Objective To analyze the bacterial distribution and antibiotic resistance of pathogenic bacteria in elderly patients with hospital-acquired pneumonia (HAP) so as to provide evidence for rational use of antibiotics. Methods The clinical data of 160 elderly patients with HAP in our hospital from June 2006 to September 2009 were analyzed retrospectively. And the pathogenic characteristics and antibiotic resistance were analyzed. Results A total of 180 pathogenic bacteria were separated: 108 Gram-negative bacteria (60.0%), 48 Gram-positive bacteria (26.7%) and 24 fungi (13.3%). In Gram-negative bacteria, Pseudomonas aeruginosa was the major pathogen (20.5%), and Staphylococcus aureus was the most prominent in Gram-positive bacteria (11.1%).The detection rate of fungi was increased in patients with long-term use of antibiotics and broadspectrum antibiotics. The Gram-negative bacilli was resistant to third-generation cephalosporin, and extended-spectrum β-lactamases (ESBLs) producing Escherichia coli and Klebsiella pneumonia were resistant to penicillin, penicillin + enzyme inhibitor, cephalosporin and monobactam antibiotics. The drug resistance of Pseudomonas aeruginosa was severe, but it was still sensitive to Ceftazidime. Gramnegative bacteria showed high sensitivities to Amikacin, Piperacillin + Tazobactam, Cefoperazone +Sulbactam, Imipenem and Meropenem. Methicillin-resistant Staphylococcus aureus (MRSA) occupied 92.6% of Staphylococcal aureus. The resistance rates of Gram-positive bacteria to Azithromycin,Ciprofloxacin, Oxacillin, Ampicillin + Sulbactam were all higher than 76%, but Gram-positive bacteria showed high sensitivities to Vancomycin, Linezolid and Teicoplanin. The staphylococcal strains that were resistant to Vancomycin, Linezolid and Teicoplanin were not found. Conclusions The major pathogen of HAP in elderly patients is Gram-negative bacilli. The detection rate of ESBLs producing Escherichia coil and Klebsiella pneumonia increases annually, and the drug resistances to the above bacteria is becoming more and more serious. But they are still highly sensitive to Amikacin,Piperacillin+ Tazobactam, Cefoperazone+ Sulbactam, Imipenem and Meropenem. The appropriate antibiotics for Gram-positive bacterial infections are Vancomycin, Linezolid and Teicoplanin.

Objective To investigate the effect of evidence-based nursing on the clinical curative effect and prognosis of patients with hypertensive cerebral hemorrhage.Methods 120 patients with hypertensive cerebral hemorrhage were selected,and they were randomly divided into observation group(60 cases) and control group(60 cases) according to the digital table.The control group was treated with routine nursing,the observation group was treated with routine nursing and evidence-based nursing.Before and after nursing,the SDS,self rating anxiety scale (SAS),neurological deficit score NIHSS,Barthel score,the incidence of sequelae,hospitalization time,nursing quality score and patients’ satisfaction with nursing were compared between the two groups.Results There were no statistically significant differences in SDS,SAS,NIHSS and Barthel scores between the two groups before nursing intervention(all P ＞ 0.05).After nursing intervention,the SDS,SAS,NIHSS and Barthel scores of the observation group were (38.74 ± 6.21) points,(35.83 ± 8.17) points,(11.24 ± 3.08) points,(92.58 ± 6.46) points,respectively,which in the control group were (44.58 ± 7.10) points,(43.66 ± 8.06) points,(15.34 ± 3.29) points,(84.27 ± 5.82) points,there were significant differences between the two groups (t =4.796,5.285,7.047,7.403,all P ＜0.05).,The incidence rate of venous thrombosis,muscle atrophy and joint ankylosis sequelae of the observation group was 8.33％,which was lower than 40.00％ of the control group,there was significant difference between the two groups(x2 =16.415,P ＜ 0.05).The hospitalization time of the observation group was (9.55 ± 2.43)d,which was shorter than (15.97 ± 4.68) d of the control group (t =9.430,P ＜ 0.05).The health education nursing quality score,ward management score,basic nursing score,nursing care of critical patients score,nursing document writing score of the observation group were (97.66 ± 2.45) points,(98.23 ± 3.46) points,(97.54 ± 3.18) points,(96.88 ± 3.49) points,(98.76 ± 1.31)points,respectively,which were higher than those of the control group [(88.79 ± 2.37) points,(90.72 ±3.52) points,(91.05 ±3.16) points,(91.67 ± 5.34) points,(93.04 ± 1.12) points],there were significant differences between the two groups(t =20.156,11.786,11.214,6.326,25.707,all P ＜ 0.05).The patients’ nursing satisfaction of the observation group (96.67％) was higher than that of the control group (85.00％),there was significant difference between the two groups (x2 =4.904,P ＜ 0.05).Conclusion Evidence -based nursing can effectively relieve patients’ anxiety and depression of patients with hypertensive cerebral hemorrhage,improve the quality of life of patients,reduce the incidence of complications,shorten the hospitalization time,improve patients'satisfaction.

