Search

Dawei Ren,1 Yan Zhang,1 Bo Du,1 Lina Wang,2 Meiheng Gong,1 Wei Zhu1 1Department of Otorhinolaryngology, the First Hospital of Jilin University, Changchun, People’s Republic of China; 2Department of Pediatric Respiration, the First Hospital of Jilin University, Changchun, People’s Republic of ChinaCorrespondence: Wei Zhu, Email zhuwei@jlu.edu.cnBackground: Electrical stimulation (ES) can effectively promote skin wound healing; however, single-electrode-based ES strategies are difficult to cover the entire wound area, and the effectiveness of ES is often limited by the inconsistent mechanical properties of the electrode and wound tissue. The above factors may lead to ES treatment is not ideal.Methods: A multifunctional conductive hydrogel dressing containing methacrylated gelatin (GelMA), Ti3C2 and collagen binding antimicrobial peptides (V-Os) was developed to improve wound management. Ti3C2 was selected as the electrode component due to its excellent electrical conductivity, the modified antimicrobial peptide V-Os could replace traditional antibiotics to suppress bacterial infections, and GelMA hydrogel was used due to its clinical applicability in wound healing.Results: The results showed that this new hydrogel dressing (GelMA@Ti3C2/V-Os) not only has excellent electrical conductivity and biocompatibility but also has a durable and efficient bactericidal effect. The modified antimicrobial peptides V-Os used were able to bind more closely to GelMA hydrogel to exert long-lasting antibacterial effects. The results of cell experiment showed that the GelMA@Ti3C2/V-Os hydrogel dressing could enhance the effect of current stimulation and significantly improve the migration, proliferation and tissue repair related genes expression of fibroblasts. In vitro experiments results showed that under ES, GelMA@Ti3C2/V-Os hydrogel dressing could promote re-epithelialization, enhance angiogenesis, mediate immune response and prevent wound infection.Conclusion: This multifunctional nanocomposite hydrogel could provide new strategies for promoting infectious wound healing. Keywords: MXene, GelMA, electrical stimulation, antimicrobial peptides, wound healing

Qingzhu Zhang,1,2 Yinhui Yao,3 Yufeng Chen,1 Dong Ren,1 Pengcheng Wang1 1Orthopedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, People’s Republic of China; 2Department of Orthopedics, the Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, People’s Republic of China; 3Department of Pharmacy, the Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, People’s Republic of ChinaCorrespondence: Pengcheng Wang, Orthopedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, People’s Republic of China, Email zhengzainingmeng@163.comAim: A high percentage of the elderly suffer from knee osteoarthritis (KOA), which imposes a certain economic burden on them and on society as a whole. The purpose of this study is to examine the risk of KOA and to develop a KOA nomogram model that can timely intervene in this disease to decrease patient psychological burdens.Methods: Data was collected from patients with KOA and without KOA at our hospital from February 2021 to February 2023. Initially, a comparison was conducted between the variables, identifying statistical differences between the two groups. Subsequently, the risk of KOA was evaluated using the Least Absolute Shrinkage and Selection Operator method and multivariate logistic regression to determine the most effective predictive index and develop a prediction model. The examination of the disease risk prediction model in KOA includes the corresponding nomogram, which encompasses various potential predictors. The assessment of disease risk entails the application of various metrics, including the consistency index (C index), the area under the curve (AUC) of the receiver operating characteristic curve, the calibration chart, the GiViTi calibration band, and the model for predicting KOA. Furthermore, the potential clinical significance of the model is explored through decision curve analysis (DCA) and clinical influence curve analysis.Results: The study included a total of 582 patients, consisting of 392 patients with KOA and 190 patients without KOA. The nomogram utilized age, haematocrit, platelet count, apolipoprotein a1, potassium, magnesium, hydroxybutyrate dehydrogenase, creatine kinase, and estimated glomerular filtration rate as predictors. The C index, AUC, calibration plot, Giviti calibration band, DCA and clinical influence KOA indicated the ability of nomogram model to differentiate KOA.Conclusion: Using nomogram based on disease risk, high-risk KOA can be identified directly without imaging.Keywords: decision support, knee osteoarthritis, nomogram, predictors, risk factors

