Objective To explore the risk factors of complicating urogenic sepsis after percutaneous nephrolithotripsy(PCNL)and construct a nomogram prediction model.Methods The data of 291 patients with stage 1 PCNL in 940 Hospital of Joint Logistics Support Force from October 2016 to October 2021 were retrospectively analyzed.The patients were divided into the sepsis group and non-sepsis group according to whether complicating urogenic sepsis after operation.The general data,stone-related data,operation-related data and laboratory detection related data were included.The independent risk factors were screened by the univariate and multivariate logistic regression analysis,and the nomogram prediction model was constructed.Results The results of univariate and multivariate logistic regression analysis showed that age≥60 years old(OR=6.438,95％CI:1.548-26.769),urinary leukocyte 3+(OR=5.651,95％CI:1.614-31.766),urinary nitrite positive(OR=7.117,95％CI:1.190-42.561),operation time≥90 min(OR=4.626,95％CI:1.137-18.817)and perfusion volume 30 L(OR=3.312,95％CI:1.090-10.061)were the independent risk factors of postoperative complicating urogenic sepsis.C-index of the constructed nomogram prediction model in the modeling samples was 0.937,the calibrated C-index was 0.914,and the model predictive efficien-cy was good.Conclusion Age ≥60 years old,urinary leukocyte 3+,urinary nitrite positive,operation time 90 min and perfusion volume ≥30 L are the independent risk factors for complicating urogenic sepsis after PCNL;the constructed nomogram prediction model has a good predictive efficiency for the occurrence of post-operative urogenic sepsis.

Objective To investigate the effect of autophagy activation on cell proliferation in human umbilical vein endothelial cells(HUVECs).Methods HUVECs were treated with rapamycin(Rapa).Western blot assay was performed to examine the expression of protein of microtubule associated protein 1 light chain 3(LC3),Beclin 1 and unc-51-like kinase 1(ULK1).Autophagosomes were detected by transmission electron microscopy(TEM),and autophagy fluorescence was detected by monodansylcadaverine staining(MDC)assay.The effect of autophagy activation on cell proliferation was assessed by CCK-8 assay and EdU assay.Vascular formation experiments were used to detect vasculogenic ability.Results After Rapa treatment,LC3,Beclin1 and ULK1 expressions were en-hanced,while the green autophagy fluorescence expression in the experimental group was stronger than that in the control group,and autophagosomes were visible by TEM;CCK-8 and EdU results showed that compared with the control group,the cell proliferation ability was weakened and tubes formation ability was reduced after the activation of autophagy in experimental cells.Conclusion Rapa upregulates autophagy activity in HUVECs to inhibit cell proliferation under certain time.

Background::Atopic dermatitis (AD) affects approximately 10% of adults worldwide. CM310 is a humanized monoclonal antibody targeting interleukin-4 receptor alpha that blocks interleukin-4 and interleukin-13 signaling. This trial aimed to evaluate the efficacy and safety of CM310 in Chinese adults with moderate-to-severe AD.Methods::This multicenter, randomized, double-blind, placebo-controlled, phase 2b trial was conducted in 21 medical institutions in China from February to November 2021. Totally 120 eligible patients were enrolled and randomized (1:1:1) to receive subcutaneous injections of 300 mg CM310, 150 mg CM310, or placebo every 2 weeks for 16 weeks, followed by an 8-week follow-up period. The primary endpoint was the proportion of patients achieving ≥75% improvement in the Eczema Area and Severity Index (EASI-75) score from baseline at week 16. Safety and pharmacodynamics were also studied.Results::At week 16, the proportion of EASI-75 responders from baseline was significantly higher in the CM310 groups (70% [28/40] for high-dose and 65% [26/40] for low-dose) than that in the placebo group (20%[8/40]). The differences in EASI-75 response rate were 50% (high vs. placebo, 95% CI 31%–69%) and 45% (low vs. placebo, 95% CI 26%–64%), with both P values <0.0001. CM310 at both doses also significantly improved the EASI score, Investigator’s Global Assessment score, daily peak pruritus Numerical Rating Scale, AD-affected body surface area, and Dermatology Life Quality Index compared with placebo. CM310 treatment reduced levels of thymus and activation-regulated chemokine, total immunoglobulin E, lactate dehydrogenase, and blood eosinophils. The incidence of treatment-emergent adverse events (TEAEs) was similar among all three groups, with the most common TEAEs reported being upper respiratory tract infection, atopic dermatitis, hyperlipidemia, and hyperuricemia. No severe adverse events were deemed to be attributed to CM310. Conclusion::CM310 at 150 mg and 300 mg every 2 weeks demonstrated significant efficacy and was well-tolerated in adults with moderate-to-severe AD.Trial Registration::ClinicalTrials.gov, NCT04805411.

