,typically corresponding to pathological changes such as atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),or adenocarcinomas predominantly featuring a lepidic growth pattern.A large number of retrospective studies have shown that sublobar resection can achieve satisfactory therapeutic outcomes for such lesions.A series of prospective studies from Japan have confirmed that for early-stage lung cancers dominated by GGOs,sublobar resection is also a viable curative surgical option.The follow-up data showed that there was no statistical difference in the survival status of these patients compared with that of pulmonary lobectomy.This article aims to delve into the role of limited lung resection in the context of lung adenocarcinoma presenting with GGO features.

Objective:To evaluate the effect of low-dose esketamine for postoperative analgesia on the postoperative depression in patients with gastrointestinal tumors.Methods:This study was a prospective randomized controlled trial. Eighty patients, aged 18-64 yr, with a body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective radical resection of the gastrointestinal tumor under general anesthesia from June to November 2023 in our hospital, were divided into 2 groups ( n=40 each) using a random number table method: esketamine group (group E) and control group (group C). Each patient received postoperative patient-controlled intravenous analgesia(PCIA). The PCIA solution in group E contained esketamine 0.5 mg/kg, dezocine 0.5 mg/kg, dexmetomidine 1.5 μg/kg and flurbiprofen ester 100 mg in 100 ml of normal saline. The PCIA solution in group C contained dezocine 0.5 mg/kg, dexmetomidine 1.5 μg/kg and flurbiprofen ester 100 mg in 100 ml of normal saline. The Hospital Anxiety and Depression Scale (HADS) was used to assess the patients′ anxiety and depression at 1 day before operation (T 0) and 2 days after operation (T 1). The Quality of Recovery-15 scale was used to evaluate the early postoperative recovery quality. Visual analog scale scores, the pressing times of patient-controlled analgesia and the number of rescue analgesia were recorded within 2 days after operation. The occurrence of drug-related adverse reactions was also recorded. Results:Seventy-eight patients were finally included, with 39 cases in group E and 39 cases in group C. Compared with group C, the postoperative HADS-depression scale score and incidence of depression were significantly decreased, the Quality of Recovery-15 scale score was increased, the visual analog scale scores were decreased ( P<0.05), and no significant changes were found in the postoperative HADS-anxiety scale score and incidence of anxiety, the pressing times of patient-controlled analgesia and the number of rescue analgesia in group E ( P>0.05). Visual hallucination was found at 1 day after operation in one patient and relieved at 2 days after operation in group E. There was no significant difference in the incidence of postoperative dizziness, nausea and vomiting between the two groups ( P>0.05). Conclusions:Postoperative analgesia with 0.5 mg/kg esketamine can alleviate postoperative depressive symptoms, enhance the efficacy of analgesia and improve the early postoperative recovery quality in patients with gastrointestinal tumors.

Japanese encephalitis is an acute central nervous system infectious disease caused by Japanese encephalitis virus (JEV) with brain parenchyma inflammation, characterized by high fever, headache, positive meningeal irritation, impaired consciousness, convulsion, and respiratory failure, with mortality rate as high as 20%-30%, and with neurological sequelae in 30%-50% of survivors. The mechanism of brain damage caused by JEV infection is still unclear, and some studies imply its close relation with immune-inflammatory response. This article reviews the research progress on immune-inflammatory response mechanism of Japanese encephalitis to help to understand its pathogenesis.