Keyang Li,1,* Debao Li,2,* Hongliang Dong,1 Dongmei Ren,2 Dandan Gong,1 Shubo Wang,1 Yang Li,1 Yuanyuan Wu,1 Jikang Yang,3 Wenjuan Yan,4 Yi Li4 1Department of Clinical Pharmacy, Jiaozuo People’s Hospital, Jiaozuo, Henan, People’s Republic of China; 2Department of Clinical Laboratory, Jiaozuo People’s Hospital, Jiaozuo, Henan, People’s Republic of China; 3Infectious Diseases Department, Jiaozuo People’s Hospital, Jiaozuo, Henan, People’s Republic of China; 4Department of Clinical Laboratory, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wenjuan Yan; Yi Li, Department of Clinical Laboratory, Henan Provincial People’s Hospital, Weiwu Road 7#, Jinshui District, Zhengzhou, Henan, 450003, People’s Republic of China, Tel +86 15225061830 ; +86 15939039006, Email yanwenjuan2008@126.com; liyilabmed@henu.edu.cnPurpose: Since the introduction of ceftazidime–avibactam (CZA) in the Chinese market, accumulating clinical evidence has substantiated its efficacy in the treatment of infections caused by carbapenem-resistant gram-negative bacteria (CR-GNB). Nevertheless, an ongoing debate persists concerning the choice between monotherapy and combination therapy when devising clinical anti-infection protocols.Patients and Methods: This retrospective, single-center observational study enrolled patients with CR-GNB infections who received CZA treatment between December 2019 and August 2023. The primary outcome assessed was 30-day mortality, and the secondary outcome measured was 14-day bacterial clearance. A multivariate Cox regression model was used to identify variables that were independently associated with 30-day mortality rate.Results: Eighty-three patients were enrolled in the study; of which, 45 received CZA monotherapy, whereas 38 received combination therapy. The overall 30-day mortality rate was 31.3%, and no significant difference was observed in the 30-day mortality rates between the CZA combination therapy and monotherapy groups (31.6% vs 31.1%, p=0.963). After adjustment by propensity score matching, the 30-day mortality rate was not significantly different between the two groups (28.6% vs 31.4%, p=0.794). Multivariate COX analysis revealed that age and SOFA score were independent predictors of 30-day mortality.Conclusion: Combination therapy with CZA and other antimicrobials was not found to have an advantage over monotherapy in reducing the 30-day mortality rate.Keywords: ceftazidime-avibactam, carbapenem-resistant gram-negative bacteria, combination therapy K. pneumoniae carbapenemase

Zheng Yang, Zhanli Shi, Kun Fang, Danhong Ren Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People’s Republic of ChinaCorrespondence: Danhong Ren, Department of Intensive Care Unit, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang Province, 310003, People’s Republic of China, Email rendanhong330@zcmu.edu.cnBackground: Rickettsia japonica infection is a rare disease, it is rare to report critical and severe case caused by this disease in Zhejiang Province, China.Patient Concerns: We report a patient who initially sought medical attention due to fever and developed coma and convulsions during treatment. The patient did not develop typical eschar and rash. Eventually, the patient needed to be treated in the intensive care unit due to acute respiratory failure.Diagnoses: The patient was diagnosed with Rickettsia japonica bloodstream infection by metagenomic next-generation sequencing (mNGS).Outcomes: Due to the critical illness, the patient was transferred to the intensive care unit, received doxycycline and other treatments, and rapidly recovered and discharged.Conclusion: The patient developed a critical illness after being infected with Rickettsia, when the medical history is unclear and clinical symptoms and signs are atypical, it is necessary to use mNGS examination for diagnosis.Keywords: rickettsia japonica, rickettsiosis, infection, metagenomic next-generation sequencing, critical illness

Haotian Wu,1,&ast; Chunxia Li,2,&ast; Song Liu,1 Shuangquan Yao,1 Zhaohui Song,1 Dong Ren,1 Pengcheng Wang1 1Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People’s Republic of China; 2Department of Imaging Medicine, General Hospital of Inner Mongolia Autonomous Region, Hohhot, Inner Mongolia, 010017, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Haotian Wu, Department of Orthopaedic Surgery, The 3rd Hospital, Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, People’s Republic of China, Tel +86-311-88603682, Fax +86-311-87023626, Email surgeon_wu@126.comPurpose: Neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and red blood cell distribution width (RDW) are novel biomarkers to indicate the inflammatory/immune response, and demonstrated to be effective in diagnosis, severity evaluation, and prognosis in a variety of chronic or acute conditions. This study aims to examine whether NLR, PLR and EDW are independently associated with mortality in necrotizing fasciitis (NF).Methods: This study retrospectively enrolled patients diagnosed with NF and based on vitality status during hospitalization or within 30 days after discharge, survival and non-survival groups were defined. For distinctly comparing NLR, PLR, RDW and others, we enrolled the matched healthy controls of the same age and sex as the survivors of NF in a 1:1 ratio, which constituted the healthy control group. Comparisons were made between three groups. Variables tested with a P value < 0.10 were further entered into the multivariate logistic regression model to identify their independent association with mortality.Results: A total of 281 subjects were included, including 127 healthy controls, 127 survivors, and 27 nonsurvivors with NF, respectively, indicating a mortality rate of 17.5%. ROC analysis showed that the optimal cutoff value for NLR, PLR and RDW was 11.1, 196.0 and 15.5%, respectively, and was tested as significant only for the first two (P < 0.001, = 0.004). Multivariate logistic analysis showed that NLR ≥ 11.1 (OR, 2.51) and PLR ≥ 196.0 (OR, 2.09) were independently associated with an increased risk of mortality in NF patients, together with age ((OR, 1.28, for each 10-year increment), comorbid diabetes mellitus (OR, 2.69) and liver disease (OR, 1.86), and elevated creatinine level (OR, 1.21 for each 10 umol/L elevation).Conclusion: Elevated NLR and PLR are significant and independent predictors of mortality and can be considered for use when evaluating patients at risk of mortality.Keywords: necrotizing fasciitis, prognosis, NLR, PLR, RDW

