Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ²=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.
Adolescent ; Brain Abscess ; Child ; Child, Preschool ; Escherichia coli ; Female ; Humans ; Hydrocephalus ; Infant ; Infant, Newborn ; Male ; Meningitis, Bacterial/epidemiology* ; Retrospective Studies ; Streptococcus agalactiae ; Streptococcus pneumoniae ; Subdural Effusion ; beta-Lactamases

Immunoglobulin G4-related sialadenitis (IgG4-RS) is an immune-mediated fibro-inflammatory disease and the pathogenesis is still not fully understood. The aim of this study was to explore the role and mechanism of interleukin-13 (IL-13) in the cellular senescence during the progress of IgG4-RS. We found that the expression of IL-13 and IL-13 receptor α1 (IL-13Rα1) as well as the number of senescent cells were significantly higher in the submandibular glands (SMGs) of IgG4-RS patients. IL-13 directly induced senescence as shown by the elevated activity of senescence-associated β-galactosidase (SA-β-gal), the decreased cell proliferation, and the upregulation of senescence markers (p53 and p16) and senescence-associated secretory phenotype (SASP) factors (IL-1β and IL-6) in SMG-C6 cells. Mechanistically, IL-13 increased the level of phosphorylated signal transducer and activator of transcription 6 (p-STAT6) and mitochondrial-reactive oxygen species (mtROS), while decreased the mitochondrial membrane potential, ATP level, and the expression and activity of superoxide dismutase 2 (SOD2). Notably, the IL-13-induced cellular senescence and mitochondrial dysfunction could be inhibited by pretreatment with either STAT6 inhibitor AS1517499 or mitochondria-targeted ROS scavenger MitoTEMPO. Moreover, IL-13 increased the interaction between p-STAT6 and cAMP-response element binding protein (CREB)-binding protein (CBP) and decreased the transcriptional activity of CREB on SOD2. Taken together, our findings revealed a critical role of IL-13 in the induction of salivary gland epithelial cell senescence through the elevated mitochondrial oxidative stress in a STAT6-CREB-SOD2-dependent pathway in IgG4-RS.
Cellular Senescence/genetics* ; Humans ; Immunoglobulin G/metabolism* ; Interleukin-13/pharmacology* ; Mitochondria/metabolism* ; Sialadenitis/metabolism*

Objective:To demonstrate the clinical efficiency and safety of palbociclib combined with endocrine therapy in the treatment of hormone receptor (HR) positive and human epidermal growth factor receptor 2 (HER-2) negative advanced breast cancer patients.Methods:A total of 95 breast cancer patients with HR-positive/HER-2 negative underwent palbociclib combined with endocrine in Jiangsu Cancer Hospital from Octorber, 2018 to Novermber, 2020 were retrospectively recruited. The short-term and long-term efficacy and adverse reactions were summarized. The primary end point was progressive free survival (PFS) and the second end points were disease control rate (DCR), objective response rate (ORR), clinical benefit rate (CBR). Log rank test and Cox proportional hazards regression model were used to analyze the influencing factors of PFS in patients.Results:The ORR, DCR and CBR of 95 patients were 29.5%, 88.4% and 72.6%, respectively. The total median PFS for palbociclib plus endocrine therapy was 10.4 months. The univariate analysis showed that visceral metastasis, the line number of palbociclib treatment and the sensitivity of endocrine therapy were associated with the PFS of patients who received palbociclib combined with endocrine ( P<0.05). The multivariate Cox regression analysis showed that the sensitivity of endocrine therapy and visceral metastasis were the independent influencing factors of PFS in patients receiving palbociclib combined with endocrine therapy. Compared with patients with visceral metastasis, HR of patients with non-visceral metastases was 3.118 (95% CI: 1.405-7.236). Compared with endocrine therapy sensitive patients, the HR of patients with primary and secondary resistance to endocrine therapy were 4.455 (95% CI: 1.380-14.385) and 1.4566 (95% CI: 0.488-4.346), respectively. The main adverse reaction was hematological toxicity. The leukopenia, neutrophilsand thrombocytopenia were main manifestations, which incidence rates were 78.9% (75/95), 85.3% (81/95) and 72.6% (69/95), respectively and the incidence rates of grade 3 to 4 of these manifestations were 27.4% (26/95), 51.6% (49/95) and 20.0% (19/95), respectively. Conclusion:Among patients with HR-positive/HER-2 negative advanced breast cancer, the treatment of palbociclib combined with endocrine drugs has yielded good clinical effects and the toxicity is manageable.

