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Huicang Liang,1,* Xuehong Duan,2,* Teng Li,3 Liang Hu,3 Jian Guo3 1Department of Laboratory Medicine, Key Laboratory of Precision Medicine for Viral Diseases, Guangxi Health Commission Key Laboratory of Clinical Biotechnology, Liuzhou People’s Hospital, Liuzhou, People’s Republic of China; 2Department of Laboratory Medicine, The First People’s Hospital of Xianyang, Xianyang, People’s Republic of China; 3Department of Laboratory Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jian Guo; Liang Hu, Department of Laboratory Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, 200123, People’s Republic of China, Email guojian1110@126.com; hu740646282@sina.comAbstract: This study presents a case of Talaromyces marneffei combined with Enterococcus faecium bloodstream infection with gastrointestinal symptoms as the sole initial clinical manifestation.The patient is a resident of Shanghai and has no recent travel history to areas with a high risk of T. marneffei infection. He was admitted to the emergency room due to severe upper abdominal pain. Laboratory tests indicated elevated levels of white blood cells, rapid C-reactive protein, and procalcitonin, while the human immunodeficiency virus (HIV) test returned negative. An abdominal CT examination revealed gas and fluid accumulation in the abdominal cavity, raising suspicion for gastrointestinal perforation and peritonitis. Initially, he received symptomatic treatment for gastrointestinal perforation and abdominal infection, but his response to the treatment was poor.Through metagenomic next-generation sequencing (mNGS) and multiple blood cultures, a mixed infection of T. marneffei and E. faecium was identified in the patient’s blood. Combination treatment with vancomycin and amphotericin B was initiated to manage the symptoms. However, we discovered genome-wide exon CARD9 mutations in the patient, complicating the treatment process. Ultimately, the delayed diagnosis of T. marneffei resulted in the patient’s severe deterioration, rendering the anti-infective treatment ineffective, and leading to the patient’s death.This report underscores the challenges associated with diagnosing T. marneffei infections in non-AIDS patients and in non-endemic regions. The diagnosis of disseminated infections poses significant difficulties, particularly when mixed infections are present, complicating clinical treatment. This highlights the critical importance of standardized blood cultures for the early diagnosis of T. marneffei. Additionally, we must prioritize timely whole-genome testing to identify potential immune gene mutations.Keywords: Talaromyces marneffei, drug susceptibility, disseminated infection, HIV, CARD9 gene mutation, antifungal antibacterial therapy

Xiang Tang,1,2,* Jinbin Chen,1,2,* Wei Peng,1,2,* Zhoutian Yang,1,2 Li Hu,1,2 Zhiwei Ye,1,2 Yizhen Fu,1,2 Dandan Hu,1,2 Zhongguo Zhou,1,2 Minshan Chen,1,2 Yaojun Zhang,1,2 Jun-Cheng Wang1,2 1State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People’s Republic of China; 2Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yaojun Zhang; Jun-Cheng Wang, Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, People’s Republic of China, Email zhangyuj@sysucc.org.cn; wangjch@sysucc.org.cnObjection: To report the efficacy and safety of triple combination therapy with bevacizumab plus anti-PD-1 (BP1) or anti-PD-L1 inhibitors (BPL) combined with hepatic arterial infusion chemotherapy (HAIC) as a first-line treatment for initially unresectable hepatocellular carcinoma (uHCC).Methods: In this retrospective study, patients with initially uHCC received either BP1-HAIC or BPL-HAIC as first-line treatment. The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS), objective response rate (ORR) and disease control rate (DCR).Results: Between January 2020 and December 2022, a total of 136 patients with initially uHCC received triple combination therapy, with 76 in the BP1-HAIC group and 60 in the BPL-HAIC group. The median PFS for the entire cohort was 11.1 months (95% CI, 8.0– 13.7 months), and the median OS was 22.4 months (95% CI, 21.3- not reached). Comparative analysis revealed no significant differences in PFS (HR, 0.91, P = 0.69) or OS (HR, 0.71, P = 0.31) between the BP1-HAIC and BPL-HAIC groups. The ORR was 46.3% per RECIST v1.1 and 66.9% per mRECIST, with a DCR of 83.1% under both criteria. Common adverse events (AEs) included hypoalbuminemia and elevated aspartate/alanine aminotransferase, with 5.1% (7/136) experienced upper gastrointestinal bleeding. Multivariate Cox analysis identified tumor number and BCLC stage as independent prognostic factors for OS, and tumor number for PFS.Conclusion: Triple combination therapy demonstrated significant therapeutic efficacy and tumor response in initially uHCC. No notable differences in outcomes were observed between the BP1-HAIC and BPL-HAIC groups. AEs were manageable in clinical practice.Keywords: hepatocellular carcinoma, immune checkpoint inhibitor, bevacizumab, hepatic arterial infusion chemotherapy, adverse event

Zhiyuan Yu,1– 3,&ast; Haopeng Liu,4,&ast; Rui Li,1– 3,&ast; Liai Hu,3 Chun Xiao,5 Yunhe Gao,2 Peiyu Li,1– 3 Wenquan Liang,2 Sixin Zhou,2 Xudong Zhao2 1Medical School of Chinese PLA, Beijing, People’s Republic of China; 2Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, People’s Republic of China; 3School of Medicine, Nankai University, Tianjin, People’s Republic of China; 4Department of Hepatobiliary Surgery, Zhangqiu District People’s Hospital, Jinan, Shandong Province, People’s Republic of China; 5Department of General Surgery, PLA Rocket Force Characteristic Medical Center, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xudong Zhao; Sixin Zhou, Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, People’s Republic of China, Email 601489554@qq.com; 35060555@qq.comBackground: The research on lymph node metastasis (LNM) in locally advanced gastric cancer (LAGC) infiltrating the subserous tissue and serous membrane (T3-4a) is significantly inadequate. This study aims to explore the clinicopathological factors related to LNM in stages T3 and T4a LAGC, while also developing predictive nomograms.Methods: After systematic searching and rigorous screening, 1995 T3 and 1244 T4a LAGC cases who underwent surgery without neoadjuvant or perioperative chemotherapy were selected. The risk factors associated with LNM were identified using both univariate and multivariate logistic regression analyses. Subsequently, the independent variables identified through the multivariate analyses were utilized to construct a nomogram.Results: The incidence of LNM in T3 and T4a LAGC was 77.1% (1539/1995) and 83.8% (1043/1244), respectively. The following factors were found to be independently associated with LNM in T3 LAGC: preoperative serum albumin < 41g/L (P=0.007), gastrointestinal obstruction (P< 0.001), tumor location (P=0.040), tumor size > 4cm (P=0.002), mixed (P=0.001) and undifferentiated histological types (P=0.002), presence of lymphovascular invasion (LVI) (P< 0.001) and nerve invasion (P< 0.001). Additionally, in T4a LAGC cases, serum albumin < 39g/L (P=0.004), tumor size > 6cm (P=0.020), mixed (P< 0.001) and undifferentiated histological types (P< 0.001), presence of gastrointestinal hemorrhage (P=0.016), neuroendocrine differentiation (P=0.024), and LVI (P< 0.001) independently influenced the occurrence of LNM.Conclusion: This study identified the risk factors associated with LNM in T3-4a LAGC cases and constructed nomograms, thereby providing valuable guidance for formulating and implementing a multidisciplinary perioperative treatment program.Keywords: locally advanced gastric cancer, lymph node metastasis, clinicopathological factors, nomogram

Zhongbao Zuo,1,&ast; Jing Wu,1,&ast; Miaochan Wang,1 Rui Wu,2 Xiaojing Zhang,2 Lanlan Hu,1 Huaizhong Cui,1 Ting Feng,3 Aifang Xu,1 Shourong Liu2 1Department of Clinical Laboratory, Hangzhou Xixi Hospital, Zhejiang, 310023, People’s Republic of China; 2Department of Hepatology, Hangzhou Xixi Hospital, Zhejiang, 310023, People’s Republic of China; 3Ultrasound Department, Hangzhou Xixi Hospital, Zhejiang, 310023, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Aifang Xu; Shourong Liu, Email 13616500869@163.com; lsr85463990@126.comIntroduction: This study aimed to explore serum HBV pre-genomic RNA (pgRNA) levels and its associated factors among HBV-infected patients in the real world.Methods: This retrospective cohort study was conducted from May 10, 2023, to January 15, 2024. Univariate logistic analysis for positive serum HBV pgRNA was performed first, and variables with statistical significance were included in a multivariate logistic model. A decreasing trend of serum HBV pgRNA and HBV DNA levels was also detected first by univariate logistic regression and then by multivariate logistic regression.Results: 482 patients were included in our analysis at baseline, and 191 patients were followed up. Multivariate logistic regression revealed that positive HBV DNA (AOR: 2.63, 95% CI: 1.46– 4.75, P=0.001), ≥ 1000 hBsAg (AOR: 2.29, 95% CI: 1.08– 4.89, P=0.03), positive HBeAg (AOR: 28.26, 95% CI: 15.2– 52.55, P< 0.001), and ALP (AOR: 1.01, 95% CI: 1.001– 1.02, P=0.03) were positively correlated with positive HBV pgRNA at baseline. Two independent multivariate logistic regression models were constructed for the decreasing trend of serum HBV pgRNA and HBV DNA for the 191 follow-up patients. Results showed that the decreasing trend of HBV pgRNA was positively correlated with positive baseline HBV DNA (AOR: 4.60, 95% CI: 1.84– 11.51, P=0.001), baseline HBsAg ≥ 1000 IU/mL (AOR: 8.74, 95% CI: 1.09– 70.10, P=0.04), and HDL (AOR: 5.01, 95% CI: 1.28– 19.66, P=0.02). The decreasing trend of HBV DNA was positively correlated with positive baseline HBV pgRNA (AOR: 3.80, 95% CI: 2.00– 8.83, P< 0.001) and AST (AOR: 1.06, 95% CI: 1.03– 1.08, P< 0.001).Conclusion: Our study revealed that HBV DNA, HBsAg, HBeAg, and ALP were significantly correlated with positive HBV pgRNA at baseline. The baseline HBV DNA, HBsAg, and HDL were significantly correlated with decreasing levels of HBV pgRNA. A decreasing trend of HBV DNA significantly correlated with patients’ baseline HBV pgRNA and AST.Keywords: chronic hepatitis B, HBsAg, HBV pgRNA, HBV DNA

Xiuri Wang,1 Yunxiao Liang,1 Liuyang Hu2 1Department of Gastroenterology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530016, People’s Republic of China; 2Department of Laboratory Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530016, People’s Republic of ChinaCorrespondence: Liuyang Hu, Department of Laboratory Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530016, People’s Republic of China, Email 1225432679@qq.comAbstract: Species of Pantoea are mainly environmental strains and plant pathogens, rarely causing human infections. Here, we describe two cases of hemodialysis catheter-related bloodstream infection caused by Pantoea in patients with uremia. To our knowledge, this is the first reported case of catheter related bloodstream infection caused by Pantoea dispersa (P. dispersa) in hemodialysis patients, as well as the first case of bloodstream infection caused by Pantoea anthophila (P. anthophila). Multiple blood cultures from the catheter showed the presence of Pantoea, and the isolated P. dispersa and P. anthophila were found to be highly sensitive to various antibiotics. Prompt use of antibiotics and catheter lock with gentamicin or amikacin led to rapid recovery of the patients, avoiding the economic burden of catheter replacement. Infections caused by Pantoea might be underestimated as methods such as VITEK® MS system often result in misidentification. Therefore, we recommend using advanced techniques such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) or 16S ribosomal RNA analysis to detect more cases of Pantoea infections. By sharing these cases, we hope to increase awareness among clinicians about the potential pathogenicity of Pantoea in hemodialysis patients. It is crucial to strengthen noting the primary concern for sources of infection with Pantoea species (plant and environmental exposures) to prevent outbreaks of Pantoea-related bloodstream infections in hospitals.Keywords: hemodialysis catheter-related bloodstream infections, nosocomial bloodstream, pantoea genus, pantoea dispersa, pantoea anthophila