Dongyue Ren,1 Lin He,2 Xiaoling Pang1 1Department of Emergency, the Fourth Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China; 2Good Clinical Practice Institution, the Fourth Affiliated Hospital of China Medical University, Shenyang, People’s Republic of ChinaCorrespondence: Xiaoling Pang, Department of Emergency, the Fourth Affiliated Hospital of China Medical University, No. 4 Chongshan East Road, Huanggu District, Shenyang, 110032, People’s Republic of China, Tel +86-18900913992, Email xlpang@cmu.edu.cnObjective: This study aimed to investigate the association of CLTA-4 gene polymorphism with Type 1 and 2 diabetes mellitus (DM) (T1DM and T2DM) in the Han population of northern China.Methods: A total of 234 Chinese Han DM patients and 187 non-diabetic subjects were included in the study. Two gene polymorphisms of the CLTA-4, including CTLA-4+49A/G (rs231775) and CTLA4-318C/T (rs5742909), were studied using polymerase chain reaction-restriction endonuclease fragment length polymorphism (PCR-RFLP) analysis. Chi-square analysis and Student’s t-test were performed to determine the distribution of the gene polymorphism and alleles at the locus of CTLA4-318C/T and CTLA4+49A/G among T1DM and T2DM patients with or without diabetic ketosis (DK), diabetic nephropathy (DN) or autoantibodies (Ab).Results: Our results indicated that the distribution frequencies of genotypes and alleles at the CTLA-4+49A/G and CTLA4-318C/T loci of T1DM patients were not significantly different from those of the controls. However, the distribution frequencies of genotypes and alleles at the CTLA-4+49A/G loci of T2DM patients were significantly different from the controls (P=0.024 for genotypes and P=0.004 for A and G alleles). Besides, the A and G alleles at the CTLA4-318C/T loci of T2DM DK+ patients showed significantly different distribution frequencies compared to those of the T2DM DK patients (P=0.001).Conclusion: Our data suggest that the gene polymorphisms of CTLA-4, including CTLA-4+49A/G and CTLA4-318C/T, are important predictors of DM. CTLA-4 may be a susceptibility gene for T2DM. Patients with T2DM carrying the T allele at the CTLA4-318 C/T locus are more predisposed to diabetic ketosis.Keywords: diabetes mellitus, gene polymorphism, CTLA-4, diabetic ketosis, diabetic nephropathy, autoantibodies

Shuangqing Chen,1,2 Shicheng Liu,1 Siwei Xu,3 Shumin Cao,4,5 Zhaohui Han,1,2 Lingxin Kong,1,5 Dahu Ren,1,5 Guochen Duan6 1Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, 050057, People’s Republic of China; 2Graduate School, Hebei North University, Zhangjiakou, 075000, People’s Republic of China; 3Department of Thoracic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, 050057, People’s Republic of China; 4Department of Oncology, Hebei General Hospital, Shijiazhuang, 050057, People’s Republic of China; 5Graduate School, Hebei Medical University, Shijiazhuang, 050011, People’s Republic of China; 6Department of Thoracic Surgery, Children’s Hospital of Hebei Province, Shijiazhuang, 050000, People’s Republic of ChinaCorrespondence: Guochen Duan, Children’s Hospital of Hebei Province, No. 133 Jianhua South Street, Yuhua District, Shijiazhuang, 050000, People’s Republic of China, Tel +8613513380703, Email duanguoc@126.com Shicheng Liu, Hebei General Hospital, No. 348, Heping West Road, Xinhua District, Shijiazhuang, 050000, People’s Republic of China, Tel +861309388955, Email 1309388955@qq.comBackground: The routine clinical nutritional and inflammatory indicators such as serum albumin, total cholesterol and lymphocytes have been widely investigated in the prognosis of small cell lung cancer (SCLC). The Naples prognostic score (NPS), based on nutritional and inflammatory status, has been identified as a prognostic impactor in several malignancies. However, the prognostic role of NPS in SCLC has not been elucidated. This study aims to evaluate the prognostic effect of NPS in SCLC patients.Patients and Methods: Patients with SCLC were recruited at Hebei General Hospital between April 2015 and August 2021. Pretreatment clinical and laboratory data were obtained. Participants were assigned into three groups according to NPS (group 0: NPS=0, group 1: NPS=1 or 2, group 2: NPS=3 or 4). Kaplan-Meier and Cox regression analysis were performed to assess the prognostic significance of NPS. The RMS package in R software was used to draw the nomogram predictive model.Results: A total of 128 patients were enrolled. The median progression-free survival (PFS) and overall survival (OS) was 7.2 and 12.3 months, respectively. The median PFS and OS was 12.3 vs 19.8 months, 7.6 vs 14.1 months and 6.0 vs 8.45 months for the three groups respectively. There were significant differences in both OS and FPS among the three groups. Survival analysis showed that NPS was significantly correlated with both OS and PFS (P< 0.05). Lower NPS is associated with longer OS and PFS. Multivariate analysis showed that NPS has an independent prognostic impact on OS (P< 0.05). The nomogram predictive model showed that NPS has good predictive power for survival rates.Conclusion: NPS is an independent prognostic factor for OS in SCLC patients. Low NPS may predict longer OS. Therefore NPS plays a vital role in the nomogram predictive model of survival rates in SCLC patients.Keywords: small cell lung cancer, Naples prognostic score, prognostic factor, nomogram predictive model