Purpose: Drug resistance is one of the main causes of chemotherapy failure in patients with small cell lung cancer (SCLC), and extensive biological studies into chemotherapy drug resistance are required. Materials and Methods: In this study, we performed lncRNA microarray, in vitro functional assays, in vivo models and cDNA microarray to evaluate the impact of lncRNA in SCLC chemoresistance. Results: The results showed that KCNQ1OT1 expression was upregulated in SCLC tissues and was a poor prognostic factor for patients with SCLC. Knockdown of KCNQ1OT1 inhibited cell proliferation, migration, chemoresistance and promoted apoptosis of SCLC cells. Mechanistic investigation showed that KCNQ1OT1 can activate transforming growth factor-β1 mediated epithelial-to-mesenchymal transition in SCLC cells. Conclusion Taken together, our study revealed the role of KCNQ1OT1 in the progression and chemoresistance of SCLC, and suggested KCNQ1OT1 as a potential diagnostic and prognostic biomarker in SCLC clinical management.

Objective:To study the value of sound touch elastography (STE) linear combined with ultrasound score (US) in the diagnosis of chronic hepatitis B (CHB) liver fibrosis, and to investigate whether their combination can improve the diagnostic efficiency of subdividing the degree of CHB liver fibrosis. Furthermore, a comparison with STE linear combined with the serological model was performed to seek the optimal linear combination model.Methods:A total of 313 subjects were enrolled from September 2018 to December 2021 in Shenzhen Third People′s Hospital Affiliated to Guangdong Medical University, including 259 patients with CHB who had completed liver biopsy and 54 healthy volunteers. CHB patients were divided into liver fibrosis group (F1-F4 group) according to METAVIR classification standard, and healthy volunteers were used as the control group. All subjects underwent liver ultrasound examination, STE and blood biochemical indexes of liver function. The US was performed according to the liver ultrasound examination, and the liver stiffness measurement (LSM) was measured by STE, aspartate aminotransferase and platelet ratio index (APRI) was calculated by blood biochemical index. Fisher discriminant analysis was used to establish the linear combination (LC) diagnostic marker of US and LSM, and the linear combination (LC2) diagnostic marker of LSM and APRI, successively. Spearman rank correlation coefficient was used to analyze the correlations between US, LSM, APRI, LC2, LC and pathological results. The ROC curves of US, LSM, APRI, LC2 and LC for diagnosing CHB liver fibrosis were plotted, and the diagnostic efficiency of above diagnostic markers was evaluated according to the accuracy, sensitivity, specificity and area under the ROC curve (AUC).Results:The formula for the linear combination of US and LSM was LC=0.986 0×US+ 0.166 7×LSM, and LC was highly positively correlated with pathological findings ( rs=0.851, P<0.001), higher than US, LSM, LC2 and APRI ( rs=0.825, 0.775, 0.802, 0.586, all P<0.001). LC showed the best diagnostic efficiency. The AUCs for diagnosing ≥F1, ≥F2, ≥F3 liver fibrosis and =F4 cirrhosis were 0.945, 0.911, 0.954, 0.955, respectively, which superior to the AUCs of US (0.913, 0.879, 0.934 and 0.916, respectively), the AUCs of LSM (0.860, 0.871, 0.934 and 0.952, respectively) and the AUCs of LC2(0.899, 0.883, 0.941, 0.946, respectively). Compared with US, the AUC of LC diagnosis of ≥F1, ≥F2, ≥F3 liver fibrosis and =F4 cirrhosis increased by 3.2%, 3.2%, 2.0% and 3.9%, respectively, with all significant differences ( P<0.05). Compared with LSM, the AUC of LC increased by 8.5%, 4.0%, 2.0% and 0.3%, respectively, with significant difference ( P<0.05) except for stage =F4 cirrhosis.Compared with LC2, the AUC of LC increased by 4.6%, 2.8%, 1.3% and 0.9%, respectively, and there were significant differences in the diagnosis of ≥F1 and ≥F2 liver fibrosis ( P<0.05). Moreover, the overall efficiency of LC2 was not significantly improved than LSM, the difference was not significant ( P>0.05). Conclusions:US, LSM, LC2 and LC can be used to diagnose the degree of CHB liver fibrosis, but LC is better than US or LSM and LC2 alone, especially in the subdivision of mild liver fibrosis, which is a promising new diagnostic marker to subdivide the degree of CHB liver fibrosis.