Jia Wei,1,&ast; Mingfen Song,1,&ast; Hong Jing Mao,1 Ruobing Qi,1 Lili Yang,1 You Xu,1 Pan Yan,1 Linlin Hu2 1Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People’s Republic of China; 2Sleep Medicine Center, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310013, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hong Jing Mao, Email maohongjing@hz7hospital.comBackground: The effectiveness of medication combined with smartphone-delivered cognitive behavioral therapy for insomnia (CBT-I) has been well verified, but there are few studies on the sequence of remission of insomnia symptoms. This study aims to understand the sequence of symptom improvement and the factors influencing the treatment effectiveness in patients with insomnia.Methods: Smartphone-delivered CBT, as a form of Online CBT, allows for training through mobile devices at any time and place. We utilized the Good Sleep 365 app to conduct a survey, involving 2820 patients who met the baseline inclusion criteria. These patients were assessed using a general demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI) to evaluate general demographic information and insomnia symptoms, and subsequently underwent CBT training using the Good Sleep 365 app. A total of 1179 patients completed follow-ups at 4 weeks, 8 weeks, 16 weeks, and 24 weeks.Results: At 4 weeks and 8 weeks, the descending order of the reduction rates of PSQI components (excluding component 6: use of sleeping medication) was: sleep latency, subjective sleep quality, sleep efficiency, sleep disturbance, sleep maintenance, and daytime dysfunction. At 16 weeks and 24 weeks, the descending order was subjective sleep quality, sleep latency, sleep efficiency, daytime dysfunction, sleep maintenance, and sleep disturbance. There were significant differences in the reduction rates of PSQI components (excluding component 6: use of sleeping medication) both at the same follow-up times and at different follow-up times (all P< 0.05). Multivariable logistic regression analysis showed that patients older than 30 years and those with a college degree or above had better treatment outcomes, whereas those with a disease duration of more than three years had worse outcomes.Conclusion: The sequence of symptom improvement in patients with insomnia changes over time, and age, educational level, and duration of disease are factors influencing treatment outcomes.Keywords: insomnia, CBT-I, PSQI, influencing factors

Shandong Jiang,1,2 Libin Hu,1,2 Hang Zhou,1,2 Jianan Wu,1,2 Jiayin Zhou,1,2 Xian Yu,1,2 Gao Chen1,2 1Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, People’s Republic of China; 2Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou, 310016, People’s Republic of ChinaCorrespondence: Gao Chen, Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou, 310009, People’s Republic of China, Email d-chengao@zju.edu.cnAbstract: Intracerebral hemorrhage (ICH) is a primary, non-traumatic cerebral event associated with substantial mortality and disability. Despite advancements in understanding its etiology and refining diagnostic techniques, a validated treatment to significantly improve ICH prognosis remains elusive. Exosomes, a subtype of extracellular vesicles, encapsulate bioactive components, predominantly microRNAs (miRNAs), facilitating and regulating intercellular communication. Currently, exosomes have garnered considerable interests in clinical transformation for their nanostructure, minimal immunogenicity, low toxicity, inherent stability, and the ability to traverse the blood-brain barrier. A wealth of studies has demonstrated that exosomes can improve the prognosis of ICH through anti-apoptosis, neurogenesis, angiogenesis, anti-inflammation, immunomodulation, and autophagy, primarily via the transportation or overexpression of selected miRNAs. More importantly, exosomes can be easily customized with specific miRNAs or bioactive compounds to establish delivery systems, broadening their potential applications. This review focuses on the therapeutic potential of exosomes in ICH, reviewing the mechanisms of molecular biology mediated by certain miRNAs, discussing the benefits, challenges, and future prospects in ICH treatment. We hope comprehensive understanding of exosomes based on miRNAs will provide new insights into the treatment of ICH and guide the translation of exosome’s research from laboratory to clinical practice. Keywords: intracerebral hemorrhage, exosomes, extracellular vesicles, microRNAs, stem cells

Shaoyan Shi, Leiming Hu, Dong Hu, Xuehai Ou, Yansheng Huang Department of Hand Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710000, People’s Republic of ChinaCorrespondence: Yansheng Huang, Department of Hand Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, 710000, People’s Republic of China, Email yshg1991@163.comAbstract: Diabetic wounds pose a significant challenge in modern healthcare due to their chronic and complex nature, often resulting in delayed healing, infections, and, in severe cases, amputations. In recent years, nanotherapeutic approaches have emerged as promising strategies to address the unique pathophysiological characteristics of diabetic wounds. This review paper provides a comprehensive overview of the latest advancements in nanotherapeutics for diabetic wound treatment. We discuss various nanomaterials and delivery systems employed in these emerging therapies. Furthermore, we explore the integration of biomaterials to enhance the efficacy of nanotherapeutic interventions. By examining the current state-of-the-art research, challenges, and prospects, this review aims to offer valuable insights for researchers, clinicians, and healthcare professionals working in the field of diabetic wound care.Keywords: diabetic wounds, nanoparticle, biomaterials, DELIVERY system

Yun Shi,1,2 Chan Wang,2 Mary Ann Sevick,1– 3 Han Bao,4 Xinyi Xu,1,2 Yulin Jiang,1,2 Ziqiang Zhu,5 Ashley Wei,1,2 Naumi M Feldman,6 Lu Hu1,2 1Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA; 2Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA; 3Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA; 4Jacobi Medical Center, New York, NY, USA; 5Wellsure Medical Practice, New York, NY, USA; 6Charles B. Wang Community Health Center, New York, NY, USACorrespondence: Lu Hu, Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Ave, New York, NY, 10016, USA, Tel +1 646-501-3438, Email lu.hu@nyulangone.orgPurpose: The purpose of this study is to describe diabetes distress and related factors among Chinese Americans with type 2 diabetes in New York City (NYC).Methods: We conducted a secondary data analysis of the baseline data from three research studies conducted among community-dwelling Chinese American adults with type 2 diabetes. Diabetes Distress Scale (DDS) was used to measure sources of diabetes distress including emotional-, regimen-, interpersonal-, and physician-related distress. A score of 2 or greater indicates moderate diabetes distress or higher. Patient Health Questionnaire-2 (PHQ-2) was used to measure depressive symptoms. Participants’ sociodemographic information was also collected. Descriptive statistics were used to describe diabetes distress, and logistic least absolute shrinkage and selection operator (LASSO) regression was used to examine factors associated with diabetes distress level.Results: Data from 178 participants (mean age 63.55± 13.56 years) were analyzed. Most participants were married (76.40%), had a high school degree or less (65.73%), had a household annual income < &dollar;25,000 (70.25%), and reported limited English proficiency (93.22%). About 25.84% reported moderate or higher overall distress. The most common sources of distress were emotional burden (29.78%), followed by regimen- (28.65%), interpersonal- (18.54%), and physician-related distress (14.04%). Participants who were younger, female, limited English proficient, and had elevated depressive symptoms were more likely to have higher diabetes distress.Conclusion: Diabetes distress is prevalent among Chinese immigrants with type 2 diabetes, especially emotional- and regimen-related distress. Given the known link between diabetes distress and poor glycemic control, it is critical to screen for diabetes distress at primary care clinics and incorporate psychological counseling in diabetes care in this underserved population.Keywords: Chinese Americans, immigrant health, ethnic minority, diabetes distress, psychological burden, mental health, stress, emotional distress

Fangfang Fan,1,2,&ast; Zhe Liang,1,2,&ast; Zhihao Liu,1 Pengfei Sun,1 Lihua Hu,1 Jia Jia,1,2 Yan Zhang,1,2 Jianping Li1,2 1Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China; 2Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianping Li, Department of Cardiology & Institute of Cardiovascular Disease, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, People’s Republic of China, Email lijianping03455@pkufh.comPurpose: Early identification of new residual risk factors for coronary heart disease (CHD) is warranted. In this study, we aim to investigate the association between the serine concentration, an important amino acid in one-carbon metabolism, and CHD in Chinese hospitalized patients.Patients and Methods: This case–control study included 428 case–control pairs comprising patients with CHD with a maximum coronary artery stenosis degree of > 70% and controls with stenosis of < 30%. The individuals were matched by age, sex, and date of coronary angiography at Peking University First Hospital from January 1, 2016, to December 31, 2019. Conditional logistic regression was used to investigate the associations between the serine concentration and CHD.Results: Patients with CHD were aged 63.48 ± 10.38 years, and 43.73% were male. Compared with controls, patients with CHD had a slightly lower serine concentration (13.35 ± 4.20 vs 13.77 ± 4.08 μg/mL), but the difference was not significant. In the multivariable conditional logistic regression analysis, for every 1 μg/mL increase in serine concentration, the odds of CHD decreased by 6% (95% confidence interval [CI] 0.90– 0.99; P = 0.010). Patients with a serine concentration of ≥ 13.41 μg/mL had a lower CHD risk than those with a serine concentration of < 13.41 μg/mL (odds ratio [OR] 0.57, 95% CI 0.39– 0.84; P = 0.004). Subgroup analyses showed that sex interacted with the relationship between serine concentration and CHD (Pinteraction = 0.039), which was more significant in males (OR 0.93, 95% CI 0.87– 0.98; P = 0.013) than in females.Conclusion: This study observed an inverse association between the serine concentration and CHD prevalence in Chinese hospitalized patients, which revealed that serine might play a protective role in CHD.Keywords: serine, coronary heart disease, case–control, one-carbon metabolism

Liang Hu,1 Han Wu,1 Jiamin Wang,2 Yang Hu1 1Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of China; 2Department of Intervention, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of ChinaCorrespondence: Yang Hu, Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of China, Email yanghu2024@126.comAbstract: Minimally invasive percutaneous nephrolithotomy (mini-PCNL) maintains a stone clearance rate similar to standard PCNL while reducing blood loss. Bleeding is a complex and serious complication that can arise after PCNL surgery. Pseudoaneurysm (PA) is an uncommon type of delayed bleeding problem, which affects less than 1% of patients after PCNL. The most effective treatment for severe post-PCNL hemorrhage is super-selective renal angiographic embolization (SRAE), but it can fail in some patients and require additional surgical intervention. This report details the case of a male patient, 55 years old, who experienced severe bleeding four times and had three SRAE procedures and one laparoscopic procedure after PCNL. The presence of a renal artery pseudoaneurysm was not initially identified during the first two attempts of angiography due to arterial spasm and a small, undeveloped lesion. This case report is intended to enhance awareness of tiny pseudoaneurysms, emphasizing the importance of avoiding oversight to improve the success rate of embolization.Keywords: super-selective renal angiographic embolization, percutaneous nephrolithotomy, haemorrhage, case

Zhuangzhi Zhou,1 Yao Chen,2 Na Tan,1 Li Hu3 1Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China Correspondence : Li Hu, Email 993602708@qq.comBackground: Extramammary Paget’s disease (EMPD) is a rare skin cancer with unclear pathogenesis, insidious progression, and high recurrence rate. The purpose of this study was to investigate the clinical features and postoperative recurrence factors of primary EMPD.Methods: We retrospectively analyzed the medical records of 40 patients with primary EMPD who underwent wide local excision surgery at a single medical center between 2009 and 2019. Risk factors for recurrence of primary EMPD were analyzed using multivariate binary logistic regression.Results: The study included 40 patients with primary EMPD, comprising 31 males (77.5%) and 9 females (22.5%), with a median age of 75.52 years (range 52– 99 years). The most common lesion location was the scrotum (22 cases, 55.0%), followed by the vulva, penis, scrotum, underarm and anus. Multivariable regression analysis revealed significant differences in the presence of ill-defined tumour borders, exudation and nodules in the primary lesion affecting the relapse of primary EMPD (p< 0.05).Conclusion: Our findings indicate that ill-defined tumour borders, exudation and nodules in the primary site should be considered as independent risk factors for disease recurrence, which may provide useful suggestions for the diagnosis, treatment and follow-up of primary EMPD.Keywords: extramammary paget’s disease, factors, recurrence, postoperative, retrospective

Liuyang Hu,1 Qi Chen,2 Xingchun Chen1 1Department of Laboratory Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530016, People’s Republic of China; 2Department of Ophthalmology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530016, People’s Republic of ChinaCorrespondence: Xingchun Chen, Department of Laboratory Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530016, People’s Republic of China, Email 369609020@qq.comAbstract: Infection caused by the Humicola sp is extremely rare. We report the first case of fungal keratitis caused by Humicola pulvericola (H. pulvericola) in a 63-year-old man with a history of exposed to hot oil two weeks ago who developed keratitis. Direct examination of confocal microscopy and corneal scrapings showed fungal hyphae and isolates were identified by morphology and by sequencing the internal transcribed spacer region of ribosomal DNA. The in vitro antifungal susceptibilities of the case strain were tested for five antifungal agents. The results showed that the infectious agent was resistant towards fluconazole, caspofungin and amphotericin B; itraconazole and voriconazole were highly effective against H. pulvericola. He was diagnosed with H. pulvericola keratitis and treated with oral itraconazole and natamycin eyedrops. After one month of treatment, the lesion gradually improved, with the best-corrected visual acuity improving to 0.8.Keywords: Humicola pulvericola, keratitis, itraconazole, fungal infection, antifungal drugs

