ObjectiveTo investigate the association between variant degree of sarcopenia and all-cause mortality in Chinese elderly residents, and to provide insights into the prevention and control of sarcopenia in the elderly population. MethodsData from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 and 2020 were analyzed, and a total of 2 792 subjects aged 65 years or older were selected according to the inclusion and exclusion criteria. Univariate and multivariate Cox proportional hazards regression analysis were performed to explore the potential factors influencing all-cause mortality among the elderly in China, and Kaplan-Meier curves were used to visualize the survival of elderly people with variant degree of sarcopenia. Finally, a multiple-adjusted Cox proportional hazards regression model was used to control the confounding factors and explore the association between sarcopenia and all-cause mortality. ResultsBefore adjusting potential covariates, univariate and multivariate Cox proportional hazards regression models showed that 10-year all-cause mortality was significantly associated with variant degree of sarcopenia, namely possible sarcopenia (HR=1.40, 95%CI: 1.1‒1.68, P<0.001), mild-to-moderate sarcopenia (HR=1.49, 95%CI:1.20‒1.86, P<0.001), and severe sarcopenia (HR=1.68, 95%CI: 1.29‒2.19, P<0.001); after adjusting all confounders, 10-year all-cause mortality remained to be significantly associated with variant degree of sarcopenia, including probable sarcopenia (HR=1.38, 95%CI: 1.15‒1.66, P<0.001), mild-to-moderate sarcopenia (HR=1.48, 95%CI: 1.19‒1.84, P<0.001) and severe sarcopenia (HR=1.71, 95%CI: 1.31‒2.23, P<0.001). ConclusionIn Chinese elderly residents, sarcopenia is positively associated with an increased risk of 10-year all-cause mortality, and the progression of sarcopenia is positively associated with an increased risk of death.

Objective:To retrieve, evaluate, and integrate domestic and foreign evidence on the prevention of central venous access device medical adhesive-related skin injury (CVAD-MARSI) , and analyze and summarize the best evidence, so as to provide a reference for establishing a sound intravenous infusion treatment system and CVAD-MARSI management mechanism.Methods:Evidence-based nursing methods were applied, and the evidence on the prevention of CVAD-MARSI in British Medical Journal (BMJ) Best Practice, UpToDate, Australia Joanna Briggs Institute (JBI) Evidence-Based Practice Database, Canada Registered Nurses' Association of Ontario, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence, Cochrane Library, Intravenous Nurses Society, PubMed, Medlive, Chinese Biomedical Literature Database, Wanfang Data, China National Knowledge Infrastructure (CNKI) was retrieved according to the "6S" model system. The evidence included guidelines, best practices, systematic reviews, expert consensus, and evidence summary. The search time limit was from January 1, 2011 to February 1, 2021. Two researchers independently completed the quality evaluation of the included literature, and carried out the evidence extraction and summary of literature that met the quality standards.Results:A total of 10 articles were included, including 3 guidelines, 1 systematic review, 5 expert consensuses, and 1 evidence summary. The best evidence covered 5 aspects including patient evaluation, skin preparation, dressing use, improvement of comfort, and organization management, with a total of 26 pieces of evidence.Conclusions:Clinical medical and nursing staff can take measures in terms of patient evaluation, skin preparation, dressing use, improvement of comfort, and organization management. In the process of evidence application, the best targeted evidence should be selected combined with the clinical situation, so as to reduce the harm of CVAD-MARSI.

