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Lv-Mei Huang, Chun-Yan Tan, Xia Chen, Ya-Juan Jiang, Yan-Rui Zhou, Hong Zhao Department of Basic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan, 421000, People’s Republic of ChinaCorrespondence: Hong Zhao, Department of Basic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, Hunan, 421000, People’s Republic of China, Tel +86-15173458044, Email zhaohong779900@163.comBackground: Understanding patients’ perceptions of their illness may be more beneficial for healthcare providers in maintaining vigilance than merely focusing on the clinical status of patients. As patients’ perceptions can significantly influence their behavior, it is possible that health care providers who are aware of patients’ thoughts in advance may help improve their intervention programs, such as increased treatment adherence. However, current research offers limited insight into the subjective perceptions of disease among patients with Chronic Obstructive Pulmonary Disease (COPD). This study aims to deeply explore COPD patients’ illness perception and coping behaviors.Methods: A descriptive qualitative approach was used, conducting semi-structured in-depth interviews with 32 COPD patients, and verbatim data recording. Data analysis was based on thematic analysis methods proposed by Braun and Clarke.Results: Through data analysis, we identified three themes to describe participants’ perceptions and coping behaviors related to COPD: inadequate knowledge regarding the disease, improper self-management of the disease, and diverse impacts resulting from the disease.Conclusion: Illness perception is crucial for COPD patients. Participants’ descriptions underscored their perceptions of the disease as well as the various challenges and consequences they face when dealing with it. To enhance care for individuals with COPD, researchers and healthcare professionals should increase awareness about the disease among patients, understanding their coping strategies, beliefs, and recognizing its significant impacts.Keywords: chronic obstructive pulmonary disease, illness perception, coping behaviors, qualitative research

Xiangjun Chen,* Weiwei Li,* Qing Fan, Xiao Liu, Xuanxiang Zhai, Xiaoyi Shi, Wenting Li, Wei Hong School of Pharmacy, Shandong Engineering Research Center of New-Type Drug Loading & Releasing Technology and Preparation, Binzhou Medical University, Yantai, Shandong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei Hong; Wenting Li, Email hongwei_sy@bzmc.edu.cn; liwenting1003@163.comIntroduction: Pseudomonas aeruginosa (P. aeruginosa)-induced pneumonia is marked by considerable infiltration of inflammatory cells and biofilm formation, which causes acute and transient lung inflammation and infection. Nevertheless, the discovery of alternative preventative and therapeutic methods is essential due to the high mortality rates in clinical settings and the resistance of P. aeruginosa infection to multiple medications.Purpose: In this research, we constructed amphiphilic Janus nanoparticles (JNPs, denoted as SSK1@PDA/CaP@CIP), loaded with hydrophobic SSK1, a β-galactosidase (β-gal)-activated prodrug for reducing macrophages, and hydrophilic ciprofloxacin (CIP), a classic antibiotic for treating infection. SSK1@PDA/CaP@CIP was designed to effectively attenuate inflammation, eradicate biofilms, and combat planktonic P. aeruginosa.Results: As expected, SSK1@PDA/CaP@CIP was able to target the infection site and demonstrated outstanding efficacy in treating P. aeruginosa strain PAO1-induced pneumonia by regulating macrophage infiltration to reduce inflammation and removing planktonic bacteria and biofilms to control infection. Additionally, the primary organs did not exhibit any discernible pathological changes following treatment with SSK1@PDA/CaP@CIP, which indicates superior biocompatibility throughout the treatment course.Discussion: In conclusion, our investigation introduced a promising approach to the treatment of pneumonia associated with PAO1.Keywords: Pseudomonas aeruginosa, pneumonia, inflammatory responses, β-galactosidase (β-gal)-activated prodrug, amphiphilic Janus nanoparticles

Qingpeng Xie,1,2,* Jiawen Gu,1,2,* Yujia Sun,3 Jinjia Hong,1,2 Jia Wang,1,2 Na Li,1,2 Yuan Zhang,1,2 Meixian Liu,1,2 Xiaoxuan Zhang,1,2 Xiangyu Zhao,1,2 Xiaohang Chen,1,2 Xing Wang1,2 1Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China; 2Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, People’s Republic of China; 3Nursing College of Shanxi Medical University, Taiyuan, 030001, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaohang Chen; Xing Wang, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, People’s Republic of China, Tel +8618834896163 ; +8613934224604, Email kqyx__cxh@163.com; wangxing@sxmu.edu.cnPurpose: Periodontitis is a chronic inflammatory oral disease that causes defects in periodontal tissue. Conventional therapies are limited, and often lead to high recurrence rates. The emerging concept of medicinal food homology has shed light on the potential of ginger as a therapeutic adjuvant for periodontitis, given its antioxidant and anti-inflammatory properties. However, fresh ginger exhibits poor stability and bioavailability. Ginger exosome-like nanoparticles (GELNs), a derivative of ginger, have not been reported to exert therapeutic effects in periodontitis. This study aimed to explore the therapeutic effects of GELNs on tissue damage caused by periodontitis and their underlying mechanisms of action.Methods: The GELNs composition was analyzed using a widely targeted metabolome. Stability was assessed using nanoparticle tracking analysis (NTA) and zeta potential measurements, flavor was evaluated using an electronic nose, and membrane penetration was studied using confocal microscopy. A periodontitis model was established in SD rats, periodontal clinical indicators were monitored, and histological changes were assessed using H&E and TRAP staining. Co-culture experiments investigate the antioxidant and reparative abilities of GELNs on periodontal ligament fibroblasts (PDLFs) in inflammatory environment. NF-κB protein expression was examined by immunofluorescence and immunohistochemistry.Results: The findings revealed that GELNs demonstrated good stability in different environments and mitigated the pungent taste of the raw ginger. In vivo experiments showed that GELNs improved periodontal clinical parameters and pathology compared with ginger juice. In vitro data suggested that GELNs enhanced the proliferation and migration of PDLFs while reducing the reactive oxygen species (ROS) levels by inhibiting the NF-κB signaling pathway in an inflammatory setting.Conclusion: This study is the first to demonstrate that GELNs have a potential therapeutic effect on periodontitis. GELNs can alleviate oxidative stress (OS) and inflammatory reactions by inhibiting the NF-κB signaling pathway. These findings provide a promising method for the treatment of periodontitis by regulating an unbalanced OS state. Keywords: ginger exosome-like nanoparticles, periodontitis, tissue repair, oxidative stress, periodontal ligament fibroblasts

Jianquan He, Xiayun Chen Department of Stomatology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, People’s Republic of ChinaCorrespondence: Xiayun Chen, Department of Stomatology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, TianHe Road, Guangzhou, Guangdong Province, 510630, People’s Republic of China, Email chenxiay@mail.sysu.edu.cnIntroduction: Even with significant progress has been made in elucidating the pathogenesis of temporomandibular disorders (TMD), the pathophysiology of temporomandibular joint (TMJ) pain is still obscure. Our study aimed to explore whether there is a causal link between immune cells and TMD-related pain.Materials and Methods: Based on the TMD-related pain data obtained from the FinnGen Research Consortium and the 731 immune traits extracted from the GWAS Catalog and utilized a two sample Mendelian Randomization (MR) method, with immune cell as the exposure and TMD-related pain as the outcome. MR analyses were conducted employing the inverse-variance weighting method (IVW) as the primary analytical method to evaluate the causal association. Sensitivity analyses were conducted to enhance the robustness, heterogeneity and horizontal pleiotropy of the results. A reverse MR analysis was also conducted for immune cell traits identified in the initial MR analysis.Results: After false discovery rate (FDR) correction, two immune traits were observed and found to be significantly associated with TMD-related pain: Hematopoietic Stem Cell absolute count (OR=0.954, 95% CI= 0.933~0.976), and HLA DR+ CD4+ T cell (OR=1.040, 95% CI=1.019~1.061). On the reverse MR analysis, no significantly associated results were found in causal effects of TMD-related pain on immune traits.Conclusion: Our study showed a potential causal relationship between immune cells and TMD-related pain, eliminating reverse causality. These discoveries significantly enhance our knowledge of the interaction between immune traits and TMD-related pain, opening new possibilities for designing treatment from an immunological perspective.Keywords: temporomandibular related pain, immune trait, immune cell, Mendelian randomization

Liudan Huang,1 Xuexin Chen,2 Yuhua Zhang1 1Department of Pediatrics, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China; 2Department of Neonatology, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of ChinaCorrespondence: Liudan Huang, Department of pediatrics, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China, Email 15917932267@163.comBackground: Neonatal respiratory distress syndrome (NRDS) is common in preterm infants. Prognostic nutritional index (PNI)((albumin (g/L)+(5×total lymphocyte count (109/L)) is a comprehensive indicator of nutritional and immune levels, and associated with several diseases. The relationship between PNI and the risk of NRDS in newborns of different gestational ages remains unclear.Methods: A total of 2722 preterm infants were included in this retrospective study. PNI level and clinical records of these neonates (adverse pregnancy and birth history, amniotic fluid contamination, nuchal cord, placental abnormality, mode of delivery, gender and birth weight of neonates, Apgar scores) were collected. The clinical features of the infants with and without NRDS were compared. Logistic regression analysis was used to evaluate the relationship between PNI and NRDS in newborns with different gestational ages.Results: There were 1226 neonates with NRDS and 1496 without NRDS. The differences in the proportions of placenta abnormality, cesarean section, and small for gestational age (SGA) among infants with 34– 37 weeks, 28+1-33+6 weeks, and ≤ 28 weeks gestational age were statistically significant. Logistic analysis showed that cesarean section (odds ratio (OR): 1.550, 95% confidence interval (CI): 1.197– 2.007, p=0.001), and low PNI (OR: 1.417, 95% CI: 1.110– 1.808, p=0.005) were associated with NRDS in infants born at 34– 37 weeks gestational. Adverse pregnancy and birth history (OR: 1.507, 95% CI: 1.124– 2.019, p=0.006), SGA (OR: 1.994, 95% CI: 1.455– 2.733, p< 0.001), and low PNI (OR: 1.626, 95% CI: 1.230– 2.149, p=0.001) were associated with NRDS in infants with 28+1-33+6 weeks gestational age. Low PNI (OR: 5.512, 95% CI: 1.555– 19.536, p=0.008) was associated with NRDS in infants with ≤ 28 weeks gestational age.Conclusion: The risk factors for NRDS in preterm infants with different gestational ages were different. But the low PNI level is associated with an increased risk of NRDS in preterm infants with all different gestational ages.Keywords: neonatal respiratory distress syndrome, preterm infants, risk factors, prognostic nutritional index

Dou Zhang,1,2,&ast; Xuyi Liu,1,2,&ast; Xiong Li,3,&ast; Xinyi Cai,1,2 Zhenying Diao,1,2 Long Qiu,1,2 Xuelin Chen,1,2 Yuyu Liu,1,2 Jianbo Sun,1 Daxiang Cui,1,4 Qiaoyuan Ye,5 Ting Yin1,2 1Research Center of Nano Technology and Application Engineering, The First Dongguan Affiliated Hospital, School of Pharmacy, Guangdong Medical University, Dongguan, Guangdong, 523808, People’s Republic of China; 2Dongguan Biomedical Nano Engineering Technology Research Center, Guangdong Medical University, Dongguan, Guangdong, 523808, People’s Republic of China; 3Department of Pharmacy, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong, 519000, People’s Republic of China; 4School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, People’s Republic of China; 5Department of Dermatology and Venereology, Second Clinical Medical College of Guangdong Medical University, Dongguan, Guangdong, 523808, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qiaoyuan Ye, Department of Dermatology and Venereology, Second Clinical Medical College of Guangdong Medical University, Dongguan, Guangdong, 523808, People’s Republic of China, Email 13650248189@163.com Ting Yin, Research Center of Nano Technology and Application Engineering, School of Pharmacy, Guangdong Medical University, Dongguan, Guangdong, 523808, People’s Republic of China, Email wsyt132@163.comPurpose: Melanoma is a highly aggressive and dangerous malignant skin tumor and there is an urgent need to develop effective therapeutic approaches against melanoma. The main objective of this study was to construct a multifunctional nanomedicine (GNR@PEG-Qu) to investigate its therapeutic effect on melanoma from the oxidative stress pathway.Methods: First, the nanomedicine GNR@PEG-Qu was synthesized and characterized, and its photothermal and antioxidant properties were confirmed. In addition, in vivo imaging capabilities were observed. Finally, the tumor inhibitory effects of GNR@PEG-Qu in vivo and in vitro as well as its biosafety were observed.Results: GNR@PEG-Qu shows good photothermal and anti-oxidation properties. Following exposure to 1064 nm laser irradiation in the second near-infrared II (NIR-II) window, GNR@PEG-Qu shows anti-tumor ability through low-temperature photothermal therapy (PTT) adjuvant drug chemotherapy. GNR@PEG-Qu makes full use of the antioxidant capacity of quercetin, reduces ROS levels in melanoma, alleviates oxidative stress state, and achieves “oxidative stress avoidance” at the tumor site. Quercetin can also downregulate the expression of the heat shock protein Hsp70, which will improve the thermal sensitivity of the tumor site and enhance the efficacy of low-temperature PTT.Conclusion: GNR@PEG-Qu nanoagent exhibits synergistic treatment and high tumor inhibition effects, which is a promising strategy developed to achieve oxidative stress avoidance and synergistic therapy of melanoma using quercetin (Qu)-coated gold nanorod (GNR@PEG).Keywords: melanoma, gold nanorods, quercetin, chemo-photothermal therapy, oxidative stress

Jin-hui Xu,1,* Xiang-long Chen,1,* Qian Zhang,1,* Zhiwei Zhuang,2 Yun-long Yuan,3 Lu-fen Duan,1 Lu Shi,1 Chenqi Zhu,1 Jing-Jing Li,1 Jian Lu,4 Yan-xia Yu,1 Lian Tang1,5 1Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, People’s Republic of China; 2Emergency Intensive Care Unit, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, People’s Republic of China; 3Medical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, People’s Republic of China; 4Intensive Care Unit, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, People’s Republic of China; 5Gusu School, Nanjing Medical University, Suzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lian Tang; Yan-xia Yu, Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, Gusu District, Suzhou, 215002, People’s Republic of China, Tel +86 512 6236 2325, Email tanglian716@aliyun.com; yuyxsz@163.comPurpose: The optimal treatment strategy in patients with hospital-acquired pneumonia (HAP) due to Gram-positive bacteria and renal insufficiency remains challenging. The objective of this study was to compare the outcomes of linezolid versus teicoplanin in HAP patients with renal insufficiency and to explore optimal dosage strategy for linezolid.Methods: The retrospective study enrolled adult patients treated with intravenous linezolid or teicoplanin at Suzhou Municipal Hospital between July 2018 and August 2023. For the comparative pharmacodynamic study, effectiveness, safety and target attainment of trough concentration (Cmin) for teicoplanin versus linezolid treatment in HAP patients with document Gram-positive bacteria and renal insufficiency were compared. For the population pharmacokinetics (PPK) analyses, linezolid concentrations collected exclusively from HAP patients with renal insufficiency were used and the optimal dosage strategy was investigated using Monte Carlo simulations.Results: Linezolid-treated patients had a higher bacterial eradication rate than teicoplanin-treated patients (88.5% vs 63.4%, P < 0.001). A higher proportion of patients in the linezolid group experienced at least one adverse reaction (42.0% vs 25.0%, P = 0.025). Significantly more supratherapeutic Cmin, less therapeutic Cmin were achieved in the linezolid group (adjusted P < 0.05). A total of 207 linezolid concentrations from 166 patients with renal insufficiency were available for the PPK analysis. Age and creatinine clearance (CrCL) were identified as significant covariates that influenced clearance. Simulations show that 300 mg q12h provide the optimal exposure in patients with a CrCL of 60 or 45 mL/min, and 200 mg q12h was recommended for patients with a CrCL of 30 or 15 mL/min.Conclusion: Linezolid-treated patients with HAP and renal insufficiency had higher bacterial eradication rates, supratherapeutic exposure and adverse reactions than teicoplanin-treated patients. Linezolid dose reduction in patients with renal insufficiency improved the probability of achieving optimal exposure.Keywords: linezolid, population pharmacokinetic, pharmacodynamic, renal insufficiency, hospital-acquired pneumonia

