OBJECTIVE To understand the epidemic condition on the resistant plasmids and their homology of the Staphylococcus aureus obtained from two hospitals in Gansu Province.METHODS The antibiotic sensitivity test,plasmid elimination,plasmid profile,and restriction endonuclease profile were used in analyzing the S.aureus resistant plasmids.RESULTS We isolated 15 strains of S.aureus from 196 samples in two different hospitals,the isolation rate was 7.7%.From them 86.7% isolates were resistant to the seven commonly used antibiotics in different degree.Only 13.3% strains were just resistant to one antimicrobial,the multi-resistant strains amounted for 46.7%.There were 12 isolates carried plasmids(80.0%).The results of plasmid elimination showed 11 strains carried resistant plasmids,and the one with 38 kb was a popular plasmid.The endonuclease profiles revealed that the same source strains had certain homology,there were similiar endonuclease profiles among strains in different wards.CONCLUSIONS The popular plasmids in different wards have certain homology,and they can be transferred among different strains of bacteria.

Abstract On 18 May 2021, the Center for Disease Control and Prevention (CDC) of X District in P City, Z Province received a co-investigation of a suspected case of intentional HIV transmission from the public security branch, and conducted epidemiological investigations on Zhao and Wang (both males). Wang was confirmed HIV-positive in 2019. Zhao had unprotected sexual encounters several times with Wang in March 2021 without being informed of Wang's HIV infection. Zhao developed fever, sore throat and other symptoms of acute infection phase on 28 March, and were confirmed HIV positive by the CDC of P City on 11 May. Zhao did not have sex with anyone else before or after having sex with Wang. In addition, Zhao had no history of surgery, blood transfusions, drug use or any other history of HIV exposure. Laboratory tests conducted by the CDC of Z Province showed that the HIV nucleic acid sequences between the samples of Zhao and Wang had a high degree of homology. Combined with the epidemiological investigation, laboratory testing and the evidence from the public security branch, it was concluded that Wang intentionally transmitted HIV to Zhao through unprotected anal sex without disclosing his HIV infection status.

Objective: To explore the application of asymmetrical sculpture in the ear reconstruction with autologous cartilage through comparing the difference of the balanced sculpture and asymmetrical sculpture. Methods: We used the method of retrospective survey and classified the patients who had undergone ear reconstruction because of microtia into two groups. Group A included the patients who had undergone operation with the application of balanced sculpture method. Group B included the patients who had undergone operation with the application of unsymmetrical sculpture method. We picked out 35 patients containing 19 patients of group A and 16 patients of group B according to our grouping criteria and exclusion criteria. The number of cases with complications was recorded, such as collapse of framework, exposure of cartilage, necrosis of skin flap and reconstructed ear infection. The clinical outcomes of two methods in refining the delicate structures of the reconstructed ear were evaluated (that is the definition, shape, size, color and projection). The time for sculpture was compared. Then we analysed the results and evaluated the effectiveness, safety and feasibility of asymmetrical sculpture′s application in the ear reconstruction. Results: Group A had 2 cases which suffered skin flap necrosis. One of them had cartilage exposure and then had secondary infection leading to local cartilage necrosis and absorption, but after active treatment and local skin flap transplantation it was cured. Group B had no skin flap necrosis, cartilage extrusion, framework deformation and distortion, framework collapse and necrosis or absorption. Group B had a higher score in definition, shape, size, color and projection, and the difference was significant in definition, shape, color and projection. In our clinical practice, the sculpture time in both group was similarly about 40 minutes after the surgery operator had skillfully mastered both techniques. Conclusions Both methods are safe and feasible. The method of asymmetrical sculpture does not require additional operative time, and the method of asymmetrical sculpture is a better one compared with the method of balanced sculpture in refining the reconstructed ear.

