Objective To analyze the atrioventricular synchronization rate after implantation of Micra AV leadless pacemaker,and the impact of postoperative programming optimization on atrioventricular synchronization rate.Methods A prospective cohort study was conducted to select patients with complete atrioventricular block who underwent Micra AV leadless pacemaker implantation at Beijing Anzhen Hospital from August 2022 to June 2023.Programming optimization were performed at 1 week,1 month,and 3 months postoperatively,and atrioventricular synchronization rate,electrical parameters,and echocardiography were recorded.Results A total of 68 patients with complete atrioventricular block implanted with Micra AV were selected,with an average age of(68.2±9.7)years,including 47 males(69.1％).All patients were successfully implanted with Micra AV,and there were no serious postoperative complications;The average threshold,sense,and impedance parameters were stable during 1 week,1 month,and 3 months after the procedure;There was no significant difference in the EF value of postoperative echocardiography(P=0.162);The average atrioventricular synchronization rates at 1 week,1 month,and 3 months postoperatively were(75.2％vs.83.8％vs.91.6％,P=0.001).Conclusions As an mechanical atrial sensing,Micra AV requires personalized adjustment of relevant parameters;Postoperative follow-up programming optimization plays an important role in the atrioventricular synchronization and comfort level in patients with complete atrioventricular block after implantation of Micra AV leadless pacemaker.

Retzius-sparing robot assisted radical prostatectomy (RS-RARP) can significantly improve the immediate urinary continence without increasing the positive rate of surgical margin.However, the learning curve is long, and fewer than 10% of the surgeons can master it.Therefore,we have optimized the procedures of RS-RARP, applying radical prostatectomy with retrograde release of neurovascular bundle to preserve it to the maximum extent.Urethral anastomosis can be performed with only one suture, which eliminates the need for Hem-o-lok and reduces subsequent complications.Our team routinely carries out this operation, and conlcudes that this surgical method can achieve good tumor control, good urinary continence, fast recovery of sexual function, few complications, and strong operability.This article details the key steps and operation experience of this technique.

Objective To retrospectively analyze the diagnostic value of thrombin-antithrombin complex(TAT),thrombomodulin(TM),and tissue plasminogen activator-inhibitor complex(t-PAIC)in severe cases of corona virus disease 2019(COVID-19).Methods A cohort of 79 patients clinically diagnosed with COVID-19 was retrospectively assembled and categorized into two groups based on disease severity:non-severe(n=51)and severe(n=28).In this study the differences of coagulation function and inflamma-tory marker levels between the two groups were compared.The correlations of TAT,TM and t-PAIC with other biomarkers were investi-gated.The diagnostic values of all the markers for severe COVID-19 were assessed.Results The patients of severe COVID-19 exhibi-ted significantly higher levels of TAT,TM,and t-PAIC compared to those of non-severe group(P＜0.001).The levels of TAT,TM and t-PAIC showed notable positive correlation with other biomarkers.TAT demonstrated the strongest positive correlation with the level of D-dimer(r=0.786,P＜0.001).Binary logistic regression analysis identified TAT(OR=1.346,P＜0.05)and t-PAIC(OR=1.128,P＜0.05)were independent risk factors in term of severe COVID-19.The combined ROC curve for TAT,TM and t-PAIC revealed high diagnostic efficacy in severe cases with the area under the curve(AUCROC)were 0.918,and the sensitivity and specificity were of 75％and 94.1％,respectively.Conclusion The results of combined measurement of TAT,TM and t-PAIC effectively demonstrates its diagnostic value in identifying severity and stratification of COVID-19 cases and may have important clinical significance for assessment of the severity and prediction of the prognosis.