Jun Zhou,1,2,&ast; Liu Shi,1,2,&ast; Chuwei Tian,1,2 Yucheng Gao,1,2 Jinyu Wang,2,3 Jin Mao,2,4 Yan Li,2,4 Wenbin Fan,1,2 Xiangxu Chen,1,2 Cheng Zhang,1,2 Tian Xie,1,2 Yunfeng Rui1,2,&ast; 1Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People’s Republic of China; 2Multidisciplinary Team for Geriatric Hip Fracture Comprehensive Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People’s Republic of China; 3Department of Rehabilitation, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People’s Republic of China; 4Department of Emergency, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yunfeng Rui, Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, NO. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, People’s Republic of China, Tel +86 13705182577, Email ruiyunfeng@126.comIntroduction: This study aims to assess the impacts of the Fast Access to Surgery in Emergency (FASE) strategy on (1) the workflow of multidisciplinary team (MDT) during hospitalization; (2) the clinical outcomes of geriatric femoral neck fracture (FNF) patients.Methods: A retrospective study was conducted in a single trauma center to evaluate the clinical data of geriatric FNF patients admitted through emergency from July 2017 to June 2022. The FASE strategy was implemented since Jan 1st 2020, and patients were categorized into the FASE group or the control group according to the time of admission (before/after the initiation timepoint of FASE strategy). Propensity score matching (PSM) was utilized to limit confounding bias between the two groups.Results: Finally, 344 patients were included after a one-to-one matching. The FASE strategy resulted in a slightly prolonged duration in emergency (6.02± 5.99 h vs 2.72± 4.22 h, p< 0.001) but was meanwhile associated with significant decreases in time to surgery (61.16± 38.74 h vs 92.02± 82.80 h, p< 0.001), actual surgery delay (67.18± 39.04 h vs. 94.25± 84.41 h, p< 0.001) and total length of hospital stay (10.57± 4.93 h vs 12.50± 4.73 h, p < 0.001). Besides, despite the consistency of transfusion rate between the two groups, improved blood management was achieved in the FASE group, as evidenced by a smaller drop in hemoglobin levels (− 20.49± 17.02 g/L vs − 25.28± 16.33 g/L, p = 0.013) in patients without preoperative or intraoperative transfusion. However, no significant differences were observed regarding the overall clinical outcomes such as mortality or postoperative complications.Conclusion: The Fast Access to Surgery in Emergency (FASE) for geriatric FNF patients effectively optimized the preoperative evaluation workflow, which significantly shortened time to surgery and length of hospital stay, and reduced perioperative blood loss. FASE strategy improved the surgical workflows and turnover efficiency of geriatric FNF patients, therefore could play an important role in the optimal MDT co-management for geriatric FNF patients. Keywords: femoral neck fracture, geriatric, emergency optimization, multidisciplinary management, early surgery

Rong Yang,1,&ast; Qing Ma,1,2,&ast; Xiaolin Zhang,3 Qian Zhao,1,4,5 Suilan Zeng,6 Hechun Yan,7 Yi Lei,1,5 Shanye Yi,1 Xin Chen,8 Nianxi Wu9 1General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2West China School of Nursing, Sichuan University, Chengdu, People’s Republic of China; 3Preventive Health Section, Dayi County Shaqu Street Community Health Service Center, Chengdu, People’s Republic of China; 4Teaching & Research Section, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 5General Practice Medical Center and General Practice Research Institute, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 6Guan Ge Center Health Center, Guangan, People’s Republic of China; 7Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, People’s Republic of China; 8Big Buddha Street Community Health Service Center, Leshan, People’s Republic of China; 9Chongqing Magic MedTech Co., Ltd., Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qian Zhao, Email 27355151@qq.comPurpose: Osteoporosis is a major health concern among the elderly, underscoring the importance of investigating its prevalence across different geographical regions. There is a current research gap regarding the incidence of osteoporosis and its variation by altitude within Sichuan, China. This study aimed to assess the prevalence of osteoporosis among populations residing at different altitudes in western Sichuan Province.Basic Procedures: This study utilized data from a population-based cohort in Sichuan, China. Representative locations were selected, and cluster random sampling was employed to conduct cohort studies across multiple sites in southwestern China. T Baseline data were collected from populations in Mianzhu, Kangting, and Sertar between July 2020 and August 2021. To assess differences in osteoporosis incidence among populations at different altitudes and with varying characteristics, we applied Chi-square and rank-sum tests.Main Findings: The study involved 4074 participants, including 1404 males (34.46%) and 791 individuals diagnosed with osteoporosis (19.42%). The prevalence of osteopenia in mid-altitude and high-altitude regions was 20.05% and 16.28%, respectively, while the prevalence of osteoporosis was significantly different, at 25.85% in mid-altitude areas compared to 13.00% in high-altitude areas (P < 0.001). Further analysis identified statistically significant differences in the prevalence of osteopenia and osteoporosis among females (P< 0.001), middle-aged (P=0.015) and elderly populations (P=0.038), as well as among individuals who were underweight (P=0.011), normal weight (P< 0.001), overweight (P< 0.001), and obese (P=0.038). As altitude increased, the prevalence of osteoporosis decreased in all groups except the elderly, while the prevalence of osteopenia decreased among women and across various BMI categories, but increased among middle-aged and elderly individuals. Additionally, in high-altitude regions, Kangting recorded an 18.10% prevalence of osteopenia and a 14.26% prevalence of osteoporosis, compared to Sertar, which exhibited a 6.54% prevalence of osteopenia and a 6.23% prevalence of osteoporosis, indicating significant differences (P< 0.001).Conclusion: This study demonstrates that higher altitudes are associated with a decreased prevalence of osteopenia and osteoporosis, particularly among females and middle-aged individuals. These results emphasize the importance of developing region-specific osteoporosis prevention strategies.Keywords: osteoporosis, aging, prevalence, altitude, Sichuan province

Yujuan Mao,1,&ast; Tianjiao Hao,2,&ast; Hongxiu Zhang,2,&ast; Xiaofei Gu,2 Jing Wang,1 Feifei Shi,1 Xiaolan Chen,1 Liuna Guo,1 Jie Gao,1 Yan Shen,2 JinLin Zhang,3 Shenglan Yu4 1Jiangsu Agri-Animal Husbandry Vocational College, Taizhou, Jiangsu, 225300, People’s Republic of China; 2Department of Pharmaceutics, China Pharmaceutical University, Nanjing, 210009, People’s Republic of China; 3Jiangsu Institute for Food and Drug Control, Nanjing, Jiangsu Province, 210019, People’s Republic of China; 4College of Animal Medicine, Jiangsu Agri-Animal Husbandry Vocational College, Taizhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shenglan Yu; JinLin Zhang, Email slyu70@126.com; zjluser@126.comIntroduction: Eprinomectin offers promise against parasitic infections. This study develops Eprinomectin (EPR) mixed micelles for transdermal delivery, aiming to enhance efficacy and convenience against endoparasites and ectoparasites. Physicochemical characterization and pharmacokinetic studies were conducted to assess its potential as an effective treatment for parasitic infections.Methods: Blank and EPR mixed micelles were prepared using PEG-40 Hydrogenated castor oil (RH-40) and Nonyl phenol polyoxyethylene ether 40 (NP-40). Critical micelle concentrations (CMC) determined using the pyrene fluorescence probe method. Particle size, EE, DL, in vitro release, permeation, and skin irritation were evaluated. In vivo pharmacokinetic studies were conducted in male Sprague-Dawley rats.Results: Results show that EPR mixed micelles present suitable stability, physicochemical properties, and safety. Moreover, the rapid release and high bioavailability of EPR mixed micelles have also been verified in the study. Pharmacokinetic experiments in vivo showed that an improvement in the transdermal absorption and bioavailability of EPR after encapsulation in mixed micelles formulations.Conclusion: The results proved that the novel mixed micelles are safe and effective and are expected to become a promising veterinary nano-delivery system.Keywords: eprinomectin, mixed micelles, transdermal delivery, pharmacokinetics

Xiaolan Guo,1 Dansen Wu,1 Xiaoping Chen,2 Jing Lin,1 Jialong Chen,1 Liming Wang,1 Songjing Shi,1 Huobao Yang,1 Ziyi Liu,3 Donghuang Hong1,4 1Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, People’s Republic of China; 2Computer Science and Mathematics, Fujian University of Technology, Fuzhou, Fujian, People’s Republic of China; 3Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 4Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, Fujian, People’s Republic of ChinaCorrespondence: Ziyi Liu, Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People’s Republic of China, Email liu-ziyi@sjtu.edu.cn Donghuang Hong, Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, No. 134, Dongjie Street, Gulou District, Fuzhou, Fujian, 350001, People’s Republic of China, Email hongdh2003@fjmu.edu.cnPurpose: The objective of this study was to identify the risk factors associated with Carbapenem-resistant Enterobacteriaceae (CRE) colonization in intensive care unit (ICU) patients and to develop a predictive risk model for CRE colonization.Patients and Methods: In this study, 121 ICU patients from Fujian Provincial Hospital were enrolled between January 2021 and July 2022. Based on bacterial culture results from rectal and throat swabs, patients were categorized into two groups: CRE-colonized (n = 18) and non-CRE-colonized (n = 103). To address class imbalance, Synthetic Minority Over-sampling Technique (SMOTE) was applied. Statistical analyses including T-tests, Chi-square tests, and Mann–Whitney U-tests were employed to compare differences between the groups. Feature selection was performed using Lasso regression and Random Forest algorithms. A Logistic regression model was then developed to predict CRE colonization risk, and the results were presented in a nomogram.Results: After applying SMOTE, the dataset included 198 CRE-colonized patients and 180 non-CRE-colonized patients, ensuring balanced groups. The two groups were comparable in most clinical characteristics except for diabetes, previous emergency department admission, and abdominal infection. Eight independent risk factors for CRE colonization were identified through Random Forest, Lasso regression, and Logistic regression, including Acute Physiology and Chronic Health Evaluation (APACHE) II score > 16, length of hospital stay > 31 days, female gender, previous carbapenem antibiotic exposure, skin infection, multi-site infection, immunosuppressant exposure, and tracheal intubation. The risk prediction model for CRE colonization demonstrated high accuracy (87.83%), recall rate (89.9%), precision (85.6%), and an AUC value of 0.877. Patients were categorized into low-risk (0– 90 points), medium-risk (91– 160 points), and high-risk (161– 381 points) groups, with corresponding CRE colonization rates of 1.82%, 7.14%, and 58.33%, respectively.Conclusion: This study identified independent risk factors for CRE colonization and developed a predictive model for assessing the risk of CRE colonization.Keywords: carbapenem-resistant Enterobacteriaceae, intensive care unit, colonization, risk factors, risk prediction model

Ye Zhao,1,&ast; Xi Chen,1,&ast; Yuhan Huang,2,&ast; Zhihan Zhang,3 Kui Wang,1 Duowu Zou,1 Teng Ma2 1Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 3Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Teng Ma, Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China, Email mrmateng@126.com Duowu Zou, Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, People’s Republic of China, Email zdw_pi@163.comPurpose: This study aimed to investigate gene expression profiles, identify potential hub genes, and predict drugs for patients with erosive esophagitis (EE). Despite its clinical significance, molecular-level exploration of this condition has been limited.Patients and Methods: RNA sequencing was performed on clinical biopsy samples from eight EE patients and eight healthy controls. Integrated bioinformatic tools were then utilized to analyze the data, including functional enrichment analysis, protein-protein interaction network analysis, weighted gene co-expression network analysis, immune infiltration analysis, and identification of small-molecule compounds. Additionally, the expressions of the identified hub genes were assessed in clinical samples.Results: A total of 2801 genes with differential expression were identified, including four potential hub genes: SOX9, SPP1, TIMP1, and TLR4. Moreover, the overexpression of these hub genes was verified in clinical samples. Analysis of Immune infiltration indicated an imbalance in the distribution of immune cell types in patients with EE. Correlation analysis between immune cells and hub genes unveiled noteworthy relationships. Specifically, SOX9 exhibited a negative correlation with CD8 T cells but a positive correlation with resting memory CD4 T cells. SPP1 displayed a positive correlation with naïve B cells, while TIMP1 exhibited a negative correlation with resting dendritic cells. Furthermore, the study identified ten small-molecule drugs with potential therapeutic effects for EE, including loreclezole and mercaptopurine.Conclusion: This study provides valuable insights into the molecular understanding of EE, offering new perspectives on disease mechanisms. The findings may inspire further research leading to the development of novel treatment strategies for EE.Keywords: erosive esophagitis, RNA sequencing, bioinformatics analysis, immune infiltration, drug prediction

Zhaobai Lao,1,&ast; Xuliang Fang,1,&ast; Shuchao Shen,1,&ast; Yuliang Zhang,2,&ast; Xin Chen,1 Helou Zhang,1 Yishan Bian,1 Chengcong Zhou,1 Ronghua Bao,2 Taotao Xu,3 Hongting Jin,1 Fangda Fu,1 Chengliang Wu,1 Changfeng Hu,4 Hongfeng Ruan1 1Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, 310053, People’s Republic of China; 2Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology, Hangzhou, Zhejiang, 311400, People’s Republic of China; 3Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, 310053, People’s Republic of China; 4College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Changfeng Hu, College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China, Email zhudianzhuifeng@163.com Hongfeng Ruan, Institute of Orthopaedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, People’s Republic of China, Email rhf@zcmu.edu.cnPurpose: Systemic lupus erythematosus (SLE) is an autoimmune disorder marked by immune system dysregulation and autoantibodies production, causing widespread inflammation and damage across various body systems. Despite the prevalent back pain in SLE patients, the link between SLE and intervertebral disc (IVD) degeneration, a primary contributor to back pain, remains inadequately understood. This study explored the impact of SLE on IVD degeneration using the MRL/lpr mouse model, which effectively replicates human SLE manifestations.Methods: The study utilized MRL/lpr mice to investigate the effects of SLE on IVD degeneration. The mice were evaluated for typical SLE phenotypes and indicators of IVD degeneration, including IVD height, IVD score, tissue integrity, extracellular matrix degradation, and apoptosis of IVD cells. Additionally, the study examined nucleus pulposus (NP) pyroptosis and inflammatory cytokine secretion. Mechanistic analysis focused on the antioxidant pathway, specifically the expression levels of NRF2, HO-1, KEAP1, and the phosphorylation levels of p65.Results: MRL/lpr mice displayed typical SLE phenotypes and exacerbated profiles of IVD degeneration, including reduced IVD height, lower IVD score, significant IVD tissue impairment, extracellular matrix degradation, and increased apoptosis of IVD cells. Notably, SLE stimulated NP pyroptosis and excessive secretion of inflammatory cytokines. Mechanistic analysis indicated that the progression of SLE impedes the antioxidant pathway by downregulating NRF2 and HO-1 expression, upregulating KEAP1, and enhancing phosphorylation levels of p65.Conclusion: Our findings highlight the mechanistic link between SLE and IVD degeneration, suggesting potential therapeutic targets for mitigating back pain in SLE patients.Keywords: systemic lupus erythematosus, intervertebral disc degeneration, nucleus pulposus, pyroptosis, NRF2/KEAP1/NF-κB pathway