Objective: To compare the clinical efficacy and patient satisfaction of 755 nm semiconductor laser for hair removal during different stages of auricular reconstruction. Methods: From July 2016 to September 2018, 86 patients who had ear reconstruction underwent 755 nm semiconductor laser for auricle hair removal in plastic surgery department of Tongji hospital affiliated to Tongji medical college of Huazhong university of science and technology. There were 39 males and 47 females with an average age 12 years old(from 6 to 28 years old). 28 cases were left ear, 58 cases were right ear. With random grouping, 40 patients underwent auricle hair removal treatment after posterior ear tissue expander implantation (post-operation of stage Ⅰ depilation group) and 46 patients underwent treatment after auricular reconstruction (post-operation of stage Ⅱ depilation group). Auricle hair removal treatments(pulse width 10-20 ms, wave length 755 nm, spot size 10 mm×15 mm, energy density 4-8 J/cm²) were respectively started at different intervention time. Each treatment time were 5-10 minutes. The end of the treatment was slight redness or edema of the local hairy follicle. The treatment was repeated every 4 weeks with a total of 5 times. The number of adverse reactions was recorded as while as the hair density, hair clearance rate and patient satisfaction before treatment and 6 months after the 5th depilation. Results: Patients in both groups successfully were completed the treatment and were followed up to about 6 months (23 to 25 weeks) after the last depilation treatment. There were only 2 cases with scratch in skin preparation and 2 cases with blisters in the postoperative of stage Ⅱ group. None of the other patients had adverse reactions. Hair density after treatment (27.63±7.75 bar/cm²) was less than before treatment (84.55±13.68 bar/cm²) in post-operation of stage Ⅰ depilation group. Hair density after treatment was 40.52±5.92 bar/cm² in post-operation of stage Ⅱ depilation group, less than before treatment (74.78±11.19 bar/cm²). The differences were statistically significant (both P<0.001). After hair removal, the hair density of post-treatment in the post-operation of stage Ⅰ depilation group was less than the post-operation of stage Ⅱ depilation group. The difference was statistically significant (P=0.000). The hair clearance rate of the post-operation of stage Ⅰ (67.32%) was higher than the post-operation of stage Ⅱ(45.81%). The difference was statistically significant (P<0.001). Patients’ satisfaction was 87.5% in the post-operation of stage Ⅰ and 69.5% in the post-operation of stage Ⅱ. The former was superior to the latter. Conclusions Auricle hair removal with semiconductor 755 nm laserstarted at stage Ⅰ that posterior ear tissue expander was implanted has more favorable clinical efficacy, and higher patient’s satisfaction rate.

Objective To reduce the cancer burden in the Jinchang cohort and provide evidence for developing cancer prevention strategies and performing effectiveness evaluation in the Jinchang cohort.We are fitting thirteen years of cancer mortality data from the Jinchang cohort by using six kinds of predicting methods to compare relative fitness and to select good predicting methods for the prediction of cancer mortality trends.Methods The mortality data of cancer in Jinchnag cohort from 2001-2013 were fitted using six kinds of predicting methods:dynamic series,linear regression,exponential smoothing,autoregressive integrated moving average (ARIMA) model,grey model (GM),and Joinpoint regression.Weight coefficients of combination models were calculated by four methods:the arithmetic average method,the variance inverse method,the mean square error inverse method,and the simple weighted average method.Results The cancer mortality was fitted and compared by using six kinds of forecasting methods;the fitting precision of the Joinpoint linear regression had the highest accuracy (87.64％),followed by linear regression (87.32％),the dynamic series (86.99％),GM (1,1) (86.25％),exponential smoothing (85.72％) and ARIMA (1,0,0) (81.98％),respectively.Prediction accuracy of the combination model derived from GM (1,1) and linear regression (＞99％) was higher than that of the combination model derived from ARIMA (1,0,0) and GM (1,1).The combination model derived from the GM (1,1) and linear regression,with weight coefficients based on the arithmetic average method and the mean square error inverse method,had the best prediction effect of the four weight calculation methods.Conclusion Prediction accuracy of the combination model,with accuracy ＞95％,was higher than that of the single prediction methods.

Objective To investigate the effect of helix and antihelix skin degloving technique in correction surgery of prominent ears.Methods Twenty-three cases of prominent ears were corrected by helix and antihelix skin degloving technique.The clinical results were observed.Results All the prominent ears were corrected with natural appearance and good symmetry results.The distance from the helix to the skull was decreased obviously (P ＜ 0.05).Cranial ear angle,the angle of helix and ear boat were significantly reduced (P ＜ 0.05).No complications such as infection,hematoma,skin flap necrosis and deformity recurrence occurred.Conclusions The auricle skin degloving technique has advantages of exact suture position,good shape,no obvious cartilage hurt and simple operation procedure.

Objective To explore the potential influencing factors and complex pathways affecting rehabilitation effect for children with autism spectrum disorder(ASD)from the perspective of parental efficacy in doctor-patient communication,and to provide evidence for improving the quality of rehabilitation service for children with ASD. Methods An anonymous face-to-face questionnaire survey was conducted to collect general demographic information of parents of children with ASD at designated rehabilitation institutions in Gansu province.The data included paren-tal efficacy in doctor-patient communication,parental compliance of treatment and children's rehabilitation out-comes were collected.A structural equation model was used to explore the impact mechanism of parental commu-nication efficacy on the rehabilitation outcomes of children with ASD. Results Data from 519 parents at 37 rehabilitation institutions across 13 cities/counties in Gansu province were collect-ed.Significant positive correlations were found between parental efficacy in doctor-patient communication,doc-tor-patient relationships,parental compliance with treatment and rehabilitation outcomes for children with ASD(P＜0.05).Through structural equation model analysis,the standardized direct effect of children with ASD from parents'doctor-patient communication efficacy was 0.151(P=0.023).The mediating effect of doctor-patient rela-tionship and parental compliance with treatment were 0.160(P=0.001)and 0.111(P=0.001),respectively,with a chained mediating effect of 0.035(P=0.001).The pathway"parental efficacy in doctor-patient communica-tion → doctor-patient relationship → ASD child's rehabilitation outcome"accounted for the highest proportion of the total mediating effect,at 52.29%. Conclusion Parental doctor-patient communication efficacy may positively impact on the rehabilitation outcomes of chil-dren with ASD directly,and indirectly through the doctor-patient relationship and parental compliance with treat-ment.Rehabilitation institutions should focus on fostering parental communication skills and enhancing high-quality and humanized rehabilitation services.

