Objective To explore the risk factors of linezolid associated thrombocytopenia and establish a risk prediction model. Methods A total of 796 patients with infection treated by linezolid from January 2010 to December 2020 in 7 intensive care units (ICU) of the First Medical Center of PLA General Hospital were selected. The basic clinical data of the patients were extracted by case retrieval system, and the patients were divided into thrombocytopenia group (n=228) and non-thrombocytopenia group (n=568) according to the occurrence of thrombocytopenia. The general data of the two groups were compared, and the risk factors of linezolid-associated thrombocytopenia were analyzed by multivariate logistic regression, and a risk prediction model was established. Then, the receiver operating characteristic curve (ROC) was used to evaluate the effectiveness of the model. Results Multivariate analysis showed age ≥80 years, duration of linezolid >7 d, WBC count ≥16×10⁹/L, platelet count <200×10⁹/L,and creatinine clearance (Ccr) <50 ml/min were independent risk factors for linezolid associated thrombocytopenia. The area under the curve (AUC) of the risk prediction model was 0.782(95%CI 0.747-0.816, P<0.001), The cut-off value was 6 points, the sensitivity was 82.1%, the specificity was 59.1%, the positive predictive value was 44.7%, and the negative predictive value was 89.1%. Conclusion The risk prediction model based on age, duration of linezolid use, WBC count, platelet count and, Ccr can effectively predict the occurrence of linezolid associated thrombocytopenia.

Objective To explore the effects of low body weight and different ages on the 28-day death and other clinical outcomes of intensive care patients. Methods Data were extracted from Medical Information Mart for Intensive Care Ⅲ(MIMIC-Ⅲ) intensive care database, and adult patients admitted to the intensive care unit (ICU) were screened. The body mass index (BMI) is calculated according to the initial weight and height when entering the ICU. According to their age, they were divided into two groups when they entered the ICU: the younger age group <65 years old, and the older age group ≥65 years old. BMI was divided into two groups: low BMI group <18.5 kg/m² and non-low BMI group ≥18.5 kg/m². Univariate analysis, multivariate logistic regression, and interaction analysis analyzed the impact of low body weight and different ages on the 28-day death and other clinical outcomes of intensive care patients. Results A total of 17 134 patients met the inclusion criteria. According to their age, they were divided into 7986 patients in the low-age group and 9148 patients in the high-age group. According to BMI, they were divided into 458 patients with low BMI and 16 676 patients with non-low BMI. Compared with non-low BMI, patients with low BMI were older(66.65±18.02 vs. 64.73±15.98, P=0.012), had a higher proportion of recent weight loss (19.7% vs. 3.7%, P<0.001) and emergency admissions (83.0% vs. 73.0%, P<0.001), had a higher prevalence of chronic obstructive pulmonary disease (COPD), rheumatoid arthritis, cancer, sepsis, and acute renal insufficiency. However, patients with low BMI had a lower prevalence of hypertension and diabetes. On the final clinical outcome, patients with low BMI had a higher prevalence of sepsis and acute renal insufficiency and longer mechanical ventilation time [29.2(12.0, 106.0) h vs. 18.7(5.7, 93.8) h, P<0.001]. In the whole cohort and different age groups,it could be seen that the 28-day mortality rate of patients with low BMI was higher than that of non-low BMI. Univariate analysis showed all the characteristics, including high age, low BIM, weight loss, emergency hospital admission, cardiac insufficiency, COPD,cancer, sequential organ failure assessment (SOFA) score, acute renal insufficiency, sepsis, septic shock, and highest white blood cell,were risk factors for 28-day death. Multivariate analysis showed that cancer and SOFA score were independent risk factors for 28-day death. In the interaction analysis, compared with the low-age group with non-low BMI, after adjusting the variables of P<0.05 in the multivariate regression and clinically significant variables, the low-age group with low BMI (OR=1.77, 95%CI 1.24-3.14, P=0.004),high-age group with non-low BMI (OR=1.84, 95%CI 1.64-2.08, P<0.001) and high-age group with low BMI (OR=2.95, 95%CI 2.09-4.17, P<0.001) were risk factors for death at 28 days. Conclusions Low BMI is a risk factor for short-term death in intensive care patients of different ages. Its poor prognosis may be related to low BMI patients with high cancer prevalence, severe illness, and longer mechanical ventilation time.