Qiong Chen,1,* Yanjin Huang,2,* Xiaomei Chen,3 Limin Xu1 1Department of Intensive Care Medicine, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China; 2Department of Nursing, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China; 3Department of Pain, Xiamen Haicang Hospital, Xiamen, Fujian, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qiong Chen, Department of Intensive Care Medicine, Xiamen Haicang Hospital, No. 89 haiyu Road, Haicang District, Xiamen, Fujian, 361026, People’s Republic of China, Tel +86 177 50612461, Email chenqiongfff@163.comPurpose: Post-traumatic stress disorder (PTSD) is a major psychiatric health issue among intensive care unit (ICU) survivors with post-intensive care syndrome (PICS). Although early PTSD intervention has been demonstrated to decrease the risk of progression from acute to chronic PTSD, information on the progression trajectory of short-term PTSD symptoms and modifiable risk factors in PICS patients is limited. This study aimed to explore the clinical progression trajectories of short-term PTSD symptoms and the associated factors in PICS patients by conducting a prospective longitudinal observational study.Patients and Methods: This study was conducted at a tertiary hospital in China. The impact of event scale-revised was used to collect data on the PTSD symptoms of patients at 1, 2, 3, and 4 months post-discharge from the ICU. The latent growth mixture model was used to construct trajectory models for PTSD symptoms and multivariate logistic regression was used to determine the factors associated with the trajectories.Results: A total of 130 ICU survivors with PICS completed the 4-month short-term follow-up. Our results showed that PTSD symptoms in PICS patients manifested as three trajectories, namely, moderate chronic (n = 17, 13.1%), recovery (n = 25, 19.2%), and resilience (n = 88, 67.7%). Compared with the resilience trajectory, age and female were identified as risk factors for the moderate chronic trajectory, while prolonged ICU stay was a risk factor for the recovery trajectory.Conclusion: Our study showed that short-term PTSD symptoms in PICS patients manifested as moderate chronic, recovery, and resilience trajectories. Additionally, our results showed that PTSD screening should be conducted for critically ill patients, especially younger, female, or long-term ICU patients, immediately after their discharge from the ICU.Keywords: post-traumatic stress disorder, latent growth mixture model, longitudinal study, post-intensive care syndrome

Shengfeng Liu,1,2 Jian Liu,1,2 Xueni Cheng,1 Dahai Fang,1 Xiaolu Chen,1 Xiang Ding,1 Xianheng Zhang,1 Yiming Chen1 1Department of Rheumatology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, People’s Republic of China; 2Anhui Key Laboratory of Application and Development of Internal Medicine of Modern Chinese Medicine, Anhui University of Chinese Medicine, Hefei, Anhui Province, People’s Republic of ChinaCorrespondence: Jian Liu, Department of Rheumatology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui Province, People’s Republic of China, Tel +86 13955109537, Email liujianahzy@126.comAbstract: Rheumatoid arthritis (RA) is a chronically progressive autoimmune disease with increasing age-standardized prevalence and incidence of RA worldwide. Its pathological features are persistent synovitis of the joint, accompanied by the release of a large number of inflammatory cytokines and cartilage and bone destruction. RA can lead to progressive joint damage, stiffness and swelling, vascular and bone-related complications, and irreversible disability, which seriously affects patients’ life treatment. Early diagnosis and treatment can enhance the quality of life of RA patients. Platelet-to-lymphocyte ratio (PLR), as a common indicator in routine blood tests, has been proposed as an indicator of systemic inflammation in recent years. Its clinical detection is less invasive, economical, rapid and simple, and has been applied to the clinical evaluation of a variety of diseases. Of note, this indicator is important in assessing disease activity in RA, co-diagnosing RA, detecting subclinical complications, and monitoring responses to anti-inflammatory therapy. Therefore, this review summarizes the relationship between PLR and RA and the relevant mechanisms, further advancing the understanding of the clinical value of PLR.Keywords: platelet-to-lymphocyte ratio, rheumatoid arthritis, inflammatory, blood platelets, lymphocytes

Shichun Huang,1,2 Xuejie Yao,2 Xueqin Chen,2 Xiuli Chen,3 Yanxia Li,3 Yashpal Kanwar,4 Faith Ka Shun Chan,5 Ping Ye,2 Ming Zhan2,6 1School of Medicine, Ningbo University, Ningbo, 315211, People’s Republic of China; 2Department of Medicine, The First Affiliated Hospital, Ningbo University, Ningbo, 315000, People’s Republic of China; 3Department of Medicine, Ningbo Baiyun Community Healthcare Center, Ningbo, 315000, People’s Republic of China; 4Department of Pathology and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA; 5School of Geographical Sciences, University of Nottingham Ningbo China, Ningbo, 315100, People’s Republic of China; 6China Health Institute, University of Nottingham Ningbo China, Ningbo, 315100, People’s Republic of ChinaCorrespondence: Ming Zhan, Department of Medicine, The First Affiliated Hospital, Ningbo University, 59 Liuting Street, Ningbo, Zhejiang Province, 315000, People’s Republic of China, Email stephen0726@163.comBackground: Metabolic syndrome (MS) and low socioeconomic status (SES) may increase the risk for chronic kidney disease (CKD). This study aimed to investigate the prevalence of MS and CKD and the association between MS, SES, and CKD among adults in Ningbo, a city in Eastern China.Methods: A cross-sectional survey of 3212 adults was conducted between July 2019 and February 2021 in Ningbo. MS was defined as the presence of three or more risk factors: elevated blood pressure, reduced high-density lipoprotein (HDL) cholesterol, elevated triglycerides, elevated plasma glucose, and abdominal obesity. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or the occurrence of albuminuria. SES was stratified according to personal education and income levels. Multivariate logistic regression was used to analyze the relationships among MS, sociodemographic factors, and CKD.Results: The age- and sex-adjusted prevalence of CKD was 9.1% (95% CI: 8.3– 10.0), the prevalence of eGFR less than 60 mL/min/per 1· 73 m² was 2.5% (95% CI 2.0– 3.0) and that of albuminuria was 7.9% (95% CI 7.0– 8.7), and the adjusted prevalence of MS was 23.1% (95% CI 21.7– 24.4). MS components, including elevated blood pressure, elevated fasting glucose, abdominal obesity, elevated serum triglyceride, or reduced serum HDL-C, were independent risk factors for CKD, and the adjusted prevalence of CKD proportionally increased with the number of MS-defined parameters. Participants with MS had 2.43-fold increased odds of developing CKD compared with those without MS. In addition, age, female sex, low SES including low educational level and low income were associated with increased odds of occurrence of albuminuria and CKD.Conclusion: The prevalence of metabolic syndrome and chronic kidney disease is high among adults in Ningbo. Metabolic syndrome and low socioeconomic status are associated with the high risk of developing chronic kidney disease.Keywords: chronic kidney disease, metabolic syndrome, socioeconomic status, prevalence, risk factors

Xiyan Yu,1,&ast; Difei Wu,2,&ast; Fangzhou Li,3 Wei Qiao,4 Xujiao Chen3 1The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 2School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Geriatrics, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, People’s Republic of China; 4The First Department of Health Care, China-Japan Friendship Hospital, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xujiao Chen, Department of Geriatrics, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, 310003, People’s Republic of China, Email lily197459@163.com Wei Qiao, The First Department of Health Care, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China, Email viviqiao601@sina.comBackground: Cardiovascular disease (CVD) has become the leading cause of death worldwide. High muscle mass can reduce the incidence and mortality of CVD. In recent years, increasing attention has been given to the relationship between intrinsic capacity (IC) and CVD. This study aims to explore the relationship between the decline of IC, muscle strength, and muscle quality in older patients with CVD, providing a new method and basis for early recognition of IC decline in the older adults.Methods: This cross-sectional study included 475 older individuals from communities in Zhejiang. General data were collected, and a comprehensive geriatric assessment (CGA) was conducted. Participants with CVD were divided into three groups: IC retention, IC impairment, and IC significantly impaired. Bioelectrical impedance analysis (BIA) measurements were completed. Student’s t-test or non-parametric tests (Mann–Whitney) were used to analyze the correlation between IC and muscle-related indicators. The best cutoff values were obtained using ROC curve analysis.Results: Compared to non-CVD patients, CVD patients were older, more educated, and had higher rates of polypharmacy and comorbidity. IC decreased more significantly in CVD patients. Age (P=0.001), Fried (P=0.024), and GDS-5 (P=0.002) increased with the severity of IC decline. ADL (P=0.002), MMSE (P=0.000), MNA-SF (P=0.000), SARC-Calf (P=0.026), waist circumference (P=0.037), and muscle quality (P=0.010) decreased with the decline in IC. When IC decreased, the cutoff values for hand grip strength, waist circumference, and muscle quality were 25.45 kg, 72.55 cm, and 3.05, respectively. When IC decreased significantly, the cutoff values were 17.15 kg, 71.55 cm, and 2.28, respectively.Conclusion: The results of this study showed that in patients with CVD, the hand grip strength and muscle quality of patients with IC injury were lower than those of patients with IC retention.Keywords: CVD, intrinsic capacity, muscle quality

Xia Chen,1 Jianmin Zhang,1 Yuanru Tang,1 Yan Zhang,2 Ziwen Ma,2 Yifan Hu2 1Department of Gynecology, Waitan Street Community Health Service Center, Shanghai, People’s Republic of China; 2Department of Gynecology and Obstetrics, Pudong New Area Health Care Hospital for Women and Child Gynecological Clinic, Shanghai, People’s Republic of ChinaCorrespondence: Jianmin Zhang, Email 360032800@qq.comPurpose: This study explores the link between women’s pre-pregnancy overweight and obesity and glucose and lipid metabolism in their early pregnancy. It assesses how early pregnancy glucose and lipid levels predict gestational diabetes mellitus (GDM) risk, aiming to offer foundational weight management strategies for overweight and obese women to prevent GDM.Patients and Methods: This study analyzed 2172 pregnant women from 2017 to 2021 at Waitan Street Community Health Service Center, Shanghai, monitoring early pregnancy (7– 10 weeks) glucose and lipid levels (TG, TC, HDL-C, LDL-C, FBG, HbA1c) and 24-week OGTT values. Pre-pregnancy BMI categorized participants into overweight and obese, normal, and underweight groups. We compared early pregnancy glycemic and lipid metrics and GDM incidence across groups, examining the relationship between pre-pregnancy BMI and early pregnancy blood metrics. The overweight and obese cohort was further split into GDM and non-GDM groups, comparing early pregnancy glycolipid indicators and assessing their predictive value for GDM development.Results: In the overweight and obese group, maternal FBG, HbA1c, TG, and LDL-C were higher, while HDL-C was lower than in normal and underweight groups (P< 0.05), with a higher GDM incidence (P< 0.05). Pre-pregnancy BMI positively correlated with FBG, HbA1c, TG, and LDL-C levels (r=0.556, 0.567, 0.686, 0.214; P< 0.05) but not HDL-C. Each 1-unit BMI increase raised GDM risk by 0.204 times (P< 0.05). FBG, TG, and LDL-C had high predictive accuracy for GDM in overweight and obese women, with AUCs of 0.991, 0.994, and 0.935, respectively.Conclusion: Pre-pregnancy overweight and obesity can cause early pregnancy glucose and lipid abnormalities, raising GDM risk. Early testing in such women is a strong predictor for GDM.Keywords: pregnant women, overweight and obesity, pre-pregnancy body mass index, glucose and lipid metabolism, gestational diabetes mellitus

Haotian Xin,1,2 Beining Yang,1,2 Yulong Jia,1,2 Qunya Qi,1,2 Yu Wang,1,2 Ling Wang,1,2 Xin Chen,1,2 Fang Li,3 Jie Lu,1,2 Nan Chen1,2 1Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People’s Republic of China; 2Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, 100053, People’s Republic of China; 3Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, People’s Republic of ChinaCorrespondence: Nan Chen, Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, No. 45 Chang-Chun St, Xicheng District, Beijing, People’s Republic of China, Tel +86 13910784187, Email chenzen8057@sina.comAbstract: Neuropathic pain (NP) is a common and persistent disease that leads to immense suffering and serious social burden. Incomplete understanding of the underlying neural basis makes it difficult to achieve significant breakthroughs in the treatment of NP. We aimed to review the functional and structural brain topological properties in patients with NP and consider how graph measures reveal potential mechanisms and are applied to clinical practice. Related studies were searched in PubMed and Web of Science databases. Topological property changes in patients with NP, including small-worldness, functional separation, integration, and centrality metrics, were reviewed. The findings suggest that NP was characterized by retained but declined small-worldness, indicating an insidious imbalance between network integration and segregation. The global-level measures revealed decreased global and local efficiency in the NP, implying decreased information transfer efficiency for both long- and short-range connections. Altered nodal centrality measures involve various brain regions, mostly those associated with pain, cognition, and emotion. Graph theory is a powerful tool for identifying topological properties of patients with NP. These specific brain changes in patients with NP are very helpful in revealing the potential mechanisms of NP, developing new treatment strategies, and evaluating the efficacy and prognosis of NP.Keywords: neuropathic pain, graph theory, brain network, magnetic resonance imaging

