Bacterial biofilms(BF)are complex microbial communities formed by bacteria on living or abiotic surfaces.Their formation significantly enhances bacterial virulence and drug resistance and is associated with a high proportion of chronic bacterial infections,posing a serious threat to human health.The ability of traditional antibiotics and commonly used disinfectants to clear biofilms is limited,and an effective new strategy to treat BF is urgently needed.Bacteriophage,as a kind of virus that can infect and lyse bacteria,has high safety and specificity,and is considered as a promising alternative method for the treatment of BF.In this paper,the mechanism of bacteriophage anti-bacterial biofilm and the application strategies based on bacteriophage and its derivatives in the prevention and control of bacteriophage biofilm formation were reviewed,which provided new ideas for the development of efficient bacteriophage anti-bacterial biofilm methods.

Objective To establish a Nomogram model for assessing the risk of intestinal colonization by Carbapenem-Resistant Klebsiella pneumoniae(CRKP)to determine the specific probability of colonization and adopt individualized prevention strategies for the purpose of reducing the occurrence of colonization and secondary infection of neonatal CRKP.Methods A total of 187 neonates hospitalized between January 2021 and October 2022 and diagnosed with CRKP colonization by rectal swab/fecal culture as well drug sensitivity identification 48 h after admission were assigned to the CRKP group.Another 187 neonates without non-CRKP colonization during the same period were set as the non-CRKP group.All the data of the two groups were used for a retrospective analysis.The caret package in R 4.2.1 was used to randomly divide the 374 cases into the model group and validation group at a ratio of 3∶1.Then the glmnet package in R 4.2.1 was used to conduct a LASSO regression analysis over the data from the model group to determine the predictive factors for modeling and the rms software package was used to build a Nomogram model.The pROC and rms packages in R 4.2.1 were used to examine the data,analyzing the consistency indexes(Cindex),receiver operating characteristic curves(ROC),and area under the curves(AUC)and performing the internal and external validation of the efficacy of the Nomogram model via the calibration curves.Results LASSO regression analysis determined eight predictors from the 35 factors probably affecting neonatal CRKP colonization:gender,cesarean section,breastfeeding,nasogastric tube,enema,carbapenems,probiotics,and hospital stay.The Nomogram model constructed using these eight predictors as variables could predict CRKP colonization to a moderate extent,with the area under the ROC curve of 0.835 and 0.800 in the model and validation group,respectively.The Hos-mer-Lemeshow test showed that the predicted probability was highly consistent with the actual probability(the modeling group:P = 0.678>0.05;the validation group:P = 0.208>0.05),presenting a higher degree of fitting.Conclusion The Nomogram model containing such variables as gender,cesarean section,breastfeeding,nasogastric tube,enema,carbapenems,probiotics,and hospital stay is more effective in predicting the risk of neonatal CRKP colonization.Therefore,preventive measures should be individualized based on the colonization probability predicted by the Nomogram model in order to keep neonates from CRKP colonization and reduce the incidence of secondary CRKP infections among them.