Objective To explore the effects of the same dose of fractionated radiation and single radiation on radiation-induced heart damage in mice.Methods Twenty-one wild-type C57BL/6J mice were randomly divided into the normal group,fractionated radiation group and single radiation group.18 Gy X-ray,via fractionated(3 Gy/time,6 times)radiation or single radiation,was used to establish a radiation-induced heart damage model.The concentrations of myocardial enzyme damage markers(creatinekinase(CK),creatinekinase-MB(CK-MB),lactate dehydrogenase(LDH)and LDH1)and peripheral serum ions(K+,Ca2+,Fe2+and Cl-)were detected by an automatic biochemical analyzer at day 7 and 28 after radiation.Ultrasound was used to detect and analyze the cardiac function of mice at day 28 after radiation,including the left ventricular ejection fraction(EF),left ventricular fractional shortening(FS),left ventricular end-diastolic volume(LVEDV),left ventricular mass(LV mass)and left ventricular end-systolic volume(LVESV).The opening of the mitochondrial permeability transition pore(mPTP)and changes of mitochondrial membrane potential of myocardial cells were observed using a laser confocal microscope.The ultrastructure of myocardia was observed under a transmission electron microscope(TEM)and cardiac fibrosis was checked by Masson staining.The atherosclerosis of the aorta was examined by gross oil red staining.Real-time quantitative PCR(RT-qPCR)and Western blotting were performed to detect the expressions ofapoptosis-related genes and proteins,B cell lymphoma-2-associated X protein(BAX)and casepase-3.Results Seven days after 18Gy X-ray irradiation,the expression levels of CK,CK-MB,LDH and LDH1 in the single radiation group increased significantly or trended up,while only CK and LDH1 in the fractionated irradiation group continued to increase.Twenty-eight days after radiation,the expression levels of 4 enzymes in myocardial zymogram were increased by both radiation methods.Seven and twenty-eight days after radiation,the concentrations of serum ions K+,Fe2+,Ca2+and Cl-were significantly decreased by both radiation methods that could lead to the decrease of EF and FS,and the increase of LV mass,LVEDV and LVESV.Single radiation made more difference to EF and FS,and the difference between the two groups was statistically significant.Both methods could decrease the mPTP and mitochondrial membrane potential,especially single radiation,and there was significant difference between the two groups.The results of TEM showed that the mitochondrial cristae of myocardial cells decreased and vacuolated,and the myocardial fiber bundles became thicker after X-ray radiation.Masson staining showed that collagen fibers were deposited in the heart tissue ofmice after X-ray irradiation,particularly in the single radiation group.Gross oil red staining ofthe aorta showed that both methods could damage the aorta of mice,and the area of atherosclerotic plaques in the single radiation group was larger,which was statistically different from that of the fractionated radiation group.The results of RT-qPCR and Western blotting showed that X-ray radiation could increase the expression levels of apoptosis-related BAX and caspase-3 in cardiac tissue,especially in the single radiation group.The mRNAexpressions of BAX and caspase-3 increased more significantly in the single radiation group.Conclusion Both fractionated radiation and single radiation at the same dose can cause heart damage,so they can be used to establish a radiation-induced heart damage model of mice.Single radiation can cause more significant damage to the heart.Different modeling methods can be selected as required.

Objective This study aims to assess the role of DNA methylation changes in tongue cancer through a comprehensive analysis of global DNA methylation alterations during experimental lingual carcinogenesis.Methods C57BL/6J mice were subjected to 16-week oral administration of 4-nitroquinoline-1-oxide(4NQO,50 mg/L).Lingual mucosa samples,being representative of normal tissue(week 0)and early(week 12)and advanced(week 28)tumorigen-esis,were harvested for microarray and methylated DNA immunoprecipitation sequencing(MeDIP-Seq).The mRNA and promoter methylation of transforming growth factor-beta-signaling protein 1(SMAD1)were evaluated with real-time quantitative reverse transcription polymerase chain reaction and Massarray in human lingual mucosa and tongue cancer cell lines.Results The cytosine guanine island(CGI)methylation level observed at 28 weeks surpassed that of both 12 weeks and 0 weeks.The promoter methylation level at 12 weeks exceeded that at 0 weeks.Notably,208 differentially expressed genes were negatively correlated to differential methylation in promoters among 0,12,and 28 weeks.The mRNA of SMAD1 was upregulated,con-current with a decrease in promoter methylation levels in cell lines compared to normal mucosa.Conclusion DNA methylation changed during lingual carcinogenesis.Overexpression of SMAD1 was correlated to promoter hypomethyl-ation in tongue cancer cell lines.

Objective To explore the clinical efficacy and influencing factors of omadacycline(OMC)in the treat-ment of patients with infectious diseases.Methods Data about hospitalized patients who received OMC monothera-py or combination therapy at Xiangya Hospital of Central South University from January 2022 to December 2023 were analyzed retrospectively.The influencing factors for failure of OMC treatment was analyzed by univariate and multivariate logistic regression analysis.Results A total of 160 patients were included in analysis,with an overall effective treatment rate of 69.4％(n=111).After treatment with OMC,patients in effective group was observed that body temperature improved([36.83±0.52]℃ vs[37.85±0.92]℃,P＜0.001),white blood cell count([7.78±4.07]× 109/L vs[10.06±6.49]× 109/L,P＜0.001),procalcitonin([0.63±1.19]ng/mL vs[4.43±10.14]ng/mL,P=0.001),C-reactive protein([35.16±37.82]mg/L vs[105.08±99.47]mg/L,P＜0.001),and aspartate aminotransferase([50.50±40.04]U/L vs[77.17±91.43]U/L,P=0.004)all decreased signifi-cantly.Only one patient had adverse reactions such as diarrhea,but treatment was not interrupted.Univariate ana-lysis showed that patients in failure treatment group had a higher acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score(17.0[9.5-22.0]vs 12.0[9.0-19.0],P=0.046)and sequential organ failure assessment(SOFA)score(7.0[4.5-10.0]vs 4.0[2.0-9.0],P=0.019).Multivariate analysis showed that end-stage liver disease(OR=77.691,95％CI:5.448-1 107.880,P=0.001),mechanical ventilation(OR=6.686,95％CI:1.628-27.452,P=0.008)and the combination treatment of vancomycin(OR=6.432,95％CI:1.891-21.874,P=0.003)were risk factors for the failure of OMC treatment,while the course of OMC treatment(OR=0.905,95％CI:0.825-0.994,P=0.037)was a protective factor for the effective treatment.Conclusion OMC can be used as an alternative therapy for refractory severe infection,with fewer adverse reaction.End-stage liver disease,mechanical ventilation and combination treatment of vancomycin are risk factors for failure of OMC treatment in in-fected patients.Adequate OMC treatment course can improve patients'clinical outcome,large-scale case studies are needed to confirm the initial conclusion.

