With the widespread use of carbapenem antibiotics,the clinical detection rate of carbapenem-resistant Gram-negative bacilli has shown a significant increase.Carbapenem-resistant Gram-negative bacilli isolates are often extensively or fully resistant,resulting in limited antimicrobial treatment options and high morbidity and mortality rates,posing a serious public health threat.The clinical treatment of carbapenem-resistant Gram-negative bacilli includes the use of single or combination antimicrobials such as polymyxin,tigecycline,and fosfomycin.A number of new antimicrobials and therapeutic approaches are under development.The clinical management of carbapenem-resistant Gram-negative infections is severely challenged by the limited choice of antimicrobial agents.Therefore,this article reviews the current status and progress of antimicrobial treatment for carbapenem-resistant Gram-negative bacilli to providing clinical reference.

Objective To investigate the effect of continuous intraoperative insulin infusion on my-ocardial blood perfusion after cardiac surgery under cardiopulmonary bypass(CPB).Methods Forty-eight patients,21 males and 27 females,aged 55-80 years,BMI 18-28 kg/m2,ASA physical status Ⅱ-Ⅳ,who underwent elective cardiac surgery with CPB were selected and randomly divided into two groups:the insulin group(group I,n = 25)and the control group(group C,n = 23).The same anesthesia protocol was implemented in both groups.After induction of anesthesia,group Ⅰ received intravenously infusion of in-sulin 30 mU·kg-1·h-1,glucose 0.12 g·kg-1·h-1,and potassium chloride 0.06 mmol·kg-1·h-1,and group C received saline 10 ml/h,all of which were infused until the end of surgery.The targeted blood glucose range for both groups was set at 6.1-11.1 mmol/L.Transesophageal echocardiography(TEE)was performed 10 minutes after induction of general anesthesia(T2)and before the end of surgery(T6)to ex-amine the coronary sinus(CS)flow spectrum and diameter,pulmonary venous flow spectrum,and calculate CS net antegrade flow velocity time integral(VTI).Femoral mean arterial pressure(MAP),central venous pressure(CVP),stroke volume(SV),cardiac index(CI)and peripheral vascular resistance index(SVRI)were recorded at T2,2 minutes before CPB(T3),the end of CPB(T5),and T6.The concentra-tions of blood glucose and lactate 5 minutes before anesthesia induction(T1),T3,30 minutes after CPB(T4),T5,T6,6 hours after surgery(T7),12 hours after surgery(T8),and 24 hours after surgery(T9)were recorded.The levels of high-sensitivity C-reactive protein(hs-CRP),high-sensitivity troponin I(hs-TnI),and creatine kinase isoenzyme(CK-MB)were recorded 1 day preoperatively,1 and 2 days post-operatively.Results Compared with group C,in group I,CS net antegrade flow VTI and blood flow per minute were significantly increased(P<0.05),and pulmonary venous peak atrial reversal wave velocity(ARp)was significantly reduced at T6(P<0.05),SV and CI were significantly increased and SVRI was significantly decreased at T5 and T6(P<0.05),lactate concentration was significantly decreased at T7 and T8(P<0.05),hs-CRP and CKMB were significantly decreased 1 and 2 days postoperatively(P<0.05),hs-TnI was significantly reduced 2 days postoperatively(P<0.05).Conclusion Continuous insulin admin-istration during cardiac surgery with CPB while maintaining blood glucose at 6.1-11.1 mmol/L can enhance myocardial blood perfusion,mitigate postoperative inflammatory response,and reduce myocardial injury.

