Aim To prepare tripterygium glycoside nanoparticles and probe into their therapeutic effect on collagen-induced arthritis ( CIA) rats. Methods Tripterygium glycosides polyglycoside nanoparticles were prepared by thin film dispersion method and their quality was assessed. The CIA model was established and drug intervention performed. The body weight, toe swelling degree and arthritis index were measured. The pathological changes of the organs, knee and ankle synovium were observed. The serum levels of kidney function and inflammatory cytokine expression were detected in rats. Results The prepared tripterygium wil-fordii polyglycoside nanoparticles were round particles with uniform distribution and stable properties under electron microscope. Compared with the model group, the swelling of the left and right toes of medication group significantly decreased (P < 0. 01), and the ar-thritis index markedly decreased ( P < 0. 01). Among them, the efficacy of the TG-NPs group was better than that of the TG group. Compared with the normal group, the indexes of heart, spleen, kidney and testis all significantly decreased (P <0. 05, P<0.01). TG-NPs group had a significantly reduced pathological ankle-joint injury in knee cartilage and increased apoptotic synovial cells. Compared with the model group, the serum levels of ALT and BUN and CRE in TG-NPs group were significantly lower (P < 0. 05 ), and IL-1β, TNF-α and IL-6 levels decreased significantly (P <0. 05). Conclusions TG-NPs have good therapeutic effect on CIA through induction of synovial cell apoptosis and decrease of the expression of inflammatory cytokines. By intravenous injection of blood circula-tion, slow and controlled release of drugs can be achieved, the first pass effect caused by oral drug can be avoided, the viscera toxicity can be reduced, which provides an experimental basis for the development of new nanoagents for the treatment of rheumatoid arthritis.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of national bloodstream infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:During the study period，9 035 strains of Gram-negative bacteria were collected from 51 hospitals，of which 7 895（87.4%）were Enterobacteriaceae and 1 140（12.6%）were non-fermenting bacteria. The top 5 bacterial species were Escherichia coli（ n=4 510，49.9%）， Klebsiella pneumoniae（ n=2 340，25.9%）， Pseudomonas aeruginosa（ n=534，5.9%）， Acinetobacter baumannii complex（ n=405，4.5%）and Enterobacter cloacae（ n=327，3.6%）. The ESBLs-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus spp. were 47.1%（2 095/4 452），21.0%（427/2 033）and 41.1%（58/141），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（58/4 510）and 13.1%（307/2 340）；62.1%（36/58）and 9.8%（30/307）of CREC and CRKP were resistant to ceftazidime/avibactam combination，respectively. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 59.5%（241/405），while less than 5% of Acinetobacter baumannii complex was resistant to tigecycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 18.4%（98/534）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of main Gram-negative bacteria resistance among different regions，with statistically significant differences in the prevalence of CRKP and CRPA（ χ2=20.489 and 20.252， P<0.001）. The prevalence of CREC，CRKP，CRPA，CRAB，ESBLs-producing Escherichia coli and Klebsiella pneumoniae were higher in provinicial hospitals than those in municipal hospitals（ χ2=11.953，81.183，10.404，5.915，12.415 and 6.459， P<0.01 or <0.05），while the prevalence of CRPA was higher in economically developed regions（per capita GDP ≥ 92 059 Yuan）than that in economically less-developed regions（per capita GDP <92 059 Yuan）（ χ2=6.240， P=0.012）. Conclusions:The proportion of Gram-negative bacteria in bloodstream infections shows an increasing trend，and Escherichia coli is ranked in the top，while the trend of CRKP decreases continuously with time. Decreasing trends are noted in ESBLs-producing Escherichia coli and Klebsiella pneumoniae. Low prevalence of carbapenem resistance in Escherichia coli and high prevalence in CRAB complex have been observed. The composition ratio and antibacterial spectrum of bloodstream infections in different regions of China are slightly different，and the proportion of main drug resistant bacteria in provincial hospitals is higher than those in municipal hospitals.