Coronary chronic total occlusion(CTO)presents one of the most formidable challenges in percutaneous coronary intervention(PCI).Left ventricular systolic dysfunction(LVSD)is frequently observed in patients undergoing CTO-PCI,who often present with more complex coronary artery lesions and a higher burden of comorbidities,leading to an elevated risk of PCI-related complications.The clinical benefits of revascularization for these patients remain controversial.How to optimize the CTO-PCI strategy and postoperative management to improve patient outcomes represents an urgent issue.This review comprehensively summarizes the clinical characteristics,interventional benefits,interventional strategies,postoperative management,as well as the short-and long-term outcomes for patients with LVSD and CTO,aiming to provide a reference for optimizing the outcome of PCI in this unique and challenging patient subgroup.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the distribution and antimicrobial resistance profiles of the common pathogens isolated from urine from 2015 to 2021 in the CHINET Antimicrobial Resistance Surveillance Program.Methods The bacterial strains were isolated from urine and identified routinely in 51 hospitals across China in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Antimicrobial susceptibility was determined by Kirby-Bauer method,automatic microbiological analysis system and E-test according to the unified protocol.Results A total of 261 893 nonduplicate strains were isolated from urine specimen from 2015 to 2021,of which gram-positive bacteria accounted for 23.8％(62 219/261 893),and gram-negative bacteria 76.2％(199 674/261 893).The most common species were E.coli(46.7％),E.faecium(10.4％),K.pneumoniae(9.8％),E.faecalis(8.7％),P.mirabilis(3.5％),P.aeruginosa(3.4％),SS.agalactiae(2.6％),and E.cloacae(2.1％).The strains were more frequently isolated from inpatients versus outpatients and emergency patients,from females versus males,and from adults versus children.The prevalence of ESBLs-producing strains in E.coli,K.pneumoniae and P.mirabilis was 53.2％,52.8％and 37.0％,respectively.The prevalence of carbapenem-resistant strains in E.coli,K.pneumoniae,P.aeruginosa and A.baumannii was 1.7％,18.5％,16.4％,and 40.3％,respectively.Lower than 10％of the E.faecalis isolates were resistant to ampicillin,nitrofurantoin,linezolid,vancomycin,teicoplanin and fosfomycin.More than 90％of the E.faecium isolates were ressitant to ampicillin,levofloxacin and erythromycin.The percentage of strains resistant to vancomycin,linezolid or teicoplanin was＜2％.The E.coli,K.pneumoniae,P.aeruginosa and A.baumannii strains isolated from ICU inpatients showed significantly higher resistance rates than the corresponding strains isolated from outpatients and non-ICU inpatients.Conclusions E.coli,Enterococcus and K.pneumoniae are the most common pathogens in urinary tract infection.The bacterial species and antimicrobial resistance of urinary isolates vary with different populations.More attention should be paid to antimicrobial resistance surveillance and reduce the irrational use of antimicrobial agents.

Objective To understand the distribution and changing resistance profiles of clinical isolates of Enterococcus in hospitals across China from 2015 to 2021.Methods Antimicrobial susceptibility testing was conducted for the clinical isolates of Enterococcus according to the unified protocol of CHINET program by automated systems,Kirby-Bauer method,or E-test strip.The results were interpreted according to the Clinical & Laboratory Standards Institute(CLSI)breakpoints in 2021.WHONET 5.6 software was used for statistical analysis.Results A total of 124 565 strains of Enterococcus were isolated during the 7-year period,mainly including Enterococcus faecalis(50.7％)and Enterococcus faecalis(41.5％).The strains were mainly isolated from urinary tract specimens(46.9％±2.6％),and primarily from the patients in the department of internal medicine,surgery and ICU.E.faecium and E.faecalis strains showed low level resistance rate to vancomycin,teicoplanin and linezolid(≤3.6％).The prevalence of vancomycin-resistant E.faecalis and E.faecium was 0.1％and 1.3％,respectively.The prevalence of linezolid-resistant E.faecalis increased from 0.7％in 2015 to 3.4％in 2021,while the prevalence of linezolid-resistant E.faecium was 0.3％.Conclusions The clinical isolates of Enterococcus were still highly susceptible to vancomycin,teicoplanin,and linezolid,evidenced by a low resistance rate.However,the prevalence of linezolid-resistant E.faecalis was increasing during the 7-year period.It is necessary to strengthen antimicrobial resistance surveillance to effectively identify the emergence of antibiotic-resistant bacteria and curb the spread of resistant pathogens.