Objective To determine the status of glycemic control in type 2 diabetic patients in Jiangsu province. Methods Survey was conducted among outpatients with type 2 diabetes mellitus from 56 diabetes centers including 23 tertiary hospitals, 18 secondary hospitals and 15 primary hospitals, covering 13 cities in Jiangsu province. Data were obtained by patient interview and by reviewing medical records of the most recent laboratory assessment and clinical examinations. Blood samples were collected during patient′s visits for assessment of HbA1C. Results The mean HbA1Cof 2 966 patients was 7.18%±1.58%. Mean age of patients was(56.4±11.2) years, mean duration of diabetes was(6.3±5.7) years, and mean body mass index was(24.5±3.3) kg/m2. The proportion of good control was 40.2% defined as HbA1C＜6.5%. 42.2% of the patients in the tertiary hospitals, 36.5% of the cases in the secondary hospitals, and 36.2% of cases in the primary hospitals achieved that goal with HbA1C＜6.5%, while age, body mass index, and duration of diabetes revealed no difference among these 3 groups of patients. Conclusions The status of glycemic control in Jiangsu province has been improved as compared with the result from national survey performed 3 years ago. Patients from tertiary hospitals are better controlled than those from secondary and primary hospitals. Structural interventions to improve diabetes care in secondary and primary hospitals are needed.

OBJECTIVES: Atrial fibrillation (AF) contributes to stroke development and progression. We aimed to quantify the mediating role of AF in the causal associations between a wide range of risk factors and stroke via a Mendelian randomization (MR) framework. METHODS: We assessed the associations of 108 traits with stroke and its subtypes in a 2-sample univariable MR approach, then conducted a bidirectional MR analysis between these 108 traits and AF to evaluate the presence and direction of their causal associations. Finally, to further investigate the extent to which AF mediated the effects of eligible traits on stroke, we applied multivariable and 2-step MR techniques in a mediation analysis where outcomes were restricted to stroke types causally affected by AF (any stroke [AS], any ischemic stroke [AIS], and cardioembolic stroke [CES]). RESULTS: Among 108 traits, 42 were putatively causal for at least 1 stroke type; of these 42 traits, 20 that had no bidirectional relationship with AF were retained. Finally, 33 associations of 15 eligible traits were examined in the mediation analysis. The mediation analyses for AS, AIS, and CES each included 11 eligible traits. After AF adjustment, the direct effects of all traits on CES were attenuated to null (all p>0.05), while the associations with AS and AIS persisted for most traits (AF-mediated proportion: from 6.6% [95% confidence interval, 2.7 to 0.6] to 52.0% [95% confidence interval, 39.8 to 64.3]). CONCLUSIONS The causal associations between all eligible traits and CES were largely mediated through AF, while most traits affected AS and AIS independently of AF.

Objective To determine the association of subclinical hypothyroidism (SCH) with body composition (measured by body impedance analysis) and insulin resistance (IR) in overweight/obese patients with polycystic ovary syndrome (PCOS).Methods A retrospective analysis was conducted of the clinical records of 109 overweight or obese [body mass index (BMI) ≥ 24 kg/m2] PCOS patients who visited the Department of Endocrinology and Fertility Center of Nanjing Drum Tower Hospital between April 2013 and April 2016 for menstrual disorder or infertility and were referred to receive weight management.24 of the patients had SCH,and 85 had euthyroid (EU).We determined the body composition of the patients with Biospace Inbody 720 body composition analyzer,measured the patients' serum lipid profiles,conducted in each patient the 75 g oral glucose tolerance test and the insulin release test,and calculated the homeostasis model assessment of insulin resistance (HO-MA-IR) indices.Results Patients with SCH and autoimmune thyroiditis (AIT) accounted for 22.02％ and 24.36％ of the total.The obesity level [(145.19±13.75)％ vs.(153.31±18.15)％,t=-2.032,P=0.045],VFA [(132.48±20.85) cm2vs.(147.35±24.26) cm2,t=-2.730,P=0.007],body fat (BF) [(31.91±5.88) kgvs.(35.43±6.89) kg,t=-2.274,P=0.025],body fat percentage (BFP) [(40.92±3.701)％ vs.(43.07±4.26)％,t=-2.241,P=0.027],body mass index (BMI) [(30.49±2.88) kg/m2 vs.(32.19±3.81) kg/m2,t=-2.026,P=0.045] and waist circumference (WC) [(98.34±7.13) cm vs.(102.86±8.74) cm,t=-2.324,P=0.022] of SCH group were significantly lower than those of euthyroid,with significant statistical difference.The levels of serum thyroid hormone (TSH) in patients with EU were positively correlated with the degree of obesity,the BF,the BFP,the BMI and the hip circumference (P=0.019,0.042,0.005,0.019,0.039),but not with the VFA (t=1.797,P=0.076).There were no statistically significant differences (P＞ 0.05) between patients with SCH and those with EU in their HOMA-IR indices,insulin levels,blood glucose,blood lipid,and ratio of IR (defined as HOMA-IR ≥2.69).Conclusions Obesity related body composition parameters were lower in PCOS patients with SCH than in those with EU.However,there was no significant difference between the two groups in blood lipid level and the ratio of IR.TSH levels in the EU group were correlated with the BMI and the BFP,but not with the VFA.A larger sample is needed to identify how and why thyroid hormones may affect the body composition and glycolipid metabolism of females with PCOS.