Yanhua Liu,1,2,&ast; Fuxing Li,1,2,&ast; Youling Fang,2,3 Qiaoshi Zhong,1,2 Yanping Xiao,1,2 Yunwei Zheng,1,2 Junqi Zhu,2,3 Chuwen Zhao,2,3 Xingwei Cao,1,2 Jianqiu Xiong,4 Longhua Hu1,2 1The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, Nanchang, People’s Republic of China; 2Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China; 3School of Public Health, Nanchang University, Jiangxi, Nanchang, People’s Republic of China; 4Department of Nursing, the Second Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianqiu Xiong, Department of Nursing, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Jiangxi, Nanchang, 330006, People’s Republic of China, Email 1773014059@qq.com Longhua Hu, Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Jiangxi, Nanchang, 330006, People’s Republic of China, Email longhuahu@163.comObjective: This research aimed to analyze the clinical characteristics, prognosis, and antimicrobial treatment of bloodstream infections (BSI) caused by Enterobacter cloacae complex (ECC).Methods: The clinical data of patients with bloodstream infections caused by Enterobacter cloacae complex from April 2017 to June 2023 were collected retrospectively. These data were then analyzed in subgroups based on the detection results of extended-spectrum β-lactamase (ESBL), 30-day mortality, and the type of antimicrobial agent used (β-lactam/β-lactamase inhibitor combinations (BLICs) or carbapenems).Results: The proportion of ESBL-producing Enterobacter cloacae complex was 32.5% (37/114). Meanwhile, ICU admission, receiving surgical treatment within 3 months, and biliary tract infection were identified as risk factors for ESBL-producing ECC-BSI. Additionally, immunocompromised status and Sequential Organ Failure Assessment (SOFA) score ≥ 6.0 were identified as independent risk factors of 30-day mortality in patients with ECC-BSI (n = 108). Further analysis in BSI patients caused by non-ESBL-producing ECC revealed that patients treated with BLICs (n = 45) had lower SOFA scores and lower incidence of hypoproteinemia and sepsis compared with patients treated with carbapenems (n = 20). Moreover, in non-ESBL-producing ECC-BSI patients, the univariate Cox regression analysis indicated a significantly lower 30-day mortality rate in patients treated with BLICs compared to those treated with carbapenems (hazard ratios (HR) [95% CI] 0.190 [0.055– 0.662], P = 0.009; adjusted HR [95% CI] 0.106 [0.013– 0.863], P = 0.036).Conclusion: This study investigated the factors influencing the susceptibility to infection by ESBL-producing strains and risk factors for 30-day mortality in ECC-BSI patients. The results revealed that ESBL-negative ECC-BSI patients treated with BLICs exhibited significantly lower 30-day mortality compared to those treated with carbapenems. BLICs were found to be more effective in ECC-BSI patients with milder disease (ESBL-negative and SOFA ≤ 6.0).Keywords: Enterobacter cloacae complex, extended-spectrum β-lactamase, bloodstream infection, risk factors, β-lactam/β- lactamase inhibitor combinations, carbapenems

Xin-Yu Liang,1,&ast; Li-yuan Mu,1,&ast; Lei Hu,2,&ast; Rui-ling She,1,&ast; Chen-yu Ma,1,&ast; Jun-han Feng,1,&ast; Zhi-yu Jiang,1 Zhao-xing Li,1 Xiu-quan Qu,1 Bai-qing Peng,1 Kai-nan Wu,1 Ling-quan Kong1 1Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China; 2Information Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ling-quan Kong, Department of Breast and Thyroid Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China, Tel +8613101380893, Email huihuikp@163.comPurpose: Glycated hemoglobin (HbA1c) is widely used in diabetes management and now recommended for diagnosis and risk assessment. Our research focused on investigating the optimal cutoff points of HbA1c for diagnosis of diabetes and prediabetes in Chinese breast cancer women, aiming to enhance early detection and tailor treatment strategies.Patients and Methods: This study involved 309 breast cancer women without diabetes history in China. Patients were categorized into groups of newly diagnosed diabetes, prediabetes, and normal glucose tolerance using oral glucose tolerance test (OGTT) according to the 2010 ADA criteria. HbA1c data were collected from all patients. Receiver operating characteristic (ROC) curve analysis was used to assess the effectiveness of the HbA1c screening.Results: Among the 309 breast cancer women without diabetes history, 96 (31.0%) were identified with diabetes and 130 (42.1%) had prediabetes according to OGTT, and the incidence of normal glucose tolerance was only 26.9% (83). ROC curve analysis, using OGTT as a reference, revealed that the area under the curve of 0.903 (P< 0.001, 95% CI, 0.867– 0.938) for HbA1c alone, indicating high accuracy. The optimal HbA1c cutoff for identifying diabetes was determined to be 6.0%, with a sensitivity of 78.1% and specificity of 86.4%. For prediabetes, the ROC curve for HbA1c alone showed that the area under the ROC curve of 0.703 (P< 0.001, 95% CI, 0.632– 0.774), with an optimal cutoff of 5.5% (sensitivity of 76.9% and specificity of 51.8%).Conclusion: The prevalence of undiagnosed diabetes is very high in breast cancer women without diabetes history in China. The optimal cutoff points of HbA1c for identifying diabetes and prediabetes are 6.0% and 5.5% in Chinese breast cancer women, respectively.Keywords: breast cancer, diabetes, HbA1c, prediabetes

Jing Wang,1,&ast; Lisha He,2,&ast; Zhiyan Jin,1,&ast; Guoguang Lu,1 Sufei Yu,1 Lingling Hu,1 Meidan Fang,1 Xiaxia Jin1 1Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Taizhou, Zhejiang Province, People’s Republic of China; 2Department of Ultrasound, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Taizhou, Zhejiang Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Meidan Fang; Xiaxia Jin, Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Taizhou, Zhejiang Province, People’s Republic of China, Tel +86 13586102337; +86 15967063239, Email fangmd@enzemed.com; jinxiax@enzemed.comObjective: To explore the early predictors and their predicting value of 28-day mortality in sepsis patients and to investigate the possible causes of death.Methods: 127 sepsis patients were included, including 79 cases in the survival group and 48 cases in the death group. The results of all patients on admission were recorded. After screening the risk factors of 28-day mortality, the receiver operating characteristic curve (ROC) was used to determine their predictive value for the 28-day mortality rate on admission, and the Kaplan-Meier curve was drawn to compare the 28-day mortality rate between groups. Finally, patients with cytokine and lymphocyte subsets results were included for investigating the possible causes of death through correlation analysis.Results: APACHE II (acute physiology and chronic health evaluation II), SOFA (Sequential Organ Failure Assessment) and red blood cell distribution width (RDW) were the risk factors for 28-day mortality in sepsis patients (OR: 1.130 vs.1.160 vs.1.530, P < 0.05). The area under the curve (AUC), sensitivity and specificity of APACHE II, SOFA and RDW in predicting the mortality rate at 28 days after admission in sepsis patients were 0.763 vs 0.806 vs 0.723, 79.2% vs 68.8% vs 75.0%, 65.8% vs 89.9% vs 68.4%. The combined predicted AUC was 0.873, the sensitivity was 89.6%, and the specificity was 82.3%. The Kaplan-Meier survival curve showed that the 28-day mortality rates of sepsis patients with APACHE II≥ 18.5, SOFA≥ 11.5 and RDW≥ 13.8 were 58.5%, 80.5% and 59.0%, respectively. In the death group, APACHE II was positively correlated with SOFA, IL-2, and IL-10, and RDW was positively correlated with PLT, TNF-α, CD3+ lymphocyte count, and CD8+ lymphocyte count.Conclusion: Sepsis patients with high APACHE II, SOFA and RDW levels at admission have an increased 28-day mortality rate. The elevation of these indicators in dead patients are related to immune dysfunction.Keywords: sepsis, APACHE II, SOFA, red blood cell distribution width, mortality, immune dysfunction

Xiang Li,1,&ast; Lei Hu,1,&ast; Abid Naeem,2,3,&ast; Shanghua Xiao,2 Ming Yang,2 Hongming Shang,4 Jing Zhang1,2 1National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, 330006, People’s Republic of China; 2Key Laboratory of Modern Preparation of TCM, Ministry of Education, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, 330004, People’s Republic of China; 3School of Life Science, Advanced Research Institute of Multidisciplinary Science, School of Medical Technology, Key Laboratory of Molecular Medicine and Biotherapy, Key Laboratory of Medical Molecule Science and Pharmaceutics Engineering, Beijing Institute of Technology, Beijing, 100081, People’s Republic of China; 4Department of Biochemistry & Chemical Biology, Vanderbilt University, Nashville, TN, USA&ast;These authors contributed equally to this workCorrespondence: Jing Zhang, Tel/Fax +86 79187118658, Email jing.zhang@jxutcm.edu.cnAbstract: Neutrophil extracellular traps (NETs) are extracellular fibers composed of deoxyribonucleic acid (DNA) and decorated proteins produced by neutrophils. Recently, NETs have been associated with the development of many diseases, including tumors. Herein, we reviewed the correlation between NETs and tumors. In addition, we detailed active compounds from traditional herbal medicine formulations that inhibit NETs, related nanodrug delivery systems, and antibodies that serve as “guiding moieties” to ensure targeted delivery to NETs. Furthermore, we discussed the strategies used by pathogenic microorganisms to evade NETs.Keywords: neutrophil extracellular traps, cancer, traditional herbal medicine formulations, nano delivery systems

Lili Wang,1,2,&ast; Lu Nie,3,&ast; Yue Liu,4,&ast; Liang Hu,2 Aiping Zhou,2 Dongjiang Wang,2 Xuebin Xu,4 Jian Guo2 1Department of Laboratory Medicine, Zhoushan Women and Children Hospital, Zhoushan, People’s Republic of China; 2Department of Laboratory Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, People’s Republic of China; 3Department of Laboratory Medicine, The First People’s Hospital of Foshan, Foshan, Guangdong, People’s Republic of China; 4Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jian Guo; Xuebin Xu, Email guojian1110@126.com; xxb72@sina.comBackground: This study aimed to provide epidemiological features of Salmonella enterica serovar Rissen, determine antimicrobial susceptibility, virulence gene profiles, and describe the potential association of S. Rissen from different sources in China.Methods: During 2008– 2019, a total of non-repetitive 228 S. Rissen isolates were collected from human, animals and environment in China. The antimicrobial susceptibility test, screening of antimicrobial and virulence genes by PCR, and pulsed-field gel electrophoresis (PFGE) were performed.Results: Among the 154 isolates from human, the majority of the cases (80.5%) occurred in summer, and S. Rissen was mainly detected in people aged 21– 40 (37.7%) and 41– 60 (28.6%) years old, and 74 non-human source S. Rissen strains were identified, with pork being the most common source. About 93.4% isolates were resistant to at least one of the 12 tested antimicrobial agents, and high frequencies of resistance were observed for tetracyclines (91.2%), trimethoprim-sulfamethoxazole (74.1%) and ampicillin (67.5%). A total of 171 (75%) isolates were resistant to at least three categories of antimicrobials, and the most common resistance profile was Tetracycline(s)-β-Lactams-Sulfonamides. The resistance rates to chloramphenicol, quinolones and sulfafurazole were significantly higher in strains isolated from human compared to non-human source strains. Among these isolates, the β-Lactams resistance was mainly associated with gene blaTEM (54.7%), sulfonamide resistance with sul2 (45.7%) and sul3 (54.3%), tetracycline resistance with tetA (81.3%). All the isolates harbored virulence genes hilA, sopB, sciN, stn and ssrB, and most of them harbored ssaQ (98.7%), mgtC (98.7%) and invA (98.2%). The majority (91.7%) of S. Rissen isolates showed high similarity (> 80%) with each other in PFGE patterns and came from human, animals and environment.Conclusion: The high frequencies of multidrug resistance and probable clonal dissemination in this serovar call for the necessity of systematic surveillance on S. Rissen in China.Keywords: Salmonella Rissen, antimicrobial susceptibility test, resistance genes, virulence genes, pulsed-field gel electrophoresis

Pingyang Ke,1,&ast; Jing Liu,1,2,&ast; Chengzhi Chen,3,&ast; Sen Luo,3,&ast; Huiwen Gu,3,&ast; Juan Gu,4 Yan Liu,1 Yuanlin Ma,1 Yuan Meng,1 Liqin Hu,1 Xin Tian,1 Fei Xiao1 1Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology, Chongqing, People’s Republic of China; 2Department of Neurology, Chongqing University Three Gorges Hospital, Chongqing, People’s Republic of China; 3Department of Occupational and Environmental Health, School of Public Health and Management, Chongqing Medical University, Chongqing, People’s Republic of China; 4Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fei Xiao; Xin Tian, Email feixiao81@126.com; xintian@cqmu.edu.cnBackground: Zinc oxide nanoparticles (ZnO NPs) has been widely used in various fields and has had an important impact on human public health. In addition, it inevitably damages human health, including neurological diseases. Therefore, this study explored the effect of ZnO NPs on epilepsy.Methods: The effect of ZnO NPs on epilepsy was observed by behavioral analysis. TLR4 expression and autophagy related pathways were detected by RNA-seq and Western blot. In addition, the cell types of autophagy were detected by immunofluorescence. Further, the electrophysiological changes of ZnO NPs induced autophagy were detected by whole-cell patch-clamp. Finally, the recovery experiment was carried out by TLR4 inhibitor (TAK-242).Results: We found that ZnO NPs enhanced epilepsy susceptibility and severity. Through RNA-seq analysis and Western blot, it was found that ZnO NPs affected the changes of TLR4 and autophagy related pathways. In addition, we found that ZnO NPs mainly affects autophagy of inhibitory neurons, resulting in excitation/inhibition imbalance. The autophagy and epileptic phenotypes were reversed with TAK-242. In general, ZnO NPs exacerbate epileptic seizures by modulating the TLR4-autophagy axis.Conclusion: ZnO NPs enhanced the susceptibility and severity of epilepsy. Mechanistically, ZnO NPs affected autophagy by changing the expression of TLR4. In particular, the ZnO NPs mainly affected the synaptic function of inhibitory neuron, leading to excitation/inhibition imbalances.Keywords: zinc oxide nanoparticles, epilepsy, excitation/inhibition balance, autophage

