Wuhu Fourth People Hospital

To investigate the bacteriological spectrum and antimicrobial resistance of intraoperative purulent samples from patients with acute appendicitis and provide evidence for empirical therapy. A retrospective study was performed on 110 patients treated between 2021 and 2023. Intraoperative samples were cultured, and susceptibility testing against 20 antibiotics was conducted according to CLSI guidelines. Ninety-eight isolates were obtained. Gram-negative bacteria predominated (91.84%), mainly Escherichia coli (71.43%), Klebsiella pneumoniae (7.14%), and Pseudomonas aeruginosa (6.12%). E. coli showed complete susceptibility to meropenem, imipenem, and amikacin, high susceptibility to piperacillin-tazobactam (97.14%) and cefoxitin (88.57%), but high resistance to amoxicillin (94.29%). K. pneumoniae was universally susceptible to carbapenems, cefoxitin, and amikacin, but resistant to amoxicillin, piperacillin, ticarcillin, cephalothin, and gentamicin. P. aeruginosa was fully susceptible to carbapenems, cefoxitin, amikacin, and piperacillin-tazobactam, but resistant to most first- and second-generation cephalosporins and several aminoglycosides. Gram-negative enteric bacteria, particularly E. coli , are the dominant pathogens in appendiceal infections. Carbapenems and amikacin retain excellent efficacy, whereas amoxicillin and several commonly used antibiotics show poor activity. Piperacillin-tazobactam represents a reasonable first-line empirical choice, while carbapenems should be reserved for severe infections or patients at risk for resistant organisms. These findings highlight the importance of local resistance surveillance to guide institution-specific antibiotic protocols.

Major Depressive Disorder (MDD) is a common psychiatric condition with a multifactorial etiology that includes inflammatory mechanisms. Tumor Necrosis Factor-α (TNF-α), a pro-inflammatory cytokine, regulates several cellular functions in health and has been associated with reduced neuronal survival and increased inflammation in cortical areas related to reward processing, motivation, and decision-making in MDD. Although TNF-α has been studied in MDD, its precise role remains unclear, highlighting the need for further investigation. We therefore conducted a case-control study and a meta-analysis to better characterize peripheral blood TNF-α levels in first-episode, drug-naïve MDD patients compared with healthy controls. In the case-control study, plasma TNF-α levels were measured in first-episode, drug-naïve patients with major depressive disorder (MDD) and healthy controls (HCs) matched on age, and sex, using high-sensitivity enzyme-linked immunosorbent assays (ELISAs). For the meta-analysis, we selected relevant case-control studies from systematic searches of PubMed, Embase, PsycINFO, and Web of Science. A random effects model was used to calculate combined standardized mean differences (SMD) and ratio of means (RoM) for result verification. A total of 63 MDD patients and 63 matched HCs were included in the case-control analysis. Plasma TNF-α levels were significantly higher in MDD patients than in HCs (z = -2.12, p < 0.05). For the meta-analysis, 16 studies comprising 866 patients and 759 controls were included. Pooled results demonstrated significantly higher TNF-α levels in MDD patients compared with HCs (SMD: Hedges’ g = 0.65, 95% CI: 0.28 to 1.01, p < 0.001). The RoM indicated a 30% higher mean concentration in patients (RoM = 1.30, 95% CI: 1.20 to 1.42, p < 0.001). However, substantial cross-study heterogeneity was observed (SMD: I² = 91.2%, p < 0.001; RoM: I² = 95.5%, p < 0.001). The results of both the case-control and meta-analysis portions of our study suggest that TNF-α levels are higher in first-episode, drug-naïve MDD patients than in healthy individuals. These findings imply that TNF-α plays an important role in the pathophysiology of MDD. Future work should examine sources of heterogeneity across studies on inflammatory factors in depression, and assess potential therapeutic targets associated with TNF-α. Not applicable.

Vitamin D deficiency is a global public health issue, highly prevalent in middle-income and Eastern Mediterranean countries. It is associated with increased risks of respiratory infections like COVID-19 and influenza, alongside osteoporosis and cardiovascular disease. Functioning as an immunomodulator, vitamin D enhances macrophage activity, suppresses inflammatory cytokines, and induces antimicrobial peptides. Observational studies link deficiency to a higher risk of infection, although clinical trial results are mixed. Risk factors include dark skin, older age, urban living, and reduced sun exposure. This narrative review synthesized findings from peer-reviewed literature (2000-2025) in databases such as PubMed, Scopus, and Web of Science. It focuses on addressing respiratory infections associated with vitamin D deficiency through multifaceted public health strategies. These include policy-led food fortification, biofortification, public awareness campaigns, and technological innovations to increase dietary vitamin D intake and reduce the global burden of deficiency and respiratory infection.