Objective To investigate the safety and efficacy of target calyx pretreatment technique in the treatment of complete staghorn calculi by endoscopic combined intrarenal surgery(ECIRS).Methods Clinical data of 21 patients with complete staghorn calculus treated by ECIRS from October 2019 to September 2021 in our hospital were retrospectively analyzed.There were 8 cases in the left side and 12 cases in the right side.One case of bilateral kidney calculus was given right side treatment in the first stage.The stone density was(1101±185)HU.The operation was performed by two surgeons.Under general anesthesia,the patient was placed in an oblique supine lithotomy position.The target calyx was designed according to preoperative imaging examination.The stone in the target calyx was broken up by flexible ureteroscope in advance to expose the papillary dome.Percutanous nephrostomy of the target calyx was performed,and F18 or F20 percutaneous work access was established under surveillance by using flexible ureteoscope and ultrasound.Results The operation was successfully accomplished in one stage in all the 21 cases.The mean operation time was(121.8±21.2)min,the postoperative hemoglobin reduction was(9.38±4.36)g/L,the postoperative hospital stay was(4.4±1.4)d,and the postoperative stone free rate(SFR)was 85.7％(18/21).A total of 6 patients had postoperative complications,including 1 case of bleeding requiring blood transfusion,3 cases of fever,1 case of hydrothorax,and 1 case of postoperative pain in the operative area requiring analgesic treatment.Conclusion For complete staghorn calculus,using flexible ureteroscope to pretreat stones of target calices and then puncturing to establish percutaneous renal working channel can significantly increase the success rate of surgery and the immediate postoperative stone free rate,reduce the number of percutaneous renal channels,and improve the safety of surgery.

Ritlecitinib is an inhibitor that acts on Janus kinase 3 and the hepatocellular carcinoma kinase family.In June 2023,the FDA approved Ritlecitinib for the treatment of severe alopecia areata in patients aged 12 years and above.Multiple clinical studies have observed hair regeneration in patients after using Ritlecitinib,which is generally safe and well tolerated during use.This article introduces its pharmacological effects,pharmacokinetics,clinical research,safety,and usage and dosage.

Objective This study aimed to investigate the effects of high-altitude hypoxia on the expression of ATP-binding cassette(ABC)transport proteins in the blood-brain barrier(BBB)and explore the mechanisms influencing their expression.Methods Wistar rats were divided into 1500 m group(Lanzhou field),4010 m group(simulated 4010 m,low-pressure oxygen chamber,hypoxia for 3 days),6000 m group(simulated 6000 m,low-pressure oxygen chamber,hypoxia for 3 days),phenytoin sodium+1500 m group(given 50 mg·kg-1 phenytoin sodium on the basis of the 1500 m group),phenytoin sodium+4010 m group(given 50 mg·kg-1 phenytoin sodium on the basis of the 4010 m group),phenytoin sodium+6000 m group(given 50 mg·kg-1 phenytoin sodium on the basis of the 6000 m group),and hypoxia 1 d group,hypoxia 2 d group,hypoxia 3 d group,hypoxia 4 d group(simulated altitude of 4010 m,low-oxygen chamber,hypoxia for 1,2,3,4 days).Western blot was used to detect the expression of BBB tissue proteins;and liquid chromatography-tandem mass spectrometry was used to measure the concentration of phenytoin sodium in cerebrospinal fluid.Results The relative expression levels of P-glycoprotein(P-gp)in the 1500 m,4010 m,6000 m groups were 1.00±0.04,1.84±0.02,2.10±0.05,respectively;the relative expression levels of multidrug resistance-associated protein-4(MRP4)were 1.00±0.05,2.77±0.08,4.42±0.03,respectively;the concentrations of phenytoin sodium in cerebrospinal fluid were(864.78±348.32),(1 000.22±273.90),and(1 214.17±314.09)ng·mL-1,respectively.The differences in the above indicators between the 1500 m,4010 m,and 6000 m groups were statistically significant(all P＜0.05).The relative expression levels of P-gp in the hypoxia 1 d,2 d,3 d,4 d groups were 1.00±0.03,1.85±0.04,3.10±0.02,2.17±0.05,respectively;the relative expression levels of MRP4 were 1.00±0.05,1.79±0.10,1.60±0.08,1.31±0.06,respectively;the differences in the above indicators between the hypoxia 1 d,2 d,3 d,4 d groups were statistically significant(all P＜0.05).Conclusion Different high-altitude hypoxic environments have different effects on the expression of ABC transport proteins in the BBB,influencing the drug concentrations of their substrate drugs in the body.

From an aqueous extract of the Angelica sinensis root head (guitou), nine pairs of lignanoid enantiomers [(+)-/(-)-1-(+)-/(-)-9], including three pairs of new structures [(+)-/(-)-1-(+)-/(-)-3] and two pairs of chiral separated enantiomers for the first time [(+)-/(-)-4 and (+)-/(-)-5], were isolated and chirally separated by column chromatography over different types of resin, normal and reversed phase silica gels, together with HPLC techniques using reversed phase and chiral columns. Their structures were determined by spectroscopic data analysis, theoretic calculation of electronic circular dichroism (ECD) spectra, and single-crystal X-ray diffraction. The chiral separated new enantiomers named (+)-/(-)-angelignanins Q-T [(+)-/(-)-1-(+)-/(-)-4] and (+)-/(-)-daphneresinol [(+)-/(-)-5], respectively.