Chuwen Zhao,1,2,&ast; Yunwei Zheng,1,&ast; Yaping Hang,1 Yanhui Chen,1 Yanhua Liu,1 Junqi Zhu,1,2 Youling Fang,1,2 Jianqiu Xiong,3 Longhua Hu1 1Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 2School of Public Health, Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 3Department of Nursing, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Longhua Hu, Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, Jiangxi, 330006, People’s Republic of China, Email longhuahu@163.com Jianqiu Xiong, Department of Nursing, the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, Jiangxi, 330006, People’s Republic of China, Email 1773014059@qq.comObjective: Escherichia coli and Klebsiella pneumoniae are prevalent Gram-negative microorganisms responsible for pneumonia, as well as the primary Enterobacteriaceae pathogens causing bacteremic pneumonia. The objective of this research is to analyze the risk factors associated with bacteremic pneumonia caused by these pathogens and develop a predictive model.Patients and Methods: This retrospective investigation encompassed a cohort of 252 patients diagnosed with Escherichia coli or Klebsiella pneumoniae-induced bacteremic pneumonia between 2018 and 2022. The primary endpoint was 30-day mortality, which was analyzed using multifactorial logistic regression, nomogram construction, and Bootstrap validation.Results: Among the 252 patients diagnosed with Escherichia coli and Klebsiella pneumoniae, 65 succumbed to the disease while 187 survived. The overall 30-day mortality was found to be 25.8%. A multifactorial logistic regression analysis revealed that diastolic blood pressure, cerebrovascular diseases/transient ischemic attacks (TIA), immunosuppression, blood urea nitrogen, Pitt score, and CURB-65 score were statistically significant factors. The Nomogram model demonstrated an AUC of 0.954, which closely aligns with the Bootstrap-derived mean AUC of 0.953 (95% CI: 0.952– 0.954).Conclusion: In patients with bacteremic pneumonia caused by Escherichia coli and Klebsiella pneumoniae, Low diastolic blood pressure (≤ 61 mmHg), pre-existing cerebrovascular disease/ transient ischemic attacks (TIA), immunosuppression status, elevated blood urea nitrogen levels (≥ 8.39 mmol/L), high Pitt score (≥ 3), and a high CURB-65 score (≥ 2) are all independent risk factors for Escherichia coli and Klebsiella pneumoniae bacteremic pneumonia, among which the first three warrant particular attention.Keywords: Klebsiella pneumoniae, Escherichia coli, bacteremic pneumonia, 30-day mortality, nomogram

Xiuri Wang,1,&ast; Yunxiao Liang,1,&ast; Qiuchen Cheng,1 Wei Nong,1 Liuyang Hu2 1Department of Gastroenterology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530016, People’s Republic of China; 2Department of Laboratory Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530016, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Liuyang Hu, Department of Laboratory Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Taoyuan Road N 6, Nanning, Guangxi, 530016, People’s Republic of China, Email 1225432679@qq.comAbstract: Nocardiosis is mainly an opportunistic infection that affects immunosuppressed individuals, with the most common manifestation being the pulmonary infection and cerebral abscesses. Abdominal abscesses caused by Nocardia is rare in diabetes patients. Here, we report a rare case of abdominal abscesses caused by Nocardia farcinica (N. farcinica) in a 56-year-old man with poorly controlled type 2 diabetes and prolonged use of corticosteroids for the treatment of secondary adrenal insufficiency. Abdominal CT suggested abdominal abscesses, and the culture of the abscess puncture fluid identified it as N. farcinica by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Treatment with a combination of trimethoprim-sulfamethoxazole (TMP-SMX) and imipenem/cilastatin (IPM/CS), along with surgical drainage and reduction in corticosteroid dosage, achieved successful outcomes in treating disseminated abdominal abscesses. Immunocompromised patients with unexplained fever, abdominal pain, and abdominal abscess should be suspected of Nocardia infection.Keywords: abdominal nocardiosis, Nocardia farcinica, abdominal abscesses, diabetes, corticosteroid

Liyu Hu, Jikang Yang, Ting Liu, Jinhuan Zhang, Xingxian Huang, Haibo Yu The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Shenzhen, People’s Republic of ChinaCorrespondence: Haibo Yu, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, No. 1 Fuhua Road, Futian District, Shenzhen, 518000, People’s Republic of China, Tel +8613603066098, Email 13603066098@163.comPurpose: Electroacupuncture is widely used to pain management. A bibliometric analysis was conducted to identify the hotspots and trends in research on electroacupuncture for pain.Methods: We retrieved studies published from 1994– 2022 on the topic of pain relief by electroacupuncture from the Web of Science Core Collection database. We comprehensively analysed the data with VOSviewer, CiteSpace, and bibliometrix. Seven aspects of the data were analysed separately: annual publication outputs, countries, institutions, authors, journals, keywords and references.Results: A total of 2030 papers were analysed, and the number of worldwide publications continuously increased over the period of interest. The most productive country and institution in this field were China and KyungHee University. Evidence-Based Complementary and Alternative Medicine was the most productive journal, and Pain was the most co-cited journal. Han Jisheng, Fang Jianqiao, and Lao Lixing were the most representative authors. Based on keywords and references, three active areas of research on EA for pain were mechanisms, randomized controlled trials, and perioperative applications. Three emerging trends were functional magnetic resonance imaging (fMRI), systematic reviews, and knee osteoarthritis.Conclusion: This study comprehensively analysed the research published over the past 28 years on electroacupuncture for pain treatment, using bibliometrics and science mapping analysis. This work presents the current status and landscape of the field and may serve as a valuable resource for researchers. Chronic pain, fMRI-based mechanistic research, and the perioperative application of electroacupuncture are among the likely foci of future research in this area.Keywords: bibliometrics, electroacupuncture, pain, VOSviewer, CiteSpace, blibliometrix

Hao Qin,1,&ast; Wenjun Wang,2,&ast; Longlong Hu,1 Zuozhong Yu,1 Yang Chen,1 Yuanbin Zhao,1 Yanhui Liao,1 Renqiang Yang1 1Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China; 2Department of Respiratory Diseases, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Renqiang Yang, Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, Jiangxi, 330006, People’s Republic of China, Tel +86-13979117790, Fax +86-0791-87357375, Email yangrenqiangcn@163.comBackground: Ischemic heart disease is one of the leading causes of death in the world, of which ST-segment elevation myocardial infarction (STEMI) is an important type. Inappropriate activation and accumulation of platelets typically induced thrombosis, which may result in acute vessel occlusion and STEMI. Multiple cytokines have been shown to regulate platelet activation, but the relationship between HMGB2 and platelet activation has not been elucidated.Methods: We collected peripheral blood of STEMI patients and healthy adults, and mass spectrometry analysis of platelet proteins was conducted. The “edgeR” package was used to identify the differentially expressed proteins (DEPs). The Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene ontology (GO) and Gene Set Enrichment Analysis (GSEA) were used to identify the significantly changed pathways. Western blot and ELISA were used to detect the expression of a high mobility group box 2 (HMGB2). Flow cytometric analysis and platelet aggregation rate were performed to evaluate the activation of platelets.Results: We identified ALOX5, HIST1H1B, S100A11, HMGB2, and RPS15A were the top five up-regulated proteins by differential expression analysis. Western blot verified that the relative protein expression of HMGB2 in platelet was significantly higher in STEMI patients compared with control adults, and the results of ELISA indicated that the serum HMGB2 level increased and significantly correlated with neutrophil count in STEMI patients. Further investigation showed that the platelet aggregation induced by ADP, the activation of integrin αIIbβ 3 and CD62P expression on platelet surface were all enhanced by the recombinant HMGB2 (rHMGB2).Conclusion: In conclusion, HMGB2 may be the key molecule to regulate platelet activation in patients with STEMI, which may serve as a potential therapeutic target for STEMI.Keywords: ST-segment elevation myocardial infarction, STEMI, proteomics analysis, platelet, HMGB2

Luo H, Hang Y, Zhu H, et al. Infect Drug Resist. 2023;16:2601–2609 Following a review of the paper post-publication, the authors realized the Funding statement on page 2607 was incorrect. The correct Funding statement is as follows: Funding This work was supported by the National Natural Science Foundation of China (82060391), the Natural Science Foundation of Jiangxi Province (No. 20202BAB216021), the Health Commission of Jiangxi Province (No. 20201034). The authors apologize for any inconvenience caused to the readers.

Xia Sheng, Ting Li, Yi Hu, Cheng-Shun Xiong, Ling Hu Department of Endocrine, The First Hospital of NanChang City, Nanchang, Jiangxi, 330008, People’s Republic of ChinaCorrespondence: Ling Hu, Email drhu_hl1172@163.comObjective: To discuss the relationship between time in range (TIR) which is deprived of the FGMS and the risk of diabetic vascular complications and to provide a theoretical foundation for the clinical application of TIR and other FGMS-deprived indexes.Methods: Patients with T2DM who wore the FGMS sensor continuously were enrolled. Relevant indexes such as TIR, time below range (TBR), time above range (TAR), a standard deviation of blood glucose (SDBG), coefficient of variation of blood glucose (CV), and mean amplitude of glycemic excursion (MAGE) generated by the FGMS were recorded, and the risk of diabetic vascular complications were followed up for one year. The TIR was measured by continuous glucose monitoring at baseline, and patients were grouped according to TIR every 20%. Finally, the Cox proportional hazards regression model was used to estimate the association of different levels of TIR with different rates of diabetic vascular complications.Results: TIR was negatively correlated with HbA1C, CV, SDBG, and amplitude of glycemic excursion (MV), wherein, the lower the TIR, the higher the HbA1C, CV, SDBG, and MV. TIR in the diabetic microvascular complication was significantly lower than that in the non-microvascular complication group, and the difference was statistically significant. TIR < 40% was identified as a risk factor for DN, DPN, and DR according to the risk assessment. The mean TAR in the DN group was significantly higher than that in the non-DN group. TAR, CV, SD, MAGE, and HbA1C in the DR group were significantly higher than those in the non-DR group. TAR, ABG, CV, SD, MAGE, and HbA1C in the DPN group were significantly higher than those in the non-DPN group.Conclusion: The relationships between the TIR and the prevalence and risk of diabetic vascular complications and the HbA1C may be negative. Other CGM-deprived indexes such as CV and MV should be integrated into glycemic control and diabetes complication prediction.Keywords: flash glucose monitoring system, diabetes, diabetic vascular complications, time in range, HbA1C

Jiangfen Wu,1 Lingyan Ren,2 Xinyi Huang,3 Li Hu,2 Liangliang Zhang,2 Dan Xie,1 Zhimin Li,4 Naijian Han,4 Shengwen Huang1,2,5 1GuiZhou University Medical College, Guiyang, Guizhou, People’s Republic of China; 2Prenatal Diagnosis Center, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China; 3School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; 4Annoroad Gene Technology (Beijing) Co., Ltd, Beijing, People’s Republic of China; 5NHC Key Laboratory of Pulmonary Immunological Diseases, Guizhou Provincial, People’s Hospital, Guiyang, People’s Republic of ChinaCorrespondence: Shengwen Huang, Guizhou Provincial People’s Hospital, Nanming District, Guiyang, People’s Republic of China, Tel +8615185134701, Fax +86-851-85937194, Email hsw713@sina.comBackground: Duchenne muscular dystrophy (DMD), an X-linked recessive neuromuscular disorder, is caused by pathogenic variants in the DMD gene encoding a large structural protein in muscle cells.Methods: Two probands, a 6-year old boy and a 1-month old infant, respectively, were clinically diagnosed with DMD based on elevated levels of creatine kinase and creatine kinase isoenzyme. CNVplex and whole exome sequencing (WES) were performed for causal variants, and Sanger sequencing was used for verification.Results: CNVplex found no large deletions or duplications in the DMD gene in both patients, but WES discovered a single-nucleotide deletion in exon 48 (NM_004006.2:c.6963del, p.Asp2322ThrfsTer16) in the proband of pedigree 1, and a nonsense mutation in exon 27 (NM_004006.2:c.3637A>T, p.K1213Ter) in the proband of pedigree 2.Conclusion: The results of our study expand the mutation spectrum of DMD and enrich our understanding of the clinical characteristics of DMD. Genetic counseling was provided for the two families involved in this study.Keywords: DMD gene, exon 48, exon 27, whole exome sequencing, Duchenne muscular dystrophy