Objective:To demonstrate the clinical efficiency and safety of palbociclib combined with endocrine therapy in the treatment of hormone receptor (HR) positive and human epidermal growth factor receptor 2 (HER-2) negative advanced breast cancer patients.Methods:A total of 95 breast cancer patients with HR-positive/HER-2 negative underwent palbociclib combined with endocrine in Jiangsu Cancer Hospital from Octorber, 2018 to Novermber, 2020 were retrospectively recruited. The short-term and long-term efficacy and adverse reactions were summarized. The primary end point was progressive free survival (PFS) and the second end points were disease control rate (DCR), objective response rate (ORR), clinical benefit rate (CBR). Log rank test and Cox proportional hazards regression model were used to analyze the influencing factors of PFS in patients.Results:The ORR, DCR and CBR of 95 patients were 29.5%, 88.4% and 72.6%, respectively. The total median PFS for palbociclib plus endocrine therapy was 10.4 months. The univariate analysis showed that visceral metastasis, the line number of palbociclib treatment and the sensitivity of endocrine therapy were associated with the PFS of patients who received palbociclib combined with endocrine ( P<0.05). The multivariate Cox regression analysis showed that the sensitivity of endocrine therapy and visceral metastasis were the independent influencing factors of PFS in patients receiving palbociclib combined with endocrine therapy. Compared with patients with visceral metastasis, HR of patients with non-visceral metastases was 3.118 (95% CI: 1.405-7.236). Compared with endocrine therapy sensitive patients, the HR of patients with primary and secondary resistance to endocrine therapy were 4.455 (95% CI: 1.380-14.385) and 1.4566 (95% CI: 0.488-4.346), respectively. The main adverse reaction was hematological toxicity. The leukopenia, neutrophilsand thrombocytopenia were main manifestations, which incidence rates were 78.9% (75/95), 85.3% (81/95) and 72.6% (69/95), respectively and the incidence rates of grade 3 to 4 of these manifestations were 27.4% (26/95), 51.6% (49/95) and 20.0% (19/95), respectively. Conclusion:Among patients with HR-positive/HER-2 negative advanced breast cancer, the treatment of palbociclib combined with endocrine drugs has yielded good clinical effects and the toxicity is manageable.

Objective: To investigate the expression discordances of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor2 (HER-2) and Ki-67 in primary and metastatic breast cancer specimens and explore the clinical significances. Methods: Biopsies of metastatic lesions were performed in 203 patients with breast cancer recurrence and metastasis indicated by physical examination and/or imaging examination. We confirmed pathological properties and assessed the expressions of ER, PR, HER-2 and Ki-67 in primary and metastatic lesions, their relationships with prognosis were also analyzed. Results: Biopsy failed in 3 patients, the pathology and immunohistochemitry results of metastatic lesions were not obtained. One person was diagnosed as tuberculosis and another was primary lung cancer. Among the 198 cases of primary and metastatic lesions, the discordance rates of ER, PR, HER-2 and Ki-67 were 27.3%, 34.3%, 11.8% and 15.1%, respectively.The expressions of ER, HER-2 and Ki-67 were not significantly different between the primary and metastatic lesions, however, the expressions of PR were more likely to turn negative in the metastases (P<0.001). The disease-free survival (DFS) of patients with ER, PR positive, HER-2 negative and low expression of Ki-67 in metastatic lesion was much longer (P<0.05). Conclusions The expressions of ER, PR, HER-2 and Ki-67 in metastatic lesions are associated with the prognosis of breast cancer patients.Their expression discordances between primary and metastatic lesions can guide the treatment and evaluate the risks of recurrence and prognosis.