Xiao Chen,&ast; Yuanhe Fan,&ast; Hongliang Tu,&ast; Jie Chen Department of Orthopedics, The First People’s Hospital of Neijiang, Neijiang, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiao Chen, Department of Orthopedics, The First People’s Hospital of Neijiang, Neijiang, Sichuan, People’s Republic of China, Email 342918992@qq.comObjective: Postoperative delirium (POD) commonly occurs in elderly individuals following hip fracture surgery, with unclear pathophysiological mechanism. Inflammation is a known factor affecting the onset of delirium. The current work aimed to examine the associations of preoperative immune inflammation-related indicators with POD occurrence in elderly cases following hip fracture surgery.Methods: The current retrospective cohort study included 437 elderly cases administered hip fracture surgery from January 2018 to December 2023. The clinicodemographic data and laboratory findings of all cases were retrospectively analyzed. Immune inflammation-related indicators were assessed, eg, MLR, NLR and PLR, as well as SII and SIRI. The bootstrap method was employed to assign cases at 7:3 to the training (48 and 258 cases in the POD and no-POD groups, respectively) and internal validation (13 and 118 cases in the POD and no-POD groups, respectively) cohorts. Next, LASSO, univariable and multivariable logistic regression analyses were applied to determine risk factors in the training cohort, based on which a nomogram model was built. The obtained nomogram was examined for accuracy by calibration plot analysis. Finally, the nomogram’s clinical value was assessed by decision curve analysis (DCA), followed by internal validation based on the training cohort.Results: Of all 437 cases, 61 developed POD, indicating a POD incidence of 13.96%. LASSO regression and multivariable analyses revealed preoperative SIRI independently predicted POD in the training cohort. The developed nomogram had an area under the curve (AUC) of 0.991 (95% CI 0.983~0.998) in the training cohort versus 0.986 (95% CI 0.966~1.000) in the validation cohort. Calibration curve analysis revealed nomogram-predicted and actual probabilities were in line. DCA demonstrated the novel nomogram could confer net benefits for POD prediction in elderly cases administered hip fracture surgery.Conclusion: The immune inflammation-related indicators SIRI could predict POD in elderly cases following hip fracture surgery.Keywords: postoperative delirium, hip fracture, elderly, immune inflammation related indicators, nomogram

Lining Zhou,1,&ast; Hong Hong,2,&ast; Fuying Chu,1 Xiang Chen,1 Chenlu Wang1 1Department of Clinical Laboratory, The Second Affiliated Hospital of Nantong University and Nantong City No.1 People’s Hospital, Nantong, People’s Republic of China; 2Department of Clinical Laboratory, Nantong Traditional Chinese Medicine Hospital, Nantong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chenlu Wang; Xiang Chen, Email wangchenlu0101@163.com; ntchenx0520@163.comBackground: Recurrence is the main factor for poor prognosis in ovarian cancer, but few prognostic biomarkers were reported. In this study, we used machine learning methods based on multiple biomarkers to develop a specific prediction model for the recurrence of ovarian cancer.Methods: A total of 277 ovarian cancer patients were enrolled in this study and randomly classified into training and testing cohorts. The prediction information was obtained through 47 clinical parameters using six supervised clustering machine learning algorithms, including K-Nearest Neighbor (K-NN), Decision Tree (DT), Random Forest (RF), Adaptive Boosting (AdaBoost), Gradient Boosting Machine (GBM), and Extreme Gradient Boosting (XGBoost).Results: In predicting the recurrence of ovarian cancer, machine learning algorithm was superior to conventional logistic regression analysis. In this study, XGBoost showed the best performance in predicting the recurrence of ovarian cancer, with an accuracy of 0.95. In addition, neoadjuvant chemotherapy, Monocyte ratio (MONO%), Hematocrit (HCT), Prealbumin (PAB), Aspartate aminotransferase (AST), and carbohydrate antigen 125 (CA125) are the most important biomarkers to predict the recurrence of ovarian cancer.Conclusion: The machine learning techniques can achieve a more accurate assessment of the recurrence of ovarian cancer, which can help clinicians make decisions, and develop personalized treatment strategies.Keywords: ovarian cancer, recurrence, machine learning, biomarkers, predictive modeling

Anni Zhao,1,&ast; Xiaomei Liu,1,&ast; Xiping Chen,1,&ast; Sha Na,1,&ast; Hui Wang,1 Xuan Peng,1 Peizhong Kong,1 Lu Li1,2 1Department of Biochemistry and Molecular Biology, School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, 230012, People’s Republic of China; 2Institute of Integrated Chinese and Western Medicine, Anhui Academy of Chinese Medicine, Hefei, 230012, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Peizhong Kong; Lu Li, Department of Biochemistry and Molecular Biology, School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, No. 350, Longzihu Road, Xinzhan District, Hefei, Anhui, People’s Republic of China, Email kongpz@ahtcm.edu.cn; deerlyee@hotmail.comObjective: To identify the polar parts in Rhubarb that cause hepatotoxicity and explore the underlying mechanisms.Methods: The rat model of liver cancer was established by gavage of diethylnitrosamine (DEN; 0.002 g/rat) for 14 weeks. Starting from the 11th week, Rhubarb granule (4 g/kg), aqueous, ethyl acetate and n-butanol extract of Rhubarb or Rhein equivalent to a dose of 4 g/kg Rhubarb granule were administered intragastrically for 4 consecutive weeks. Liver tissues from rats treated with DEN and Rhubarb granules were used for non-targeted metabolomics analysis. The correlation between pyruvate kinase isozyme type M2 (PKM2) expression level and the progress and prognosis of hepatocellular carcinoma (HCC) was evaluated through bioinformatics analysis based on TCGA database. Liver tissues and blood samples from rats treated with DEN and aqueous, ethyl acetate and n-butanol extract of Rhubarb were used for the screening of hepatotoxic polar parts of Rhubarb. The liver injuries were evaluated by the changes in pathology, liver function, and the expression levels of proliferating cell nuclear antigen (PCNA) and transforming growth factor beta1 (TGF-β 1). The mechanism studies focus on PKM2 expression, and the metabolic reprogramming via detecting the activities of lactate dehydrogenase A (LDHA) and isocitrate dehydrogenase (ICDH). Furthermore, molecular docking analysis was performed to validate the target interaction between Rhein and PKM2, and the hepatotoxicity of Rhein was evaluated by testing liver function in the DEN-induced liver cancer model.Results: The non-targeted metabolomics analysis revealed that Rhubarb promoted aerobic glycolysis in the rat model of DEN-induced liver cancer. And bioinformatics analysis revealed that high PKM2 expression was closely related to the progression and poor prognosis of HCC. In vivo studies indicated that the aqueous extract of Rhubarb, but not ethyl acetate and n-butanol extract, promoted the liver injuries induced by DEN. The mechanism study showed that the aqueous extract of Rhubarb increased the expression of PKM2 and promoted aerobic glycolysis. Moreover, Rhein had a strong binding affinity for PKM2 and aggravated liver injury in the DEN-induced liver cancer model.Conclusion: Aqueous extract of Rhubarb promoted hepatotoxicity via facilitating PKM2-mediated aerobic glycolysis in the rat model of DEN-induced liver cancer. Keywords: aqueous extract of rhubarb, hepatotoxicity, PKM2, aerobic glycolysis, Rhein

Zhen Ruan,1,&ast; Xianwen Chen,1,&ast; Menghuan Song,1 Ruxu Jia,2 Hang Luo,3 Carolina Oi Lam Ung,1,4,5 Hao Hu1,4,5 1State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, Macau SAR, People’s Republic of China; 2Global Business School for Health, University College London, London, UK; 3Shanghai Palan DataRx Co., Ltd, Shanghai, People’s Republic of China; 4Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Macau, Macau SAR, People’s Republic of China; 5Centre for Pharmaceutical Regulatory Sciences, University of Macau, Macau, Macau SAR, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hao Hu, University of Macau, Room 1050, E12 Research Building, Macau, Macau SAR, People’s Republic of China, Email haohu@um.edu.moAim: This study aimed to conduct a retrospective observational study in China to investigate the real-world utilization of glucagon-like peptide-1 receptor (GLP-1RA) in China.Methods: Type 2 diabetes mellitus (T2DM) patients were retrieved from the electronic medical records of 18 hospitals from 2016 to 2020. A descriptive analysis detailed patient characteristics and clinical outcomes. Multivariate logistic regression analysed the factors associated with daily and weekly GLP-1RA.Results: Fifteen thousand one hundred and seventy-six individuals were included. At the 6-month follow-up, the overall estimated mean change from baseline in HbA1c was − 1.26± 1.91% (p < 0.001), the “Weekly GLP-1RA” group was − 1.58± 2.03% (p < 0.001), and the “Daily GLP-1RA” group was − 1.25± 1.90% (p < 0.001). At the 12-month follow-up, the overall estimated mean change from baseline in HbA1c was − 0.95± 1.80% (p < 0.001), the “Weekly GLP-1RA” group was − 1.05± 1.93% (p < 0.001), and the “Daily GLP-1RA” group was − 0.95± 1.80% (p < 0.001). At 6 months following GLP-1RA initiation, there were statistically significant improvements in the mean TC, LDL-C, and TG at 6 months or 12 months separately following GLP-1RA initiation. Statistically significant improvements were observed in the mean HDL-C after 6 months. Compared with the baseline (11.92%), the proportion of patients who had an incidence of all hypoglycemia was lower at the 6-month follow-up (9.73%). Patients with dyslipidemia were more likely to use weekly GLP-1RA (OR =1.61, 95% CI: 1.27– 2.06, p < 0.001).Conclusion: In China, weekly GLP-1RA demonstrated better effectiveness compared to the daily GLP-1RA. The results confirmed the efficacy of GLP-1RA in clinical trials.Keywords: type 2 diabetes mellitus, glucagon-like peptide-1 receptor agonist, GLP-1RA, retrospective, China, electronic medical record, real-world

Jing Zhao,&ast; Jiuxiang He,&ast; Xiaoyan Ding, Yuxin Zhou, Minchi Liu, Xiaozhong Chen, Wenxuan Quan, Dong Hua, Jun Tong, Jintao Li College of Basic Medicine, Army Medical University, Chongqing, 400038, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jintao Li, College of Basic Medicine, Army Medical University, Gaotanyan Street, No. 30, Shapingba District, Chongqing, 400038, People’s Republic of China, Tel +1-86-23-68771389, Fax +1-86-23-68771391, Email ljtqms@tmmu.edu.cnBackground: The global prevalence of Dengue virus (DENV) infection poses a significant health risk, urging the need for effective vaccinations. Peptide vaccines, known for their capacity to induce comprehensive immunity against multiple virus serotypes, offer promise due to their stability, safety, and design flexibility. Spherical nucleic acid (SNA), particularly those with gold nanoparticle cores, present an attractive avenue for enhancing peptide vaccine efficacy due to their modularity and immunomodulatory properties.Methods: The spherical nucleic acid-TBB (SNA-TBB), a novel nanovaccine construct, was fabricated through the co-functionalization process of SNA with epitope peptide, targeting all four serotypes of the DENV. This innovative approach aims to enhance immunogenicity and provide broad-spectrum protection against DENV infections. The physicochemical properties of SNA-TBB were characterized using dynamic light scattering, zeta potential measurement, and transmission electron microscopy. In vitro assessments included endocytosis studies, cytotoxicity evaluation, bone marrow-dendritic cells (BMDCs) maturation and activation analysis, cytokine detection, RNA sequencing, and transcript level analysis in BMDCs. In vivo immunization studies in mice involved evaluating IgG antibody titers, serum protection against DENV infection and safety assessment of nanovaccines.Results: SNA-TBB demonstrated successful synthesis, enhanced endocytosis, and favorable physicochemical properties. In vitro assessments revealed no cytotoxicity and promoted BMDCs maturation. Cytokine analyses exhibited heightened IL-12p70, TNF-α, and IL-1β levels. Transcriptomic analysis highlighted genes linked to BMDCs maturation and immune responses. In vivo studies immunization with SNA-TBB resulted in elevated antigen-specific IgG antibody levels and conferred protection against DENV infection in neonatal mice. Evaluation of in vivo safety showed no signs of adverse effects in vital organs.Conclusion: The study demonstrates the successful development of SNA-TBB as a promising nanovaccine platform against DENV infection and highlights the potential of SNA-based peptide vaccines as a strategy for developing safe and effective antiviral immunotherapy.Keywords: nanovaccine, dengue virus, spherical nucleic acid, immunogenicity, peptide antigen

Hongmei Xu,1 Ningning Wu,2 Hui Yu,3 Chuanqing Wang,4 Jikui Deng,5 Hongmei Wang,5 Chunzhen Hua,6 Yinghu Chen,6 Xuejun Chen,7 Ting Zhang,8 Hong Zhang,9 Yiping Chen,10 Shifu Wang,11 Qing Cao,12 Huiling Deng,13 Sancheng Cao,14 Jianhua Hao,15 Wei Gao,16 Chunmei Jing2 1Infectious Disease Department, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, People’s Republic of China; 2Department of Clinical Laboratory, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, People’s Republic of China; 3Infectious Disease Department, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, People’s Republic of China; 4Department of Clinical Microbiology Laboratory, Nosocomial Infection Control Department, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, People’s Republic of China; 5Infectious Disease Department, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China; 6Infectious Disease Department, Children’s Hospital of Zhejiang University, Zhejiang, People’s Republic of China; 7Department of Medical Laboratory, Children’s Hospital of Zhejiang University, Zhenjiang, People’s Republic of China; 8Digestive and Infectious Disease Department, Children’s Hospital of Shanghai Jiaotong University, Shanghai, People’s Republic of China; 9Department of Medical Laboratory, Children’s Hospital of Shanghai Jiaotong University, Shanghai, People’s Republic of China; 10Pediatric Infectious Disease Department, Second Affiliated Hospital, and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 11Department of Medical Laboratory, Qilu Children’s Hospital, Shandong University, Shandong, People’s Republic of China; 12Infectious Disease Department, Shanghai Children’s Medical Center, Shanghai, People’s Republic of China; 13Infectious Disease Department, Xi’an Children’s Hospital, Xi’an, People’s Republic of China; 14Department of Medical Laboratory, Xi’an Children’s Hospital, Xi’an, People’s Republic of China; 15Infectious Disease Department, Children’s Hospital of Kaifeng City, Kaifeng, People’s Republic of China; 16Department of Medical Laboratory, Children’s Hospital of Kaifeng City, Kaifeng, People’s Republic of ChinaCorrespondence: Chunmei Jing, Department of Clinical Laboratory, Children’s Hospital of Chongqing Medical University, Chongqing Medical University, No. 136 Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, People’s Republic of China, Email jcm791203@163.comObjective: Aim to investigate the pathogens distribution and drug resistance of gram-negative bacteria causing bloodstream infection (BSIs) in Infectious Disease Surveillance of Pediatric from 2016 to 2022. The prevalence of four important drug resistance phenotypes was studied: difficult-to-treat resistance, fluoroquinolone resistance, carbapenem resistance, and extended-spectrum cephalosporin resistance, and to provide reference basis for preventing and treating BSIs diseases in children.Methods: Strain identification and antimicrobial susceptibility tests were independently performed at each hospital. Data were analyzed using Whonet 5.6 and GraphPad Prism 8 software. The Mann–Whitney U-test was used to examine and compare temporal changes.Results: A total of 39977 BSIs strains were isolated, with 27.1% of the negative bacteria causing BSIs (10824 strains). The highest bacteria detected were E. coli and S. maltophilia in the neonatal and pediatric groups. The detection rate of carbapenem-resistant-K. pneumoniae (CRKPN) in neonate group was 31.4%, significantly increased compared with pediatric group, whose detection rate was 24.7%. The rates of resistance to levofloxacin and trimethoprim/sulfamethoxazole were significantly lower in neonatal groups than pediatric groups in BSIs caused by K. pneumoniae. To imipenem and meropenem were 3.6% and 3.9% among neonatal isolates, which was lower than 4.7% and 5.8 among pediatric BSIs caused by E. coli. Isolated from neonatal BSIs caused by A. baumannii showed lower resistance ratios to all the agents tested than those from pediatric. However, only the prevalence of piperacillin/tazobactam resistance was statistically lower than that in pediatric BSIs caused by P. aeruginosa. The average detection rates of carbapenem resistance, extended-spectrum cephalosporin resistance, and fluoroquinolone resistance for K. pneumoniae and E. coli were 28.1%,41.4%,11.6% and 4.0%,24.3%,31.1%, respectively.Conclusion: The detection rate of gram-negative pathogens showed an increasing trend among the bloodstream infection. The detection rate of CRKPN assumed a downward trend in 2018. There are differences types of pathogens between the neonatal group and the pediatric group, The detection rate of CRKPN in the neonate group was significantly higher than pediatric group. The first average detection rates for carbapenem resistance, extended-spectrum cephalosporin resistance, and fluoroquinolone resistance were obtained for A. baumannii, K. pneumoniae, and Escherichia coli, respectively. Those data showed a high level of antimicrobial resistance, which has posed an urgent threat to Children’s health, suggested that effective monitoring of antimicrobial resistance and antimicrobial stewardship among children in China are required.Keywords: bloodstream infection, pathogenic bacterium, difficult-to-treat resistance, carbapenem resistance, extended-spectrum cephalosporin resistance, fluoroquinolone resistance

