To compare the economic efficacies of the oral antidiabetic drugs in National Essential Medicine for treating type 2 diabetes mellitus.200 diabetic patients with body mass indices between 19-27 kg/m2 were assigned into 5 groups:group A received glibenclamide,group B glipizide,group C metformin,group D glibenclamide +metformin,and group E glipizide + metformin.Pharmacoeconomic evaluation was performed by cost-effectiveness analysis( CEA ).Fasting glucose level in patients treated with these 5 drugs all decreased significantly,as well as HbA1c.Glibenclamide was more in line with the principles of pharmacoeconomics,but should be used carefully for its serious and prolonged hypoglycemia,especially in elderly patients.According to the method of cost-effectiveness analysis,it was more economical to use metformin to control fasting glucose level while it is more reasonable to use glipizide to control the postprandial glucose whereas controlling of postprandial blood glucose is considered as a priority.Glipizide+mefformin combination may be recommended to the patients whose blood glucose level is poorly controlled by a single drug alone.

Objective To observe the effect of pravastatin on the expression of heat shock protein B7 (HSPB7) in acute myocardial infarction (AMI) rats. Methods A total of 80 AMI rats were randomly divided into AMI group and pravas-tatin (P) group. Forty SD rats were used as sham operation (SH) group. Rats were then subdivided into 1 h, 3 h, 6 h and 12 h subgroups (10 for each group). Rats were not ligated after thoracotomy in SH group. The 1eft anterior descending coronary ar-tery was ligated in rats of AMI group. The 1eft anterior descending coronary artery was ligated in P group and given intragas-tric administration of 0.5 mg/(kg · d) pravastatin. The other groups were given the same amount of normal saline via gavage. The left ventricle infarcted myocardial tissues were taken at each time intervals. The corresponding myocardial tissues were harvested in sham-operated rats. The HSPB7 mRNA and protein expressions were measured by RT-PCR and immunohisto-chemistry respectively.Results The expression levels of HSPB7 mRNA and protein were significantly higher in the AMI group and P group than those of SH group(P<0.01). The expression levels of HSPB7 mRNA and protein were significantly increased 1 h after AMI and reached the peak value at 3 h after AMI. The expression levels of HSPB7 mRNA and protein were still higher in 6-h group and 12-h group than those of SH group. The expression levels of HSPB7 were higher in differ-ent time points of P group than those of AMI group. Conclusion HSPB7 could express in the early stage of acute myocardi-al infarction in rats. Pravastatin could promote the upregulation of HSPB7 in myocardial infarcted border zone after AMI, which may play a protective role in early myocardial infarction.

Abstract: Objective To summarize the clinical characteristics of 35 patients with human monkeypox in Chengdu City, in order to provide theoretical basis for prevention and control of monkeypox epidemic in China. Methods A total of 35 patients diagnosed with monkeypox infection by Chengdu CDC from July 1 to July 23, 2023 were included in our study. The results of general clinical data, blood laboratory tests, lymph node ultrasound and chest CT results were collected in order to analyze the clinical features of human monkeypox patients in Chengdu City. Results All 35 monkeypox patients were young adult males, and there were no serious or fatal cases. Among them, 32 cases (91.4%) were men who have sex with men (MSM), and 30 cases had engaged in male-to-male sexual behavior within 21 days prior to the onset of the disease, of which 13 cases had taken protective measures. Fever symptoms were observed in 26 cases (74.3%) of the patients, with 19 cases experiencing fever within 1-6 days after the appearance of rash. The initial rash commonly occurred in the male external genitalia. Color ultrasound examinations indicated that all patients had swollen inguinal lymph nodes. C-reactive protein was elevated in 26 cases (74.3%) of patients, and 19 cases showed CD3+CD4+T/CD3+CD8+T< 1.0. 15 cases (42.8%) of the patients were infected with both monkeypox virus and HIV, 28.5% (10/35) of patients had concomitant skin infections and anorectal proctitis,respectively. The mean time from rash onset to the shedding of rash scabs was 14.8 days. Conclusions The MSM population in sexually active age group is the main infection object of human monkeypox virus. In monkeypox patients in Chengdu City, the rash starting at genital areas and rash occurring before systemic symptoms were common. Swollen inguinal lymph nodes are especially common in monkeypox patients. Skin infection and anorectal proctitis are the most common complications in monkeypox patients in Chengdu City. The abnormal cellular immune function in monkeypox patients is mainly reflected in the inverted ratio of CD3+CD4+T/CD3+CD8+T. Currently, there is no evidence to suggest that protective measures during male-to-male sexual behavior can reduce the risk of human monkeypox infection.