Chromatography is one of the most important separation and analytical techniques in production activity and academic research.With the growing demand for applications,the development of targeted separation devices is costly.However,the difficulty of constructing modeling makes it difficult to validate the theoretical studies of chromatography.Three dimensional(3D)printing,as a technology that can fabricate objects by depositing materials from the bottom to up,can custom print complex structures for specific needs,and shows many advantages such as low cost,low waste,high precision,high flexibility and parallel manufacturing,demonstrating great potential in the field of chromatography separations.In recent years,with the rapid development of 3D printing technology,the printing resolution and speed have progressively improved,and the range of printable materials has largely expanded.This has led to preliminary research and application of 3D printing technology in the field of chromatography separation,resulting in brand new discoveries and technological innovations.This article made a comprehensive overview of the latest advancements in research and application of 3D printing technology in separation science,including 3D printed columns,3D printed stationary phase,and 3D printed solid-phase extraction devices.Finally,The prospects and challenges of 3D printing technology in separation science were discussed.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To standardize nursing management on postoperative patients with a left ventricular assist-ant device(LVAD).Methods The first draft of the Consensus was formed on the basis of literature review.2 rounds of expert consultations and a round of online meeting discussion were held for adjustments and modifications the draft of the Consensus.Results The recovery rate of the inquiry questionnaire was 93.75%.The authority coefficients of the 2 rounds of inquiry experts were 0.927 and 0.920.The concentration degree of expert opinions for each indicator was greater than 3.5 score,and the coefficient of variation was less than 0.25.The Kendall harmony coefficients for 2 rounds of correspondence were 0.402 and 0.407(P<0.01).The final Consensus formed through expert consultations and meetings includes 7 themes:hemodynamic monitoring,LVAD function monitoring,coagulation function monitoring,percutaneous cable and wound care,exercise rehabilitation care,health education and guidance,and pre-discharge assessment.Conclusion The Consensus is scientific,rigorous,and authoritative.The Consensus covers all aspects of postoperative care for patients with LVAD,and it will benefit to clinical practice.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-positive bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-positive bacteria from blood cultures in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:A total of 3 163 strains of Gram-positive pathogens were collected from 51 member units，and the top five bacteria were Staphylococcus aureus（ n=1 147，36.3%），coagulase-negative Staphylococci（ n=928，29.3%）， Enterococcus faecalis（ n=369，11.7%）， Enterococcus faecium（ n=296，9.4%）and alpha-hemolyticus Streptococci（ n=192，6.1%）. The detection rates of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）were 26.4%（303/1 147）and 66.7%（619/928），respectively. No glycopeptide and daptomycin-resistant Staphylococci were detected. The sensitivity rates of Staphylococcus aureus to cefpirome，rifampin，compound sulfamethoxazole，linezolid，minocycline and tigecycline were all >95.0%. Enterococcus faecium was more prevalent than Enterococcus faecalis. The resistance rates of Enterococcus faecium to vancomycin and teicoplanin were both 0.5%（2/369），and no vancomycin-resistant Enterococcus faecium was detected. The detection rate of MRSA in southern China was significantly lower than that in other regions（ χ2=14.578， P=0.002），while the detection rate of MRCNS in northern China was significantly higher than that in other regions（ χ2=15.195， P=0.002）. The detection rates of MRSA and MRCNS in provincial hospitals were higher than those in municipal hospitals（ χ2=13.519 and 12.136， P<0.001）. The detection rates of MRSA and MRCNS in economically more advanced regions（per capita GDP≥92 059 Yuan in 2022）were higher than those in economically less advanced regions（per capita GDP<92 059 Yuan）（ χ2=9.969 and 7.606， P=0.002和0.006）. Conclusions:Among the Gram-positive pathogens causing bloodstream infections in China， Staphylococci is the most common while the MRSA incidence decreases continuously with time；the detection rate of Enterococcus faecium exceeds that of Enterococcus faecalis. The overall prevalence of vancomycin-resistant Enterococci is still at a low level. The composition ratio of Gram-positive pathogens and resistant profiles varies slightly across regions of China，with the prevalence of MRSA and MRCNS being more pronounced in provincial hospitals and areas with a per capita GDP≥92 059 yuan.