Yuan Yuan,1 Ze Wu,2 Xu Chen,3 Bin Xie2 1Department of Pathology, Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 2Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China; 3Pathology Center, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Bin Xie, Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China, Email mrxiebin@163.comObjective: To assess the impact of rheumatoid arthritis (RA) on histopathological features and the risk of postoperative recurrence in chronic rhinosinusitis with nasal polyps (CRSwNP) patients.Methods: A retrospective cohort study of CRSwNP patients who underwent functional endoscopic sinus surgery was performed. Patients were followed up for more than two years, and classified into RA and Non-RA groups, recurrent and non-recurrent groups. The influence of RA on histopathological features and the risk of CRSwNP recurrence was explored.Results: A total of 517 CRSwNP patients were finally recruited, including 78 RA patients. The RA group exhibited a higher recurrence rate, tissue eosinophil counts and percentages compared to the non-RA group (P < 0.05). Tissue eosinophil count and percentage, and the prevalence of allergic rhinitis were significantly higher in the recurrent group in compared to the non-recurrent group (P < 0.05). Multivariate logistic regression analysis identified tissue eosinophil count and percentage, RA, and allergic rhinitis as significant predictors of increased recurrence risk (P < 0.05). Both adjusted and unadjusted models affirmed RA as an independent risk factor for CRSwNP postoperative recurrence (P < 0.05). Kaplan-Meier curves further indicated a higher recurrence risk in CRSwNP patients with RA than those without (P < 0.05).Conclusion: Our findings suggest that RA significantly exacerbates tissue eosinophilic inflammation and independently heightens the risk of postoperative recurrence in CRSwNP patients. These insights underscore the need for tailored therapeutic strategies addressing the complex interplay between CRSwNP and RA to mitigate recurrence risks and improve clinical outcomes.Keywords: rheumatoid arthritis, chronic rhinosinusitis with nasal polyps, endoscopic sinus surgery, recurrence

Haoran Li,1 Xi Chen,2 Hui Feng,1 Fangyi Liu,3 Jie Yu,1 Ping Liang1 1Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin, People’s Republic of China; 3Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of ChinaCorrespondence: Jie Yu; Ping Liang, Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China, Email jiemi301@163.com; liangping301@126.comPurpose: The diagnosis of liver abscess (LA) caused by Gram-positive bacteria (GPB) and Gram-negative bacteria (GNB) depends on ultrasonography, but it is difficult to distinguish the overlapping features. Valuable ultrasonic (US) features were extracted to distinguish GPB-LA and GNB-LA and establish the relevant prediction model.Materials and Methods: We retrospectively analyzed seven clinical features, three laboratory indicators and 11 US features of consecutive patients with LA from April 2013 to December 2023. Patients with LA were randomly divided into training group (n=262) and validation group (n=174) according to a ratio of 6:4. Univariate logistic regression and LASSO regression were used to establish prediction models. The performance of the model was evaluated using area under the curve(AUC), calibration curves, and decision curve analysis (DCA), and subsequently validated in the validation group.Results: A total of 436 participants (median age: 55 years; range: 42– 68 years; 144 women) were evaluated, including 369 participants with GNB-LA and 67 with GPB-LA, respectively. A total of 11 predictors by LASSO regression analysis, which included gender, age, the liver background, internal gas bubble, echogenic debris, wall thickening, whether the inner wall is worm-eaten, temperature, diabetes mellitus, hepatobiliary surgery and neutrophil(NEUT). The performance of the Nomogram prediction model distinguished between GNB-LA and GPB-LA was 0.80, 95% confidence interval [CI] (0.73– 0.87). In the validation group, the AUC of GNB was 0.79, 95% CI (0.69– 0.89).Conclusion: A model for predicting the risk of GPB-LA was established to help diagnose pathogenic organism of LA earlier, which could help select sensitive antibiotics before the results of drug-sensitive culture available, thereby shorten the treatment time of patients.Keywords: liver abscess, Gram-positive bacteria, Gram-negative bacteria, ultrasonography features, prediction model

Xuanling Chen,1,&ast; Xuewei Qin,1,&ast; Yutong Zhuang,2 Zhengqian Li,3 Zhenhu Liang,4 Hua Zhang,5 Lan Yao,1 Xiaoli Li,6 Jianghong He,7 Xiangyang Guo3 1Department of Anesthesiology, Peking University International Hospital, Beijing, People’s Republic of China; 2Department of Neurosurgery, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 3Department of Anesthesiology, Peking University Third Hospital, Beijing, People’s Republic of China; 4Institute of Electrical Engineering, Yanshan University, Qinhuangdao, People’s Republic of China; 5Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, People’s Republic of China; 6The State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, People’s Republic of China; 7Department of Neurosurgery, Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiangyang Guo, Peking University, Third Hospital, 49 huayuan North Road, Haidian District, Beijing, 100191, People’s Republic of China, Email puthmzk@hsc.pku.edu.cn Jianghong He, Beijing Tiantan Hospital, 119 South Fourth Ring Road West, Fengtai District, Beijing, 100069, People’s Republic of China, Email hejianghong@sina.cnObjective: To observe whether maintaining the appropriate depth of anesthesia with Bispectral Index (BIS) can improve the prognosis of Spinal Cord stimulation (SCS) implantation in patients with chronic Disorders of consciousness (DoC).Methods: 103 patients with DoC undergoing SCS implantation were reviewed, and 83 patients with DoC were included according to the standard of inclusion and exclusion Criteria. Patients were divided into a BIS group (n =45) and a non-BIS group (n =38) according to whether BIS monitoring was used during the operation. The depth of anesthesia in the BIS group was maintained between 40– 60. The anesthesiologist adjusted the depth of anesthesia in the non-BIS group according to clinical experience. Relevant information such as disease course, cause, anesthesia time, and operation time were collected. Preoperative CRS-R(preoperative) score, postoperative CRS-R(24h), and postoperative CRS-R(3m) changes were collected.Results: The CRS-R(3m) score in the BIS group was higher than that in the non-BIS group (preoperative), and the difference was statistically significant (P < 0.05). In CRS-R (24h), the BIS group was higher than the non-BIS group, and the difference was statistically significant (X2=8.787, P =0.004). The improvement of consciousness was included in the multivariate Logistic regression analysis model, and it was found that the thalamus was an independent factor affecting the improvement of consciousness (P < 0.05). During follow-up, 1 patient in the BIS group had a decrease in consciousness from MCS− to VS/ UWS and 2 patients in the non-BIS group died during follow-up.Conclusion: Patients can be benefit in hearing in CRS-R (24h). We recommend the use of BIS to monitor the depth of anesthesia in patients with DoC to improve patient outcomes.Keywords: chronic disturbance of consciousness, vegetative state/unresponsive wakefulness syndrome, spinal cord stimulation, general anesthesia, bispectral index, improved coma recovery scale

Junzi Chen,&ast; Yumin Xiang,&ast; Rong Bao, Yuyi Zheng, Yingxi Fang, Jiajia Feng, Di Wu, Xiaojie Chen Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310053, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaojie Chen; Di Wu, Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, People’s Republic of China, Email chenxiaojie0902@163.com; wudichem@zju.edu.cnIntroduction: Breast cancer ranks among the most prevalent cancers in women, characterized by significant morbidity, disability, and mortality. Presently, chemotherapy is the principal clinical approach for treating breast cancer; however, it is constrained by limited targeting capability and an inadequate therapeutic index. Photothermal therapy, as a non-invasive approach, offers the potential to be combined with chemotherapy to improve tumor cellular uptake and tissue penetration. In this research, a mesoporous polydopamine-coated gold nanorod nanoplatform, encapsulating doxorubicin (Au@mPDA@DOX), was developed.Methods: This nanoplatform was constructed by surface coating mesoporous polydopamine (mPDA) onto gold nanorods, and doxorubicin (DOX) was encapsulated in Au@mPDA owing to π-π stacking between mPDA and DOX. The dynamic diameter, zeta potential, absorbance, photothermal conversion ability, and drug release behavior were determined. The cellular uptake, cytotoxicity, deep penetration, and anti-tumor effects were subsequently investigated in 4T1 cells. After that, fluorescence imaging, photothermal imaging and pharmacodynamics studies were utilized to evaluate the anti-tumor effects in tumor-bearing mice model.Results: This nanoplatform exhibited high drug loading capacity, excellent photothermal conversion and, importantly, pH/photothermal dual-responsive drug release behavior. The in vitro results revealed enhanced photothermal-facilitated cellular uptake, drug release and tumor penetration of Au@mPDA@DOX under near-infrared irradiation. In vivo studies confirmed that, compared with monotherapy with either chemotherapy or photothermal therapy, the anti-tumor effects of Au@mPDA@DOX are synergistically improved.Conclusion: Together with good biosafety and biocompatibility, the Au@mPDA@DOX nanoplatform provides an alternative method for safe and synergistic treatment of breast cancer. Keywords: breast cancer, synergistic therapy, polydopamine, gold nanorod, chemotherapy

Anbang Zhao,1,2,&ast; Bin Hao,1,2,&ast; Simin Liu,3,&ast; Xiaoyu Qiu,1,2,&ast; Xiaoping Ming,1,2 Xiuping Yang,1,2 Jie Cai,1,2 Zhen Li,4,5 Xiong Chen1,2 1Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China; 2Sleep Medicine Center, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China; 3Department of Neurosurgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 4Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China; 5Bariatric and Metabolic Disease Surgery Center, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiong Chen, Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China, Email zn_chenxiong@whu.edu.com Zhen Li, Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China, Email kamel_li@163.comPurpose: The diagnosis of severe OSA still relies on polysomnography, which causes a strong sense of restraint in patients with obesity. However, better prediction tools for severe OSA applicable to patients with obesity have not been developed.Patients and Methods: Relevant clinical data of 1008 patients with OSA who underwent bariatric surgery in our hospital were collected retrospectively. Patients were divided into training and test cohorts by machine learning. Univariate and multivariate logistic regression analysis was used to screen associations, including liver stiff measurement (LSM) and abdominal visceral tissue (aVAT), and to construct a severe OSA risk prediction nomogram. Then, we evaluated the effectiveness of our model and compared our model with the traditional Epworth Sleepiness Scale (ESS) model. Finally, our associations were used to explore the correlation with other indicators of OSA severity.Results: Our study revealed that age, biological sex, BMI, LSM, aVAT, and LDL were independent risk factors for severe OSA in patients with obesity. A severe OSA risk prediction nomogram constructed by six indicators possessed high AUC (0.845), accuracy (77.6%), and relatively balanced specificity and sensitivity (72.4%, 82.8%). The Hosmer-Lemeshow test (P=0.296, 0.785), calibration curves, and DCA of the training and test cohorts suggested better calibration and more net clinical benefit. Compared with the traditional ESS model, our model had higher AUC (0.829 vs 0.545), sensitivity (78.9% vs 12.2%), PPV (77.9% vs 53.3%), and accuracy (75.4% vs 55.2%). In addition, the associations in our model were independently correlated with other indicators reflecting OSA severity.Conclusion: We provided a simple, cheap, and non-invasive nomogram of severe OSA risk prediction for patients with obesity, which would be helpful for preventing further complications associated with severe OSA.Plain Language Summary: Question: Can we predict severe OSA in patients with obesity by their metabolic complications through some non-invasive examinations?Findings: Compared with traditional questionnaires, we developed and validated a new prediction model, including liver stiffness measurement and abdominal visceral adipose tissue, to screen severe OSA in bariatric surgery candidates through non-invasive examinations, which may contribute to perioperative safety and ultimate weight loss outcomes.Meaning: For patients with obesity who are in hospital because of metabolic disorders, it is necessary for them to be screened for possible severe OSA according to our new prediction nomogram, which is helpful for preventing further complications and perioperative risk associated with severe OSA.Keywords: obstructive sleep apnea, obesity, liver stiffness measurement, visceral adipose tissue, nomogram

Dong Wu,1,&ast; Bingyu Long,1,&ast; Bangxiao Huang,1,&ast; Xiaomei Zhong,1 Xiaoer Chen,1 Xiaoping Shen,1 Qiu Huang,1 Wenchao Zhang,1 Jiayuan Wu,2 Min Chen,1 Dongming Li,1 Bin Wu,1 Dong Lv,3 Dan Huang,1 Xuanna Zhao1 1Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 2Department of Clinical Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China; 3Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xuanna Zhao; Dan Huang, Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, No. 57, South of Renmin Road, Zhanjiang, Guangdong, 524013, People’s Republic of China, Email 792665234@qq.com; 287538250@qq.comBackground: Education and living environment are related to mental health. But the independent and combined effects of them on mental health among patients with chronic obstructive pulmonary disease (COPD) are uncertain.Methods: The independent and combined effects of education and living environment on mental health were assessed by binary logistic regression in 1064 COPD patients. Additive interaction was assessed with the relative excess risk ratio (RERI), attribution percentage (AP), and synergy index (SI).Results: Our results shown that low education level and urban living environment were independently associated with higher risks for anxiety (odds ratio [OR]: 1.56, 95% confidence interval [CI] 1.06– 2.29 and OR:2.15, 95% CI 1.51– 2.05) or depression (OR:1.62, 95% CI 1.17– 2.27 and OR: 2.01, 95% CI 1.46– 2.75) among COPD patients. The combination effect of them was also associated with higher risks for anxiety (OR: 7.90, 95% CI 3.83– 16.29, P < 0.001) or depression (OR: 11.79, 95% CI 5.77– 24.10, P < 0.001) among these patients. Furthermore, we observed strong synergistic additive interactions between them for anxiety (SI: 11.57, 95% CI 1.41– 95.27; RERI: 6.31, 95% CI 1.60– 11.01; AP: 0.8, 95% CI 0.66– 0.94) and depression (SI: 31.31, 95% CI 1.59– 617.04; RERI: 10.44, 95% CI 2.66– 18.23; AP: 0.89, 95% CI 0.8– 0.97).Conclusion: Low education levels and living in urban areas had an independent and synergistic effects on mental health among COPD patients.Keywords: anxiety, China, COPD, depression, education, living environment