Objective To establish a noninvasive diagnostic model for liver fibrosis in chronic hepatitis B(CHB)patients with normal alanine aminotransferase(ALT)and an age of≤30 years by selecting specific indicators from the commonly used noninvasive indicators such as clinical,biochemical,and imaging indicators,to avoid invasive liver biopsy in such patients to some extent,and to guide the timing of antiviral therapy.Methods A total of 251 CHB patients with normal ALT and an age of≤30 years who underwent liver biopsy in Shenzhen Third People's Hospital and The First Hospital of Changsha from January 2019 to January 2022 were enrolled,with 175 patients in the model group and 76 patients in the validation group,and commonly used clinical indicators were obtained based on clinical experience and related articles.The two-independent-samples t test or the two-independent-samples Mann-Whitney U rank sum test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.A Spearman rank correlation analysis was used to investigate the correlation between each indicator and liver fibrosis and identify the indicators with correlation(P<0.01,r>0.200);a Logistic regression analysis was used to establish a noninvasive diagnostic model,and the receiver operating characteristic(ROC)curve was used to evaluate its performance and perform validation of the model;this model was then compared with the widely used models of aspartate aminotransferase-to-platelet ratio index(APRI)and fibrosis-4(FIB-4).The Kappa consistency test was used to investigate the consistency of pathological results.Results A total of 17 commonly used clinical indicators were obtained,among which 9 indicators(ALT,aspartate aminotransferase[AST],gamma-glutamyl transpeptidase[GGT],ferritin[FERR],platelet count[PLT],procollagen type Ⅲ amino-terminal peptide[PⅢP],collagen Ⅳ[CⅣ],HBV DNA,and spleen thickness)were correlated with liver fibrosis(P<0.01,r>0.232).Based on the above indicators,the predictive model was established as P=1/(1+e-γ),γ=-1.902+0.106×AST-0.011×PLT-0.265×HBV DNA+0.059×PⅢP,in which P was the probability for predicting≥S2 liver fibrosis and γ was the predictive index.The comparison between each indicator and the model showed that the model had the largest area under the ROC curve of 0.852,with a sensitivity of 92.7%and a specificity of 76.9%.The model was validated in 76 patients and showed an accuracy of 77.600%.The model was compared with APRI and FIB-4,and the results showed that the model has good accuracy.Conclusion Compared with the models of APRI and FIB-4 commonly used in the world,this model can more accurately judge the degree of liver fibrosis in such patients,thereby replacing liver biopsy to some extent and guiding the timing of antiviral therapy.

Objective Exploring the relationship between changes in serum Golgi apparatus transmem-brane glycoprotein 73(GP73)and chitosanase 3-like protein 1(CHI3L1)levels and liver fibrosis and lesion sever-ity in patients with hepatitis B(CHB).Methods Using a case-control study,80 patients diagnosed with CHB infection and developing liver fibrosis in the Infectious Disease Department of Changsha First Hospital from June 2020 to June 2023 were selected as the liver fibrosis group,while 120 patients diagnosed with CHB infection but not developing liver fibrosis in the Infectious Disease Department of our hospital were selected as the control group.The serum GP3,CHI3L1,liver function,and fibrosis indicators of the two groups of patients were compared,and the liver fibrosis group was divided into mild according to Scheuer system standards Perform stratified analysis on patients with significant liver fibrosis.Results The serum GP3 and CHI3L1 levels in the liver fibrosis group were significantly higher than those in the control group,with statistical significance(P＜0.05);The ROC curves were plotted using serum GP3,CHI3L1,and GP3+CHI3L1,respectively.The sensitivity for diagnosing liver fibrosis in CHB patients was 62.81%,60.94%,and 96.33%,with specificity of 80.66%,80.05%,and 75.30%.The AUC values under the curves were 0.792,0.756,and 0.908,respectively;The levels of ALT,AST,HA,LN,PC III NP,C IV,and CG in the liver fibrosis group were higher than those in the control group,and the PLT measurement values were lower than those in the control group,with statistical significance(P＜0.05);49 patients with moderate to severe liver fibrosis(33 in S2 phase and 16 in S3 phase)and 31 patients with mild liver fibrosis(all in S1 phase)had significantly higher serum GP3 and CHI3L1 levels than mild patients,with statistical significance(P＜0.05);The levels of DBIL,ALT,AST,HA,LN,PC III NP,C IV,and CG in patients with moderate to severe liver fibrosis were higher than those in the mild group,and the PLT measurement values were lower than those in the mild group,with statistical significance(P＜0.05).Conclusion The serum GP3 and CHI3L1 levels in CHB patients with liver fibrosis are significantly elevated,and there is a certain correlation with the degree of liver fibro-sis.The combination of these two indicators is beneficial for diagnosing liver fibrosis in CHB patients.