Objective To investigate the surgical procedure,complication and cosmetic effects of tissue expander in immediate breast reconstruction after nipple sparing mastectomy(NSM).Methods From Jul.2014 to Apr.2018,the clinical data of 23 breast cancer patients (two patients were bilateral) undergoing NSM and expander immediate breast reconstruction were analyzed retrospectively.Results All of the 25 procedures were NSM plus expander based immediate breast reconstruction.The overall complication rate was 12％,including:one seroma,one mild nipple necrosis and one nipple malposition.The median follow up period was 12 months,no grade Ⅲ or Ⅳ contractures were found.Appearance satisfaction was applied to the Harvard scoring system,doctor score:fair(2 cases;8％),good(2 cases;8％),excellent(21 cases;84％);patient score:good(4 cases;16％),excellent(21 cases;84％).No local recurrence was observed.Conclusion NSM with lateral incision and immediate reconstruction was found to be technically feasible and associated with few complications and satisfactory esthetic outcomes.

Objective To evaluate the impact of clinical and pathological factors on incidence and prognosis of brain metastasis from breast cancer.Methods The clinical data of 4473 stage Ⅳ breast cancer patients were collected from The Surveillance,Epidemiology,and End Results (SEER) database.All these patients were divided into brain metastasis group (n=345) and non-brain metastasis group (n=4 128).The clinical and pathological factors between the two groups were compared using x2 test and binary Logistic regression.The OS of 345 brain metastasis patients was calculated using the Kaplan-Meier method and impact of clinical and pathological factors on the survival rate was analyzed by Log-rank method.Multivariate Cox regression model was used to find out the independent risk factors.Results Between brain metastasis group and non-brain metastasis group,these following clinical and pathological factors showed the scatistical significance on brain metastasis:age,histological grade,T stage,N stage,ER,PR and HER expression (P＜0.05).Binary Logistic regression results showed that age,T stage,N stage,ER,PR were independent factors affecting brain metastasis (P＜0.05).The prognosis analysis showed that marital status,histological grade,ER,PR,molecular subtype,radiotherapy and chemotherapy,surgery at primary lesions,surgery at metastasis site,liver metastasis,lung metastasis and numbers of other organs metastasis were significantly correlated with the survival of breast cancer patients with brain metastasis (P＜0.05).Cox regression analysis showed that histological grade,ER,PR,molecular subtype,radiotherapy and chemotherapy,surgery at primary lesions,surgery at metastasis site were independent prognostic factors in breast cancer patients with liver metastasis.Conclusions Breast cancer patients with brain metastasis have a poor prognosis.Molecular subtype should be considered for prediction of prognosis for patients with brain metastasis.Radiotherapy and surgery at metastasis or primary site may improve survival of patients.

OBJECTIVE: To explore the expression of mRNA and its protein in burned rats and their effects on burn wound healing. METHODS: A partial-thickness burn of 30% total body surface ar ea was created on the back of 40 Wistar rats. In situ hybridization and immunohi stochemical methods were used to evaluate the location and the amount of the c-fos mRNA and its protein in normal skin and the burned skin, respectively, at 3 h, 6 h, 1 d, 3 d, 7 d and 14 d after burn. RESULTS: Under a light microscope, both the expression of c-fo s mRNA and its protein could be found in the normal skin, but their induction le vels were much higher in the burned skin. The level of fos protein expression reached peak at 3 h after burn while that of c-fos mRNA reached peak at 6 h aft er burn. CONCLUSIONS: The expression of c-fos can be induced by burns. And the peak level expression of c-fos mRNA comes later than that of c-fos p rotein. It indicates that the action of fos protein is induced by post-translat ional modification of pre-existing fos molecules.