Fuxing Li,1,&ast; Junqi Zhu,1,&ast; Yaping Hang,1 Yanhui Chen,1 Shumin Gu,1 Suqin Peng,1 Youling Fang,1 Longhua Hu,1 Jianqiu Xiong2 1Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 2Department of Nursing, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Longhua Hu, Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, Jiangxi, 330006, People’s Republic of China, Email longhuahu@163.com Jianqiu Xiong, Department of Nursing, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, Jiangxi, 330006, People’s Republic of China, Email 1773014059@qq.comObjective: This research aimed to investigate the variations in clinical features and prognosis of HABP caused by E. coli and K. pneumoniae. We also aimed to evaluate the risk variables related to 30-day death in the investigated groups.Methods: A single-center retrospective cohort research lasting four years was performed. A total of 117 patients with HABP were involved in this research. The primary prognosis was 30-day death.Results: Among 117 patients with HABP, 60 patients were infected with K. pneumoniae (KP-HABP), and 57 patients were infected with E. coli (E. coli-HABP). A higher proportion of males, ICU admission, undergoing tracheotomy and trachea cannulation, carbapenem-resistant strains, inappropriate empirical therapy (IET), immune compromise, diabetes mellitus, and sepsis were observed in the patients with KP-HABP (all P < 0.05). Meanwhile, the median SOFA score and Pitt score were significantly (P

Ru Ma,1,&ast; Qiang Chen,1,&ast; Ying Huang,2 Zhongle Cheng,2 Xiaowei Wang,2 Lingling Xia,1 Lifen Hu1 1Department of Infectious Diseases, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China; 2Department of Clinical Laboratory, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lifen Hu; Lingling Xia, Department of Infectious Diseases, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230031, People’s Republic of China, Tel +86-551-62922258 ; +86-551-62922383, Fax +86-551-62922281, Email lifen.hu@163.com; 13966684365@163.comPurpose: The purpose of this study was to analyze the prognosis of patients tested positive for Stenotrophomonas maltophilia (SMA) from different sources.Methods: A retrospective study was conducted among 651 patients tested positive for SMA from January 2020 to October 2022 in the First Affiliated Hospital of Anhui Medical University. The patients were divided into seven groups by the source of SMA. Univariate and multivariate analyses were used to identify risk factors for mortality in patients tested positive for SMA from different sources.Results: A total of 651 SMA isolates were collected from various sources, including sputum (348 isolates, 53%), bronchoalveolar lavage fluid (52, 8%), abdominal drainage fluid (76, 12%), wound secretion (66, 10%), blood (62, 10%), urine (41, 6%) and cerebrospinal fluid (6, 1%). Compared with other groups, the mortality of the patients in the bronchoalveolar lavage fluid culture group, blood culture group, and abdominal drainage fluid culture group was higher, at 40.38%, 32.26%, and 26.32%, respectively. Multivariate analysis showed that continuous renal replacement therapy was an independent risk factor for mortality in patients with SMA bloodstream infection (P=0.020, OR=6.86), and effective antimicrobial therapy after being positive for S. maltophilia isolates (P=0.002, OR=0.10) was negatively correlated with the death of patients with SMA bloodstream infection. Age ≥ 65 years (P= 0.043, OR=4.96), kidney disease (P=0.045, OR=4.62) and antifungal agent exposure (P=0.036, OR=5.13) were independent risk factors for mortality in patients with SMA intra-abdominal infection. Antifungal agent exposure (P=0.024, OR=0.51) and glycopeptide exposure (P=0.045, OR=0.53) were independent risk factors for mortality in patients in the sputum culture group.Conclusion: SMA has a high rate of antimicrobial resistance and can cause multisite infection. Pulmonary infections, bloodstream infections and abdominal infections caused by SMA have high mortality, and timely standardized treatment can reduce mortality.Keywords: Stenotrophomonas maltophilia, prognosis, antimicrobial susceptibility, treatment

Xinyue Hu, Beibei Wang, Li Hu, Dong Han, Jing Wu Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of ChinaCorrespondence: Jing Wu, Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HB, 430022, People’s Republic of China, Tel +86-27-85351618, Email drjingwu@hust.edu.cnPurpose: Although remimazolam is a popular novel anesthetic, there is a lack of data in the literature about current and future trends. Therefore, the aim of this study was to explore emerging trends and potential hotspots of remimazolam research over the past 15 years through bibliometric methods.Methods: Relevant articles on remimazolam published from 2007 to 2022 and propofol from 1997 to 2001 were retrieved from the Web of Science Core Collection database. Data were collected using Microsoft Excel and graphs were generated with the Bibliometrix package in R software. Visual bibliometric maps were created using VOS viewer and CiteSpace software.Results: In total, 184 articles were included for analysis. Remimazolam-related research tended to increase, especially from 2020 to 2022. China produced the most publications (327), whereas the USA dominated in quality (h-index = 16). Among institutions, PAION Deutschland GmbH produced the most articles (Np = 21). Similar to initial research and development of propofol, the hotspots of remimazolam research have extended beyond pharmacokinetics and pharmacodynamics to adverse reactions, clinical scenarios, specific populations, and compatible regimens, as confirmed by high numbers of common references and keywords.Conclusion: Remimazolam research has developed rapidly over the past two years. Remimazolam can achieve faster onset and recovery, and more stable hemodynamics than midazolam or propofol, enabling gradual piloting of applications from endoscopy and general anesthesia to sedation of critical care patients; foreseeing specific population (patients with hepatic or renal impairment and reduced cardiovascular reserve, the elderly, and children) through compatible anesthetics regimens to more optimal and safe. Future studies of remimazolam are likely to include adverse reactions, effects on different organ systems, and identification of monitoring indicators.Keywords: remimazolam, CNS 7056, bibliometric analysis, applications, specific population, research trends

Haoyuan Xu,&ast; Wanpeng Li,&ast; Huankang Zhang, Huan Wang, Li Hu, Xicai Sun, Dehui Wang Department of Otolaryngology - Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, 200031, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xicai Sun; Dehui Wang, Department of Otolaryngology - Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fen Yang Road, Shanghai, People’s Republic of China, Email laryngeal@163.com; wangdehuient@sina.comObjective: To investigate the effects of endoscopic endonasal surgery (EES) on longitudinal quality of life (QoL) in patients with malignant tumors of the anterior skull base.Methods: Eligible patients prospectively completed the Anterior Skull Base Surgery Questionnaire (ASBQ) and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaires in referring to 3 different periods throughout their treatment and recovery.Results: Forty patients were included. The median volume coronal maximum length of the tumor was 3.6 cm (95% CI 2.7– 4.1cm). Overall QoL significantly worsened at 1 month postoperatively but returned to baseline after 1 year. Unrelieved symptoms in specific domains prompted further evaluation of individual items. Transient worsening of taste (p=0.011) and olfaction (p=0.004) lasted for 1 month but gradually relieved within the first postoperative year, but vision consistently worsened over the course of the treatment (p=0.126). Age> 50 years (p< 0.001), comorbidities (p< 0.001), tumor necrosis (p< 0.001) and recurrence (p=0.001) were associated with worse preoperative QoL. Poor long-term QoL was noted in those undergoing adjuvant therapy (p=0.032). Overall ASBQ scores (p=0.024), subdomain scores in specific symptoms (p=0.016), and vision scores (p=0.009) were worse only in patients with the greater coronal maximum diameter at 1-month postoperatively. Greater coronal maximum diameter was related to worse preoperative subdomain scores regarding specific symptoms (p=0.030) and decreased postoperative long-term decreased vision scores (p=0.014).Conclusion: Long-term site-specific and sinonasal QoL eventually stabilized after EES. Greater coronal maximum diameter was significantly associated with worsened vision function. Temporarily worse olfactory, vision, and taste function may be tied to decreased short-term QoL.Keywords: quality of life, endoscopic endonasal surgery, anterior skull base, malignant tumors, prospective study

Tingting Li,1,2 Wenjing Han,1,2 Xinlu Yang,1 Yu Wang,1 Li Peng,1 Lingwei He,1 Lianjia Hu,1 Jiayuan Liu,1 Min Xia,1 Sheng Wang1,2 1Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China; 2Department of Anesthesiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, People’s Republic of ChinaCorrespondence: Sheng Wang, Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Luyang District, Hefei, Anhui Province, People’s Republic of China, Tel +86 191 5600 7726, Email iamsheng2020@ustc.edu.cnPurpose: This study aimed to explore the effects of different injection rates of propofol on postoperative cognition in elderly patients undergoing laparoscopic inguinal hernia repair.Methods: A total of 180 elderly patients who planned to undergo laparoscopic inguinal hernia repair were randomly divided into three groups: slow injection of propofol (VS-Group, 30 mg kg− 1 h− 1); medium injection of propofol (VM-Group, 100 mg kg− 1 h− 1) or fast injection of propofol (VF-Group, 300 mg kg− 1 h− 1). Propofol was induced by microinfusion pump, and the depth of anesthesia was monitored by bispectral index (BIS). Propofol and remifentanil were continuously infused during anesthesia maintenance and adjusted according to BIS. The primary outcome was the use of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to measure the incidence of postoperative cognitive decline (POCD) in elderly patients on the first and seventh postoperative day. Secondary outcomes included induced dose of propofol, incidence of burst suppression and maximum electroencephalographic (EEG) effect of propofol (BIS-min) during induction.Results: The incidence of POCD on the first and seventh day postoperatively was similar among the three groups (P > 0.05). However, with the increase of propofol injection rate, induced dose of propofol, incidence of burst suppression and BIS-min during induction, the number of patients requiring vasoactive agents were significantly increased (P < 0.001). Multivariate regression analysis showed that the brief duration of burst suppression during induction did not affect the occurrence of POCD, while age and duration of hospitalization were risk factors for POCD.Conclusion: For elderly patients undergoing laparoscopic inguinal hernia repair, lowering the injection rate of propofol (such as 30 mg kg− 1 h− 1) cannot decrease the incidence of early POCD, but reduces induction dose of propofol and use of vasoactive drugs, making the patient’s hemodynamics more stable.Keywords: propofol, injection rate, bispectral index, burst suppression, elderly, postoperative cognitive decline

Haoyuan Xu,&ast; Wanpeng Li,&ast; Xiaole Song,&ast; Huankang Zhang, Huan Wang, Jingjing Wang, Li Hu, Houyong Li, Xicai Sun,&ast; Dehui Wang&ast; Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Dehui Wang; Xicai Sun, Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye Ear Nose and Throat Hospital, Fudan University, 83 Fen Yang Road, Shanghai, People’s Republic of China, Email wangdehuient@sina.com; laryngeal@163.comBackground: As a cancer stem cells (CSCs) surface marker, Lgr5 plays an important role in the signal transduction of cancer cells and is a potential biomarker for cancer diagnosis and prognosis. However, the expression and prognostic value of Lgr5 in recurrent nasopharyngeal carcinoma (rNPC) remains ambiguous.Materials: We used RNA sequencing to screen differentially expressed mRNAs in eleven specimens of rNPC tissues and five fresh adjacent normal tissue samples and the CSC marker, Lgr5, was identified. The expression level of Lgr5 in rNPC samples was also detected by immunohistochemistry and Western blot assay. The chi-square test was used to analyze the relationship between the clinicopathological variables and the immunostaining of Lgr5. The Log-rank method was used for prognosis analysis. The Cox regression model was used for univariate and multivariate analysis.Results: Significantly elevated expression of Lgr5 in the rNPC tissues was observed compared to the normal tissues using RNA sequencing, Western blot and immunohistochemistry. The expression of Lgr5 was significantly correlated with the T stage (P=0.014). High Lgr5 expression (P=0.007), tumor necrosis (P=0.013) and WHO type II (P=0.043) in rNPC patients exhibited worse overall survival (OS). Lgr5 expression was proved to be an independent risk factor for OS (P=0.035) in multivariate analyses, and had promising predictive value for survival and recurrence in rNPC patients (area under the ROC curve: 0.711 and 0.665, P=0.017 and 0.028, respectively).Conclusion: Lgr5 as a CSC marker is a promising therapeutic target and could be employed to predict the survival prognosis of rNPC patients.Keywords: recurrent nasopharyngeal carcinoma, cancer stem cell, Lgr5, survival