Dan Ren,1 Wen-Ling Wang,2 Gang Wang,2 Wei-Wei Chen,2 Xiao-Kai Li,2 Guo-Dong Li,2 Sai-Xi Bai,2 Hong-Min Dong,2 Wang-Hua Chen2 1Oncology Department, Guizhou Medical University, Guiyang, Guizhou, 550000, People’s Republic of China; 2Department of Abdominal Oncology, Affiliated Hospital of Guizhou Medical University, Affiliated Tumor Hospital of Guizhou Medical University, Guiyang, Guizhou, 550000, People’s Republic of ChinaCorrespondence: Wen-Ling WangDepartment of Abdominal Oncology, Affiliated Hospital of Guizhou Medical University, Affiliated Tumor Hospital of Guizhou Medical University, No. 1 Beijin West Road, Yunyan District, Guiyang, Guizhou, 550000, People’s Republic of ChinaTel +86 138 8507 7539Fax +86 851 86512900Email wangww35@outlook.comObjective: The aim of this study was to develop a nomogram-based model to predict the three-year and five-year overall survival (OS) of patients with stage II/III colon cancer following radical resection.Methods: A total of 1156 patients with stage II/III colon cancer who underwent radical resection at the Affiliated Hospital of Guizhou Medical University between December 2012 and December 2018 were enrolled. Lasso regression was used to screen out 12 variables: age, prealbumin, albumin, degree of differentiation, total tumor-node-metastasis (TNM) stage, T stage, N stage, prognostic nutritional index (PNI), platelet/lymphocyte count, carcinoembryonic antigen, carbohydrate antigen 19-9 (CA19-9), and postoperative adjuvant chemotherapy. The data set was then randomly split into a modeling set and a validation set, and the bootstrap method was used to verify the internal validity of the final model. A nomogram was then used to present the model, and the risk groups were categorized according to the total score in the nomogram.Results: This study established and developed a simple, easy-to-use predictive model that included age, degree of differentiation, N stage, CA19-9, PNI, and postoperative chemotherapy as variables. In the multivariate Cox regression analysis, only postoperative chemotherapy was identified as an independent risk factor for death in patients with colon cancer. The receiver operating characteristic curve showed that the model demonstrated good resolution, with an area under the curve of 0.803. Decision curve analysis indicated that the model had a good positive net gain, and the bootstrap method was used to verify its stability. In the OS rate, the C-index was 0.78. According to the total score of the nomogram, the risk group was layered by drawing the Kaplan–Meier (K–M) curve. In the three-year OS K–M curve, the survival rates of the low-risk group, the medium-risk group, and the high-risk group were 96%, 93%, and 82%, respectively. In the five-year OS K–M curve, the survival rates of the low-risk group, the medium-risk group, and the high-risk group were 94%, 90%, and 73%, respectively.Conclusion: The nomogram-based prediction model developed in this study is stable and has good resolution, reliability, and net gain. It will therefore be useful for clinicians performing risk stratification and postoperative monitoring and in the development of personalized treatment options for patients with stage II/III colon cancer.Keywords: colon cancer, nomogram, overall survival, prognosis

Haiying Wang, Dongliang Ren, Hui Li, Shunyi Wang Department of Orthopaedic Surgery, Baoding No.1 Central Hospital, Baoding, 071000, People’s Republic of ChinaCorrespondence: Shunyi WangDepartment of Orthopaedic Surgery, Baoding No.1 Central Hospital, 320 Changcheng North Street, Baoding, Hebei, 071000, People’s Republic of ChinaTel +8613021878068Fax +863125975050Email hbtswhy1@163.comAbstract: To our knowledge, the periprosthetic joint infection (PJI) caused by Mycoplasma hominis is a rare postoperative complication after total knee arthroplasty (TKA). Just a few cases associated with Mycoplasma hominis infection after TKA were reported all over the world currently. In view of the difficulty involved in isolating this microorganism, Mycoplasma hominis infection may be under-recognized and should be considered in culture-negative cases where the microbial etiology is not easily identified. Metagenomic sequencing is a new tool to identify pathogens undetected by conventional methods. In this report, we present a case where metagenomic sequencing was used to identify Mycoplasma hominis as a novel PJI pathogen after TKA in our hospital.Keywords: knee, infection, Mycoplasma hominis, metagenomic sequencing