Objective:To explore the regulatory effects of long non-coding RNA H19(LncRNA H19)on the osteogenic differentia-tion of MC3T3-E1 cells under the stimulation of advanced glycation end products(AGEs).Methods:MC3T3-E1 cells were cultured under the stimulation of 10 μg/mL AGEs.The cells were observed by alkaline phosphatase(ALP)staining after 7 d and alizarin red staining after 21 d culture respectively.Cell transfection technology was used to overexpress LncRNA H19 in the cells,RT-qPCR was used to detect the mRNA expression levels of ALP,Runx-2,OCN,SP7 before and after transfection of LncRNA H19.Western blotting was used to detect the protein expression of Runx-2 and[3-catenin in the cells.Results:Under the stimulation of AGEs,the ALP stai-ning color of MC3T3-E1 cells became lighter,the formation of calcified nodules was reduced,the mRNA expression levels of ALP,Runx-2,OCN,SP7 and LncRNA H19 were decreased(P＜0.05),and the protein expression level of Runx-2 was decreased.After transfection of LncRNA H19(lv-H19),the mRNA expression of LncRNA H19 was significantly up-regulated(P＜0.05),the mRNA expression of ALP,Runx-2,OCN and SP7 genes was increased(P＜0.05),ALP staining was deeper,and the expression of β-catenin was increased.Conclusion:Under the stimulation of AGEs,LncRNA H19 may affect the osteogenic differentiation of MC3T3-E1 cells by activating the expression of WNT/[3-catenin.

T cell infiltration and proliferation in tumor tissues are the main factors that significantly affect the therapeutic outcomes of cancer immunotherapy. Emerging evidence has shown that interferon-gamma (IFNγ) could enhance CXCL9 secretion from macrophages to recruit T cells, but Siglec15 expressed on TAMs can attenuate T cell proliferation. Therefore, targeted regulation of macrophage function could be a promising strategy to enhance cancer immunotherapy via concurrently promoting the infiltration and proliferation of T cells in tumor tissues. We herein developed reduction-responsive nanoparticles (NPs) made with poly (disulfide amide) (PDSA) and lipid-poly (ethylene glycol) (lipid-PEG) for systemic delivery of Siglec15 siRNA (siSiglec15) and IFNγ for enhanced cancer immunotherapy. After intravenous administration, these cargo-loaded could highly accumulate in the tumor tissues and be efficiently internalized by tumor-associated macrophages (TAMs). With the highly concentrated glutathione (GSH) in the cytoplasm to destroy the nanostructure, the loaded IFNγ and siSiglec15 could be rapidly released, which could respectively repolarize macrophage phenotype to enhance CXCL9 secretion for T cell infiltration and silence Siglec15 expression to promote T cell proliferation, leading to significant inhibition of hepatocellular carcinoma (HCC) growth when combining with the immune checkpoint inhibitor. The strategy developed herein could be used as an effective tool to enhance cancer immunotherapy.

Objective To evaluate the quality of postoperative recovery of patients undergoing cardiac great vessels surgery by 15-item Recovery Quality Score Scale(QoR-15),to retrospectively analyze the influence of perioperative multi-factors on postoperative recovery quality,and to establish the predictive model.Methods Clinical data of patients who underwent cardiac great vascularsur-gery from March 2020 to September 2022 were collected through electronic medical record system and the postoperative QoR-15 score were evaluated.The data including gender,age,postoperative follow-up time,American Society of Anesthesiologists(ASA)classification,preoperative lactate level,co-morbidities,emergency or not,extracorporeal circulation or not,etc.were collected.The modified frailty index(mFI)was also calculated.Surgical patterns,operation time,extracorporeal circulation time,aortic block time,type of heart recurrence,perioperative fluid therapy,extracorporeal circulation temperature,and other postoperative data as well as postoperative data including ICU retention time after surgery,total length of stay and QoR-15 score were recorded.The univariate and multivariate Logistic regression analysis were then applied to construct a prediction model,and its accuracy was validated.Results A total of 213 patients were included,in which 15 patients were excluded,and 198 postoperative QoR-15 score sheets were received.Gender,ASA classification,preoperative lac-tate level,postoperative follow-up time,and mFI were significant influencing factors on the quality of rehabilitation of patients undergoing cardiac or great vascular surgery.The prediction model of ln(p/1-p)=-5.571+0.862 × gender+3.844 × ASA classification+3.143 × preoperative lactate level+2.001 × postoperative follow-up time+3.712 × mFI,which had good predictive and classifi-cation effects.Conclusion Gender,ASA classification,preoperative lactate level,postoperative follow-up time and mFI are influencing factors on the recovery quality of patients after cardiac great vascular surgery.