Objective:To investigate the status of the professional construction of head nurses in the tertiary hospitals of Shandong Province, and to master the professional cognition and attitude of the head nurses, and to provide reference for the formulation of the professional construction plan for the head nurses in the tertiary hospitals.Methods:A cross-sectional survey of 2 629 head nurses from 55 tertiary hospitals in Shandong Province was conducted using a self-designed questionnaire survey on the status of professional construction of head nurses in tertiary hospitals in Shandong Province.Results:The selection and training system of the head nurses in the tertiary hospitals in Shandong Province was mature. 93.00%(2 357/2 534) of the head nurses were undergraduate degrees, 18.40%(465/2 534) of the head nurses used all the working hours for nursing management, and 86.00%(2 179/2 534) were the main economic sources with the current position; 68.20%(1 728/2 534) were believed that the head nurse should be a trained nurse, 87.90%(2 227/2 534) thought that the head nurse′s professional construction was necessary, and the professional feasibility score was 77.93±19.75. The regression analysis showed that the factors affecting the head nurse′s own professional construction were age, satisfaction with salary satisfaction and self-worth ( P<0.05); 32.50%(257/791) of the head nurses suggested improving the management training system, 20.61%(163/791) recommended that the hospital should pay attention to the professional construction of the head nurse, and 7.33%(58/791) recommended establishing the standardization of professional standards. Conclusions:To improve the investment time of the head nurses and encourage the head nurses to continue the education management; the hospital should appropriately reduce the age requirements of the head nurses and improve the salary; establish a sound professional system and management training system for the head nurses, and comprehensively recommend the head nurses. Promote the professional development of the head nurse team

Objective To investigate the susceptibility and resistance of clinical isolates from hospitals in several regions of China .Methods Fifteen general hospitals and two children′s hospitals were involved in this program . Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby‐Bauer method or automated systems .Results were analyzed according to CLSI 2014 breakpoints .Results A total of 78 955 clinical isolates were collected from January to December 2014 ,of which gram negative organisms and gram positive cocci accounted for 72 .6% and 27 .4% ,respectively . Methicillin‐resistant strains in S .aureus(MRSA)and coagulase negative Staphylococcus(MRCNS)accounted for an average of 44 .6% and 83 .0 % ,respectively .The resistance rates of methicillin‐resistant strains to β‐lactams and other antimicrobial agents were much higher than those of methicillin‐susceptible strains .However ,92 .0% of MRSA strains were still susceptible to trimethoprim‐sulfamethoxazole ,while 85 .6% of MRCNS strains were susceptible to rifampin .No staphylococcal strains were found resistant to vancomycin ,teicoplanin or linezolid .In Enterococcus spp .,the resistance rates of E .f aecalis strains to most tested drugs (except chloramphenicol) were much lower than those of E . f aecium .Some strains of both species were resistant to vancomycin .Vancomycin resistant strains of E . f aecalis and E . f aecium were mainly V anA ,V anB or V anM type based on their phenotype or genotype .Regarding non‐meningitis S .pneumoniae strains ,the prevalence of penicillin‐susceptible S .pneumoniae strains isolated from both adults and children were higher than those isolated in 2013 ,but the prevalence of penicillin‐intermediate S . pneumoniae or penicillin‐resistant S . pneumoniae strains decreased . The prevalence of ESBLs producingstrainswas55.8% in E.coliand29.9% in Klebsiellaspp.(K.pneumoniaeand K.oxytoca)and24.0% in Proteus mirabilis isolates on average . ESBLs‐producing Enterobacteriaceae strains were more resistant than non‐ESBLs‐producing strains in terms of antibiotic resistance rates . The strains of Enterobacteriaceae were still highly susceptible to carbapenems .Overall less than 10 % of these strains were resistant to carbapenems . About 62 .4% and 66 .7% of Acinetobacter spp .(A .baumannii accounts for 93 .0 % ) strains were resistant to imipenem and meropenem ,respectively . Compared with the data of year 2013 ,extensively‐drug resistant strains in K . pneumoniae and A .baumannii increased . Conclusions The antibiotic resistance of clinical bacterial isolates is growing .The disseminated multi‐drug or pan‐drug resistant strains in a special region poses a serious threat to clinical practice and implies the importance of strengthening infection control .