Dengfeng Ren,1– 3 Guoxiu Wang,4 Yu Zhang,5 Jie Kan,6 Qiuxia Dong,7 Junhui Zhao,3 Faxiang Ji,3 Hao Li,3 Yushuang Luo,3 Mingzhe Lin,3 Guoyuan Li,3 Zhibo Liu,3 Xinfu Ma,8 Qijing Guo,3 Fuxing Zhao,1,2 Guoshuang Shen,2,8 Jiuda Zhao1– 3 1Research Center for High Altitude Medicine, Qinghai University, Xining, People’s Republic of China; 2Breast Disease Diagnosis and Treatment Center, Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, People’s Republic of China; 3Department of Medical Oncology, Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, People’s Republic of China; 4Department of Medical Oncology, Yangquan No.1 People’s Hospital, Yangquan, People’s Republic of China; 5Department of Medical Oncology, Qinghai Red Cross Hospital, Xining, People’s Republic of China; 6Department of Medical Oncology, People’s Hospital of Qinghai Province, Xining, People’s Republic of China; 7Department of Medical Oncology, The Fifth People’s Hospital of Qinghai Province, Xining, People’s Republic of China; 8Department of Surgical Oncology, Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, People’s Republic of ChinaCorrespondence: Jiuda ZhaoResearch Center for High Altitude Medicine, Qinghai University, Xining, 810000, People’s Republic of ChinaTel +86 13327661976Email jiudazhao@126.comGuoshuang ShenBreast Disease Diagnosis and Treatment Center, Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, 810000, People’s Republic of ChinaTel +86 13109708777Email guoshuangshen@126.comBackground: Apatinib improves progression-free survival and overall survival with an acceptable safety profile in Chinese patients with chemotherapy-refractory advanced or metastatic gastric cancer. However, the efficacy and safety of apatinib are unclear for elderly patients. This study was undertaken to prospectively investigate the efficacy and safety of apatinib for elderly patients with unresectable advanced or metastatic gastric cancer, who experienced progression to at least one lines of chemotherapy.Methods: This open-label, single-arm, phase II study enrolled patients aged ≥ 60 years with advanced gastric cancer, who experienced progression to one or more lines of chemotherapy at five centers in China. Patients received apatinib in an oral dose of 500mg or 250mg daily according to the research physicians’ decision. The primary end point was progression-free survival, and the secondary end points were objective response rate, disease control rate, overall survival, and safety.Results: Forty-eight patients were enrolled between June 2017 and September 2019. The median age was 65.5 years (range 60– 80 years). Twenty-seven patients (56.3%) started treatment with an initial dose of 500 mg and 21 patients (43.7%) with 250 mg. The median progression-free survival and overall survival were 3.00 months (95% confidence interval, 2.17– 3.84) and 8.10 months (95% confidence interval, 4.35– 11.85), respectively. The objective response rate and disease control rate assessed by the investigators were 16.7% and 72.9%, respectively. The common side effects were fatigue (58.3%), hypertension (47.9%), abdominal pain (33.3%), proteinuria (29.2%), leukopenia (22.9%), and neutropenia (20.8%). Hypertension (22.9%) was the major grade 3/4 toxicity.Conclusion: These data suggest that apatinib is effective and relatively tolerable for elderly patients with unresectable advanced or metastatic gastric cancer who have received at least first-line chemotherapy.Keywords: apatinib, efficacy, safety, elderly patients, advanced gastric cancer

Debao Li,1,* Keyang Li,2,* Hongliang Dong,2 Dongmei Ren,1 Dandan Gong,2 Fuguo Jiang,1 Chunhua Shi,1 Junmin Li,1 Qi Zhang,3 Wenjuan Yan,3 Yi Li3 1Department of Clinical Laboratory, Jiaozuo People’s Hospital, Jiaozuo, Henan, People’s Republic of China; 2Department of Clinical Pharmacy, Jiaozuo People’s Hospital, Jiaozuo, Henan, People’s Republic of China; 3Department of Clinical Laboratory, Henan Provincial People’s Hospital, Zhengzhou, Henan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wenjuan Yan; Yi LiDepartment of Clinical Laboratory, Henan Provincial People’s Hospital, Weiwu Road 7#, Jinshui District, Zhengzhou, 450003, Henan, People’s Republic of ChinaTel +86 15225061830; +86 15939039006Email yanwenjuan2008@126.com; liyilabmed@henu.edu.cnPurpose: Carbapenem-resistant Klebsiella pneumoniae (CRKP) represents a serious problem worldwide. Herein, we describe the evolution of ceftazidime–avibactam (CZA) resistance by sequencing clinical isolates from a patient with CRKP infection undergoing CZA treatment.Patients and Methods: In this study, six CRKP strains were isolated from sputum and blood samples of a patient with CRKP infection after intracerebral hemorrhage. Two strains were selected for whole-genome analysis.Results: Drug susceptibility testing showed that the MIC of CZA for CRKP strains isolated after 6 days of CZA treatment was 64-fold higher than that for three CRKP strains isolated before CZA treatment (4 vs > 256 μg/mL), whereas the MIC of imipenem and meropenem was 128-fold (> 32 vs 0.25 μg/mL) and 16-fold (> 32 vs 2 μg/mL) lower relatively, respectively. Multilocus sequence typing showed that all six CRKP strains isolated from the patient were ST11 and pulsed-field gel electrophoresis confirmed that they were of the same clone. Two strains were selected for whole-genome analysis. The aspartic acid residue at position 179 in the Ω loop was replaced by a tyrosine residue in the resistant strain, and the plasmid carried a blaKPC-2 to blaKPC-33 mutation. The results of the modified carbapenem inactivation method and the carbapenemase inhibitor enhancement and colloidal gold enzyme immunochromatographic assays for blaKPC-33 were negative.Conclusion: This is the first report from Henan to show that treatment with CZA for 6 days can cause mutations and change the phenotype from CZA sensitive to resistant. Therefore, routine testing for drug susceptibility and carbapenemase phenotypes should be conducted during treatment with CZA, and genotype determination is essential.Keywords: ceftazidime–avibactam, drug resistance, carbapenem-resistant Klebsiella pneumoniae, K. pneumoniae carbapenemase-2, ST11