Objective To evaluate the quality of postoperative recovery of patients undergoing cardiac great vessels surgery by 15-item Recovery Quality Score Scale(QoR-15),to retrospectively analyze the influence of perioperative multi-factors on postoperative recovery quality,and to establish the predictive model.Methods Clinical data of patients who underwent cardiac great vascularsur-gery from March 2020 to September 2022 were collected through electronic medical record system and the postoperative QoR-15 score were evaluated.The data including gender,age,postoperative follow-up time,American Society of Anesthesiologists(ASA)classification,preoperative lactate level,co-morbidities,emergency or not,extracorporeal circulation or not,etc.were collected.The modified frailty index(mFI)was also calculated.Surgical patterns,operation time,extracorporeal circulation time,aortic block time,type of heart recurrence,perioperative fluid therapy,extracorporeal circulation temperature,and other postoperative data as well as postoperative data including ICU retention time after surgery,total length of stay and QoR-15 score were recorded.The univariate and multivariate Logistic regression analysis were then applied to construct a prediction model,and its accuracy was validated.Results A total of 213 patients were included,in which 15 patients were excluded,and 198 postoperative QoR-15 score sheets were received.Gender,ASA classification,preoperative lac-tate level,postoperative follow-up time,and mFI were significant influencing factors on the quality of rehabilitation of patients undergoing cardiac or great vascular surgery.The prediction model of ln(p/1-p)=-5.571+0.862 × gender+3.844 × ASA classification+3.143 × preoperative lactate level+2.001 × postoperative follow-up time+3.712 × mFI,which had good predictive and classifi-cation effects.Conclusion Gender,ASA classification,preoperative lactate level,postoperative follow-up time and mFI are influencing factors on the recovery quality of patients after cardiac great vascular surgery.

Objective:To investigate the clinical efficacy of plasma exchange combined with dual plasma molecular adsorption system (PE+ DPMAS) in treating patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF).Methods:A total of 114 HBV-ACLF patients admitted to The Affiliated Hospital of Southwest Medical University in Luzhou City and treated with PE+ DPMAS from June 2014 to January 2018 were included. According to different basis of liver diseases, there were type A, type B and type C. The laboratory data and model for end-stage liver disease (MELD) of patients before PE+ DPMAS and 48 h after treatment, and the prognosis of patients at 90 d were retrospectively analyzed. Independent sample t test, paired sample t test, nonparametric test, variance analysis and chi-square test were used for statistical analysis. Results:The clinical stages among patients with type A (22 cases), type B (39 cases) and type C (53 cases) were mainly early (seven, 17, 22 cases) and mid-stages (eight, 14, 20 cases). Before PE+ DPMAS, alanine aminotransferase (ALT), prealbumin (pAlb), albumin (Alb), creatinine (Cr), total bilirubin (TBil), prothrombin time (PT), international normalized ratio (INR), prothrombin activity (PTA), and MELD were all not statistically different among the patients in the three groups (all P>0.05). After PE+ DPMAS treatment, ALT, TBil, PT, INR, MELD, pAlb, Alb, and PTA in patients with type A were statistically different compared with those before treatment ( Z=5.104, t=5.555, 4.974, 4.481, 7.984, -5.396, -2.784 and -6.752, respectively, all P<0.05). ALT, TBil, PT, INR and MELD in patients with type B were significantly decreased, while pAlb and PTA were significantly increased after treatment ( Z=-5.428, t=4.867, 4.405, 4.179, 6.186, -6.290 and -4.533, respectively, all P<0.01). ALT, pAlb and TBil in patients with type C after PE+ DPMAS treatment were significantly different from those before treatment ( Z=-5.723, t=-2.525 and 2.462, respectively, all P<0.05). There was no statistically significant difference in Cr of the three groups before and after treatment (all P>0.05). The patients with type A had the shortest hospital stay ((17.95±5.92) d), while the patients with type C had the longest stay ((25.77±7.02) d). The hospital stay of patients with type B was (21.79±6.72) d. The difference was statistically significant ( F=11.317, P<0.01). After 90 d follow-up, four patients (18.18%) with type A died, nine patients (23.08%) with type B died, and 25 patients (47.17%)with type C died. The difference was statistically significant ( χ2=8.615, P=0.013). Conclusion:HBV-ACLF patients with type A and type B have better prognosis after PE+ DPMAS treatment compared to patients with type C who are in the decompensated stage of liver cirrhosis.