Objective To compare the clinicopathological features, differential diagnosis and treatment between perirenal angiomyolipoma (AML) and liposarcoma. Methods Eleven cases of AML and thirty-nine cases of liposarcoma around the kidney from Peking University International Hospital from January 2015 to December 2020 were reviewed in terms of clinical manifestations, imaging examination, pathological morphology, immunophenotype and treatment follow-up. Results The tumors in both groups were close to the kidney, and the imaging signs of renal defect were not distinctive enough to diagnose correctly.Perirenal AML was mainly female (P=0.003), the age of onset was younger than liposarcoma (P<0.001). Most of perirenal AML were single (90.9%, 10/11) and primary (100.0%, 11/11), the histomorphology was mostly accompanied by vascular hyaline degeneration(63.6%, 7/11), and Melan-A and HMB45 were positive by immunohistochemistry. While liposarcoma was often multiple (51.3%,20/39) and recurrent (79.5%, 31/39), Ki-67, P16, CDK4, MDM2 were more highly expressed than AML (P<0.05), and MDM2 gene was amplified. There was no significant difference in the maximum diameter and necrosis between the two groups (P>0.05). Conclusions Retroperitoneal perirenal AML and liposarcoma have similar imaging features, and gender, age, tumor number,primary/recurrent character, histomorphology, protein expression and gene amplification detection are helpful to differentiate them.Liposarcoma needs more extensive resection, active treatment and follow-up.

Objective To evaluate the safety and effectiveness of ultrasound-guided percutaneous thermal ablation in the treatment of low-risk unifocal papillary thyroid microcarcinoma (PTMC). Methods Patients with single-focal PTMC admitted to the 928th Hospital of the PLA Joint Logistic Support Force from June 2017 to June 2019 were selected, and ultrasound-guided percutaneous thermal ablation therapy was performed. The extent of ablation was assessed with contrast-enhanced ultrasound immediately after thermal ablation, and the ablation area, and thyroid function were measured for clinical evaluation at 1, 3, 6, 12,and 18 months, respectively. Clinical evaluation was performed at 1, 3, 6 and 12 months after thermal ablation. Results A total of 214 patients with PTMC were included, including 62 males (29.0%) and 152 females (71.0%), aged 17-77 (44.1±13.1) years old.The maximum diameter of the tumor was 0.2-1.0 (0.59±0.18) cm. The patients were followed up at 1, 3, 6, 12 and 18 months after thermal ablation, the follow-up time was 12-18 (15.14±3.01) months. After the initial thermal ablation, the maximum diameter of the ablated area was (1.372±0.440) cm, and gradually decreased to (1.108±0.438) cm, (0.753±0.440) cm, (0.483±0.324) cm,(0.162±0.205) cm, and (0.047±0.140) cm. After initial thermal ablation, the volume of ablated lesion was (1.083±1.819) cm³, and gradually decreased to (0.606±1.259) cm³, (0.273±0.784) cm³, (0.069±0.154) cm³, (0.006±0.156) cm³, and (0.001±0.004) cm³.The volume reduction ratio (VRR) at 1, 3, 6, 12 and 18 months after thermal ablation was 0.457±0.218, 0.837±0.150,0.943±0.090, 0.994±0.012, 0.999±0.002. There was a significant difference in VRR between every two follow-up visits (P<0.001).The thyroid function test results of patients before and 1 month after thermal ablation were normal, and there were no statistically significant differences (P>0.05). During the follow-up period, no tumor regrowth, local recurrence or distant metastasis was found.The most common complication was mild pain (31.8%, 68/214). Some patients developed toothache, sub-mandibular radiation pain and unilateral headache during ablation, and the pain symptoms were relieved immediately after ablation. All local pain symptoms were relieved 24-48 h after thermal ablation without treatment. Conclusions Ultrasound-guided percutaneous thermal ablation for the treatment of low-risk PTMC is safe and effective. It has less trauma and fewer complications, and can preserve the patient's thyroid function. This is a safe and effective alternative strategy for the treatment of low-risk PTMC, especially for patients who are not suitable for surgical treatment.

Objective To report a case of granulomatous polyangiitis (GPA) with breast involvement, and perform a literature review to better understand this disorder. Methods Retrospectively analyze the data of a case of GPA with breast involvement, to summarize the clinical characteristics of GPA with breast involvement by searching the database (CNKI, Wanfang Data, PubMed) and comprehensively analyze the literature results. Results A case of 53-year-old woman was admitted to the Department of Rheumatology and Immunology of the First Medical Center of Chinese PLA General Hospital because of "inflamed eyelids for 8 months, hearing loss for 6 months, breast induration for 4 months". The symptoms of mammary gland were bilateral-painful breast induration with ulceration. The patient was diagnosed with GPA by positive proteinase 3 (PR3) antibody and biopsy.After treatment with prednisone and cyclophosphamide, the patient experienced a relapse and then was treated with rituximab.By March 2021 (searching CNKI, Wanfang Data and PubMed), a total of 28 English cases of GPA with breast involvement and no Chinese case were found by searching literature. The disorder often occurs in women aged 40 to 60 (60.7%, 17/28), and the typical manifestation was unilateral breast (75.0%, 21/28) involvement. Positive PR3 antibody (69.2%, 9/13) is common. Pathological characteristics of the mammary are infiltration of lymphocyte, vasculitis and granulomatosis lesion. Conclusions The disorder of GPA with breast involvement is rare with non-specific breast symptoms. Detection of anti-neutrophil cytoplasmic antibodies and pathological examination can assist the diagnosis.