Objective:To investigate the drug resistance and pathogenic mechanism of a uropathogenic Escherichia coli (UPEC) strain UPEC132 at the genome-wide level. Methods:The susceptibility of UPEC132 strain to 16 antimicrobial agents was determined by minimum inhibitory concentration (MIC) assay. The UPEC132 strain was genotyped by multilocus sequence typing (MLST). The three-generation sequencing platform was used to sequence and assemble the whole genome of the UPEC132 strain. Drug resistance and virulence gene function annotations were predicted by Prodigal software and screened by using genome database. Genome sequences of the UPEC132 strain and 23 other UPEC strains collected from GenBank were phylogenetically analyzed, and a phylogenetic tree was constructed by RAxML software.Results:The UPEC132 strain was resistant to ampicillin, ampicillin/sulbactam, tetracycline, erythromycin, chloramphenicol and cefazolin. Its genotype was ST10522 by MLST. The whole genome of the UPEC132 strain included one complete genome (chromosome) and two plasmid sequences. The sequence sizes of the chromosome and plasmids 1 and 2 were 5 234 468 bp, 117 139 bp and 101 356 bp, and the guanine-cytosine (GC) content was 50.48%, 49.05%, and 54.04%, respectively. There were 4 856, 140 and 116 genes annotated in the chromosome and plasmids 1 and 2, respectively. Drug resistance genes were mainly distributed in the chromosomal genome, mainly including the multidrug resistance efflux pump gene clusters. Only blaTEM-1 and tetG genes were carried in the plasmid 2. Virulence genes were also mainly distributed in the chromosome genome, including nine pilus adhesins, five iron uptake systems and three secretory toxins. Gene clusters encoding Afa and type Ⅳ fimbriae were located on plasmids 1 and 2, respectively. The phylogenetic tree showed that the UPEC132 strain was not in the same branch with either of the 23 UPEC strains. Conclusions:The UPEC132 strain belonged to ST10522, which was a newly named ST type of Escherichia coli and first reported at home and abroad. The genome-wide genetic information of the UPEC132 strain was fully revealed. The multidrug resistance genes and virulence genes carried by the UPEC132 strain were associated with its drug resistance and pathogenicity.

On October 23, 2017, a 52-year-old male patient with 3 recurrences of dermatofibrosarcoma protuberans in the left shoulder and chest was admitted to the Department of Burns and Plastic Surgery of Dali Bai Autonomous Prefecture People′s Hospital. Dermatofibrosarcoma protuberans on the skin were completely resected, leaving wound defect of 10 cm×10 cm. The wound was planned to be repaired by the transplantation of right anterolateral thigh perforator free flap. However, the anterolateral thigh perforator branch was absent during flap removal, and only one small perforating branch was found. Moreover, it was difficult to separate. Therefore, this flap cutting was given up. The anteromedial thigh perforator was explored through the same incision, and a thicker perforator was found, which was supplied by an independent iatrogenic artery. The length and diameter of the vascular pedicle matched with the blood vessels in the receiving site. An anteromedial thigh perforator flap (10 cm×10 cm) was cut to repair the defect. The postoperative 9-month follow-up revealed that the color, texture, and thickness of the flap were good, the two-point discrimination distance was 30 mm, and the linear scar remained at the donor site of right thigh.

Objective To analyze the characteristics of antibiotic resistance in group A Streptococ-cus ( GAS) strains isolated from children with scarlet fever in Tianjin in order to provide reference for clinical drug administration. -ethods GAS strains were collected from 2011 to 2016. A total of 276 isolates were analyzed by antibiotic susceptibility test and emm typing. Results All of the isolates were susceptible to penicillin, cefazolin and vancomycin, while 98. 2％ were susceptible to both chloramphenicol and levofloxa-cin. The resistance rates to azithromycin, erythromycin, clarithromycin, clindamycin and tetracycline were 97. 8％, 97. 1％, 94. 2％, 94. 2％ and 79. 3％. The concomitant resistance to erythromycin, azithromycin, clarithromycin, clindamycin and tetracycline was 73. 2％. The resistance rates of GAS strains isolated from different years to tetracycline, clindamycin, clarithromycin, erythromycin and azithromycin were significantly different. A statistically significant difference was found between the percentages of emm12 and emm1 strains resistant to tetracycline (84. 0％ vs 59. 5％, χ2=13. 820, P=0. 000). Conclusions The isolated GAS strains are sensitive toβ-lactams and highly resistant to macrolide antibiotics, clindamycin and tetracycline. Penicillin remains the preferred treatment for GAS infection and cephalosporins may be used as a substitute if the patient is allergic to penicillin.