Objective: To analyze the influencing factors for residual lesions after radiofrequency ablation in elderly patients with liver cancer. Methods: Clinical data of 65 elderly patients with liver cancer treated by radiofrequency ablation in our hospital from January 2014 to December 2016 were retrospectively analyzed.The influencing factors on residual lesions after radiofrequency ablation were analyzed by univariate analysis and multivariate logistic regression. Results: Of 102 lesions in 65 elderly patients with liver cancer, 87 lesions were completely ablated at the first time, and the first complete ablation rate of lesion was 85.29%(87/102). All visible lesions were completely ablated in 56 patients at the first time, and the first complete ablation rate of cases was 86.15%(56/65). Fifteen lesions in 9 patients were incompletely ablated.Univariate analysis showed that gender(χ²=0.740, P=0.390), cirrhosis(χ²=0.745, P=0.388), hepatitis B(χ²=0.057, P=0.812)and type of liver cancer(χ²=0.171, P=0.682)had no significant effect on the residual lesions after radiofrequency ablation, but the number of lesions(χ²=6.694, P=0.010), the lesion size(χ²=14.382, P=0.000)and liver function classification(χ²=5.359, P=0.030)had statistically significant effects on residual lesions after radiofrequency ablation.Further multivariate logistic regression analysis showed that the number of lesions ≥ 3(OR=1.916, 95%CI: 1.326~2.571, P=0.029), the size of lesions≥3 cm(OR=2.362, 95%CI: 2.180~2.923, P=0.000)were risk factors for residual lesions after radiofrequency ablation. Conclusions Radiofrequency ablation has a better therapeutic effect on liver cancer in elderly patients.The number and size of lesions have a certain impact on the residual lesions after radiofrequency ablation.

Objective To investigate the risk factors of laparoscopic cholecystectomy (LC) in patients with previous gastrectomy.Methods This retrospective study reviewed a database of patients who underwent LC at our hospital during the period of Jan 2010 and May 2015.Results Comparesd with those of no history of gastrectomy the average operation time in patients with previous gastrectomy was longer (t =15.608,P ＜ 0.05) the intraoperative blood loss was higher (t =3.061,P ＜ 0.05),and the operation time of patients with a long interval (＞ 5 years) between gastrectomy and LC was shorter (t =6.405,P ＜ 0.01).The conversion rate did not differ between the two groups (P ＞ 0.05),but the conversion rate significantly reduced after a comprehensive preoperative evaluation procedure (x2 =15.282,P ＜ 0.01).Conclusion LC for benign gallbladder diseases is safe,effective and feasible in patients with a history of gastrectomy,if a comprehensive preoperative evaluation is adopted and in experinced hands.

Objective To study the effect of enhanced MK gene expression in hepatic carcinoma cells.Methods The recombinant plasmid pIRES2-EGFP-MK was transfected into SMMC 7721 cells.The mRNA and protein expression levels of MK gene in these cells were determined by real-time PCR,Western blotting and flow cytometry.The intracellular DNR accumulation of these cells was measured by flow cytometry.To investigate the effect of MK gene mediated multidrug resistance,MTT assay was employed to determine the cellular sensitivity of different chemotherapeutic drugs in MK-overexpressed SMMC 7721 cells.Results The mRNA and protein expression levels of MK gene significantly increased after the recombinant plasmid pIRES2-EGFP-MK transfected into SMMC 7721 cells,suggesting that the recombinant plasmid pIRES2-EGFP-MK can enhance the transcription of MK effectively.The DNR accumulation of MK transfected cells decreased significantly (4.06 ± 0.88,P ＜ 0.05),and IC50 of MK transfected cells to ADM/5-FU increased significantly (15 ± 3,27 ± 4,P ＜ 0.05).Conclusions After the recombinant plasmid pIRES2-EGFP-MK transfected into hepatic carcinoma cells,expression of midkine increased,enhancing the resistance of hepatic carcinoma cells to chemotherapeutic drugs.