Objective To investigate the effect of family nursing intervention on life satisfaction in patients with hemodialysis.Methods 128 patients with hemodialysis in our hospital were randomly divided into experimental group and control group,64 cases in each group.Traditional health nursing methods were used in control group and home nursing intervention was carried out in experimental group.Patients' life satisfaction in the two groups was investigated by Neugarten' life satisfaction scale,the life satisfaction,nutrition and kidney function were compared between the two groups.Results The life satisfaction score,blood urea nitrogen,Creatinine,Albumin,hemoglobin in the two groups before intervention were similar ( P ＞ 0.05 ).After intervention,the life satisfaction score,life satisfaction index A,life satisfaction index B were (20.07 ± 1.39),( 17.35 ± 1.04) and ( 18.49 ± 1.10) in experimental group,but ( 14.71 ± 0.81 ),( 15.00 ± 0.75 ) and (15.49 ±0.85) in sequence in control group,there were statistically significant differences between the two groups(t =22.43,2.10,10.30; P ＜ 0.05 ),blood urea nitrogen,Creatinine,Albumin,hemoglobin in experimental group after intervention were better than that in control group ( P ＜ 0.05 ).Conclusions Home nursing intervention can improve life satisfaction of patients with hemodialysis in community then it can improve the quality of life.

Objective:To compare the differences of chemical components between single decoction and mixed decoction with different compatibility ratio of Inulae Flos- Haematitum medicinal pair. Methods:UPLC method was used to determine the contents of 5-caffeoylquinic acid, chlorogenic acid, 4-dicaffeoylquinic acid, caffeic acid, isoquercitrin, isochlorogenic acid B, 1,5- dicaffeoyl quinic acid, isochlorogenic acid C and the fingerprints of the single decoctions and mixed decoctions of Inulae Flos- Haematitum medicinal pair in four groups of proportions. The "peak area/sample weight" value of each common peak in the fingerprints was calculated, and the SPSS 26.0 was used for independent-sample t-test analysis. Results:There are significant differences in the "peak area/weight" values of peak 1, peak 2, peak 4, peak 6 , peak 9, peak 10, peak 12, peak 13, peak 15 between mixed decoction and single decoction of Inulae Flos - Haematitum medicinal pair with different compatibility ratios ( P<0.05), with statistical significance; when the compatibility ratio of Inulae Flos- Haematitum medicinal pair was 3:1, the difference of fingerprints and index components content between single decoction and combined decoction was the largest. Except for peak 7 and peak 14, the difference of "peak area/sample weight" value of other characteristic peaks was statistically significant ( P<0.05), and the content difference of 8 index components was statistically significant ( P<0.05). Conclusion:There are differences in the chemical components of Inulae Flos - Haematitum medicinal pair for single decoction and mixed decoction.

Objective To establish a quantitative analysis of multi-compounds by single-marker(QAMS)method for the simultaneous determination of four compounds in formula granules of Pteris multifida and optimize the extraction process of total flavonoids.Methods The relative correction factors(RCFs)of lonicerin,luteolin and apigenin in the formula granules of Pteris multifida were calculated by using the UPLC method with rhoifolin as the internal reference,and their durability was investigated.The external standard method(ESM)was used to determine the content of four compounds in the formula granules of Pteris multifida,and the difference between the calculated values and the measured values was compared.The effects of ultrasonic time,ethanol volume fraction,solid-liquid ratio and ultrasonic power on the extraction rate of total flavonoids were studied by single factor experiment.On this basis,Box-Behnken test with three factors and three levels was conducted to optimize the extraction process of total flavonoids,and the verification experiment was conducted.Results The content of rhoifolin in the formula granules was 0.035%-0.056%,and the content of lonicerin,luteolin and apigenin by QAMS method was 0.085%-0.167%,0.014%-0.028%and 0.004%-0.008%,respectively,which had no significant difference with the external standard method.The optimal extraction conditions of total flavonoids were 80%ethanol water,solid-liquid ratio 1:20,40 minutes extraction,the average extraction rate was 24.46 mg·g-1.Conclusion The established QAMS method was accurate and feasible,and the optimized extraction process of total flavonoids based on Box-Behnken response surface method was simple and feasible,which could lay a foundation for the quality evaluation of the Pteris multifida formula granules.