Objective To develop a health-promoting lifestyle scale for women with polycystic ovary syndrome(PCOS),and to test its reliability and validity,and preliminarily apply it.Methods Based on the Pender health promotion model,the item pool of the scale was constructed through literature research,semi-structured interviews and group discussions.After 2 rounds of Delphi expert consultation and pre-survey,the initial scale was formed.From April to July 2022,316 patients with PCOS in the health management center,reproductive medicine center and endocrinology department of a tertiary hospital in Nanjing were selected for item analysis,exploratory factor analysis and reliability test,respectively.From August to October 2022,358 PCOS patients were selected for confirmatory factor analysis.From November 2022 to February 2013,294 PCOS patients were selected,and the scale was used to investigate the status of health-promoting lifestyle in PCOS patients.Results The health-promoting lifestyle scale for PCOS patients included 5 dimensions and 33 items.The total content validity index of the scale was 0.942,and the content validity index of each item was 0.810-1.000.5 common factors were extracted by 2 exploratory factor analyses,and the cumulative variance contribution rate was 62.399％.Confirmatory factor analysis showed that the model fit was good.The Cronbach's a coefficient of the total scale was 0.930;the split-half reliability was 0.842;the test-retest reliability was 0.888.The preliminary application results showed that the total score of health-promoting lifestyle in PCOS patients was(96.925±14.273),and the average score of items was(2.937±0.433),which was at a medium level.Conclusion The health-promoting lifestyle scale for PCOS patients has good reliability and validity,which can be used as a tool for medical staff to assess the level of health-promoting lifestyle of PCOS patients,and can help nurses to quickly identify the level and dimensions of health-promoting lifestyle of patients,so as to formulate individualized precise health management plans.

To explore the clinical characteristics, diagnosis, and management of pancreatic glucagonoma, a retrospective analysis of the clinical data and diagnostic algorithm of a patient with pancreatic glucagonoma was conducted, along with literature review. Pancreatic glucagonoma is a rare neuroendocrine tumor that originates from the pancreatic alpha cells. The main manifestations of glucagonoma syndrome(GS) include necrolytic migratory erythema, diabetes, anemia, and other systemic involvement. Early diagnosis of GS is challenging and crucial. Early identification and recognition of skin lesions contribute to timely diagnosis and treatment of the disease. Surgical resection is an effective treatment modality for glucagonoma.

Objective To analyze the characteristics and variation trend of respirable dust concentration in the working environment of a coal mine from 2013 to 2020. Methods A large coal mine in Shaanxi Province was selected as the research site. The inspection data regarding the respirable dust concentration across the years were collected. The characteristics and dynamic changes of respirable dust concentration were analyzed. Results The content of free silica in the main workplaces of the coal mine was less than 10% , and the dust was classified as the coal dust. The average annual concentrations of respirable dust varied in different workplaces, with the highest values in the fully mechanized winning and continuous mining face (0.32 mg/m³~18.68 mg/m³) and fully mechanized mining face (0.36 mg/m³~8.11 mg/m³). The average annual concentrations of respirable dust varied among different jobs, with the highest value among continuous miner drivers (1.30mg/m³~18.68 mg/m³), followed by shuttle truck drivers (0.32 mg/m³~14.77 mg/m³), crusher drivers (0.59 mg/m³~8.23 mg/m³), fully mechanized winning machine drivers (0.99 mg/m³~5.05 mg/m³), fully mechanized mining machine drivers (1.10 mg/m³~8.11 mg/m³), and timbermen (1.10mg/m³~6.09 mg/m³). The average concentration of respirable dust increased to the highest level during 2013-2014, then showed a downward trend during 2015-2018, and rebounded to a certain extent during2019-2020. Conclusion Respirable dust was widely distributed in the workplaces and across jobs. The concentrations of respirable dust were high, but the overall trend was downward.