Objective:To evaluate the anesthetic effect of remazolam when combined with sufentanil in elderly patients with liver cirrhosis and esophageal and gastric varices undergoing endoscopic sclerotherapy.Methods:A total of 150 cirrhotic patients with liver cirrhosis and esophageal and gastric varices, regardless of gender, aged 65-80 yr, with body mass index of 18-24 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱor Ⅲ, who underwent endoscopic sclerotherapy under non-intubated general anesthesia from March 2022 to September 2023 in our hospital, were selected and divided into 2 groups ( n=75 each) by a random number table method: sufentanil plus propofol group (PS group) and sufentanil plus remazolam group (RS group). Anesthesia was induced with intravenous propofol 1-2 mg/kg and sufentanil 0.1 μg/kg and maintained by intravenous infusion of propofol 4-10 mg·kg -1·h -1 in PS group. Anesthesia was induced with intravenous remimazolam 0.1-0.2 mg/kg and sufentanil 0.1 μg/kg and was maintained with intravenous infusion of remimazolam 0.5-2.0 mg·kg -1·h -1 in RS group. BIS values were maintained between 40 and 60 during operation in both groups. Endoscopy was placed when the patients lost consciousness (modified observer′s assessment of alertness/sedation score ≤1). Sclerosing agent laurosinol injection was injected into esophageal submucosal varices in both groups. The time to loss of consciousness and recovery of consciousness, intraoperative body movement and cardiovascular events, and postoperative hypoxemia and nausea and vomiting were recorded. The operator-patient satisfaction was assessed by the visual analogue scale. Results:Compared with PS group, no significant changes were found in the incidence of intraoperative bradycardia, time to loss of consciousness and time to recovery of consciousness( P>0.05), the incidence of intraoperative hypotension was significantly decreased, the incidence of postoperative hypoxemia and nausea and vomiting was decreased, and the satisfaction scores for operators and patients were increased in RS group ( P<0.05). No obvious body movement was found in the two groups. Conclusions:Sufentanil combined with remifentanil provides better anesthetic effect than sufentanil combined with propofol in elderly patients with esophageal and gastric varices undergoing endoscopic sclerotherapy.

Acute kidney injury (AKI) is a common serious complication after acute ischemic stroke (AIS), which is associated with an increased mortality and disability. However, the clinical prevalence is often underestimated or overlooked. This article reviews the pathogenesis, risk factors, predictive factors, and predictive models of AKI in patients with AIS, in order to provide a basis for early clinical identification and diagnosis of AKI in patients with AIS.

Objective:To develop a risk prediction model for acute kidney injury (AKI) in young, middle-aged and elderly patients with acute ischemic stroke (AIS), and verify the predictive ability of the model.Methods:Patients admitted to the Department of Neurology, Lianyungang Hospital Affiliated to Xuzhou Medical University from January 2018 to August 2022 were retrospectively included as a modeling cohort, and patients with AIS from September 2022 to September 2023 were prospectively included as a validation cohort. Independent risk factors for AKI were determined by multivariate logistic regression analysis, and risk prediction models for AKI in young AIS patients group and middle-aged and elderly AIS patients group were developed. The predictive power of the model was tested using the receiver operating characteristic (ROC) curve. Results:The young group included 760 patients with AIS, of which 584 (76.84%) were in the modeling cohort, and 146 (25.00%) had AKI. Multivariate logistic regression analysis showed that anemia, systolic blood pressure, homocysteine, alcohol consumption, blood urea nitrogen, and National Institutes of Health Stroke Scale (NIHSS) score were independent risk factors for AKI (all P<0.05). ROC analysis showed that the area under the curve of the predictive model was 0.938 (95% confidence interval 0.912-0.963), the Youden index was 0.747, and the optimal cut-off value was 0.249. The sensitivity and specificity of predicting AKI were 84.8% and 89.9%, respectively. A total of 1 417 patients with AIS were included in the middle-aged and elderly group, of which 833 patients (58.79%) were in the modeling cohort and 230 (27.61%) had AKI. Multivariate logistic regression analysis showed that hypertension, atrial fibrillation, previous stroke history, smoking, infection, triglycerides, NIHSS score, use of antihypertensive drugs, use of loop diuretics, serum creatinine, and blood urea nitrogen were the independent risk factors for AKI ( P<0.05). ROC analysis showed that the area under the curve of the predictive model was 0.838 (95% confidence interval 0.808-0.868), the Youden index was 0.539, the optimal cut-off value was 0.242, and the predictive sensitivity and specificity were 78.3% and 75.6%, respectively. The Hosmer-Lemeshow goodness of fit test showed the predictive accuracy of the model was in good agreement with the actual occurrence of risk (the young group: χ2=8.968, P=0.345; the middle-aged and elderly group: χ2=11.250, P=0.188). The validation cohort analysis shows that the model had high prediction accuracy and credibility in two groups. Conclusion:The model can specifically predict the risk of AKI in young, middle-aged and elderly patients with AIS, with high sensitivity and specificity.