Objective To analyze the relationship between the abdominal fat and the progress of carotid atherosclerosis in the subject ageing 51-100 years.Methods 140 subjects receiving health examination in the department of health of Peking Union Medical College Hospital from 2015 to 2016 were included in the research.The abdominal fat area and distribution were calculated according to abdominal CT,and the progress of atherosclerosis in carotid artery was determined by ultrasound.Results In the population of 51-100 years old,there were no statistically significant difference in abdominal fat area and distribution among carotid artery plaque thickening group,arteriosclerosis nori-progressing group and plaque reducing group;In the population of 51-80 years old,the total abdominal fat was significantly higher in carotid artery plaque thickening group than in arteriosclerosis non-progressing group and plaque reducing group (P=0.05,P =0.03),abdominal visceral fat area also increased,but no significant difference was found (P＞0.05),and no significant differences in abdominal fat distribution was found (P＞0.05.Conclusion The less total area of abdominal fat is,the slower the progress of atherosclerosis in carotid artery is in the population of 51-80 years old.

Objective To explore the role and mechanism of inducible nitric oxide synthase inhibitor 1 400W in alleviating ischemia-reperfusion injury of human intrahepatic bile duct epithelial cells.Methods Human intrahepatic bile duct epithelial cells (HIBEC) in logarithmic phase were inoculated into culture plate at an appropriate density.The samples were randomly divided into control group (group C),ischemiareperfusion group (group I/R) and ischemia-reperfusion + 1 400W group (group I/R + 1 400W).Group C was cultured routinely;cells in I/R and I/R + 1 400W groups were placed in a three-gas incubator for 12h for simulating ischemia and then normal culture for 6h for simulating reperfusion.The I/R + 1 400W group had a final concentration of 100 μmol/L of 1 400W before ischemia and hypoxia.After reperfusion,cells and culture medium were collected,CCK 8 was used for detecting cell vitality,microplate method for detecting the content of lactate dehydrogenase (LDH) in culture medium,AnnexinV-FITC/PI double stain for detecting apoptosis level,Western blot for analyzing the expressions of endoplasmic reticulum stress (ERS)related protein cysteinyl aspartic acid protease 12 (caspase-12),glucose regulatory protein 78 (GRP78) C/EBP homologous protein (CHOP) and inducible nitric oxide synthase (iNOS).Results As compared with group C,cell viability significantly decreased in I/R and I/R+ 1 400W groups (53.8％ ± 2.3％ vs.100％,66.5 ％ ± 2.8 ％ vs.100 ％) (P＜0.05) while LDH increased markedly in cell culture medium (287.4 ±9.0U/L vs 120.2 ± 8.7U/L,212.0 ± 8.3U/L vs 120.2 ± 8.7U/L) (P＜0.05).Apoptosis accelerated markedly (41.5％±2.3％ vs5.2％±0.5％,32.7％± 1.8％ vs 5.2％±0.5％) (P＜0.05) and the expressions of caspase-12,GRP78,CHOP and iNOS spiked (P＜0.05);as compared with I/R group,cell viability of I/R+ 1 400W group rose while LDH,apoptosis level,caspase-12,GRP78 and CHOP declined in cell culture medium (P＜0.05).Conclusions 1 400W may alleviate ischemia-reperfusion injury of human intrahepatic bile duct epithelial cells and its mechanism may be correlated with a suppression of endoplasrnic reticulum stress.