Objective: To retrospectively analyze distribution characteristics of pathogenic bacteria and their antimicrobial susceptibility in patients with diabetic foot osteomyelitis(DFO). Methods: Sixty cases of suspected DFO were collected from the Endocrinology Department of Henan Provincial People′s Hospital. After admission, bone biopsy was carried out to confirm the pathological diagnosis, and the pathogenic bacteria and drug sensitivity were determined by bone culture. In addition, bacterial culture was carried out in the basal tissue of the wound, and the results of bacterial culture were compared with those of bone culture. Results: Sixty patients were diagnosed as DFO after bone biopsy. Among the 60 patients, 45 patients underwent bone culture and basal tissue culture. There are 24 patients of whom the results were consistent, accounting for 53.3%. The positive rate of bone culture was 55.0%, there were 16 strains of gram-positive bacteria and 22 strains of gram-negative bacteria. Staphylococcus aureus(9 strains) occurrence was the most, common finding, followed by Escherichia coli(6 strains). The course of diabetic foot, albumin(ALB), and antibiotic usage rate before admission were lower in bone culture positive group than those in bone culture negative group, while white blood cell(WBC) and C-reactive protein(CRP) were higher in bone culture negative group(P<0.05). There was no significant difference in gender, age, course of diabetes, HbA_1C, and creatinine(CREA) levels between the two groups(P>0.05). The results of bone culture showed that Staphylococcus aureus was the main Gram-positive bacteria, which was more sensitive to vancomycin, tigecyclin, linezolid, etc. Escherichia coli was the main Gram-negative bacteria, which was more sensitive to tigecyclin, carbapenems, amikacin, etc. Conclusion Bone biopsy and bone culture should be carried out in cases for suspected DFO patients to identify the pathogenic bacteria, and the bone tissue should be preserved and obtained according to the operation specification before the application of antibiotics, and the appropriate antibiotics should be selected according to the drug sensitivity results.

OBJECTIVE：To evaluate the current situation and implementation effect of the pilot project of electronic prescription and remote pharmaceutical care in social pharmacy from the perspective of consumers ，and to provide reference for improving and optimizating the electronic prescription and remote pharmaceutical care in social pharmacy. METHODS ：Totally 264 consumers in 6 counties and 36 drugstores of Chengdu were randomly selected for the questionnaire survey. Descriptive statistics were conducted by using SPSS 23.0 software. Compare the distribution and differences of various. The influential factors in consumer satisfaction based on χ2 test and ordinal multiple Logistic regression analysis. Consumers were randomly selected for semi-structured interviews. Text analysis was conducted by Nvivo 12.0 software to refine the problem of this service . RESULTS ：A total of 271 questionnaires were distributed to consumers in various districts of Chengdu ，and 264 valid questionnaires were collected，with an effective recovery rate of 97.4％. Among 264 respondents，178（67.9％）knew about electronic prescription and remote pharmaceutical care ；197（74.6％）received electronic prescription and remote pharmaceutical care service in pharmacies ； 202（76.5％）said they needed this service ，and 63（23.9％）expressed that they would like to pay for it. Of the 197 respondents who had received the service ，163（82.2％）were satisfied or very satisfied with the service ，and only one （0.5％）was dissatisfied with the service. Waiting time ，satisfaction of drug demand ，staff attitude ，service platform configuration ，the qualifications of tele-practice pharmacists and service quality were the main influential factors of satisfaction ；while the service also suffered from difficulties in electronic prescription circulation ，inadequate service monitoring measures ，insufficient certification of physicians and pharmacists，cultural lag ，and irregular service processes. CONCLUSIONS ：Electronic prescription and remote pharmaceutical care service in social pharmacy is inadequate in terms of technical level ，institutional design and social acceptance. It is recommended that relevant departments implement incentive policies ，optimize technology ；follow up supporting policies in time ，strengthen supervision；and increase social publicity and supervision ，so as to promote the continuous improvement and long-term development of electronic prescription and remote pharmaceutical care in social pharmacy.