Humans ; China/epidemiology* ; SARS-CoV-2 ; COVID-19

Objective:To evaluate the effects of different concentrations of ropivacaine on the growth and migration of lung cancer cells.Methods:Human lung adenocarcinoma cell strain A549 cells and human lung squamous cell strain H520 cells were divided into 4 groups ( n=24 each) using a random number table method: control group (group C) and different concentrations of ropivacaine groups (Ⅰ-Ⅲ groups). Cells were commonly cultured in group C. Ropivacaine 3, 5 and 7 mmol/L were added and then the cells were cultured in Ⅰ-Ⅲ groups, respectively. The cell survival rate was determined using the CCK-8 method at 24, 48 and 72 h of treatment (T 1-3). The cell cycle and apoptosis were detected at T 1 using flow cytometry. The expression of Cyclin D1, cyclin-dependent kinase 4 (CDK4), cleaved poly (ADP-ribose) polymerase-1 (PARP-1) and cleaved caspase-3 was detected using Western blot. Wound healing assay was used to measure cell migration distance. The activities of RhoA and Rac1 were detected by microplate spectrophotometry. Results:The cell viability of A549 and H520 cells sequentially decreased at T 1-3, the proportion of G0/G1 phase and apoptosis sequentially increased, the expression of Cyclin D1 and CDK4 was down-regulated sequentially at T 1, the expression of cleaved PARP-1 and cleaved caspase-3 was up-regulated sequentially, and the cell migration distance, RhoA, and Rac1 activity decreased sequentially in C, Ⅰ, Ⅱ and Ⅲ groups ( P<0.05). Conclusions:Ropivacaine can inhibit the growth and migration ability of lung cancer cells in a concentration-dependent manner, which is related to induction of cell cycle arrest and apoptosis.

Objective:To investigate the effect of psychological support during perithrombotic period on post-stroke depression (PSD) in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received intravenous thrombolysis in the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 1, 2021 to July 31, 2021 were enrolled prospectively. The intervention group received one-to-one individual psychological support therapy in the perithrombolytic period on the basis of receiving standard intravenous thrombolytic therapy. At 30 d after onset, Hamilton Depression Scale was used to assess whether PSD occurred. Multivariate logistic regression analysis was used to evaluate the independent influencing factor of PSD. Results:A total of 126 patients with AIS were enrolled, and 86 of them were male (68.25%). Their age was 63.65±10.46 years; 65 were in the intervention group and 61 were in the control group. The incidence of PSD in the intervention group was significantly lower than that in the control group (20.00% vs. 36.07%; χ2=4.049, P=0.044). Multivariate logistic regression analysis showed that psychological intervention (odds ratio [ OR] 0.333, 95% confidence interval [ CI] 0.132-0.838; P=0.020] was an independent protective factor for PSD, while ischemic heart disease ( OR 4.510, 95% CI 1.181-17.217; P=0.028), alcohol consumption ( OR 3.421, 95% CI 1.317-8.888; P=0.012), anticoagulation therapy ( OR 3.145, 95% CI 1.155-8.567; P=0.025) and modified Rankin Scale score before thrombolysis ( OR 1.627, 95% CI 1.142-2.317; P=0.007) were the independent risk factors for PSD. Conclusion:Perithrombolytic psychological support may reduce the incidence of PSD.