Objective:To construct an Internet + linkage model based on medical alliance and evaluate its implementation effect.Methods:From October 2020 to June 2021, convenience sampling was used to select 132 patients with malignant tumors who were treated with peripherally inserted central catheters (PICC) chemotherapy and discharged with catheters in Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine. The 67 patients who returned to the PICC outpatient clinic of Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine during the treatment interval for PICC maintenance were set as the control group, and the routine maintenance method was adopted. A total of 65 patients who chose maintenance points near their residence for PICC maintenance during the treatment interval were set as the observation group. On the basis of the control group, the maintenance method based on the Internet + linkage mode of medical alliance was adopted. The PICC self-management ability, catheter-carrying satisfaction, PICC complication, average cost and average time spent on PICC maintenance during treatment were compared between the two groups.Results:There were no significant differences in the scores of daily life with catheters, exercise with catheters, catheter abnormality handling, compliance with catheter maintenance and confidence in catheter management between the two groups ( P>0.05) . There was no significant difference in the scores of Catheter Satisfaction Survey in the two groups of patients ( P>0.05) .There was also no significant difference in the incidence of PICC complications between the two groups ( P>0.05) . The registration fee, maintenance fee, and transportation fee for PICC maintenance in the observation group were lower than those in the control group, and the round-trip time and visit time were shorter than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The Internet + linkage model based on the medical alliance can ensure the quality of PICC maintenance for patients with malignant tumors undergoing PICC chemotherapy and discharged with catheters, and improve their PICC self-management ability, which has good economic and time benefits.

Objective:To construct a diabetes foot prediction model for adult patients with type 2 diabetes based on retrospective cohort study using data from a regional health data platform.Methods:Using Yinzhou Health Information Platform of Ningbo, adult patients with newly diagnosed type 2 diabetes from January 1, 2015 to December 31, 2022 were included in this study and divided randomly the train and test sets according to the ratio of 7∶3. LASSO regression model and bidirectional stepwise regression model were used to identify risk factors, and model comparisons were conducted with net reclassification index, integrated discrimination improvement and concordance index. Univariate and multivariate Cox proportional hazard regression models were constructed, and a nomogram plot was drawn. Area under the curve (AUC) was calculated as a discriminant evaluation indicator for model validation test its calibration ability, and calibration curves were drawn to test its calibration ability.Results:No significant difference existed between LASSO regression model and bidirectional stepwise regression model, but the better bidirectional stepwise regression model was selected as the final model. The risk factors included age of onset, gender, hemoglobin A1c, estimated glomerular filtration rate, taking angiotensin receptor blocker and smoking history. AUC values (95% CI) of risk outcome prediction at year 5 and 7 were 0.700 (0.650-0.749) and 0.715(0.668-0.762) for the train set and 0.738 (0.667-0.801) and 0.723 (0.663-0.783) for the test set, respectively. The calibration curves were close to the ideal curve, and the model discrimination and calibration powers were both good. Conclusions:This study established a convenient prediction model for diabetic foot and classified the risk levels. The model has strong interpretability, good discrimination power, and satisfactory calibration and can be used to predict the incidence of diabetes foot in adult patients with type 2 diabetes to provide a basis for self-assessment and clinical prediction of diabetic foot disease risk.

Objective:To develop a prediction model for the risk of diabetic retinopathy (DR) in patients with newly diagnosed type 2 diabetes mellitus (T2DM).Methods:Patients with new diagnosis of T2DM recorded in Yinzhou Regional Health Information Platform between January 1, 2015 and December 31, 2022 were included in the study. The predictor variables were selected by using Lasso-Cox proportional hazards regression model. Cox proportional hazards regression models were used to establish the prediction model for the risk of DR. Bootstrap method (500 resamples) was used for internal validation, and the performance of the model was assessed by C-index, the receiver operating characteristic curve and area under the curve (AUC), and calibration curve.Results:The predictor variables included in the final model were age of T2DM onset, education level, fasting plasma glucose, glycated hemoglobin A1c, urinary albumin, estimated glomerular filtration rate, and history of lipid-lowering agent and angiotensin converting enzyme inhibitor uses. The C-index of the final model was 0.622, and the mean corrected C-index was 0.623 (95% CI: 0.607-0.634). The AUC values for predicting the risk of DR after 3, 5, and 7 years were 0.631, 0.620, and 0.624, respectively, with a high degree of overlap of the calibration curves with the ideal curves. Conclusion:In this study, a simple and practical risk prediction model for DR risk prediction was developed, which could be used as a reference for individualized DR screening and intervention in newly diagnosed T2DM patients.