Ting Zhang,1 Bin Guan,1 Sipin Tan,2 Hong Zhu,1 Dan Ren,1 Ruomeng Li,1 Lan Xiao1 1Department of Traditional Chinese Medicine, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410008, People’s Republic of China; 2Key Laboratory of Sepsis, Translational Medicine of Hunan, Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410008, People’s Republic of ChinaCorrespondence: Lan XiaoDepartment of Traditional Chinese Medicine, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Changsha, Hunan, 410008, People’s Republic of ChinaTel +86-15802686038Email xiaol038@163.comBackground: It was indicated that nucleotide-binding oligomerisation domain‑like receptor protein 1 (NLRP1) inflammasome-mediated pyroptosis is involveg in the progression of Alzheimer’s disease (AD). This study was designed to explore the effect of Bushen Huoxue Acupuncture on cognitive defect and NLRP1 inflammasome-mediated pyroptosis in AD mouse.Methods: Senescence-accelerated mouse prone 8 (SAMP8) mice were used as a model of AD. Bushen Huoxue Acupuncture was performed in four acupoints: “Baihui acupoint” (GV20), “Shenshu acupoint” (BL23), “Xuehai acupoint” (SP10), and “Geshu acupoint” (BL17). Morris water maze test was performed to evaluate the cognitive function of the mouse. The levels of Aβ1-40, Aβ1-42, IL-1β, and IL-18 were examined by ELISA assay. Neuronal apoptosis and damage in hippocampal tissues were measured using TUNEL and Nissl staining, respectively. The expression of NLRP1, ASC, cleaved caspase-1, IL-1β, and IL-18 was examined using Western blot.Results: Bushen Huoxue Acupuncture improved the learning and memory deficits of AD mouse. Meanwhile, Bushen Huoxue Acupuncture decreased the production of Aβ in hippocampal tissues of SAMP8 mice and attenuated the neuronal apoptosis and damage. Furthermore, Bushen Huoxue Acupuncture inhibited NLRP1 inflammasome activation in SAMP8 mice.Conclusion: Bushen Huoxue Acupuncture could notably attenuate the cognitive defect of mouse AD model and inhibit NLRP1 inflammasome-mediated pyroptosis.Keywords: Bushen Huoxue Acupuncture, Alzheimer’s disease, NLRP1 inflammasome, pyroptosis, hippocampal neurons

Haini Liu, 1 Jingjie Zhao, 2 Yi Cao, 1 Hualin Jiang, 3 Shaoru Zhang, 1 Zhongqiu Hua, 1 Jing Ren, 1 Dan Ren 1 1Department of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2College of Media, Xijing University, Xian, People’s Republic of China; 3Department of Epidemiology and Health Statistics, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of ChinaCorrespondence: Hualin Jiang; Shaoru ZhangHealth Science Center, Xi’an Jiaotong University, No. 76 Yanta West Road, Yanta, Xi’an, Shanxi 710061, People’s Republic of ChinaTel +86 029 8265 7015Fax +86 029 8265 7017Email 596684532@qq.com; tgshru011@126.comPurpose: Drug-resistant tuberculosis (DR-TB) remains a major global public health issue. For DR-TB patients, effective adaptation is crucial to prevent disease progression, improve health outcomes and decrease mortality. To date, there is no appropriate tool for evaluating the adaptation status of DR-TB patients. In this work, we aim to develop an adjustment scale for DR-TB patients (AS-DRTBP) and to evaluate its psychometric properties.Patients and Methods: The development of the AS-DRTBP was based on the theory of the Roy adaptation model (RAM). The scale was designed through a literature review, in-depth individual interviews, a Delphi survey, and pilot testing. In total, 433 patients with DR-TB were recruited to validate the instrument. The split-half reliability coefficient, Cronbach’s alpha coefficient, and test-retest reliability coefficient were calculated to assess the reliability of the instrument. Content validity, construct validity and concurrent validity tests were applied to calculate the validity of the instrument.Results: The final AS-DRTBP consisted of four dimensions and 26 items. The Cronbach’s alpha coefficient, split-half reliability coefficient and test-retest reliability coefficient were 0.893, 0.954, and 0.853, respectively. The content validity index was 0.92. Four factors that explained 64.605% of the total variance were also further determined by confirmatory factor analysis (CFA). The CFA results showed that the fitting effect of the model was appropriate (CMIN/DF = 1.681, GFI = 0.832, AGFI = 0.799, RMSEA = 0.055, SRMR = 0.0684). The AS-DRTBP and adjustment scale had correlation in the total score, and the correlation coefficient was 0.355 (p< 0.05).Conclusion: The findings of this study demonstrate that the AS-DRTBP is a reliable and valid instrument for measuring the adaptation status of patients with DR-TB, allowing health providers to comprehend the adaptive level of DR-TB patients and thus laying the foundation for interventions to help these patients achieve a physiologically, psychologically and socially optimal outcome.Keywords: adaptation, drug-resistant tuberculosis, validation, reliability, adjustment