Objective To explore the selection strategy of diagnostic and therapeutic regimens and assess the efficacy for postoperative infection following internal fixation of patellar fractures. Methods A retrospective analysis was conducted on the clinical data of 12 patients with postoperative infection after internal fixation of patellar fractures. Results A total of 6 patients underwent complete removal of the internal fixation devices during debridement and were subsequently fixed with knee braces, while the other 6 had their original internal fixation devices removed and replaced with Kirschner wire fixation. Three patients developed septic arthritis and underwent knee arthroscopic lavage treatment. All 12 patients underwent bacterial culture and metagenomic next-generation sequencing (mNGS) testing, and the key pathogenic bacteria were successfully identified by mNGS. All wounds achieved primary healing within 2 weeks after closure. At the final follow-up, all patients exhibited good fracture healing, with Böstman patellar fracture function scores ranging from 24 to 29 (mean score of 26.58), and the outcomes were evaluated as excellent in 7 cases and good in 5, resulting in an excellent and good rate of 100.0%. Conclusion For patients with early and delayed postoperative infections following internal fixation of patellar fractures, removal of the internal fixation devices can help reduce the risk of infection recurrence. For patients with concurrent septic arthritis, early diagnosis and timely implementation of arthroscopic joint debridement and irrigation and drainage are crucial.

Critically ill patients are at high risk for hospital acquired infections, which can significantly increase the mortality rate and treatment costs for these patients. Therefore, in the process of treating the primary disease, strict prevention and control of new hospital infections is an essential component of the treatment for critically ill patients. The treatment of critically ill patients involves multiple steps and requires a concerted effort from various aspects such as theory, management, education, standards, and supervision to achieve effective prevention and control of hospital infections. However, there is currently a lack of unified understanding and standards for hospital infection prevention and control. To address this, in March 2024, a group of experts in critical care medicine, infectious diseases, and hospital infection from China discussed the current situation and issues of hospital infection control in the intensive care unit together. Based on a review of the latest evidence-based medical evidence from both domestic and international sources, 2024 Expert Consensus on Hospital Acquired Infection Control Principles in the Department of Critical Care Medicine was formed, aiming to provide a basis for the development of hospital infection prevention and control strategies in the field of critical care medicine.

Gallbladder carcinoma,a relatively rare malignancy within the biliary tract,presents a grave prognosis primarily due to asymptomatic early stages leading to advanced stage diagnosis and the absence of efficacious treatment options.Research has identified chronic inflammation,predom-inantly caused by gallstones,as a critical etiological factor.While surgical intervention offers potential curative outcomes in early stages,the majority of cases are identified too late for optimal surgical outcomes.Chemotherapy and targeted therapy,despite offering new therapeutic avenues,have not significantly improved overall survival rates.Thus,understanding the pathogenesis of gallbladder cancer,especially its association with key genetic and molecular pathways,is imperative for devising novel therapeutic strategies.This review delineates the epidemiology,pathogenesis,current treat-ment modalities,and research advancements in gallbladder cancer,aiming to provide innovative in-sights for clinical management and guide future research endeavors.

Objective To explore the effect of rifampicin on the pharmacokinetics of linezolid in mice and provide pharmacokinetic evidence for the formulation of safe drugs for clinical use of pulmonary tuberculosis.Methods Fifty male KM mice were randomly divided into 2 groups:Control group,rifampicin group;the control group was given 15 mg·kg-1 linezolid;the rifampicin group was given 100 mg·mL-1 rifampicin,continuous administration for 7 days,followed by gavage,administration of 15 mg·kg-1 linezolid;blood and lung tissue were collected from mouse at different time points after administration.High performance liquid mass spectrometry(LC-MS/MS)was used to determine plasma concentration of linezolid and compared the pharmacokinetics between groups.Pharmacokinetic parameters were calculated using DAS 2.0 software.Results Main pharmacokinetic parameters of plasma linezolid in control group,rifampicin group were as follows:AUC0_t were(23.88±1.16)and(19.06±2.56)pg·mL-1·h,respectively;t1/2 were((1.15±0.11)and(1.11±0.10)h,respectively;Cmax were(9.93±0.46)and(7.74±1.17)μg·mL-1,respectively.The main pharmacokinetic parameters of the lungs in the control group and the rifampicin group were as follows:AUC0_t were(18.76±4.29)and(14.90±1.52)μg·mL-1·h,respectively;t1/2 were(1.94±0.50)and(1.44±0.07)h,respectively;Cmax were(8.28±2.67)and(6.82±1.57)μg·mL-1,respectively.AUC0_t and Cmax in plasma and AUC0_t in lung tissue of control group were significantly different from those of rifampicin group(all P＜0.05).Conclusion After the combination of rifampicin,linezolid plasma and lung tissue exposure decreased significantly,and attention should be paid to monitoring linezolid trough concentration when the two drugs were combined to avoid treatment failure caused by low effective concentration.

Using column chromatography methods including the macroporous adsorbent resin, MCI gel CHP 20P, ODS-A-HG, Sephadex LH-20, combined with chromatographic separation methods such as TLC and reversed-phase HPLC, three glycosides (1-3) and two peptides including two new compounds were isolated from the ethanol extract of arthropod Scolopendra subspinipes mutilans. Their structures were identified as colosides A and B (1 and 2), 3,4-dihydroxyquinoline-4-O-β-D-glucopyranoside (3), aurantiamide (4), cyclo (L-phe-L-val) (5) by UV, NMR and HR-ESI-MS spectroscopic techniques.