Objective To investigate the expression discordances of estrogen receptor ( ER), progesterone receptor (PR), human epidermal growth factor receptor2 ( HER?2) and Ki?67 in primary and metastatic breast cancer specimens and explore the clinical significances. Methods Biopsies of metastatic lesions were performed in 203 patients with breast cancer recurrence and metastasis indicated by physical examination and／or imaging examination. We confirmed pathological properties and assessed the expressions of ER, PR, HER?2 and Ki?67 in primary and metastatic lesions, their relationships with prognosis were also analyzed. Results Biopsy failed in 3 patients, the pathology and immunohistochemitry results of metastatic lesions were not obtained. One person was diagnosed as tuberculosis and another was primary lung cancer. Among the 198 cases of primary and metastatic lesions, the discordance rates of ER, PR, HER?2 and Ki?67 were 27.3%, 34.3%, 11.8% and 15.1%, respectively.The expressions of ER, HER?2 and Ki?67 were not significantly different between the primary and metastatic lesions, however, the expressions of PR were more likely to turn negative in the metastases (P＜0.001). The disease?free survival (DFS) of patients with ER, PR positive, HER?2 negative and low expression of Ki?67 in metastatic lesion was much longer ( P＜0.05). Conclusions The expressions of ER, PR, HER?2 and Ki?67 in metastatic lesions are associated with the prognosis of breast cancer patients.Their expression discordances between primary and metastatic lesions can guide the treatment and evaluate the risks of recurrence and prognosis.

Objective To investigate the expression discordances of estrogen receptor ( ER), progesterone receptor (PR), human epidermal growth factor receptor2 ( HER?2) and Ki?67 in primary and metastatic breast cancer specimens and explore the clinical significances. Methods Biopsies of metastatic lesions were performed in 203 patients with breast cancer recurrence and metastasis indicated by physical examination and／or imaging examination. We confirmed pathological properties and assessed the expressions of ER, PR, HER?2 and Ki?67 in primary and metastatic lesions, their relationships with prognosis were also analyzed. Results Biopsy failed in 3 patients, the pathology and immunohistochemitry results of metastatic lesions were not obtained. One person was diagnosed as tuberculosis and another was primary lung cancer. Among the 198 cases of primary and metastatic lesions, the discordance rates of ER, PR, HER?2 and Ki?67 were 27.3%, 34.3%, 11.8% and 15.1%, respectively.The expressions of ER, HER?2 and Ki?67 were not significantly different between the primary and metastatic lesions, however, the expressions of PR were more likely to turn negative in the metastases (P＜0.001). The disease?free survival (DFS) of patients with ER, PR positive, HER?2 negative and low expression of Ki?67 in metastatic lesion was much longer ( P＜0.05). Conclusions The expressions of ER, PR, HER?2 and Ki?67 in metastatic lesions are associated with the prognosis of breast cancer patients.Their expression discordances between primary and metastatic lesions can guide the treatment and evaluate the risks of recurrence and prognosis.

Objective To understand the health literacy status,influencing factors and demand carrying out the health education based on the mobile terminal among college students to provide a new idea for formulating and implementing the health literacy promotion plan for university students.Methods The multi-stage stratified cluster random sampling method was adopted to extract 1 949 students from partial universities in Nanjing City and conduct the investigation by adopting the Rapid Estimate System of Health Literacy and Health Education Demand Based on the Mobile Terminal Questionnaire of College Students.The influence factors were analyzed by using the univariate analysis and ordinal multi-classification Logistic regression analy sis.Results The university students with high,marginal and low health literacy level accounted for 31.3％,48.9％ and 19.8％ respectively.The proportions of the students with high health literacy in the four dimensions,including health knowledge,health behaviors,health skill and health status,were 57.9％,18.3％,61.0％ and 44.5％ respectively.The ordinal multi-classification Logistic regression analysis showed that the major influence factors affecting the health literacy of university students were gender,education background of mothers,majors,grades,electively taking the health education course.81.2 ％ of university students wanted to or urgently wanted to understand the health literacy knowledge.The main route getting the health literacy knowledge by the university students was network(83.8％).91.8％ of students were willing to learn the health literacy knowledge through mobile terminal.87.1％ of students believed that the WeChat was suitable to learn the health knowledge,81.3％ of students hoped to use the WeChat platform for learning the health knowledge,73.8％ of students hoped the Wechat to push the health knowledge with the modes of words combined with images and video.It was recommended that the health knowledge pushing for 1-3 times per week was suitable.Conclusion The health literacy of university students is at the marginal level.The health behaviors literacy is most lacking and the demand for the health education based on the mobile terminal is stronger.The health literacy intervention of university students should sufficiently apply the new media platform superiority and the emphasis should be placed on the populations of males,low education background mothers,non-medicine major,low grade and without electively taking the health education course.