Yi Cao,1 Wei Chen,2 Shaoru Zhang,1,3 Hualin Jiang,3 Haini Liu,1 Zhongqiu Hua,1 Dan Ren,1 Jing Ren1 1Department of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of China; 2Nursing Department, Xi’an Chest Hospital, Xi’an City, People’s Republic of China; 3Department of Epidemiology and Health Statistics, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of ChinaCorrespondence: Shaoru ZhangHealth Science Center, Xi’an Jiaotong University, No 76 Yanta West Road, Yanta, Xi’an, Shaanxi 710061, People’s Republic of ChinaTel +86 29 8265 7015Fax +86 29 8265 7017Email tgshru011@126.comPurpose: No instrument exists for measuring TB patients’ self-efficacy which is vital for choosing and insisting in benefit TB-management behaviors. Our study aimed to develop and test a new tuberculosis self-efficacy scale (TBSES).Patients and methods: The TBSES was designed through literature review, individual interviews, Delphi surveys, and pilot testing. After that, 460 TB patients were recruited to validate TBSES. Exploratory and confirmatory factor analysis and correlation analysis were used to evaluate the scale reliability and validity. The cut-off point for TBSES was identified using receiver operating characteristic (ROC) analysis.Results: The final TBSES includes 21 items scored on a 5-point Likert scale, and these items are loaded in four distinct factors that explain 67.322% of the variance, both exploratory and confirmatory factor analysis proved that the scale had good construct validity. The scale had adequate internal consistency, split-half reliability, test-retest reliability, as well as demonstrated content, concurrent validity. The ROC analysis results showed the cut-off point was 86.5.Conclusion: This 21-item TBSES demonstrated favorable psychometric properties. It provides an instrument for not only measuring specific self-efficacy in TB, but also identifying patients with low self-efficacy and determining the specific area toward designing interventions for enhance self-efficacy.Keywords: tuberculosis, self-efficacy, scale development, reliability, validity

Qianqian Sun,1,2 Fan Yuan,1,2 Decheng Ren,1,2 Gaini Ma,1,2 Fengping Yang,1,3 Xi Wu,1,3 Lin He,1,3 Guang He1,21Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai 200030, P.R. China; 2Shanghai Key Laboratory of Psychotic Disorders, Shanghai Institute of Mental Health, Shanghai Jiao Tong University, Shanghai 200030, P.R. China; 3Institute for Nutritional Sciences, Shanghai Institutes of Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, P.R. ChinaPurpose: Venlafaxine is one of the commonly prescribed antidepressants for major depressive disorder (MDD). Accumulated evidence revealed the involvement of glutamatergic system in the pathophysiology of MDD and antidepressant treatment. Methods: We recruited 193 MDD patients who have been taking venlafaxine for 6 weeks, and investigated whether single nucleotide polymorphisms (SNPs) in GSK-3β and BDNF were associated with treatment response. Nine SNPs were selected randomly depending on association studies. Efficacy of treatment was determined by 17-item Hamilton Rating Scale. Allele and genotype frequencies were compared between responders and nonresponders.Results: After adjusting the false discovery rate, no significant difference was observed between response and nonresponse groups in allele or genotype distributions after venlafaxine treatment for 6 weeks.Conclusion: Our results indicated that genetic variants in the GSK-3β and BDNF may not be associated with treatment response in MDD patients treated with venlafaxine.Keywords: association, GSK-3β, BDNF, major depressive disorder, venlafaxine

Honglin Zhao,* Dian Ren,* Yi Liu, Xin Li, Yi Wu, Gang Chen, Jun ChenDepartment of Lung Cancer Surgery, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China *These authors contributed equally to this work Abstract: Intrathoracic goiters generally occupy anterior mediastinum, rarely involving the posterior mediastinal space. Reported herein is a 54-year-old female with a giant posterior mediastinal mass that was successfully resected via right posterolateral thoracotomy. The final pathologic diagnosis was giant posterior mediastinal goiter. This patient has done well postoperatively, with no evidence of local recurrence at 12-month follow-up. Related surgical strategies in past publications are summarized. Keywords: intrathoracic goiter, posterior mediastinal mass, thoracotomy

Zhicheng Zhang, Fang Li, Tiansheng Sun, Dajiang Ren, Xiumei Liu PLA Institute of Orthopedics, Beijing Army General Hospital, Beijing, People's Republic of China Background: Many previous studies have focused on the effects of IN-1, a monoclonal antibody that neutralizes Nogo (a neurite growth inhibitory protein), on neurologic regeneration in spinal cord injury (SCI). However, safety problems and the short half-life of the exogenous antibody are still problematic. In the present study, the NogoA polypeptide was used as an antigen to make a therapeutic NogoA vaccine. Rats were immunized with this vaccine and were able to secrete the polyclonal antibody before SCI. The antibody can block NogoA within the injured spinal cord when the antibody gains access to the spinal cord due to a compromised blood–spinal cord barrier. Olfactory ensheathing glial cell transplantation has been used in a spinal cord contusion model to promote the recovery of SCI. The present study was designed to verify the efficacy and safety of NogoA polypeptide vaccine, the effects of immunotherapy with this vaccine, and the synergistic effects of the vaccine and olfactory ensheathing glial cells in repair of SCI. Methods: A 13-polypeptide fragment of NogoA was synthesized. This fragment was then coupled with keyhole limpet hemocyanin to improve the immunogenicity of the polypeptide vaccine. Immunization via injection into the abdominal cavity was performed in rats before SCI. The serum antibody level and ability of the vaccine to bind with Nogo were detected by enzyme-linked immunosorbent assay. The safety of the vaccine was evaluated according to the incidence and severity of experimental autoimmune encephalomyelitis. Olfactory ensheathing glia cells were obtained, purified, and subsequently implanted into a Wistar rat model of thoracic spinal cord contusion injury. The rats were divided into four groups, ie, an SCI model group, an olfactory ensheathing glia group, a vaccine group, and a combined treatment group. Animal behavior, histopathology, and axonal regeneration were compared between the four treatment groups. Results: The antibody against the polypeptide was detected in rat serum by enzyme-linked immunosorbent assay. Experimental autoimmune encephalomyelitis was not found in the immunized rats. Three months after injury, Basso, Beattie, Bresnahan scores and nerve fiber counts in biotinylated dextran amine nerve tracing studies were significantly better in the combined treatment group than in the other groups. Conclusion: The polypeptide NogoA vaccine can stimulate the humoral immune system to produce antibodies against the NogoA polypeptide. The binding reaction between the antibody and antigen was shown in ex vivo experiments. No evidence was found to suggest a relationship between NogoA vaccination and increased risk of experimental autoimmune encephalomyelitis. The combined strategy of olfactory ensheathing glial cell implantation and NogoA vaccination may promote regeneration of axons and functional recovery in the spinal cord contusion injury model. This study may provide a new strategy for combining modalities to enhance axonal regeneration and a better balance of the CNS microenvironment after SCI. Keywords: spinal cord injury, immunotherapy, cell transplantation, olfactory ensheathing glial cells, NogoA, vaccine