Objective To investigate the effect of minocycline(Mino)on the polarization of types M1/M2 microglia(pro-and anti-inflammatory type)in the spinal dorsal horn of rats with neuropathic pain(NP)induced by spinal nerve ligation(SNL)and its underlying mechanism.Methods A total of 36 adult male SD rats were randomly stratified into Sham-operation(Sham)group,SNL group and Mino+SNL group by stratified random sampling based on body weight.Mechanical pain threshold and cold nociceptive thresholds of rat hind paw were measured in 1 d before and 14 d after modelling.Spinal cord tissue at the lumbar 5(L5)segment was taken at 14 d after modelling,and the total number of microglia as well as the numbers of M1 and M2 microglia in the spinal dorsal horn were measured with immunohistochemistry and stereology.With aid of bioinformatics techniques,the core target in the spinal cord,Cst7,was selected.Then,the protein levels of microglia marker Iba-1,M1 microglia marker iNOS,M2 microglia marker CD206,Cst7 encoded protein cystatin F(CF)and pathway CatS/CX3CL1/CX3CR1 were detected with Western blotting.The expression levels of TNF-α,IL-6 and IL-10 in the spinal cord tissues were measured with ELISA.Results The mechanical pain and cold nociceptive thresholds were both significantly higher in the M+SNL group than the SNL group at 7～14 d after modelling(P＜0.01).The total number of microglia and the numbers of M1/M2 microglia in the spinal dorsal horn as well as the expression levels of CatS,CX3CL1,CX3CR1,TNF-α,IL-6,and IL-10 in the spinal cord tissues were obviously increased,and the expression level of CF was notably decreased in the SNL model group than the Sham group(P＜0.01).While,Mino treatment remarkably reversed above phenomena,with decreased total number of microglia and number of M1 microglia as well as expression levels of CatS,CX3CL1,CX3CR1,TNF-α and IL-6,and increased number of M2 microglia as well as CF and IL-10 levels when compared with the SNL group(P＜0.05).Conclusion Mino alleviates SNL induced neuropathic pain,probably through up-regulating CF in the microglia,and thus inhibiting the CatS/CX3CL1/CX3CR1 signaling pathway,promoting the conversion of microglia from type M1 to M2 to balance the imbalance in the M1/M2 polarization,and thus reducing neuroinflammation.

Objective:To discuss the clinical curative effect of the treatment of bundling bone fragment with figure-of-eight suture through double bone tunnels in the chronic bong mallet finger.Methods:A retrospective analysis was performed on patients with chronic bong mallet fingers who underwent surgery in the Department of Hand and Foot Microsurgery of Nanjing Jiangbei Hospital from May 2021 to February 2023. During the procedure, made into transverse double bone tunnels on the base of the distal phalanx with 0. 8 mm Kirschner wire, bundling bone fragment with figure-of-eight suture through double bone tunnels, then fixed with Kirschner wire elastic compression. Removal of the Kirschner wire 3 weeks after the procedure, the active flexion and extension range of the joints of the affected finger and the corresponding finger were measured at the last follow-up, then the range of motion (ROM) of the distal interphalangeal joint (DIPJ) and total action movement (TAM) of the fingers (affected and healthy finger) were recorded. The curative effects were evaluated according to the TAM system of the American Association of Hand Surgeons, including 4 grades: excellent, good, fair, and poor. SPSS 13. 0 software was used for statistical analysis of the data, and the measurement data conforming to normal distribution were expressed as Mean ± SD. The ROM of DIPJ and TAM of the affected finger were compared with the corresponding healthy finger 6 months after surgery by a paired sample t test. P<0. 05 indicates that the difference is statistically significant. Results:A total of 30 patients (30 digits) were enrolled, including 19 males and 11 females, and the age ranged from 18 to 62 years old, with an average age of 31 years old. The time from injury to operation was 24 to 65 days (mean of 35 days) . According to Wehbe and Schneider classification, there were 8 cases of type Ⅰa, 6 cases of type Ⅰb, 7 cases of type Ⅱa, 5 cases of type Ⅱb, 2 cases of type Ⅲa and 2 cases of type Ⅲb. All incisions healed well, the intraoperative blood loss was minimal, with no infection. All 30 cases were followed up for 6 to 7 months. All fractures were well aligned and healed, malformed fingers were completely corrected, and no needle tunnel infection or needle breakage were observed. At the last follow-up, the differences of the ROM of the DIPJ [ (30. 2±3. 5) °vs. (30. 4±3. 3) °, t=2. 57, P=0. 463] and the TAM [ (235. 3± 3. 6) ° vs. (237. 7± 4. 2) °, t=1. 78, P= 0. 247 ] between the affected and healthy fingers were not statistically significant. Finger function assessment: 27 cases were excellent, and 3 cases were good, and the excellent and good rate was 100%. Conclusion:Satisfactory therapeutic outcome for the treatment of chronic bong mallet finger deformity can be achieved by bundling bone fragment with figure-of-eight suture through double bone tunnels. It is an effective and practical method.