Youling Fang,1,2 Qiaoshi Zhong,1 Yanhui Chen,1 Yaping Hang,1 Xueyao Fang,1 Yanping Xiao,1 Xingwei Cao,1 Hongying Zhu,3 Hong Luo,1 Suqin Peng,1 Shumin Gu,1 Fuxing Li,1 Junqi Zhu,1 Jianqiu Xiong,4 Longhua Hu1 1Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 2School of Public Health, Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 3Clinical Laboratory of Ganzhou People’s Hospital, Ganzhou, Jiangxi, People’s Republic of China; 4Department of Nursing, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of ChinaCorrespondence: Longhua Hu; Jianqiu Xiong, Email longhuahu@163.com; 1773014059@qq.comObjective: To analyze the clinical characteristics, outcomes, and risk factors of patients treated with ceftazidime/avibactam, polymyxin, or tigecycline (CPT) compared with those receiving a conventional therapy (CT) (ie, imipenem, levofloxacin, or gentamicin).Methods: A single-center retrospective cohort study included patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) treated at one Chinese tertiary hospital between March 2012 and November 2022 was performed. Clinical characteristics, outcomes, and risk factors of patients treated with CPT or CT were compared. Predictors of 30-day mortality of patients with CRKP-BSI were also analysed in our study.Results: Among 184 recruited patients with CRKP-BSI, 39.7% (73/184) were treated with CPT, while 60.3% (111/184) were treated with CT. Compared to patients treated with CT, patients treated with CPT had worse conditions, as evidenced by a higher rate of underlying diseases and invasive procedures; however, they also had a better prognosis and lower rates of 14-day treatment failure (p = 0.024). In addition, univariate analysis and multivariate analysis showed that SOFA score [odds ratio (OR) = 1.310, 95% confidence interval (CI) 1.157– 1.483; p < 0.001] and cold weather (OR = 3.658, 95% CI 1.474– 9.081; p = 0.005) were independent risk factors for 30-day mortality.Conclusion: Compared to CRKP-BSI patients treated with CT, patients treated with CPT had worse conditions but better prognoses. CRKP-BSI occurred more frequently in hot weather; however, higher 30-day mortality was associated with cold weather. A randomized trial is needed to confirm these observational results.Keywords: carbapenem-resistantKlebsiella pneumoniae, polymyxin, tigecycline, ceftazidime/avibactam, bloodstream infection, hot weather, cold weather

Shumin Gu,1,* Jianqiu Xiong,2,* Suqin Peng,1 Longhua Hu,1 Hongying Zhu,3 Yanping Xiao,1 Hong Luo,1 Yaping Hang,1 Yanhui Chen,1 Xueyao Fang,1 Xingwei Cao,1 Youling Fang,1 Fuxing Li,1 Junqi Zhu,1 Qiaoshi Zhong1 1Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 2Departmentof Nursing, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China; 3Clinical Laboratory of Ganzhou People’s Hospital, Ganzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qiaoshi Zhong, Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, Jiangxi, 330006, People’s Republic of China, Tel +86151-8047-5673, Email zhong20000947@sina.comObjective: This study aimed to determine the clinical features, risk factors, and effective antimicrobial therapy for Carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection (BSI).Methods: This was a retrospective analysis of data from patients with CRAB bacteremia in a Chinese tertiary hospital between January 2012 and October 2021. Risk factors, predictors of 30-day mortality, and effective antimicrobial therapy for CRAB BSI were identified using logistic and cox regression analyses.Results: Data from 276 patients with Acinetobacter baumannii (AB) BSI were included, of whom 157 (56.9%) had CRAB BSI. The risk factors that were significantly associated with CRAB BSI included previous intensive care unit (ICU) stay (P < 0.001), immunocompromised status (P < 0.001), cephalosporin use (P = 0.014), and fluoroquinolone use (P = 0.007). The 30-day mortality of the CRAB BSI group was 49.7% (78/157). ICU stay after BSI (P = 0.047), sequential organ failure assessment (SOFA) score ≥ 10 (P < 0.001), and multiple organ failure (MOF) (P = 0.037) were independent predictors of 30-day mortality. Among antibiotic strategies for the treatment of patients with CRAB BSI, we found that definitive regimens containing cefoperazone/sulbactam were superior to those without cefoperazone/sulbactam in reducing the 30-day mortality rate (25.4% vs 53.4%, P = 0.005). After propensity score matching, we observed a significant increase in the 30-day mortality (77.8%vs 33.3%, P = 0.036) in patients receiving tigecycline monotherapy compared to those receiving cefoperazone/sulbactam monotherapy. The mortality rate of patients receiving tigecycline with cefoperazone/sulbactam was also higher than that of patients receiving cefoperazone-sulbactam monotherapy; however, the difference was not significant (28.6%vs 19.0%, P = 0.375).Conclusion: The severity of patient conditions was significantly associated with mortality in patients with CRAB BSI. Those Patients treated with cefoperazone/sulbactam had better clinical prognoses, and tigecycline should be used with caution.Keywords: carbapenem-resistant, Acinetobacter baumannii, bacteremia, tigecycline, cefoperazone/sulbactam

Hong Luo,1 Yaping Hang,1 Hongying Zhu,2 Qiaoshi Zhong,1 Suqin Peng,1 Shumin Gu,1 Xueyao Fang,1 Longhua Hu1 1Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 2Clinical Laboratory of Ganzhou People’s Hospital, Ganzhou, Jiangxi, People’s Republic of ChinaCorrespondence: Longhua Hu, Email longhuahu@163.comBackground: Carbapenemase-producing Klebsiella pneumoniae is an unprecedented threat to public health, and its detection remains challenging. Analysis of microbial volatile organic compounds (VOCs) may offer a rapid way to determine bacterial antibiotic susceptibility.Purpose: The aim of this study was to explore the VOCs released by carbapenemase-producing carbapenem-resistant Klebsiella pneumoniae (CRKP) using headspace solid-phase microextraction/gas chromatography-mass spectrometry (HS-SPME/GC-MS).Methods: Test bacteria were incubated in trypticase soy broth to the end of exponential growth phase, and imipenem was added in the middle time. Headspace VOCs were concentrated and analyzed using HS-SPME/GC-MS.Results: The compound 3-methyl-1-butanol was found to be a biomarker among the 26 bacterial isolates (10 KPC-positive, 10 NDM-positive, 2 IMP-positive, 2 carbapenemase-negative CRKP, and 2 carbapenem-susceptible K. pneumonoiae).Conclusion: This study explored a promising new strategy for the screening of carbapenemase-producing CRKP strains. Further research with larger sample sizes will potentially accelerate the application of biomarkers in routine microbiology.Keywords: carbapenem-resistantKlebsiella pneumoniae, volatile organic compounds, headspace solid-phase microextraction combined with gas chromatography-mass spectrometry

Lianbo Hu,1 Bingrong Zheng,2 Yang Yang,2 Chunmei Chen,2 Meiwei Hu2 1Physical Examination Center, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Meiwei Hu, Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University, No. 318 Chaowang Road, Hangzhou, Zhejiang, 310014, People’s Republic of China, Email 20134013@zcmu.edu.cnIntroduction: CircRNA is closely correlated with a wide variety of processes of acute myeloid leukemia (AML), whereas the novel circRNAs, their molecular mechanism and the specific function they played in AML should be explored in depth.Methods: The microarray chip data of AML patients and normal samples in the Gene Expression Omnibus (GEO) database were selected to differentially expressed (DE) circRNA, miRNA, and mRNA genes. The miRNA gene was the intersection of the circRNA target gene predicted using CSCD and the miRNA gene screened from AML patients, while the mRNA gene was the intersection of the target gene mRNA of miRNA predicted using miRanda and miRTarBase software and the mRNA gene screened from AML patients. The hub mRNAs related to survival were further screened through Cox proportional hazard regression. CircRNA/miRNA/mRNA interaction network was constructed by using Cytoscape software.10 circRNAs and 6 miRNAs in bone marrow mononuclear cells (BMMNCs) of AML patients (n=43) and healthy controls (n=35) were determined by RT-qPCR. Correlations between them were analyzed by Pearson correlation coefficient.Results: 10 circRNAs, 6 miRNAs, and 33 mRNAs were identified. Subsequently, the network of circRNAs, miRNAs, and hub genes was built using Cystoscope. Four key circRNAs, seven hub genes and their regulatory pathways were identified. The result of RT-qPCRs showed that hsa_circ_0009581 and hsa_circ_0005273 were significantly upregulated in AML patients while hsa_circ_0000497 and hsa_circ_0001947 were significantly downregulated. Hsa-miR-150-5p was significantly downregulated; hsa-miR-454-3p was upregulated in AML patients. Hsa_circ_0009581 and hsa-miR-150-5p; hsa_ circ_0001947 and hsa-miR-454-3p were inversely correlated using Pearson’s correlation coefficient.Conclusion: This study suggests that differentially expressed circRNAs take on a critical significance to AML development and may be the effective therapeutic targets. We suppose that hsa_circ_0009581 promotes leukemia development through hsa-miR-150-5p and hsa_circ_0001947 through hsa-miR-454-3p. hsa_circ_0001947 and hsa_circ_0009581 may provide new directions in the pathogenesis of AML.Keywords: acute myeloid leukemia, circRNA, pathogenesis, bioinformation analysis

Lujia Hu,1,2,&ast; Chen Chen,1,&ast; Junli Zhu,1 Yao Zhang,3 Yun Chen,4,5 Yufei Jia6 1School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People’s Republic of China; 2Department of Basic Health Care, Tianjin Hedong District Health Commission, Tianjin, People’s Republic of China; 3Department of Human Resources, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 4The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People’s Republic of China; 5Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China; 6Department of Human Resources, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Junli Zhu, School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, No. 10, Xitoutiao, Youanmen Wai, Fengtai District, Beijing, 100069, People’s Republic of China, Tel +86 18701515093, Fax +86 01083911578, Email smallying@126.comBackground: In China, physicians have long faced long working hours, high stress levels, and tensions between physicians and patients, which can lead to negative behaviors. Understanding physicians’ expectations and requirements of the hospital and increasing satisfaction with their psychological contract can help improve physician motivation and stabilize the hospital team.Aim: The study aims to analyze the relationship between physicians’ psychological contract violations and different behavioral choices, encourage hospitals to conclude a balanced psychological contract with physicians, and provide governance and intervention strategies for hospital human resource management.Methods: Stratified cluster sampling was used to select 321 physicians from four public hospitals in Beijing for questionnaire surveys. Descriptive statistical analysis, t-test, ANOVA, correlation analysis, and regression models were performed using Stata 15.0 and SPSS 26.0 to analyze the relationship between psychological contract violations, physicians’ EVLN behaviors and organizational justice.Results: Psychological contract violation had a positive effect on exit behavior and neglect behavior, and a negative effect on voice behavior and loyalty behavior. Organizational justice plays a mediating role between psychological contract violation and physicians’ exit, voice and loyalty behaviors.Conclusion: Psychological contract violation can drive negative behavior among physicians, and organizational justice can play a mediating role in this. Public hospitals should establish a healthy psychological contract with physicians and place a premium on organizational justice to promote constructive behaviors and prevent destructive behaviors. This study constructs a more complete theoretical framework to explain physicians’ behavior, and further dynamic tracking investigations are necessary because the evolution of physicians’ behavior is a dynamic and long-term process.Keywords: tertiary public hospitals, physicians, psychological contract violation, EVLN, China, mediation effect

Lei Hu,1,&ast; Xiaoyuan Jin,2,&ast; Yundong Li,3 Dan Yang,1 Ziqing Zhang,1 Xiaoyu He,1 Weiju Chen,1 Ni Gong1 1School of Nursing, Jinan University, Guangzhou, Guangdong, People’s Republic of China; 2Department of Social Medicine of School of Public Health, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 3School of Ethnology and Sociology, Yunnan University, Kunming, Yunnan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ni Gong; Weiju Chen, School of Nursing, Jinan University, No. 601 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, People’s Republic of China, Tel +86 15013217344;+86 18688898425, Email gongni_1025@163.com; weijuchen2008@163.comBackground: Consistent and effective self-management is a major challenge for people with diabetes and long-term effects can be difficult to sustain despite the many interventions. Interventions often fail to take patients’ perceptions of self-management into account from their perspective. Exploring the needs preferences and the influencing factors of self-management in patients can improve the effectiveness of self-management.Methods: This study used a mixed research approach, exploring patient needs and preferences through web crawl methods and using qualitative interviews to explore the logic of preferences. 1605 data were obtained from 4 online health communities through web crawlers. Data were coded using grounded theory to analyze self-management needs. The codes were also coded for frequency statistics and ranked to explain the self-management preferences. The second phase explained the logic of the ranked distribution of preferences through one-on-one interviews with 22 patients.Results: This study summarized six self-management needs of people with diabetes through web crawler data, among which medication management and conflict between disease and daily life were the most important concerns of patients. The reasons why patients are particularly concerned about these two needs were explored through qualitative interviews, and it was found that patients’ concerns about medication were mainly due to the following three aspects: the effect of drugs is direct and obvious, medication use makes life less complicated, and progressive side effects. The patients’ concerns about the conflict between disease and daily life are often caused by the following three aspects: diabetes impacts social roles, disease complicates life, and reducing the impact of the disease on life.Conclusion: The self-management needs of Chinese diabetics have six themes. Medication management, conflict between disease and daily life, diet, diabetes knowledge, blood glucose monitoring and exerciseIn order of frequency of mention and possible preference: medication management, conflict between disease and daily life were the most frequent needs, while diet, knowledge about diabetes, blood glucose monitoring and exercise were their least frequent needs.Understanding the individual’s perception and understanding of diabetes self-management and the expression of the patient’s daily life situations can guide the medical team to optimize collaboration on personalized care plans.Keywords: type 2 diabetes, self-management, needs, preferences, person-centered care, patients’ experience