Yun Zhu,1,&ast; Lingyan Li,2,&ast; Wenxiao Wang,3,&ast; Xiaodan Liu,1 Meng Xue Zhang,1 Xiumin Chen,4 Xiaofeng Hou,5 Weimei Wang,6 Tuo Min,7 Jinmei Liu,8 Lecui Liu,9 Chengjun Liu,10 Zhong Jiang,11 Yanping Wang,12 Dayun Chang,13 Hua Pan1 1Department of Pediatric Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China; 2Department of Pediatrics, Zibo Maternal and Child Health Hospital, Zibo, Shandong, People’s Republic of China; 3Department of Pediatrics, Yantai Yuhuangding Hospital, Yantai, Shandong, People’s Republic of China; 4Department of Pediatrics, Qingzhou People’s Hospital, Weifang, Shandong, People’s Republic of China; 5Department of Pediatrics, Laizhou City People’s Hospital, Laizhou, Shandong, People’s Republic of China; 6Department of Pediatrics, Haiyang People’s Hospital, Haiyang, Shandong, People’s Republic of China; 7Department of Pediatrics, Jining First People’s Hospital, Jining, Shandong, People’s Republic of China; 8Department of Pediatrics, West Coast New District Hospital of Chinese Medicine, Huangdao, Shandong, People’s Republic of China; 9Department of Neonatology, People’s Hospital of Wulian, Wulian, Shandong, People’s Republic of China; 10Department of Pediatrics, Linyi Central Hospital, Linyi, Shandong, People’s Republic of China; 11Department of Pediatrics, Rehabilitation University Qingdao Central Hospital, Qingdao, Shandong, People’s Republic of China; 12Department of Pediatrics, Qingdao Traditional Chinese Medicine Hospital, Qingdao, Shandong, People’s Republic of China; 13Department of Pediatrics, Weihai Municipal Hospital, Weihai, Shangdong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hua Pan, Department of Pediatric Intensive Care Unit, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong, 266003, People’s Republic of China, Tel +8618366205226, Email panhua1881@163.comIntroduction: The Omicron variant is the present predominant COVID-19 strain worldwide. Accurate mortality prediction can facilitate risk stratification and targeted therapies. The study aimed to evaluate the feasibility of the difference in hematocrit and albumin (HCT-ALB) levels, alone or combined with the pediatric Sequential Organ Failure Assessment (pSOFA) score and lactate level, to predict the in-hospital mortality of COVID-19 Omicron variant-infected pediatric patients.Methods: A multicenter retrospective cohort study was performed for children with COVID-19 Omicron variant infection between December 2021 and January 2022. The demographics, clinical characteristics, hospital admission laboratory test results, and treatments were recorded. The in-hospital mortality was documented. The associations between HCT-ALB levels and mortality, and between HCT-ALB+pSOFA+lactate and mortality were analyzed.Results: A total of 119 children were included. The median age was 1.6 (interquartile range: 0.5– 6.2) years old. There were 70 boys and 49 girls. The mortality rate was 14.3% (17/119). The univariate and multivariate Cox regression analysis revealed that HCT-ALB was associated to in-hospital mortality (hazard ratio: 1.500, 95% confidence interval: 1.235– 1.822, p< 0.001). The receiver operating characteristic curve analysis revealed that HCT-ALB can be used to accurately predict in-hospital mortality at a cut-off value of − 0.7 (area under the curve: 0.888, sensitivity: 0.882, specificity: 0.225, Youden index: 0.657, p< 0.001). These patients were assigned into three groups based on the HCT-ALB level, pSOFA score, and lactate level (low-, medium-, and high-risk groups). The Kaplan-Meier analysis revealed that the mortality increased in the high-risk group, when compared to the medium-risk group (p< 0.01). The latter group had a higher mortality, when compared to the low-risk group (p< 0.01).Conclusion: The HCT-ALB level can be applied to predict the in-hospital mortality of children infected with the COVID-19 Omicron variant. Its combination with other variables can improve prediction performance.Keywords: COVID-19, omicron variant, hematocrit, albumin, mortality

Liling Chen,1 Cunqing Zheng,1 Honglin Luan,2 Xinyuan Chen3 1Department of Clinical Laboratory, Wenzhou Seventh People’s Hospital, Wenzhou, Zhejiang Province, People’s Republic of China; 2Department of Psychiatry, Wenzhou Seventh People’s Hospital, Wenzhou, Zhejiang Province, People’s Republic of China; 3Department of Clinical Laboratory, Wenzhou Central Hospital, Wenzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Xinyuan Chen, Department of Clinical Laboratory, Wenzhou Central Hospital, Bailidonglu Street, Lucheng District, Wenzhou, 325000, People’s Republic of China, Tel +8615858805715, Fax +86057788070190, Email 742846523@qq.comPurpose: This study aimed to assess High-density Lipoprotein (HDL)-based Inflammatory Indices and lipid profile changes in antipsychotic-naive first-episode schizophrenia (AN-FES) patients, chronic schizophrenia (CS) patients, and explore the clinical and predictive value of these parameters for schizophrenia.Patients and Methods: The study cohort included 52 AN-FES patients, 46 CS patients, and 52 healthy controls (HCs), with an average age of 24 years. Upon admission, patients underwent complete blood count and lipid profile analyses. Various ratios were calculated, including neutrophil-to-HDL (NHR), monocyte-to-HDL (MHR), lymphocyte-to-HDL (LHR), and platelet-to-HDL (PHR), as well as lipid ratios like triglycerides/HDL, non-HDL/HDL, total cholesterol/HDL, and low-density lipoprotein/HDL. For the AN-FES group, these evaluations were repeated after two months of treatment with atypical antipsychotics. Statistical analyses included correlation analysis, Receiver Operating Characteristic (ROC) curve analysis, and univariate and multivariate regression.Results: Compared to HCs, CS patients exhibited significantly higher MHR and NHR values, while AN-FES patients showed elevated levels of PHR, MHR, and NHR. No significant differences were observed in LHR or lipid ratios across the three groups. In the AN-FES cohort, MHR correlated positively with neutrophil counts, and NHR with monocyte counts. Additionally, white blood cell counts were positively associated with both MHR and NHR. Following treatment, NHR levels decreased, whereas TG/HDL ratios increased, with MHR and PHR remaining elevated. ROC analysis highlighted NHR as the most diagnostically valuable parameter (AUC = 0.799), with 86.5% specificity at an optimal cutoff of 3.534, outperforming MHR and PHR. Regression analyses recognized NHR (OR=2.225) as an independent risk factor for schizophrenia, even after adjusting for confounders.Conclusion: HDL-based inflammatory indices, particularly NHR, may serve as valuable diagnostic and prognostic markers in young adults with schizophrenia, even though significant alterations in lipid ratios were not observed in this demographic.Keywords: neutrophil-to-HDL ratio, NHR, monocyte-to-HDL ratio, MHR, platelet-to-HDL ratio, PHR, lipid ratios, schizophrenia, inflammatory indices

Na Zhang,&ast; Hongping Ge,&ast; Xinru Chen, Tianhui Ye, Weikang Shi, Meiyan Wang Department of Dermatology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Meiyan Wang, Email wmy196501@163.comAbstract: Condyloma acuminatum (CA), commonly known as anogenital warts, is a prevalent sexually transmitted disease primarily caused by low risk human papillomavirus (HPV) types 6 and 11. This case report outlines the successful use of photodynamic therapy (PDT) to treat extensive condyloma acuminatum in a young female patient with systemic lupus erythematosus (SLE) undergoing immunosuppressive treatment. The patient also had cervical intraepithelial neoplasia grade I. Carbon dioxide laser treatment were initially used to remove some surface warts, followed by PDT, resulting in satisfactory outcomes. After seven sessions, the warty growths were successfully removed. Interdisciplinary collaboration, involving rheumatology, gynecology, and dermatology, facilitated comprehensive management. This case highlights the efficacy and safety of PDT in treating condyloma acuminatum and suggests its potential as an alternative treatment for young SLE patients with similar conditions.Keywords: condyloma acuminatum, photodynamic therapy, systemic lupus erythematosus

Xueya Chen,1,&ast; Zhiling Yan,2,&ast; Weipeng Liu,1 Lili Guo,1 Jinmei Xu,2 Li Shi,3 Yufeng Yao1 1Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming, People’s Republic of China; 2Department of Gynaecologic Oncology, The No. 3 Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China; 3Department of Immunogenetics, Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Li Shi, Department of Immunogenetics, Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming, Yunnan, 650118, People’s Republic of China, Email shili.imb@gmail.com Yufeng Yao, Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming, Yunnan, 650118, People’s Republic of China, Email leoyyf@gmail.com; yufeng_yao@imbcams.com.cnPurpose: Cervical cancer (CC) poses a significant threat to women’s health worldwide, and multiple signaling pathways have been confirmed to be involved in its development. The AMPK signaling pathway plays a central role in maintaining energy homeostasis, and its dysregulation is closely associated with the occurrence of CC. Changes in microRNA (miRNA) expression levels might be related to the AMPK signaling pathway. Single nucleotide polymorphisms (SNPs) can affect the function of miRNA and result in the development of CC. To investigate the association between the SNPs of AMPK pathway-associated miRNAs and CC in a Han Chinese population, we selected eight miRNA genes located in the AMPK pathway and analyzed nine SNP loci within these genes to explore whether they are associated with genetic susceptibility to cervical intraepithelial neoplasia (CIN) and CC.Methods: A total of 2,220 subjects were included in this study, including 928 healthy controls, 421 CIN patients, and 871 CC patients. Nine candidate SNPs (rs895819 in miR-27a, rs10061133 in miR-449b, rs41291179 in miR-216a, rs76481776 in miR-182, rs10406069 in miR-5196, rs12803915 and rs550894 in miR-612, rs66683138 in miR-3622b, and rs2620381 in miR-627) were genotyped using the TaqMan method.Results: The results showed significant differences in the allele distribution of rs41291179 and rs12803915 between the control group and the CIN group, as well as between the control group and the CC group (all P values < 0.005). The A allele of rs41291179 and the G allele of rs12803915 were associated with decreased risk of CIN (OR = 0.05, 95% CI: 0.01– 0.39; OR = 0.61, 95% CI: 0.49– 0.76) and CC (OR = 0.08, 95% CI: 0.01– 0.66; OR = 0.71, 95% CI: 0.59– 0.86), respectively.Conclusion: Our results suggest that polymorphisms in miRNA genes of the AMPK signaling pathway are associated with the development of CC.Keywords: genotyping, SNP, gene enrichment, genetic susceptibility

Zhengwen Feng,1 Hui Li,1 Xiaolei Chen,1 Tiancheng Zhang,2 Yanxiang Chen,3 Shuang Shao,1,&ast; Juan Du1,&ast; 1School of General Practice and Continuing Education, Capital Medical University, Beijing, People’s Republic of China; 2Department of General Practice, Dahongmen Community Health Service Center, Beijing, Fengtai District, People’s Republic of China; 3Department of general practice, Changying Community Health Service Center, Beijing, Chaoyang District, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Juan Du; Shuang Shao, School of General Practice and Continuing Education, Capital Medical University, 10 You’ Anmen Outer West 1 st Street, Beijing, 100069, People’s Republic of China, Email cuckoo@ccmu.edu.cn; shaoshuang@ccmu.edu.cnPurpose: Our study aimed to explore the current status of patient participation in medication safety from the perspectives of general practitioners (GPs), pharmacists, and outpatients in Beijing, China.Patients and Methods: A qualitative study using semi-structured in-depth individual interviews with GPs, pharmacists, and outpatients. Subjects were identified by purposive sampling until code saturation. Semi-structured qualitative interviews were conducted with GPs, pharmacists, and patients from community health service centers in three urban districts of Beijing, China. The interviews were transcribed verbatim and the text was analysed using thematic analysis techniques including familiarising with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report.Results: A total of eight GPs, seven pharmacists, and 18 outpatients were interviewed. Data analysis led to the generation of five key themes: (1) mutual trust between patient and GP, (2) communication with healthcare professionals, (3) acquisition of knowledge about medication safety, (4) implementation of medication self-management at home, and (5) different attitudes toward participation in medication decisions. Patients participated in medication safety in multiple ways. However, insufficient knowledge about medication safety, lack of awareness of the patient’s role in ensuring medication safety, shortage of consultation lengths, and being misled by some information were problems with patient participation in medication safety.Conclusion: This exploratory study contributes to our initial understanding of patient participation in medication safety. There were still many issues and barriers in the process of patient participation. Appropriate policies and measures, such as providing various forms of patient education, ensuring sufficient physician-patient communication, giving full play to the role of pharmacists, and making judicious use of digital health tools should be taken to improve medication safety by fully utilising the role of patients.Plain Language Summary: Medication safety is a significant concern around the world. Patient participation in the medication process is effective in reducing the incidence of medication errors and improving medication safety. However, the role of outpatients with chronic conditions in ensuring medication safety is often neglected. This study aims to explore the perspectives and experiences of GPs, pharmacists, and outpatients by qualitative interviews in Beijing, China. The study involved a series of interviews with eight GPs, seven pharmacists, and 18 outpatients living with noncommunicable diseases. The interview revealed five themes: (1) mutual trust between patient and GP, (2) communication with healthcare professionals, (3) acquisition of knowledge about medication safety, (4) implementation of medication self-management at home, and (5) different attitudes toward participation in medication decisions. The findings might help propose suggestions for patient participation in medication safety. Integrating these findings into future studies can help healthcare professionals formulate interventions and better support patients in participating in the medication process.Keywords: medication safety, patient participation, patient safety, qualitative study, noncommunicable disease, community health service centers

Fei Chen,1,2 Rujun Chen,3,&ast; Jiangfeng Zhou,1,2,&ast; Weiyi Xu,1,2,&ast; Jiahui Zhou,1,4 Xianxian Chen,1,5 Xiaohua Gong,1 Zimiao Chen1 1Department of Endocrinology and Metabology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People’s Republic of China; 2Wenzhou Medical University, Zhejiang, People’s Republic of China; 3Department of Burn, 906 Hospital of the Joint Logistics Team, PLA, Wenzhou, People’s Republic of China; 4Department of Internal Medicine, The First People’s Hospital of Longwan District, Wenzhou, People’s Republic of China; 5Department of Internal Medicine, The People’s hospital of Pingyang, Wenzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaohua Gong; Zimiao Chen, Department of Endocrinology and Metabology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People’s Republic of China, Email gxh1204@163.com; zimiaochen@163.comBackground: Thyroid hormone levels are associated with the distribution of body components in humans.Objective: This study aimed to investigate the associations between thyroid hormone (TH) levels, central sensitivity to THs, and body composition in overweight and obese patients with euthyroid type 2 diabetes mellitus (T2DM).Methods: This cross-sectional study included 1215 euthyroid T2DM patients (721 men and 494 women) aged 20– 80 years. The thyroid hormone sensitivity indices included the thyroid feedback quartile-based index (TFQI), thyrotroph T3 resistance index (TT3RI), thyrotroph T4 resistance index (TT4RI), and thyroid-stimulating hormone index (TSHI). The appendicular fat ratio, trunk fat ratio, android fat ratio, gynoid fat ratio, and appendicular skeletal muscle mass (ASM) were measured via dual-energy X-ray absorptiometry.Results: The data revealed a greater proportion of subjects with impaired central sensitivity to THs in the obese group. TFQIFT4 and TFQIFT3 levels were positively correlated with the upper limb fat ratio, lower limb fat ratio, gynoid fat ratio, and total fat ratio. TSHI was positively correlated with body mass index (BMI), upper limb fat ratio, lower limb fat ratio, trunk fat ratio, android fat ratio, gynoid fat ratio, total fat ratio, and appendicular skeletal muscle mass index (ASMI) in women. In men, TSHI was only positively correlated with upper limb fat ratio, lower limb fat ratio, and total fat ratio. Logistic regression analysis indicated that TT3RI and TFQIFT3 were independently and positively associated with central obesity and low muscle mass in overweight and obese men. No significant differences were found among the women.Conclusion: THs central sensitivity is related to the body composition of euthyroid T2DM patients. Specifically, high levels of TT3RI and TFQIFT3 are associated with central obesity and low muscle mass in T2DM men with overweight and obesity.Keywords: thyroid hormones central sensitivity, euthyroid, body components, muscle mass, fat ratio, obese