Solar wind heating is an outstanding issue that has been discussed for decades. Research on the connection between solar wind particle temperatures and turbulence may provide insight into this issue. Based on Parker Solar Probe observations, this paper investigates the properties of solar wind proton and electron temperatures in relation to turbulent magnetic energy, via the calculation of correlation coefficients (CCs) between particle temperatures and magnetic energy. The calculations are regulated by the spatial scale, plasma beta (β), and the angle between the solar wind velocity and background magnetic field, where the plasma beta is the ratio of plasma thermal to magnetic pressure. Results show that the correlation between proton temperature and magnetic energy is positive and can be strong with a CC exceeding 0.8. The strong correlation preferentially occurs at ion scales, with the wind velocity and background magnetic field quasi-perpendicular and over a wide beta range (β < 3.0). On the other hand, the correlation between electron temperature and magnetic energy is commonly negative, often with an intermediate or negligible CC, accordingly. The CC with an amplitude up to 0.8 can arise at larger scales with the wind velocity and background magnetic field quasi-(anti)parallel and in the low-beta case (β < 0.6). The implication of these findings on the physics of turbulent heating in the solar wind is discussed. [ABSTRACT FROM AUTHOR]

The Sea-level Response to Ice Sheet Evolution (SeaRISE) effort explores the sensitivity of the current generation of ice sheet models to external forcing to gain insight into the potential future contribution to sea level from the Greenland and Antarctic ice sheets. All participating models simulated the ice sheet response to three types of external forcings: a change in oceanic condition, a warmer atmospheric environment, and enhanced basal lubrication. Here an analysis of the spatial response of the Greenland ice sheet is presented, and the impact of model physics and spin-up on the projections is explored. Although the modeled responses are not always homogeneous, consistent spatial trends emerge from the ensemble analysis, indicating distinct vulnerabilities of the Greenland ice sheet. There are clear response patterns associated with each forcing, and a similar mass loss at the full ice sheet scale will result in different mass losses at the regional scale, as well as distinct thickness changes over the ice sheet. All forcings lead to an increased mass loss for the coming centuries, with increased basal lubrication and warmer ocean conditions affecting mainly outlet glaciers, while the impacts of atmospheric forcings affect the whole ice sheet. Key Points Sensitivity study of Greenland to atmospheric, oceanic and subglacial forcings Each forcing result in a different regional thickness response All forcings lead to an increased mass loss for the coming centuries ©2013. American Geophysical Union. All Rights Reserved.

Atmospheric, oceanic, and subglacial forcing scenarios from the Sea-level Response to Ice Sheet Evolution (SeaRISE) project are applied to six three-dimensional thermomechanical ice-sheet models to assess Antarctic ice sheet sensitivity over a 500 year timescale and to inform future modeling and field studies. Results indicate (i) growth with warming, except within low-latitude basins (where inland thickening is outpaced by marginal thinning); (ii) mass loss with enhanced sliding (with basins dominated by high driving stresses affected more than basins with low-surface-slope streaming ice); and (iii) mass loss with enhanced ice shelf melting (with changes in West Antarctica dominating the signal due to its marine setting and extensive ice shelves; cf. minimal impact in the Terre Adelie, George V, Oates, and Victoria Land region of East Antarctica). Ice loss due to dynamic changes associated with enhanced sliding and/or sub-shelf melting exceeds the gain due to increased precipitation. Furthermore, differences in results between and within basins as well as the controlling impact of sub-shelf melting on ice dynamics highlight the need for improved understanding of basal conditions, grounding-zone processes, ocean-ice interactions, and the numerical representation of all three. Key Points Sensitivity study of Antarctica to atmospheric, oceanic and subglacial forcings Different sectors of Antarctica are vulnerable to the forcings Atmospheric forcing lead to a growth, but dynamic forcing lead to a mass loss ©2013. American Geophysical Union. All Rights Reserved.