Simin Yang,1,&ast; Lihua He,2,&ast; Ke Li,3,&ast; Xiaoyu Yu,1 Lijun Ni,1 Liang Hu,1 Jian Guo,1 Ewelina Biskup,4,5 Lunxian Tang,3 Wenjuan Wu1 1Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 2Department of Hospital Infection Management, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 3Department of Emergency Intensive Care Unit, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China; 4Department of Basic and Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, People’s Republic of China; 5Department of Internal Medicine, University Hospital of Basel, Basel, Switzerland&ast;These authors contributed equally to this workCorrespondence: Lunxian Tang; Wenjuan Wu, Tel +86-15921155750 ; +86-13386057159, Email 456tlx@163.com; wwj1210@126.comPurpose: To investigate whether rapid active molecular screening and infection prevention and control (IPC) interventions can reduce colonization or infection with carbapenem-resistant Enterobacterales (CRE) in a general emergency intensive care unit (EICU) without enough single-room isolation.Methods: The study was designed as a before-and-after quasi-experiment. Before the experimental period, the ward was rescheduled and the staff were trained. From May 2018 to April 2021, active screening was performed by seminested real-time fluorescent polymerase chain reaction (PCR) detection with rectal swabs from all patients on admission to the EICU, and the results were reported in 1 hour. Other IPC interventions including hand hygiene, contact precautions, patient isolation, environmental disinfection, environment surveillance, monitoring, auditing and feedback were conducted under strict supervision. The patients’ clinical characteristics were collected simultaneously.Results: In this 3-year study, 630 patients were enrolled and 19.84% of the patients were initially colonized or infected with CRE as shown by active molecular screening. The average drug resistance ratio to carbapenem shown by clinical culture detection of Klebsiella pneumoniae (KPN) before the study was performed was 71.43% in EICU. The drug resistance ratio decreased significantly from 75%, 66.67% to 46.67% in the next 3 years (p< 0.05) during which active screening and IPC interventions were strictly executed. While the ratio gaps between EICU and the whole hospital were narrowed from 22.81%, 21.11% to 4.64%. Patients with invasive devices, skin barrier damage, and the recent use of antibiotics on admission were found to have a higher risk of being colonized or infected with CRE (p< 0.05).Conclusion: Active rapid molecular screening and other IPC interventions may significantly reduce CRE nosocomial infections even in wards without enough single-room isolation. The key to reduce the spread of CRE in the EICU is the strict execution of IPC interventions by all medical staff and healthcare workers.Keywords: carbapenem-resistant, Enterobacterales, active screening, infection prevention and control intervention, emergency intensive care unit, nosocomial infection

Li Hu,1,2,&ast; Zhuoer Shen,3,&ast; Daqing Pei,1,2 Jintao Sun,4 Bin Zhang,1 Zhipeng Zhu,1 Weiwei Yan,1 Hongmei Zhou,1– 3 Erdan An1,2 1Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing City, People’s Republic of China; 2Key Laboratory of Basic Research and Clinical Transformation of Perioperative Precision Anesthesia, Jiaxing City, People’s Republic of China; 3Department of Anesthesiology, Bengbu Medical College, Bengbu City, People’s Republic of China; 4Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University, Hangzhou City, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hongmei Zhou; Erdan An, Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Huancheng Strasse 1518, Jiaxing, 314000, People’s Republic of China, Tel +86 13867300139 ; +86 13515733732, Fax +86 573 82080930, Email drhongmeizhou@163.com; anerdan@sina.comPurpose: Ultrasound-guided modified thoracolumbar fascial plane block (MTLIP) has been reported effective for postoperative pain control following lumbar surgery. Although trauma of the Tianji robot-assisted lumbar internal fixation is reduced, the degree of pain cannot be ignored.MTLIP may improve operation efficiency and reduce puncture complications.This study aimed to explore whether MTLIP is not inferior to thoracolumbar fascial plane block (TLIP) in the treatment of lumbar internal fixation.Methods: This prospective double-blinded, non-inferiority randomized trial enrolled patients underwent Tianji robot-assisted lumbar internal fixation between April and August 2022 to either MTLIP or TLIP. The primary outcome was an effective dermatomal block area after 30 min. Secondary outcomes included the numeric rating scale (NRS) scores, nerve block operation time, puncture times, image clarity, patient satisfaction, intraoperative opioid consumption, complications/adverse reactions, and Oswestry Disability Index (ODI).Results: Sixty participants were randomized to MTLIP (n=30) and TLIP (n=30). The effective dermatomal block area 30 min after block was non-inferior in the MTLIP group (283.6 ± 62.6 cm2) compared with the TLIP group (261.4± 53.2 cm2) (P=0.145; estimated mean difference: − 22.17, 95% CI: − 52.19, 7.85; smaller than the non-inferiority margin of 39.5). Compared with TLIP, MTLIP showed shorter operation time, smaller puncture times, and better target definition and satisfaction scores (all P< 0.001). Sufentanil amount, remifentanil amount, PCIA sufentanil dosage, parecoxib amount, NRS scores (increased with time in the two groups but without inter-group differences), and complications were not significantly different between the two groups (all P> 0.05).Conclusion: This non-inferiority trial supports the hypothesis that MTLIP yields a non-inferior effective dermatomal block area compared with TLIP for Tianji robot-assisted lumbar internal fixation.Clinical Trials Registration: Chinese Clinical Trial Registry (ChiCTR2200058687);.Keywords: local anesthetics, regional anesthesia, lumbosacral plexus, lumbar internal fixation, robotic surgical procedures

Yu Ni,1,&ast; Yuqin Chen,2,&ast; Xuheng Jiang,3 Tao Pu,1 Ling Zhang,4 Shaobin Li,2 Linhong Hu,1 Bing Bai,1 Tingting Hu,1 Limei Yu,2 Yibin Yang1,2 1Department of Nephrology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, People’s Republic of China; 2Key Laboratory of Cell Engineering of Guizhou Province, Zunyi City, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, People’s Republic of China; 3Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, People’s Republic of China; 4Zhuhai Campus of Zunyi Medical University, Zhuhai, 519041, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Limei Yu, Department of Nephrology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, People’s Republic of China, Email ylm720@sina.com Yibin Yang, Key Laboratory of Cell Engineering of Guizhou Province, Zunyi City, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, People’s Republic of China, Email yyb1011@sina.comBackground and Aims: Diabetic kidney disease (DKD) is a prevalent and intractable microvascular complication of diabetes mellitus (DM), the process of which is closely related to abnormal expression of angiogenesis-regulating factors (ARFs). Stem cell transplantation might be a novel strategy for treating DKD. This study aims to explore the effect of transplantation of human amniotic mesenchymal stem cells (hAMSCs) on renal microangiopathy in a type 1 DKD rat model (T1DRM).Methods: Seventy-two rats were randomly divided into three groups, including normal control group, DKD group, and hAMSCs transplantation group. T1DRM was established using a rat tail vein injection of streptozotocin (STZ) (55 mg/kg). hAMSCs were obtained from placental amniotic membranes during cesarean delivery and transplanted at 3 and 4 weeks through penile veins. At 6, 8, and 12 weeks following transplantation, blood glucose levels, renal function, pathological kidney alterations, and the expressions of ARFs’ mRNA and protein were analyzed.Results: In T1DRM, transplanted hAMSCs that were homed at the injured site of kidneys increased ARFs’ expression and decreased blood glucose levels. Compared to the DKD group, the levels of 24-h urinary protein, serum creatinine, urea, and kidney injury molecule-1 (KIM-1) were reduced in hAMSCs transplantation group. In terms of renal pathology such as the degree of basement membrane thickening, hAMSCs transplantation was also less severe than the DKD group, thereby alleviating kidney injury.Conclusion: hAMSCs transplantation might ameliorate STZ-induced chronic kidney injury through increasing ARFs’ expression in kidneys and lowering blood glucose levels.Keywords: DKD, hAMSCs, renal microangiopathy, angiogenesis-regulating factors

In this work, the effect of extrusion process on the mechanical properties and the stress corrosion cracking (SCC) resistance of 7N01 aluminum alloys were systematically investigated by tensile testing, slow strain rate testing (SSRT), electrochemical experiment, scanning electron microscopy (SEM), electron backscattered diffraction (EBSD), and transmission electron microscope (TEM) observation, respectively. The results showed that with the increase of extrusion temperature, the SCC resistances of the alloys deteriorated, and this tendency was also proved by the electrochemical experiments including polarization curves and EIS results. The Microstructure observation results revealed that recrystallization played an important role on the SCC resistances of the alloys: the new recrystallization grain boundaries with higher grain boundary energy and wider PFZ could magnify the difference of electrochemical property between grain boundary area and the grain interior, thus raising the stress corrosion crack sensitivity of the alloys.

Qi Zhao, Ran Guo, Zixuan Fan, Linlin Hu, Zhimin Hu, Yuanli Liu School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of ChinaCorrespondence: Yuanli Liu, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, Beijing, 100730, People’s Republic of China, Email liuyuanli_pumc@163.comPurpose: Although complementary and alternative medicine (CAM) is used around the world, there has been a lack of comprehensive understanding of major factors affecting patients’ decision to use CAM. This study aimed to describe the preferences of Chinese patients regarding what conditions they will use Traditional Chinese Medicine (TCM) for and to determine the factors associated with these preferences.Patients and Methods: This study used data from the China Healthcare Improvement Evaluation Survey in January 2021, a national cross-sectional survey conducted at 163 hospitals across 31 provinces. A convenient sampling method was used to conduct the patient satisfaction survey, and 28,993 patients in an ambulatory setting constituted our study sample on TCM use. A multiple-choice question regarding TCM listed nine medical conditions and asked the patient about what condition he/she and his/her family members would use TCM. In addition to descriptive statistics, we used a binary logistic regression model to investigate factors affecting the likelihood of patients’ decision to use TCM for multiple conditions.Results: The majority of the surveyed patients (76.3%) would use TCM for the purpose of disease prevention, and more than half (67.3%) for multiple medical/health conditions, 34.0% for dealing with chronic diseases, 33.0% for common symptoms, 26.9% for rehabilitation, and 26.3% for sleeping disorder. Female and older patients, as well as patients with a higher education level, urban residency, and higher family income, were found to be associated with a higher probability of using TCM for multiple conditions than their counterparts (odd ratios [OR]> 1, P< 0.05).Conclusion: This study reveals a preference for TCM in a large sample of Chinese patients, especially used for prevention. Generally, patients with a higher socioeconomic status had a more positive attitude toward TCM.Keywords: use of traditional Chinese medicine, medical conditions, consideration

Yanyan Liu,1– 3,&ast; Wei Wang,1,&ast; Mingjuan Guo,4,&ast; Zhicheng Xu,1 Yi Yang,1– 3 Liang Yu,1– 3 Yasheng Li,1– 3 Lifen Hu,1– 3 Ying Ye,1– 3 Jiabin Li1– 4 1Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China; 2Anhui Center for Surveillance of Bacterial Resistance, Health Commission of Anhui Province, Hefei, People’s Republic of China; 3Institute of Bacterial Resistance, Anhui Medical University, Hefei, Anhui, People’s Republic of China; 4Department of Infectious Diseases, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jiabin Li; Ying Ye, Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Jixi Road no. 218, Hefei, 230022, People’s Republic of China, Tel +86-551-2922713, Fax +86-551-2922281, Email lijiabin@ahmu.edu.cn; yeying2@163.comPurpose: To analyze the differences in clinical distribution and antimicrobial resistance of pathogens among northern Anhui, central Anhui, and southern Anhui in 2021, and to provide a basis for the rational use of drugs for clinicians in different regions.Methods: Nonrepetitive pathogens isolated from clinical samples of inpatients and outpatients from 59 member units with qualified data in 2021 were obtained from the Anhui Province Antimicrobial Resistance Surveillance System, which was divided into northern Anhui, central Anhui, and southern Anhui by region. Identification and antimicrobial susceptibility analyses were carried out using the Vitek 2 Compact and standard disc diffusion method. The results were determined according to the American Clinical Laboratory Standards Institute in 2021 with data analyzed using WHONET 5.6 and SPSS 17.0.Results: A total of 133,268 pathogenic bacteria were isolated from clinical samples. Staphylococcus aureus (S. aureus) was the most common gram-positive bacterium and Escherichia coli (E. coli) was the most common gram-negative bacterium. Sputum was the main source of clinical specimens. The detection rates of methicillin-resistant S.aureus, methicillin-resistant coagulase-negative Staphylococcus, carbapenem-resistant E. coli, carbapenem-resistant Klebsiella pneumoniae (K. pneumoniae), carbapenem-resistant Acinetobacter baumannii, third-generation cephalosporin-resistant E. coli, and third-generation cephalosporin-resistant K. pneumoniae were higher in northern Anhui than in southern Anhui (P< 0.0001). E. coli, K. pneumoniae, and Pseudomonas aeruginosa were sensitive to amikacin. Strains resistant to vancomycin, linezolid, and teicoplanin were not isolated until 2021.Conclusion: There were significant differences in bacterial resistance in different regions of Anhui Province. Antibiotic resistance in northern Anhui was the most serious in 2021. Antimicrobial agents must be used according to the resistance of the bacteria in the local region.Keywords: pathogens, antibacterial agents, drug resistance, different regions