Objective To study the risk factors for extraesophageal symptoms in the patients with reflux esophagitis. Method One hundred and thirty-nine reflux esophagitis cases diagnosed by endoscophy and pH monitoring of the esophagus and hospitalized in Characteristic Medical Center of Strategic Support Army from March 2018 to November 2019. These cases were divided into positive or negative groups according to reflux symptom index (RSI) > or <13. Differences in gender, age, body mass index (BMI), smoking, drinking, emotional factors (anxiety and depression evaluation), reflux esophagitis microscopic classification,24-hour esophageal pH monitoring related index (Demeester index) were taking into account in logistical regression to identify the potential cause of reflux esophagitis. Results The positive group had higher age [(58.8±15.4) years], higher BMI (63%),higher anxiety (36%) and higher DeMeester (54%) than negative group [(52.8±11.7) years, 39%, 14%, 27% respectively], and the differences were statistically significant (P<0.05). There were no significant differences in gender, smoking, drinking, depression rate and endoscopic grade of reflux esophagitis between the two groups (P>0.05). Logistic multiple regression results showed that high BMI and positive DeMeester score were independent risk factors for patients with extrasoesophageal symptoms (OR=1.896, 95%CI 1.363-3.942, P<0.05; OR=6.868, 95%CI 1.648-18.087, P<0.01). Conclusions Higher BMI (overweight) and positive DeMeester score have predictive value for extraesophageal symptoms of the patients with reflux esophagitis, and they would increase the incidence of extraesophageal symptoms.

ESKAPE pathogens are the most common conditional pathogenic bacteria in nosocomial infection. Considering that ESKAPE pathogens are not sensitive to conventional antimicrobial treatment, some emerging treatment strategies that could effectively deal with ESKAPE pathogens will bring huge economic and social benefits. Seven emerging strategies to potentiate the effects of current antimicrobial including anti-virulence strategies, prevention of biofilm formation, antimicrobial peptides, plant-derived antimicrobial, nanoparticle drug delivery system, photodynamic therapy, phage therapy and so on will be discussed in present review. All of strategies discussed here aim to provide direction for further development of ideal drugs and solutions to handle antibiotic resistance.

Heart failure is the end state of various cardiovascular diseases, accompanied by a seriesof energy metabolism changes including transformation of energy substrates, mitochondrial dysfunction, and depletion of high-energy phosphate compounds, etc. In normal heart, fatty acid is the main energy metabolism substrate. However, myocardial substrate metabolism is damaged during heart failure, and metabolic substrate conversion characterized by ketone body occurred. It is of great significance to better understand the metabolism substrate selection during heart failure, regulatory mechanism and its pathophysiological significance for developing novel therapeutics targeting heart failure. The research progress on the changes of myocardial energy metabolism substrates in heart failure, especially the latest progress of ketone body as the substrate in recent years were reviewed in present paper.

Rimmed vacuole myopathy is a group of disease with characteristic myopathological features, which including deposition of abnormal proteins, such as β-amyloid protein (Aβ) and phosphorylated tau proteins etc. In recent years, positron emission tomography (PET) has been widely used in the imaging diagnosis of Alzheimer's disease (AD) due to the development of molecular imaging technology. Recently, some studies have indicated that molecular imaging PET can also show the abnormal deposition proteins in muscles, which is helpful for the early diagnosis and differential diagnosis of rimmed vacuolar myopathy, and provides a new application for PET. The application directions of PET in rimmed vacuolar myopathy were reviewed in this article, in order to provide a reference base for the implementation of clinical work.

Intervertebral disc degeneration (IDD) is a common orthopedic disease characterized by reduction of nucleus pulposus cells and degradation of extracellular matrix. Its specific pathogenesis is not clear. The current treatment can only improve the clinical symptoms of patients, but can not delay or reverse the process of degeneration. Therefore, to find an effective method to repair IDD has become the main goal of current research. In recent years, exosomes have gradually become a research hotspot in the field of regenerative medicine. Exosomes carrying a large number of nucleic acids, proteins, lipids, cytokines and other bioactive molecules participate in the information transmission between different cells and play an important role in regulating the biological functions of receptor cells. Studies have confirmed that exosomes can inhibit the apoptosis and inflammatory reaction of nucleus pulposus cells, promote the proliferation and regeneration of nucleus pulposus cells, and have the potential to cure IDD. In this paper, the characteristics and functions of exosomes from different cell sources and its effect and mechanism in IDD repair were summarized, in order to provide reference for the subsequent studies.