Objective To investigate the antimicrobial resistance profile of the clinical isolates collected from selected hospitals across China. Methods Twenty-nine general hospitals and five 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 interpreted according to CLSI 2017 breakpoints. Results A total of 190 610 clinical isolates were collected from January to December 2017, of which gram negative organisms accounted for 70.8％ (134 951/190 610) and gram positive cocci 29.2％ (55 649/190 610). The prevalence of methicillin-resistant strains was 35.3％ in S. aureus (MRSA) and 80.3％ in coagulase negative Staphylococcus (MRCNS) on average. MR strains showed much higher resistance rates to most of the other antimicrobial agents than MS strains. However, 91.6％ of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole, while 86.2％ of MRCNS strains were susceptible to rifampin. No staphylococcal strains were found resistant to vancomycin. E. faecalis strains showed much lower resistance rates to most of the drugs tested (except chloramphenicol) than E. faecium. Vancomycin-resistant Enterococcus (VRE) was identified in both E. faecalis and E. faecium. The identified VRE strains were mainly vanA, vanB or vanM type based on phenotype or genotype. The proportion of PSSP or PRSP strains in the non-meningitis S.pneumoniae strains isolated from children decreased but the proportion of PISP strains increased when compared to the data of 2016. Enterobacteriaceae strains were still highly susceptible to carbapenems. Overall, less than 10％ of these strains (excluding Klebsiella spp.) were resistant to carbapenems. The prevalence of imipenem-resistant K. pneumoniae increased from 3.0％ in 2005 to 20.9％ in 2017, and meropenem-resistant K. pneumoniae increased from 2.9％ in 2005 to 24.0％ in 2017, more than 8-fold increase. About 66.7％ and 69.3％ of Acinetobacter (A. baumannii accounts for 91.5％) strains were resistant to imipenem and meropenem, respectively. Compared with the data of year 2016, P. aeruginosa strains showed decreasing resistance rate to carbapenems. Conclusions Bacterial resistance is still on the rise. It is necessary to strengthen hospital infection control and stewardship of antimicrobial agents. The communication between laboratorians and clinicians should be further improved in addition to surveillance of bacterial resistance.

Objective To investigate the distribution and antimicrobial resistance profiles of the common pathogens isolated from urine from 2015 to 2021 in the CHINET Antimicrobial Resistance Surveillance Program.Methods The bacterial strains were isolated from urine and identified routinely in 51 hospitals across China in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Antimicrobial susceptibility was determined by Kirby-Bauer method,automatic microbiological analysis system and E-test according to the unified protocol.Results A total of 261 893 nonduplicate strains were isolated from urine specimen from 2015 to 2021,of which gram-positive bacteria accounted for 23.8％(62 219/261 893),and gram-negative bacteria 76.2％(199 674/261 893).The most common species were E.coli(46.7％),E.faecium(10.4％),K.pneumoniae(9.8％),E.faecalis(8.7％),P.mirabilis(3.5％),P.aeruginosa(3.4％),SS.agalactiae(2.6％),and E.cloacae(2.1％).The strains were more frequently isolated from inpatients versus outpatients and emergency patients,from females versus males,and from adults versus children.The prevalence of ESBLs-producing strains in E.coli,K.pneumoniae and P.mirabilis was 53.2％,52.8％and 37.0％,respectively.The prevalence of carbapenem-resistant strains in E.coli,K.pneumoniae,P.aeruginosa and A.baumannii was 1.7％,18.5％,16.4％,and 40.3％,respectively.Lower than 10％of the E.faecalis isolates were resistant to ampicillin,nitrofurantoin,linezolid,vancomycin,teicoplanin and fosfomycin.More than 90％of the E.faecium isolates were ressitant to ampicillin,levofloxacin and erythromycin.The percentage of strains resistant to vancomycin,linezolid or teicoplanin was＜2％.The E.coli,K.pneumoniae,P.aeruginosa and A.baumannii strains isolated from ICU inpatients showed significantly higher resistance rates than the corresponding strains isolated from outpatients and non-ICU inpatients.Conclusions E.coli,Enterococcus and K.pneumoniae are the most common pathogens in urinary tract infection.The bacterial species and antimicrobial resistance of urinary isolates vary with different populations.More attention should be paid to antimicrobial resistance surveillance and reduce the irrational use of antimicrobial agents.