Liu Hu1,2 &ast;, Jie Xu1 &ast;, Wenli Zhang,1,2 Junrui Wang,1,2 Ni Fang,1,2 Ying Luo,1,2 Lian Xu,1,2 Jia Liu,1 Yu Zhang,1 Haitao Ran,3 Dajing Guo,1 Jun Zhou1 1Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Chongqing Key Laboratory of Ultrasound Molecular Imaging & Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3Department of Ultrasound, Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jun Zhou, Tel +86 23 6288 7295, Email zhoujun@hospital.cqmu.edu.cnBackground and Objective: Thrombosis is a common disease that poses a great threat to life and health. Most thrombolytic effects of traditional treatments or nanomedicine are not efficient or safe enough. Therefore, we designed a nanoparticle (NP) with a combination of a phase transition material and thrombolytic drugs for efficient and safe thrombolysis.Methods: A thrombus fibrin-targeted and phase transition NP was designed and contained perfluorohexane (PFH) and the thrombolytic drug rtPA core, with CREKA polypeptides attached to the shell of the PLGA NPs. Characterization of the phase transition and ultrasound imaging of the NPs was carried out under low-intensity focused ultrasound (LIFU). LIFU-responsive drug release in vitro was also explored. Under the synergistic effect of PFH and rtPA, the efficient thrombolysis ability of the NPs was studied in vitro and in vivo. In vivo monitoring of thrombosis and biosafety were also verified.Results: The PPrC NPs had good ultrasound imaging ability under LIFU irradiation and were related to the phase transition characteristics of the NPs. CREKA polypeptides can effectively increase the aggregation of the NPs on thrombi. Under static and dynamic conditions in vitro, the “liquid to gas” transformation effect of PFH can perform the destruction function of the excavator at the thrombus site and promote the specific release of rtPA, and the subsequent rtPA drug thrombolysis can further fully dissolve the thrombus. In vivo experiments showed that the NPs can monitor the formation of thrombi and have good thrombolytic effects, with significantly reduced bleeding side effects. The biochemical indexes of the rats were within normal limits after treatment.Conclusion: PPrC NPs loaded with PFH and rtPA combining a mechanical way of blasting with thrombolytic drugs may be a promising new and reliable approach for thrombus monitoring and treatment.Keywords: low-intensity focused ultrasound, thrombolysis, PFH, rtPA, phase transition

Le Hu,1,2 Ying Zhang,1,2 Jia Wang,1,2 Jingchao Xuan,1,2 Jun Yang,1,2 Junyu Wang,1,2 Bing Wei1,2 1Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Clinical Center for Medicine in Acute Infection, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Junyu Wang; Bing Wei, Department of Emergency Medicine, Beijing Chao-Yang Hospital Jingxi Branch, Capital Medical University, No. 5 Jingyuan Road, Shijingshan, Beijing, 100043, People’s Republic of China, Email wangjunyu_cyyy@126.com; dr_weibing@126.comPurpose: To determine the utility of a novel serum biomarker for the outcome prediction of critically ill patients with pneumonia.Patients and Methods: A retrospective analysis of critically ill patients was performed at an emergency department. The expression and prediction value of parameters were assessed. Binary logistic regression analysis was utilized to determine the indicators associated with in-hospital mortality of pneumonia patients. The Last Absolute Shrinkage and Selection Operator was used to further determine the independent predictors, which were validated by multiple logistic regression. The receiver operator characteristic curve was performed to assess their prediction values. A prognostic nomogram model was finally established for the outcome prediction for critically ill patients with pneumonia.Results: Retinol-binding protein (RBP) was significantly reduced in non-survived and pneumonia patients. CURB-65 score, levels of RBP, and blood urea nitrogen (BUN) were associated with in-hospital mortality of critically ill patients with pneumonia. Their combination was determined to be an ideal prognostic predictor (area under the curve of 0.762) and further developed into a nomogram prediction model (c-index 0.764).Conclusion: RBP is a novel in-hospital mortality predictor, which well supplements the CURB-65 score for critical pneumonia patients.Keywords: critical illness, retinol-binding proteins, mortality prediction

Yinhua Luo,1,&ast; Xiaohong He,2,&ast; Linbo Hu,3 Jinbo Zhao,1 Ke Su,1 Yuhua Lei,1 Yuanhong Li1 1Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, People’s Republic of China; 2Centre for Disease Control and Prevention, Enshi Center for Disease Control and Prevention, Enshi Prefecture, People’s Republic of China; 3Health Management Centre, Central Hospital of Tujia and Miao Autonomous Prefecture, Enshi Prefecture, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuanhong Li, Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, People’s Republic of China, Email lyh0101@vip.163.comBackground: Ischemic cardiomyopathy (ICM) with high morbidity and mortality is closely associated with an abnormal equilibrium of circulation selenium levels. The oxidative stress theory is the most accepted theory of selenium causing ischemic cardiomyopathy. However, the role of inflammatory responses in ICM has received limited attention.Methods: This study included 119 subjects, 43 of whom were patients with ICM, and 76 were healthy controls. Blood specimens were collected from subjects and serum levels of inflammatory and oxidative stress indicators and plasma levels of selenium were measured.Results: When plasma selenium and indicators of inflammation and oxidative stress were compared between groups, plasma selenium levels were significantly lower in the ICM group than in the control group (68.83874 vs 104.39775, p=0.02032), while indicators of inflammation such as tumour necrosis factor-alpha (TNF-α) (79.09773 vs 46.15634, p< 0.001), interleukin-6 (IL-6) (49.41484 vs 38.46923, p< 0.01) and neutrophil/lymphocyte ratio (3.696574 vs 2.383658, p< 0.001) were significantly higher in the ICM group than in the control group (all of these results were statistically different). Additionally, malondialdehyde (MDA), a marker of oxidative stress, was considerably higher in the ICM group than in the control group (61.63078 vs 39.0609, p< 0.01). In contrast, there were no significant differences in superoxide dismutase (SOD) levels between groups (p> 0.05). The Poisson regression analysis revealed a significant association between selenium and high levels of MDA, IL-6 and TNF-α (p< 0.05). Additionally, selenium was negatively connected with SOD levels and the neutrophil/lymphocyte ratio, but this relationship was not statistically significant (p=0.96, 0.15, respectively).Conclusion: Selenium deficiency is strongly associated with the development of ICM, and with levels of inflammation and oxidative stress in patients with ICM. Selenium can prevent the development and delay the progression of ICM by alleviating inflammatory responses.Keywords: inflammatory responses, ischemic cardiomyopathy, oxidative stress, selenium

Ting Li,1,&ast; Ling Hu,1,&ast; Xiao-Ling Yin,1 Yi Zou,1 Hai-Yan Fu,1 Hong-Lin Li2 1Department of Endocrinology, The First Hospital of Nanchang (The Third Affiliated Hospital of Nanchang University), Nanchang, Jiangxi, People’s Republic of China; 2Department of Biochemistry, Medical College of Georgia, Augusta, GA, USA&ast;These authors contributed equally to this workCorrespondence: Ling Hu, Department of Endocrinology, The First Hospital of Nanchang (The Third Affiliated Hospital of Nanchang University), No.128 of Xiangshan North Road, Donghu District, Nanchang, Jiangxi, 330008, People’s Republic of China, Tel +86 0791-88862350, Fax +86 0791-6782945, Email ythulingh@163.comObjective: To retrospectively review the clinical data of type 2 diabetes mellitus (T2DM) patients hospitalized in Nanchang, China, summarized the prevalence of osteoporosis (OP) in T2DM patients in this area, and analyzed related influencing factors.Methods: The clinical data of hospitalized patients with T2DM were collected retrospectively. According to the results of bone mineral density test, the subjects were divided into the normal bone mass group, the osteopenia group, and the OP group. Age, gender, educational background, body mass index (BMI), waist-to-hip ratio (WHR), duration of T2DM, glycosylated hemoglobin, serum lipids, and complications of T2DM in the three groups were analyzed and compared.Results: The prevalence of OP in patients with T2DM was 35.77%. There were statistically significant differences in age, gender, BMI, WHR, duration of T2DM, educational background, the level of high-density lipoprotein cholesterol (HDL-C), the prevalence of diabetic retinopathy (DR), and diabetic peripheral neuropathy among the three groups (P < 0.05). Logistic regression analysis showed that increasing age, prolonged duration of T2DM, low BMI, high levels of HDL-C, and complicated DR were risk factors for osteopenia and OP.Conclusion: The prevalence of OP in T2DM was high. Risk factors for abnormal bone mass in T2DM might be females, advanced age, long duration of T2DM, low BMI, high levels of HDL-C, and diabetic microangiopathy.Keywords: type 2 diabetes mellitus, osteoporosis, risk-factors, prevalence

Lixiu Hu,1,&ast; Yong Xu,2,&ast; Hui Meng3 1Department of Pharmaceutical, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Pharmaceutical, Shanghai Punan Hospital of Pudong New District, Shanghai, People’s Republic of China; 3Department of Pharmaceutical, 905 Hospital of People’s Liberation Army, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hui Meng, Email Menghui0801@163.comPurpose: Puerarin (PUR) is a major bioactive ingredient extracted from the root of Pueraria lobata (Willd.) Ohwi, which is known as Gegen in traditional Chinese medicine. Conventional PUR ophthalmic dosage forms such as solutions and suspensions have many drawbacks, including-rapid precorneal elimination of the drug mainly due to lacrimal duct drainage. The purpose of this study is to develop a thermal responsive in situ gel system containing PUR-loaded human albumin nanoparticles (PUR-HSA-NPs ISG).Methods: The system has the required sol-gel phase transition temperature, and therefore can be used for local ocular administration to treat glaucoma. The formulation was evaluated for its sol-gel transition temperature, viscosity and in vitro release. In vivo eye irritation was evaluated in rabbits. In this study, the animal model of glaucoma was used to evaluate the pharmacodynamics of PUR-HSA-NPs ISG in vivo.Results: Morphologically, the PUR-HSA-NPs ISG exhibited a normal spherical shape with no aggregation or degradation. It had a mean size of 64.8 nm, and the drug-loading and encapsulation efficiency were 7.1%± 0.3% and 80.7%± 7.4%, respectively. The gelation temperature of the prepared PUR-HSA-NPs ISG thermogelling solutions was 37°C. Meanwhile, the PUR-HSA-NPs ISG showed thixotropic behavior with the downward curve exhibiting lower shear stress values as compared to corresponding points on the upward curve. The pharmacological results showed a continuous reduction of the IOP value for a long time and that the value remained in a lower-level range compared to that in the PUR eye drop group. According to the pharmacodynamic results, the Bcl-2/Bax ratio of the PUR-HSA-NPs ISG group was closest to 1 (0.8798, 24 h), with obvious reduction of tissue cell apoptosis.Conclusion: Through this study, it was found that PUR-HSA-NPs ISG is an ideal ocular drug delivery system. It is hoped that this product could be further promoted for clinical applications in the future.Keywords: puerarin, albumin nanoparticles, thermoresponsive in situ gel, ophthalmic delivery

Hu L, Wang H, Rao M, et al. Int J Nanomedicine. 2014;9(1):1127–1138. We, the Editors and Publisher of International Journal of Nanomedicine, have retracted the following article. Following publication, the authors raised concerns about the duplication of images within the article. Specifically, The images for Figure 4C and 4F have been duplicated, as have the images for Figure 4D and 4E. The images for Figure 6A and 6B have been duplicated, as have the images for Figure 6C and 6D. It was noted that some images for Figures 2 and 10 may have duplicated regions, however, this was caused by an error during the publication process. When approached for an explanation, the authors were cooperative but wereg unable to provide an adequate explanation for the duplicated images and not all the original data for the study was available. As verifying the validity of published work is core to the integrity of the scholarly record, we are therefore retracting the article and the authors agreed with this decision. We have been informed in our decision-making by our editorial policies and COPE guidelines. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.