Juncai Lv,1,&ast; Weiwei Yan,1,&ast; Ran Zhang,1 Xi Chen,1,2 Ziyuan Ren,1,2 Dawei Chen,1 Jinming Yu1 1Department of Radiation Oncology and Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China; 2Cheeloo College of Medicine, Shandong University Cancer Center, Jinan, Shandong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinming Yu; Dawei Chen, Department of Radiation Oncology and Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China, Tel +86-531-8798-4777, Fax +86-531-8798-4079, Email sdyujinming@163.com; dave0505@yeah.netPurpose: There exists a dearth of research concerning non-small cell lung cancer (NSCLC) patients experiencing overall progressive disease concomitant with shrinking lesions after immunotherapy. This is a special type of mixed response. We aim to evaluate the clinical characteristics and treatment options of these patients during immunotherapy.Patients and Methods: We categorized patients into two groups: Progressive Disease with Mixed Responses (PDMR) (n = 31) and Progressive Disease with None Mixed Responses (PDNMR) (n = 144), depending on whether at least one target lesion had shrunk by ≥ 30% at the point of overall progression. Computed tomography scans and magnetic resonance imaging were utilized to evaluate the clinicopathological significance of these patients, and a multivariate analysis was conducted to scrutinize the clinical characteristics and prognosis-influencing factors in these patients.Results: Patients in the PDMR group had worse staging and a greater proportion of previous radiotherapy. The median overall survival (mOS 22 vs 36.4 months; P = 0.019) and median progression-free survival (mPFS 5.83 vs 9.03 months; P = 0.031) of the PDMR group were shorter than PDNMR group. Longer subsequent OS with continued immunotherapy after PDMR compared with patients who do not continue with immunization after PDMR (mOS 23.9 vs 6.5 months; P = 0.024).Conclusion: PDMR was primarily observed in stage IV patients and previously irradiated patients. OS and PFS were inferior in patients with PDMR compared to patients with PDNMR. The continuation of immunotherapy in PDMR patients could extend their survival.Keywords: non-small cell lung cancer, immunotherapy, mixed response, progression

Xiaoqin Chen,1 Lifang Lin,2 Qiuping Zhong,1 Heming Wu,2 Zhiyuan Zheng,2 Baisen Zhang,3 Liubing Lan1 1Department of Maternity, Meizhou People’s Hospital, Meizhou City, Guangdong Province, 514031, People’s Republic of China; 2Department of Central Laboratory, Meizhou People’s hospital, Meizhou City, Guangdong Province, 514031, People’s Republic of China; 3Department of Ultrasound, Meizhou People’s hospital, Meizhou City, Guangdong Province, 514031, People’s Republic of ChinaCorrespondence: Liubing Lan, Department of maternity, Meizhou People’s hospital, No. 63, Huang Tang Road, Meijiang District, Meizhou City, Guangdong Province, 514031, People’s Republic of China, Email hipiing1284@sina.comObjective: To explore the influencing factors of fetal birth defects (BD) and construct a nomogram model.Methods: A total of 341 newborns admitted to Meizhou people’s hospital from September 2021 to September 2023 were randomly grouped into a modeling group (239 cases) and a validation group (102 cases). The modeling group fetuses were separated into BD and non-BD groups. Multivariate logistic regression analyzed risk factors for BD; R software constructed a nomogram model; Receiver operating characteristic (ROC) curve evaluated the model’s discrimination for BD.Results: The top 5 types of BD were congenital heart disease, polydactyly/syndactyly, cleft lip/palate, ear malformation, and foot malformation, with incidence rates of 23.81%, 20.63%, 12.70%, 11.11%, and 7.94%, respectively. BD incidence was 26.36% (63/239). Significant differences between BD and non-BD groups were found in maternal age, gestational age, history of adverse pregnancy/childbirth, gestational hypertension, adverse emotions during pregnancy, and folic acid intake duration (P< 0.05). Logistic regression showed maternal age (OR: 4.125), gestational age (OR: 3.066), adverse pregnancy history (OR: 10.628), gestational hypertension (OR: 5.658), adverse emotions (OR: 5.467), and folic acid intake duration (OR: 4.586) were risk factors for BD (P< 0.05). The modeling group’s ROC AUC was 0.938, calibration curve slope close to 1, H-L test =8.342, P=0.692; external validation AUC was 0.961, calibration slope close to 1, H-L test =7.634, P=0.635.Conclusion: Identified risk factors include maternal age, gestational age, adverse pregnancy history, gestational hypertension, adverse emotions, and folic acid intake duration. The nomogram model shows good discrimination and consistency for evaluating neonatal BD risk.Keywords: fetus, birth defects, influencing factors, nomogram

Fei Gao,1,&ast; Siqi He,1,&ast; Jing Li,1 Xiaoyue Wang,2 Xiaoting Chen,2 Xiaoning Bu1 1Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaoning Bu, Department of Respiratory and Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring Road West, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +8613641000837, Email 13641000837@163.comPurpose: Systemic Immune-Inflammation Index (SII), calculated by (neutrophils count × platelet count)/lymphocytes count, is a novel index of the local immune response and systemic inflammation response. The SII has been shown to play an important role in the prognosis of many diseases, including cardiovascular diseases, cancer and COPD. However, its role in the prognosis of bronchiectasis remains unclear and requires further investigation. This study aimed to investigate the association between SII and readmissions in patients with acute exacerbations of bronchiectasis.Patients and Methods: We conducted a retrospective cohort study of all bronchiectasis patients admitted to the respiratory ward in Beijing Chaoyang Hospital from January 2020 to January 2022. Patients were classified into four groups according to the quartiles of log2(SII) at admission. The primary endpoint was readmission at 1-year follow up. Univariate and multivariate cox regression models were applied to investigate the relationship between SII and readmissions at 1-year follow up in patients with bronchiectasis.Results: A total of 521 patients were included in our study. The median (IQR) SII at admission were 506.10 (564.84). Patients with higher SII tended to be older, male, past and current smokers, have lower BMI, and more dyspnea symptoms. They also had higher inflammatory markers and received a greater spectrum of antibiotics and more intravenous glucocorticoids. Higher SII at admission were independently associated with readmission in patients with acute exacerbations for bronchiectasis following confounder adjustment (OR =1.007; 95% CI, 1.003– 1.011; p < 0.001).Conclusion: Patients with elevated SII levels were typically older males, often smokers, with lower BMI and increased dyspnea. They received more antibiotics and intravenous glucocorticoids. Higher SII at admission are associated with readmission in patients with acute exacerbations of bronchiectasis. SII has potential clinical value as a predictive biomarker for clinical outcomes in bronchiectasis, offering a valuable tool for management strategies.Keywords: chronic respiratory disease, inflammation, prognosis

Jinfeng Ai,1 Yihan Sun,2 Minrong Yan,1 Maolin Liu,1 Dongjun Zhong,1 Wei He,2 Xu Kang,2 Xinsheng Chen2 1The Second Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou, People’s Republic of China; 2Dermatology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, People’s Republic of ChinaCorrespondence: Xu Kang; Xinsheng Chen, Email Kangxuwf@163.com; xinshengchen@souhu.comAbstract: Follicular atresia triad, also known as paradoxical acne (FOT), is a rare and serious clinical syndrome in dermatology, mainly manifested by coalescing acne, purulent perifolliculitis of the head, and suppurative sweating inflammation, and FOT combined with necrotising fasciitis of the lower limbs and squamous cell carcinoma is rare both at home and abroad. In this article, we share the clinical data and treatment of a patient with follicular atresia triad and necrotising fasciitis and squamous cell carcinoma of the left lower limb for your reference.Keywords: follicular atresia triad, necrotising fasciitis, squamous cell carcinoma

Zhiwei Sun,1,&ast; Xiangru Chen,1,&ast; Fang Miao,2,&ast; Na Meng,3 Keqiang Hu,1 Shaotang Xiong,4 Ximing Peng,1 Liya Ma,5 Chuchao Zhou,1 Yanqing Yang1 1Department of Plastic Surgery, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, 430060, People’s Republic of China; 2Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China; 3Department of Cardiovascular Medicine, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, 430060, People’s Republic of China; 4The Second People’s Hospital of China Three Gorges University·the Second People’s Hospital of Yichang, Hubei, People’s Republic of China; 5The Centre of Analysis and Measurement of Wuhan University, Wuhan University, Wuhan, 430072, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yanqing Yang; Chuchao Zhou, Email yangyq0106@163.com; chuchaozhou@163.comIntroduction: Graphene oxide (GO) nanoparticles have emerged as a compelling photothermal agent (PHTA) in the realm of photothermal antibacterial therapy, owing to their cost-effectiveness, facile synthesis, and remarkable photostability. Nevertheless, the therapeutic efficacy of GO nanoparticles is commonly hindered by their inherent drawback of low photothermal conversion efficiency (PCE).Methods: Herein, we engineer the Ag/GO-GelMA platform by growing the Ag on the surface of GO and encapsulating the Ag/GO nanoparticles into the GelMA hydrogels.Results: The resulting Ag/GO-GelMA platform demonstrates a significantly enhanced PCE (47.6%), surpassing that of pure GO (11.8%) by more than fourfold. As expected, the Ag/GO-GelMA platform, which was designed to integrate the benefits of Ag/GO nanoparticles (high PCE) and hydrogel (slowly releasing Ag+ to exert an inherent antibacterial effect), has been shown to exhibit exceptional antibacterial efficacy. Furthermore, transcriptome analyses demonstrated that the Ag/GO-GelMA platform could significantly down-regulate pathways linked to inflammation (the MAPK and PI3K-Akt pathways) and had the ability to promote cell migration.Discussion: Taken together, this study presents the design of a potent photothermal antibacterial platform (Ag/GO-GelMA) aimed at enhancing the healing of infectious wounds. The platform utilizes a handy method to enhance the PCE of GO, thereby making notable progress in the utilization of GO nano-PHTAs. Keywords: Ag/GO nanoparticles, photothermal therapy, photothermal conversion efficiency, hydrogel, infectious wound healing

Xiaoqin Wei,1,&ast; Fang Wang,2,&ast; Ying Liu,3 Zeyong Li,4 Zhong Xue,2 Mingyue Tang,5 Xiaowen Chen1 1School of Medical Imaging, North Sichuan Medical College, Nanchong City, Sichuan Province, People’s Republic of China; 2Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd, Shanghai, People’s Republic of China; 3Department of Radiology, The First Affiliated Hospital of Chengdu Medical College, Chengdu City, Sichuan Province, People’s Republic of China; 4Department of Radiology, Bishan Hospital of Chongqing Medical University, ChongQing, People’s Republic of China; 5Department of Physics, School of Basic Medicine, North Sichuan Medical College, Nanchong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiaowen Chen, School of Medical Imaging, North Sichuan Medical College, 234 Fujiang Road, Nanchong City, Sichuan Province, People’s Republic of China, 637001, Email 56833804@qq.comPurpose: To predict the efficacy of patients treated with hepatectomy and transarterial chemoembolization (TACE) based on machine learning models using clinical and radiomics features.Patients and Methods: Patients with HCC whose first treatment was hepatectomy or TACE from June 2016 to July 2021 were collected in the retrospective cohort study. To ensure a causal effect of treatment effect and treatment modality, perfectly matched patients were obtained according to the principle of propensity score matching and used as an independent test cohort. Inverse probability of treatment weighting was used to control bias for unmatched patients, and the weighted results were used as the training cohort. Clinical characteristics were selected by univariate and multivariate analysis of cox proportional hazards regression, and radiomics features were selected using correlation analysis and random survival forest. The machine learning models (Deathhepatectomy and DeathTACE) were constructed to predict the probability of patient death after treatment (hepatectomy and TACE) by combining clinical and radiomics features, and an optimal treatment regimen was recommended. In addition, a prognostic model was constructed to predict the survival time of all patients.Results: A total of 418 patients with HCC who received either hepatectomy (n=267, mean age, 58 years ± 11 [standard deviation]; 228 men) or TACE (n=151, mean age, 59 years ± 13 [standard deviation]; 127 men) were recruited. After constructing the machine learning models Deathhepatectomy and DeathTACE, patients were divided into the hepatectomy-preferred and TACE-preferred groups. In the hepatectomy-preferred group, hepatectomy had a significantly prolonged survival time than TACE (training cohort: P < 0.001; testing cohort: P < 0.001), and vise versa for the TACE-preferred group. In addition, the prognostic model yielded high predictive capability for overall survival.Conclusion: The machine learning models could predict the outcomes difference between hepatectomy and TACE, and prognostic models could predict the overall survival for HCC patients.Keywords: radiomics, hepatocellular carcinoma, prognosis, hepatectomy