Objective:To evaluate the feasibility of transforaminal endoscopic nerve root decompression for degenerative lumbar spinal stenosis (DLSS).Methods: From July 2011 to April 2016,96 cases of single segment DLSS were involved.All the patients had unilateral lower extremity neurological symptoms,signs,neurogenic intermittent claudication of less than 500 m.Imaging examinations (CT or MRI) or diagnostic nerve root block confirmed single segment degeneration.The mean age was (71.6±5.4) years,male: 55 cases,female: 41 cases.Their intraoperative blood loss,operation time,complications,ambulation time and discharge time were recorded.Leg pain VAS,ODI were used to evaluate the pain and lumbar function of the patients.The clinical efficacy was evaluated by Nakai evaluation.Results: All the patients were performed endoscopic decompression of the lateral recess and nerve root by removing the ventral part of the superior facet joint,the ligamentum flavum and the intervertebral disc.The decompression range was from the inferior edge of the upper pedicle to the superior edge of the lower pedicle.The nerve root was detected to have no compression and the pulse of nerve root returned to normal.The patient got ambulant on the operation day and discharged if he had no discomfort symptom.In the study,68 cases got follow up.The mean follow-up time was 12.1 months (6-63 months).The VAS at dif-ferent follow-up time points was improved relative to the baseline,and the difference was statistically significant (F=491.60,P<0.001).The ODI at different follow-up time points was improved relative to the baseline,and the difference was statistically significant (F=189.91,P<0.001).The excellent and good rates of Nakai evaluation were 79.4％ (excellent in 42 cases,good in 12 cases,fair in 10 cases and poor in 4 cases).The mean intraoperative blood loss was (49.29±11.86) mL.The mean operation time was (92.46±21.34) min.The mean ambulation time was 1.8 h.The mean discharge time was 2.3 days.Postoperative epidural hematoma was found in 1 case.Foot drop was found in 1 case.Second stage open surgery was performed in 6 cases.Conclusion: We can apply transforaminal endoscopic decompression for the patients of lumbar spinal stenosis who have unilateral nerve root irritation.Patients with transforaminal endoscopic decompression can get less surgical trauma,quick recovery and obtain good short-term outcome.

Objective To analyze the clinical effect of debridement in the treatment of Kashin-Beck disease under an ankle arthroscopy.Methods Totally 40 patients with ankle Kashin-Beck disease who had underwent surgery in the Fifth Hospital of Daqing from January 2015 to October 2016 were selected as the research subjects.All patients were treated with cleaning treatment under arthroscopy,evaluated via the visual analogue scale method,and compared pain before and 6,12 month after the treatment.Walking function and ankle motion of the patients were evaluated via an ankle-scoring system,and the quality of life of patients was investigated before and after the treatment through a questionnaire survey.Results The visual analogue scale of before and 6,12 months after the treatment was (6.2 ± 1.0),(2.3 ± 1.2) and (1.6 ± 0.4) scores,respectively;ankle foot score (53.3 ± 6.8),(86.6 ± 5.1) and (88.7 ± 6.2) scores,respectively;ankle activity score (15.9 ± 4.1),(36.9 ± 4.9) and (41.8 ± 6.4) scores,respectively;and life quality score (53.1 ± 4.0),(75.4 ± 6.6) and (88.7 ± 10.5) scores,respectively.The differences between groups were statistically significant (F =2.1,2.6,2.3,2.5,P ＜ 0.05).Visual analogue scale of 6 and 12 months after the treatment was significantly lower than that before the treatment,ankle foot score and ankle activity score and life quality score were significantly higher than those before the treatment (P ＜ 0.05).Conclusion The debridement under an ankle arthroscopy can effectively reduce the pain of patients with Kashin-Beck disease,and improve the walking function of the patients obviously,significantly improve the patients' life quality,and the method should be widely applied in clinical treatment.