Cognitive impairment plays a crucial role in the development from clinical high-risk(CHR) to schizophrenia-spectrum psychosis. Understanding its dynamic change trajectories has significant preventive value. This study aims to comprehensively explore the dynamic cognitive trajectories of clinical high-risk(CHR) individuals over a three-year period, compare the trajectories among CHR individuals who convert to psychosis(CHR-C), those who do not(CHR-NC), and healthy controls(HC). This prospective study was part of the Shanghai At Risk for Psychosis(SHARP)-extended program. CHR participants, from psychological counseling outpatient clinics and medication - naive, were followed up at baseline (T1), 2 months ± 1 week (T2), 1 year ± 1 month (T3), 2 years ± 1 month (T4), and 3 years ± 1 month (T5). All participants completed the Chinese version of the MATRICS Consensus Cognitive Battery(MCCB) at these five strictly fixed time points to assess neurocognitive function. Conversion to psychosis was determined as main outcome. A total of 43 CHR(median age, 16[IQR, 15-18] years; 14 men[32.6%]) and 18 HC(median age, 17[IQR, 16-18] years; 8 men[44.4%]) completed five fixed-time cognitive assessments over three years. During the three-year period, CHR individuals were categorized into CHR-C(n = 19) and CHR-NC(n = 24). CHR-C individuals showed more significant cognitive impairments at all time points compared to CHR-NC and HC. The cognitive decline in CHR-C was most prominent in the first year. Growth curve modeling showed that, compared with the HC group, the CHR-C group had a significant negative impact on the composite score of neurocognition(t = -2.809, p = 0.007), and the effect of time is marginally significant(t = -1.911, p = 0.057). The repeated-measures analysis of variance(RMANOVA) indicated significant differences among groups and time-related changes in cognitive scores. Over the entire period, there were highly significant main effects of Time(F = 15.162, p < 0.001, η2 = 0.275) and Group(F = 17.896, p < 0.001, η2 = 0.472). Moreover, different cognitive domains exhibited distinct change trends across the three groups. The first year after CHR identification is a critical period for observing cognitive changes. These findings emphasize short-term cognitive changes' importance in predicting psychosis and inform early intervention strategies.

Background: To evaluate the efficacy of laparoscopic para-aortic lymphadenectomy in the treatment of gynecologic malignancies through a literature review comparing the extraperitoneal and transperitoneal approaches. Methods: A comprehensive computerized search of PubMed, Embase, the Cochrane Library, Medline, Web of Science, and other relevant databases was conducted, covering the period from January 2010 to January 2025, to collect studies that compared the transperitoneal and extraperitoneal approaches to laparoscopic para-aortic lymphadenectomy in the treatment of gynecologic malignancies. Relevant data were extracted and analyzed using the Review Manager (RevMan) version 5.4.1 statistical software. Outcome indexes included operation time, intraoperative blood loss, number of para-aortic lymph nodes dissected, hospitalization days, and incidence of surgical complications. Results: A total of 525 manuscripts were retrieved, of which 8 were included. Our analysis showed no statistically significant differences between the extraperitoneal and transperitoneal groups in terms of operative time, intraoperative bleeding, and hospitalization days. However, the complication rate was significantly lower in the extraperitoneal group than in the transperitoneal group. Additionally, the number of para-aortic lymph nodes (PAL) retrieved was significantly higher in the extraperitoneal group compared to the transperitoneal group [mean difference (MD) = 0.43, 95% confidence intervals (CI) (0.13 to 0.72, p = 0.004)]. Conclusion: Laparoscopic para-aortic lymphadenectomy for gynecologic malignancies offers several advantages when performed via the extraperitoneal route. This approach reduces surgical trauma, shortens hospital stay, lowers the rate of complication, and increases the number of lymph nodes that can be resected compared to the transperitoneal route. Registration: The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD420251033897; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251033897).