Objective To evaluate the changing pattern of antibiotic resistance inKlebsiella strains isolated from the patients in 19 hospitals across China based on the data from CHINET Antimicrobial Resistance Surveillance Program during the period from 2005 through 2014.Methods Kirby-Bauer disk diffusion and automated susceptibility testing methods were used to test the susceptibility ofKlebsiella isolates to the commonly used antibiotics. The results were interpreted according to the criteria of the Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing (CLSI-2014).Results A total of 61 406Klebsiella strains were identified between 2005 and 2014, includingK. pneumoniae (56 281 strains), K. oxytoca(4 779),Klebsiella pneumoniae subsp.Ozaenae (300) and otherKlebsiella species (46). Most (89.0%, 54 664/61 406) of theKlebsiella strains were isolated from inpatients, and 60.0% (36 835/61 406) were from respiratory tract speciems. About 16.7% (10 248/61 406) of the strains were isolated from pediatric patients aged 0-17 years and 83.3% (51 158/61 406) from adult patients. The prevalence ofKlebsiella spp. increased with time from 10.1% in 2005 to 14.3% in 2014. Based on the surveillance data during the 10-year period, we found a marked increase of resistance to imipenem (2.9% to 10.5%) and meropenem (2.8% to 13.4%) inKlebsiella spp. The prevalence of ESBLs-producing isolates inK. pneumoniae andK. oxytoca decreased from 39.0% in 2005 to 30.1% in 2014. The resistance to amikacin, ceftazidime, ciprolfoxacin, pipracillin-tazobactam and cefoperazone-sulbactam was on decline. The resistance rate to cefotaxime remained high about 49.5%. Carbapenem resistantance was identiifed in 5 796 (9.4%) of the isolates, including 5 492 strains ofK. pneumoniae and 280 strains ofK. oxytoca. Overall, 4 740 (7.8%) strains were identiifed as extensively-drug resistant (XDR), including 4 520 strains ofK. pneumoniae and 202 strains ofK. oxytoca. The carbapenem-resistant strains showed high (>60%) resistance rate to majority of the antimicrobial agents tested, but relatively low resistance to tigecycline (16.8%), amikacin (54.4%), and trimethoprim-sulfamethoxazole (55.5%).Conclusions During the 10-year period from 2005 through 2014, carbapenem resistance amongKlebsiella isolates has increased dramatically in the hospitals across China. The level of resistance to other antibiotics remains stable.

Objective To investigate the susceptibility and resistance of clinical isolates collected from hospitals in several regions of China . Methods Fourteen general hospitals and two children ’ s hospitals were involved in this program . Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated Systems .Results were analyzed according to CLSI 2013 breakpoints .Results A total of 84 572 clinical isolates were collected from January to December 2013 ,of which gram negative organisms and gram positive cocci accounted for 73 .0% and 27 .0%respectively .Methicillin-resistant strains in S .aureus (MRSA) and coagulase negative Staphylococcus (MRCNS) accounted for an average of 45 .2% and 73 .5% respectively .The resistance rates of methicillin-resistant strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible strains .However ,92 .2% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole while 87 .4% of MRCNS strains were susceptible to rifampin . No staphylococcal strains were found resistant to vancomycin ,teicoplanin or linezolid .In Enterococcus spp .,the resistance rates of E . f aecalis strains to most tested drugs (except chloramphenicol) were much lower than those of E . f aecium .Some strains of both species were resistant to vancomycin .Vancomycin-resistant strains of E . f aecalis and E . f aecium were mainly VanA type based on their phenotype .Regarding non-meningitis S . pneumoniae strains ,the prevalence of penicillin-susceptible S . pneumoniae and penicillin-intermediate S . pneumoniae strains isolated from both adults and children were lower than those isolated in 2012 ,but the prevalence of penicillin-resistant S .pneumoniae strains increased .The prevalence of ESBLs producing strains was 54 .0% in E .coli ,31 .8% in Klebsiella spp .(K .pneumoniae and K .oxytoca) and 16 .5% in Proteus mirabilis isolates on average . ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLs-producing strains in terms of antibiotic resistance rates .The strains of Enterobacteriaceae were still highly susceptible to carbapenems .Overall less than 7 .0% of these strains were resistant to carbapenems .About 62 .8% and 59 .4% of Acinetobacter spp .(A .baumannii accounts for 89 .2% ) strains were resistant to imipenem and meropenem ,respectively .Compared with the data of year 2012 , extensively-drug resistant strains in K . pneumoniae and A . baumannii decreased .Conclusions The antibiotic resistance of clinical bacterial isolates is growing in 2013 .The disseminated multi-drug or pan-drug resistant strains in a special region poses a serious threat to clinical practice and implies the importance of strengthening infection control .