Objective: Non-syndromic cleft lip with or without cleft palate (NSCL/P) is a common birth defect with its genetic evidence widely explored. This study explored the potential the parent-of-origin (PoO) effect of WNT pathway on the risks of NSCL/P, using a case-parent trio design. Methods: Data on the single nucleotide polymorphism (SNP) of WNT genes were selected from a genome-wide association study (GWAS). A total of 806 Chinese non-syndromic cleft lip patients, with or without cleft palate (NSCL/P) case-parent trios, were gathered from an international consortium. PoO effect of WNT pathway genes and its haplotypes were explored by log-linear models. Additional Wald tests were performed to assess: a) the heterogeneity of PoO effect between different maternal exposures, b) the interaction between PoO effect, c) maternal exposure to environmental tobacco smoke (ETS), and d) multivitamin supplementation during pregnancy. The threshold for statistical significance was adjusted as 3.47×10^-4, according to Bonferroni correction. Results: After quality control, a total of 144 SNPs within seven genes were included for analyses, among which 8 SNPs were of potential PoO effect (P<0.05). However, none of them achieved the statistical significance after Bonferroni correction. The haplotype rs4074668-rs12725747 (T-A) on WNT9A showed significant PoO effect, based on the haplotype test for PoO (P=2.74×10^-4). In addition, no statistically significant interaction was found in further exploration of this haplotype under environmental exposures as ETS or multivitamin supplementation. Conclusions Genes in the WNT pathway may influence the NSCL/P risks through the potential PoO effect. Particularly, the haplotype rs4074668-rs12725747 (T-A) on WNT9A presented significant PoO effect on NSCL/P, statistically. From this current study, findings on WNT pathway related risks among the NSCL/P, need to be further validated by independent samples in the future.

From November 2015 to July 2017, six patients with skin and soft tissue defects of vulva, vagina, and buttock after resection of vulvar tumors were hospitalized in our unit. All patients were female, aged 45-70 years. Among them, four patients had bilateral defects, and two patients had unilateral defect. The defect area on each side ranged from 6 cm×4 cm to 12 cm×6 cm. Internal pudendal artery perforator " angel wing" island flaps were used to repair and reconstruct the defects. The area of flaps ranged from 7 cm×5 cm to 14 cm×7 cm. The donor sites were sutured directly. All 10 flaps of 6 patients survived. Two patients had local incision infection 3 days after operation. One of the two patients was healed 2 weeks after dressing change, and the other one underwent debridement and suture 1 week after dressing change and was healed 1 week after surgery. Follow-up for 6-12 months after surgery showed no recurrence of tumors, no eversion of vagina, better shape of vulva in bilateral reconstruction cases, and slightly worse symmetry in unilateral reconstruction cases. The skin of the reconstructed area was soft, with sensations of pain, temperature, and touch recovered in varying degrees. The distance of a two-point discrimination was 20-30 mm. Linear scars were left in the flap donor sites, with no impact on squatting or striding. In vaginal examination, 1.5 to 2.0 fingers could be inserted in bilateral reconstruction cases, while 2.0 to 3.0 fingers could be inserted in unilateral reconstruction cases. The anus functioned well during defecation.

Objective To explore the relationship between the body weight and the structure and function of the left ventricle in the elderly inpatients,in order to emphasize the importance of body weight in the health management for elderly patients.Methods A total of 152 elderly inpatients meeting the enrollment criteria and providing informed consent were consecutively recruited.The height,body weight,body mass index (BMI),liver and kidney function,glycosylated hemoglobin,blood lipid,blood uric acid and structure and function of left ventricular were measured by anthropometry,biochemical examination and echocardiography respectively.The clinical characteristics,metabolic parameters,structure and function of left ventricular were compared among the low/normal weight,overweight and obesity groups.The correlation between left ventricular diastolic dysfunction (E/A ≤ 0.7) and the metabolic factors was analyzed.Results The incidences of lower/ normal weight,overweight and obesity in elderly inpatients were 29.6％ (45/152),52.6％ (80/152) and 17.8％ (27/152) respectively.Compared with the lower/normal weight group,the level of systolic blood pressure,glycosylated hemoglobin (P=0.005),left atrial diameter (P =0.000),left ventricular posterior wall dimension (P=0.010),left ventricular diastolic diameter (P=0.010),left ventricular mass (P=0.000),relative wall thickness and septal thickness increased significantly in overweight and obesity groups (all P＜ 0.05).A higher proportion of left ventricular diastolic dysfunction was observed in overweight and obesity groups in the patients aging 60-69 years (P=0.028).There was positive correlation between left ventricular diastolic dysfunction and BMI (P=0.022).Conclusions Overweight/obesity increases the risk of left ventricular diastolic dysfunction among elderly inpatients.The body weight management needs to be strengthened in health management for the elderly patients.