Tong Guo,1,2 Yuan Feng,1,2 Jingjing Zhou,1,2 Linghui Meng,1,2 Xuequan Zhu,1,2 Xu Chen,1,2 Le Xiao,1,2 Lei Feng,1,2 Ling Zhang,1,2 Yu-Tao Xiang,3,4 Yan-Jie Zhao,1,2 Gang Wang1,2 1Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China; 3Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences, Institute of Translational Medicine, University of Macau, Taipa, Macao SAR, People’s Republic of China; 4Centre for Cognitive and Brain Sciences, University of Macau, Taipa Macao SAR, People’s Republic of ChinaCorrespondence: Yan-Jie Zhao; Gang Wang, Email yzhao118@126.com; gangwangdoc@ccmu.edu.cnBackground: Understanding the dynamic relationship between depressive symptoms and quality of life (QOL) is essential in improving long-term outcomes for patients with Major Depressive Disorder (MDD). While previous studies often relied on cross-sectional data, there is a pressing need for stronger evidence based on longitudinal data to better inform the development of effective clinical interventions. By focusing on key depressive symptoms, such interventions have the potential to ultimately enhance QOL in individuals with MDD.Methods: This multi-center prospective study, conducted between 2016 and 2020, enrolled outpatients and inpatients diagnosed with MDD across twelve psychiatric hospitals in China. Longitudinal data on Patient Health Questionnaire – 9 (PHQ-9) and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) was analyzed using an Extended Bayesian Information Criterion (EBIC) graphical least absolute shrinkage and selection operator (gLASSO) network model to explore the connections between depressive symptom changes and QOL changes. Flow network was applied to investigate relationships between individual symptom changes and overall QOL score change, as well as daily functional independence.Results: This study included 818 participants with complete data after 8-week antidepressant treatment. Apart from the overlapping items from PHQ-9 and Q-LES-Q-SF, the three edges between “mood” (delta-QLES2) and “anhedonia” (delta-DEP1), between “physical health” (delta-QLES1) and “sleep problems” (delta-DEP3), and between “physical health” (delta-QLES1) and “sad mood” (delta-DEP2) were the most strong bridges between the cluster of depressive symptoms alleviation and the cluster of QOL change. “Anhedonia” (delta-DEP1), “sad mood” (delta-DEP2) and “loss of energy” (delta-DEP4) had the highest bridge strength between the alleviations of depressive symptoms and the total score change of Q-LES-Q-SF. Anhedonia had the greatest connection with participants’ satisfaction with function in daily life.Conclusion: This study highlighted the potential for developing highly effective interventions by targeting on central symptoms, thereby to ultimately improve QOL for patients with MDD.Keywords: network analysis, patients with MDD, acute phase treatment, depressive symptoms, quality of life

Xiaoqin Chen,1,2 Liubing Lan,1,2 Heming Wu,1 Mei Zeng,1,2 Zhiyuan Zheng,1 Qiuping Zhong,2 Fengdan Lai,2 Yonghe Hu2 1Department of Prenatal Diagnostic Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China; 2Department of Obstetrics, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of ChinaCorrespondence: Liubing Lan, Department of Prenatal Diagnostic Center, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, No. 63 Huangtang Road, Meijiang District, Meizhou, People’s Republic of China, Email 13411221666@163.comObjective: To explore and evaluate the value of chromosomal microarray analysis (CMA) in prenatal diagnosis of fetuses with ultrasound abnormalities.Methods: A retrospective analysis was performed on 370 fetuses with ultrasound abnormalities received invasive prenatal diagnosis at Meizhou People’s Hospital from October 2022 to December 2023. Fetal specimens were analyzed by CMA, and the detection rates of aneuploidy and pathogenic (P)/likely pathogenic (LP) copy number variations (CNVs) in ultrasound structural abnormalities (malformations of fetal anatomy) and non-structural abnormalities (abnormalities of fetal nonanatomical structure) were analyzed.Results: There were 114 (30.8%) cases with isolated ultrasound structural abnormalities, 226 (61.1%) cases with isolated non-structural abnormalities (182 isolated ultrasound soft markers abnormalities, 30 isolated fetal growth restriction (FGR), and 8 isolated abnormalities of amniotic fluid volume), and 30 (8.1%) cases with both structural and non-structural abnormalities. The overall detection rate of aneuploidy and P/LP CNVs in isolated ultrasonic structural abnormalities was 5.3%, among which cardiovascular system abnormalities were the highest. In addition, the largest number of fetuses with non-structural abnormalities was nuchal translucency (NT) thickening (n = 81), followed by ventriculomegaly (n = 29), and nasal bone dysplasia (n = 24). The detection rate of chromosomal abnormalities of fetuses with abnormal ultrasound soft markers was 9.9%, and the detection rate in single abnormal ultrasound soft marker, and multiple ultrasound soft markers abnormalities was 9.7% (16/165) and 11.8% (2/17), respectively. Moreover, the detection rate of chromosomal abnormalities of fetuses with FGR and structural abnormalities combined with non-structural abnormalities was 6.7% (2/30), and 13.3% (4/30), respectively.Conclusion: The incidence of chromosomal abnormalities (aneuploidy and P/LP CNVs) varies among different fetal ultrasound abnormalities.Keywords: chromosomal microarray analysis, copy number variation, abnormal ultrasound fetus, prenatal diagnosis

Xuliang Shi,1,&ast; Miaomiao Hou,1,&ast; Xiaoyan Chen,2 Ya Zhu3 1College of Education, Hebei University, Baoding, Hebei Province, 071002, People’s Republic of China; 2Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong; 3Center for Mental Health Education and Counseling, Guangdong University of Science and Technology, Dongguan, Guangdong Province, 523083, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xuliang Shi, Associate professor at the College of Education, Hebei University, Baoding, 071002, People’s Republic of China, Email shixl163@163.comObjective: This longitudinal study examined the reciprocal relationship between sleep disturbances with non-suicidal self-injury and whether self-compassion mediates these associations.Methods: A total of 5785 freshmen were sampled from a large-scale health-related cohort among Chinese college students at the baseline. This study spanned six waves with a six-month interval between each wave. Data from the last four waves were used because self-compassion or non-suicidal self-injury was not measured in the first two waves. The cross-lagged panel models were used to examine the longitudinal dynamic relationships between sleep disturbances, self-compassion, and non-suicidal self-injury.Results: The results showed that all the auto-regressive paths were significant. For the cross-lagged paths, there was a reciprocal relation between sleep disturbances and self-compassion. Importantly, self-compassion played a longitudinal mediating role in the prediction from sleep disturbances to non-suicidal self-injury (indirect effect = 0.007 to 0.009, all p values < 0.001).Conclusion: Psychological interventions targeting improved sleep quality and self-compassion may hold great promise for reducing the incidence of non-suicidal self-injury.Keywords: sleep disturbances, self-compassion, NSSI, longitudinal design

Li Zhou,1,&ast; Youlin Wu,1,2,&ast; Jiani Wang,1 Haiyun Wu,1 Yongjun Tan,1 Xia Chen,1,3 Xiaosong Song,1,4 Yu Ren,1 Qin Yang1 1Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Neurology, Chongzhou People’s Hospital, Sichuan, People’s Republic of China; 3Department of Neurology, the Seventh People’s Hospital of Chongqing, Chongqing, People’s Republic of China; 4Department of Neurology, the Ninth People’s Hospital of Chongqing, Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qin Yang, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, People’s Republic of China, Tel +86-023-89012008, Fax +86-023-68811487, Email xyqh200@126.comBackground and Purpose: Ischemic stroke is a leading cause of mortality and disability globally, necessitating accurate prediction of intra-hospital mortality (IHM) for improved patient care. This study aimed to develop a practical nomogram for personalized IHM risk prediction in ischemic stroke patients.Methods: A retrospective study of 422 ischemic stroke patients (April 2020 - December 2021) from Chongqing Medical University’s First Affiliated Hospital was conducted, with patients divided into training (n=295) and validation (n=127) groups. Data on demographics, comorbidities, stroke risk factors, and lab results were collected. Stroke severity was assessed using NIHSS, and stroke types were classified by TOAST criteria. Least absolute shrinkage and selection operator (LASSO) regression was employed for predictor selection and nomogram construction, with evaluation through ROC curves, calibration curves, and decision curve analysis.Results: LASSO regression and multivariate logistic regression identified four independent IHM predictors: age, admission NIHSS score, chronic obstructive pulmonary disease (COPD) diagnosis, and white blood cell count (WBC). A highly accurate nomogram based on these variables exhibited excellent predictive performance, with AUCs of 0.958 (training) and 0.962 (validation), sensitivities of 93.2% and 95.7%, and specificities of 93.1% and 90.9%, respectively. Calibration curves and decision curve analysis validated its clinical applicability.Conclusion: Age, admission NIHSS score, COPD history, and WBC were identified as independent IHM predictors in ischemic stroke patients. The developed nomogram demonstrated high predictive accuracy and practical utility for mortality risk estimation. External validation and prospective studies are warranted for further confirmation of its clinical efficacy.Keywords: ischemic stroke, nomogram, predictors, lasso, intra-hospital mortality

Ming Wei,1 Xi Chen,1 Jun Liu,1 Tianmeng Li,1 Peng Wang,1 Shuai Wang,1 Jing Wang,2,3 Li Gu1 1Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Jing Wang, Beijing Anding Hospital, Capital Medical University, 5 Ankang Hutong Road, Xicheng District, Beijing, 100088, People’s Republic of China, Email kycwangjing@mail.ccmu.edu.cn Li Gu, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People’s Republic of China, Email didcm2006@mail.ccmu.edu.cnPurpose: Carbapenem-resistant Enterobacterales (CRE) infection is an urgent threat to human health. This study aimed to develop and validate a novel multiplex real-time PCR (multi-qPCR) assay for the detection of the blaKPC, blaNDM, blaIMP, blaOXA-48-like, and blaVIM genes in CRE isolates and clinical samples, as well as to compare it with three phenotypic methods.Methods: The reliability and limit of detection (LOD) of the multi-qPCR assay were evaluated. PCR and DNA sequencing were used as the reference methods to identify carbapenemase genes in CRE isolates and clinical samples. The accuracy of the multi-qPCR assay, modified carbapenem inactivation and EDTA-modified carbapenem inactivation method (mCIMandeCIM), carbapenemase inhibitor-based combined disk test (CDT), and colloidal gold-based immunochromatographic test was compared with the reference methods with 182 isolates of CRE. Furthermore, 112 clinical samples were collected to validate the efficacy of this multi-qPCR assay.Results: The standard deviations (CVs) of intra-assay and inter-assay of the multi-qPCR assay were ≤ 0.53% and ≤ 2.04% for detecting the five major carbapenemase genes, respectively; while the LOD ranged from 2× 102 copies/mL to 8× 102 copies/mL. PCR and DNA sequencing confirmed 168 out of 182 CRE isolates producing carbapenemase(s): KPC (n = 93), NDM (n = 46), IMP (n = 8), OXA-48-like (n = 14), VIM (n = 1), KPC&NDM (n = 5), and KPC&NDM&IMP (n = 1). The accuracy of mCIMandeCIM, CDT, Colloidal Gold, and the multi-qPCR assay was 96.2%, 89.6%, 100%, and 100% respectively for detecting carbapenemase(s) producers. Moreover, the sensitivity and specificity of the multi-qPCR assay were all 100% for the detection of each carbapenemase gene in clinical samples, compared with PCR and sequencing.Conclusion: For clinical isolate detection, the multi-qPCR assay is comparable to Colloidal Gold, and superior to mCIMandeCIM and CDT; while for clinical samples detection, it also shows excellent performance. Therefore, the multi-qPCR assay has great potential for clinical diagnosis.Keywords: carbapenem-resistant Enterobacterales, carbapenemases detection, multiplex real-time PCR assay, mCIM/eCIM, combined disk test, immunochromatographic test

Xinyue Chen,1 Xue Zhang,2 Ruijia Gao,2 Yu Huang,3 Shimeng Mao,2 Bing Wang,4 Jiying Feng4 1Department of Anesthesiology, Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of China; 2Department of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 3Department of Anesthesiology, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 4Department of anesthesiology, the Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People’s Hospital of Lianyungang, Lianyungang, Jiangsu, People’s Republic of ChinaCorrespondence: Jiying Feng, No. 6 East Zhenhua Road, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China, Email fengjymz@163.comPurpose: Anxiety and depression can affect the physiology of the gastrointestinal tract through the brain-gut axis, causing gastrointestinal dysfunction, which is mainly manifested as indigestion, diarrhoea, constipation, or abdominal pain. Preoperative anxiety arises in children due to separation from parents, fear of unfamiliar surroundings and anaesthesia and surgical procedures.To discuss the effect of alleviating preoperative anxiety on postoperative recovery of gastrointestinal function in children with indirect inguinal hernia after laparoscopic high ligation of the hernia sac.Patients and Methods: 90 children with laparoscopic high ligation of the herniated sac in oblique inguinal hernia were randomly divided into control group (Group C) and experimental group (Group M). The Group M was given midazolam oral solution 0.5mg/kg (maximum dose 20mg), and The Group C was given 5% glucose solution with the same dose.Primary outcome was the time to first postoperative defecation and I-FEED scores.The secondary outcomes included mYPAS-SF scores; child sedation scores; child-parent separation scores; parental STAI scores;PHBQ scores;FLACC scores, operative time, and fluid input and surgeon job satisfaction.Results: Compared with Group C, there was a shorter time to first postoperative defecation (P < 0.05), and lower I-FEED scores on postoperative day 1 (P < 0.05). The mYPAS-SF scores, which were significantly different in Group M at T1, T2, and T3 (P < 0.05), parental STAI scores at S1, child sedation scores and child-parent separation scores in T1, and surgeon job satisfaction between the two groups were significantly different (P < 0.05). There were no statistically significant differences in I-FEED scores on days 2 and 3, PHBQ scores, FLACC scores, operative time, and fluid input between the two groups of children (P > 0.05).Conclusion: Preoperative application of midazolam oral solution to relieve preoperative anxiety helps to promote the recovery of postoperative gastrointestinal function in children with indirect inguinal hernia and increases the surgeon job satisfaction.Keywords: preoperative anxiety, gastrointestinal function, midazolam:pediatric surgery

Song Li,1,&ast; Nandong Hu,2,&ast; Zicheng Wei,2 Jiangchuan Wang,2 Rongzhou Wang,2 Xifa Gao,2 Yingping Qiu,2 Xiao Chen2 1Department of Radiology, The Second Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, 230040, People’s Republic of China; 2Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiao Chen; Yingping Qiu, Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Nanjing, 210029, People’s Republic of China, Tel +86 025 86617141, Email chxwin@163.com; ypqiusz@111.comIntroduction: Osteoporosis diagnosis often utilizes quantitative computed tomography (QCT). This study explored the validity of applying lumbar bone mineral density (LBMD) standards to thoracic vertebrae (T8-T10) for osteoporosis detection during CT lung cancer screenings. This study investigated the utility of thoracic BMD (BMD-T8-T10) for detecting osteoporosis in older persons during CT lung cancer screening.Methods: We studied 701 participants who underwent QCT scans for both LBMD and BMD-T8-T10. Osteoporosis was diagnosed using ACR criteria based on LBMD. We determined BMD-T8-T10 thresholds via a receiver operating characteristic (ROC) curve and translated BMD-T8+T9+T10 to LBMD (TTBMD) using linear regression. Kappa test was used to evaluate the accuracy of BMD-T8-T10 thresholds and TTBMD in diagnosing osteoporosis.Results: Raw BMD-T8-T10 poorly identified osteoporosis (kappa = 0.51). ROC curve analysis identified BMD-T8-T10 thresholds for osteopenia (138 mg/cm3) and osteoporosis (97 mg/cm3) with areas under the curve of 0.97 and 0.99, respectively. We normalized BMD-T8-T10 to TTBMD based on the formula: TTBMD = 0.9 × BMD-T8-T10 - 2.56. These thresholds (kappa = 0.74) and TTBMD performed well in detecting osteoporosis/osteopenia (kappa = 0.74).Conclusion: Both calculating BMD-T8-T10 threshold (138.0 mg/cm3 for osteopenia and 97 mg/cm3 for osteoporosis) and normalizing BMD-T8-T10 to LBMD demonstrated good performance in identifying osteoporosis in older adults during CT lung cancer screening.Keywords: quantitative computed tomography, thoracic vertebral bone mineral density, osteoporosis, Computed tomography, lung cancer