Objective:To explore the clinical application values of a nomogram based on preoperative breast MRI and axillary ultrasonography imaging parameters for predicting the risk of sentinel lymph node (SLN) metastasis in early-stage breast cancer patients.Methods:Three hundred and ninty-seven female patients (mean age 48.0±10.7 years old, range 25-81 years old) who admitted to Sun Yat-sen University Cancer Center from May 2007 to December 2017 were enrolled in this study. All patients were diagnosed as primary unilateral invasive early-stage breast cancer confirmed by surgical pathology. Preoperative breast MRI, axillary ultrasonography and clinical pathological data of enrolled patients were retrospectively analyzed. According to the pathological results of sentinel lymph node biopsy (SLNB), the cases were divided into negative SLN group ( n=200) and positive SLN group ( n=197). Clinicopathologic data, MRI and axillary ultrasound features were analyzed and compared between two groups. Logistic regression analysis was used to select independent risk factors. Then a predictive model was constructed and a nomogram was made for visualizing the associations between the predictive factors and SLN metastasis. Goodness-of-fit of the model was evaluated by using the Hosmer-Lemeshow test. Predictive performance was assessed based on the receiver operating characteristic (ROC) curves. Bootstrap resampling was performed for internal validation. Results:Significant differences were found in patient age, lymphovascular invasion status, PR status, HER2 status and molecular subtype between negative and positive SLN groups (all P<0.05); MRI features including tumor size, mass margin, long and short diameter, as well as the ratio of long to short diameter of LNs, LN margin, presence or absence of LN hilum, and axillary LNs symmetry were found significantly different between negative and positive SLN groups (all P<0.05); as for the axillary LN ultrasonography parameters, the interface between cortex and medulla, presence or absence of cortical thickening, and LN hilum were significantly different between negative and positive SLN groups (all P<0.05). Logistic regression analysis results showed that several factors could be identified as predictors of SLN metastasis, including patient age, MRI features (lymph node margin, presence or absence of lymph node hilum, and lymph node symmetry), axillary ultrasonography descriptors (presence or absence of cortical thickening) and pathological factors (lympovascular invasion, PR and HER2 status). The nomogram with patient age and the above imaging factors showed good,prediction performance with the area under the ROC as 0.778. Combining with the pathological parameters, the prediction performance of the nomogram model was significantly improved, yielding the area under the ROC of 0.866. Conclusions:The nomogram based on breast MRI and axillary ultrasonography can be applied as a noninvasive quantitative tool to predict the risk of SLN metastasis in early-stage breast cancer, which may facilitate decision-making for axillary treament strategy preoperatively.

Objective To optimize the spray drying process of Banlangen(Isatidis Radix)formula granules based on quality by design(QbD)concept.Methods Using powder yield and the contents of uridine,adenosine,guanosine,and(R,S)-goitron as the critical quality attributes(CQAs),Plackett-Burman design was used to screen out critical process parameters(CPPs)for inlet temperature,spray pressure,liquid temperature,pump speed,and liquid relative density.The central-composite design(CCD)test was used to optimize the CPPs,which were screened.Based on the quadratic polynomial regression model,the design space of spray drying process of Banlangen(Isatidis Radix)formula granules was established,and further validated by experiments.Results Plackett-burman test results show that liquid relative density and inlet velocity are the key parameters for the study.The variance analysis results of CCD test showed that the constructed model in a good prediction ability,since the P-values of model was less than 0.01 and P-values of items lack of fit was more than 0.05.The optimized design space of CPPs was the liquid relative density 1.05-1.08,and pump speed 30%-40%.Conclusion Based on the QbD concept,the design space for the spray drying process of Banlangen(Isatidis Radix)formula granules can improve the stability of its process and help ensure the consistency of product quality.

According to the International League Against Epilepsy (ILAE) standards, the Newborn Working Group of the ILAE put forward 6 necessary questions about the management of neonatal anti-seizure medication and gave evidence-based recommendations in 2023. The basic framework is systematic review+expert consensus. The clinical recommendations of ILAE guidelines 2023 and the similarities and differences between ILAE guidelines 2023 and ILAE guidelines 2011 were analyzed and interpreted in this paper, in order to provide reference for colleagues involved in neonatal convulsion management in China.