To investigate the genetic relatedness between carbapenem-resistant Klebsiella pneumoniae(CRKP) strains isolated from intestinal colonization and subsequent bloodstream infections.

OBJECTIVE To evaluate the long-term cost-effectiveness of insulin degludec and insulin aspart （IDegAsp） in patients with type 2 diabetes mellitus （T2DM） in China. METHODS A cost-effectiveness analysis was conducted from the perspective of the Chinese healthcare system， using the CORE diabetes model to simulate long-term （20-year） health and economic outcomes. Baseline cohort characteristics and treatment effect data were derived from the CREATE study. The prices of glucose- lowering drugs were obtained from medical insurance payment standards and the average winning bid prices in the follow-up round of the specialized centralized procurement for insulin， while the daily dosages were derived from the CREATE study. The costs of complications and utility values were obtained from published literature， with a discount rate of 5%. One-way sensitivity analysis， scenario analysis， and probabilistic sensitivity analysis were performed to verify the robustness of the results. RESULTS Patients switching from previous once-daily basal insulin regimens to IDegAsp therapy gained an incremental 0.190 quality-adjusted life year （QALY） with direct medical cost savings of 42 163.58 yuan. For those switching from premixed insulin therapies， IDegAsp treatment provided 0.130 incremental QALY and reduced direct healthcare costs by 41 129.11 yuan. The outcome was significantly influenced by the discount rate and the cost of complications. Probabilistic sensitivity analysis and scenario analysis confirmed the robustness of these findings. CONCLUSIONS Switching from previous daily basal insulin or premixed insulin regimens to IDegAsp in Chinese patients with T2DM can improve patients’ long-term health outcomes and achieve cost savings， making it a more cost-effective treatment option.

Objective:To investigate the correlation between blood uric acid level and body composition, exercise capacity, and cardiopulmonary function in medical examination population.Methods:In this cross-sectional study, 83 individuals who underwent physical examinations at Peking University Third Hospital from June 1, 2023, to October 1, 2023, and met the inclusion criteria were included. According to whether they had hyperuricemia (HUA), the participants were divided into HUA group (53 cases) and non-HUA group (30 cases). Body composition parameters, such as body mass index and visceral fat area, were measured with a body composition analyzer. Exercise capacity indicators, including grip strength, vertical jump, back strength, and sit-and-reach test, were measured using specific monitoring devices. Cardiopulmonary function was assessed using the stair index test. The clinical characteristics of the two groups were compared with t-tests or chi-square tests, and the correlation between uric acid levels and body composition, exercise capacity, and cardiopulmonary function was analyzed. Results:The HUA group had significantly higher skeletal muscle mass, body fat mass, body mass index, and visceral fat area when compared with the non-HUA group [(31.92±5.60) vs (26.11±6.19) kg, (23.66±9.33) vs (17.19±5.00) kg, (26.53±3.68) vs (23.27±3.59) kg/m2, 91.20 (74.25, 123.90) vs 68.25 (56.25, 90.48) cm 2, respectively] (all P<0.05). The grip strength, vertical jump, and back pull strength were all lower in the HUA group [32.70 (25.25, 40.30) vs 42.35 (35.95, 48.10) kg, 30.30 (24.10, 36.48) vs 40.55 (33.06, 45.10) kg, 24.20(20.60, 32.23) vs 29.90 (25.20, 35.50) cm, 65.60 (51.75, 78.00) vs 91.00 (67.25, 111.50) kg, respectivley] (all P<0.05). The increased step index was positively correlated with reduced risk of hyperuricemia ( OR=0.875, 95% CI: 0.793-0.966) ( P<0.05). Conclusions:Blood uric acid level is correlated with cardiopulmonary function in medical examination population. Individuals with better cardiopulmonary function have a lower risk of developing HUA. However, the relationship between blood uric acid level and body composition and exercise capacity is not clear.

Objective:To explore the current situation of fear of progression among parents of school-age children with asthma, and to analyze the latent profile categories and influencing factors, so as to provide the reference for the formulation of prevention and intervention.Methods:Using convenient sampling method, school-age children with asthma and their parents treated in the Affiliated Children's Hospital of Xiangya School of Medicine, Central South University from March to August 2023 were selected as the study objects. The General Data Questionnaire, Parent Fear of Progression Scale, Childhood Asthma Control Test, and Social Support Rating Scale were used to investigate school-age children with asthma and their parents. Latent profile analysis was performed on the fear of disease progression among parents of school-age children with asthma, and χ2 test and binary Logistic regression were used to explore the influencing factors. Results:A total of 210 parents of the children were included with 51 fathers and 159 mothers.The age distribution was 20-30 years old with 42 parents, 31-40 years old with 112 parents, 41-50 years old with 56 parents. In 210 children with asthma, there were 123 males and 87 females, with 141 cases aged<10 years old and 69 cases aged ≥10 years old. The fear of progression among parents of school-age children with asthma could be divided into two potential profile categories: "psychological dysfunction group (46.7%, 98/210)" and "psychological health good group (53.3%, 112/210)". The results of binary Logistic regression analysis showed that asthma family history, combined allergic rhinitis, child-parent relationship, marital status, asthma symptom control level, and social support level were the influencing factors of fear of progression among parents of school-age children with asthma( OR values were 0.925-10.010, all P<0.05). Conclusions:The fear of progression among parents of school-age children with asthma is at a moderate level, and there are obvious different classification characteristics. In the future, targeted and precise prevention and intervention should be implemented according to the category characteristics of fear of progression among parents of school-age children with asthma.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

To summarize the nursing experience of a patient with inhalation of nitric acid fumes treated by veno-venous extracorporeal membrane oxygenation combined with continuous renal replacement therapy.The key points of nursing include:to pay close attention to the changes of respiratory function,to strictly implement lung protective ventilation strategy;to timely remove airway secretions to ensure effective respiratory;to prevent and control infection;to optimize fluid management to facilitate tissue perfusion;to prevent thrombosis and reduce the risk of bleeding;prevention and treatment of blood transfusion reaction,the postoperative nursing of complicated with upper gastrointestinal bleeding.After active treatment and careful nursing,the patient was discharged from the hospital in a stable condition.After 6 months of follow-up after discharge,the patient recovered well with no pulmonary complications.

Objective:This study aimed to explore the implementation plan of the grid management joint scientific research clinic and to evaluate its impact on enhancing the scientific research capabilities of nursing staff.Methods:Nursing research team developed an implementation strategy for the grid management joint scientific research clinic in 2023 and then promoted it across the hospital. The scores of nursing staff were compared on the self-evaluation scale, general self-efficacy scale, and research innovation achievements before (April-December 2022) and after (January-September 2023) the implementation.Results:The research capabilities of nurses increased significantly from 103.13±2.56 to 141.32±18.09 ( P<0.001), and their self-efficacy increased significantly from 1.95±0.26 to 2.15±0.53 ( P<0.001). The number of college-level and above scientific research projects, the number of journal publications, the number of authorized patterns, the number of participation in academic exchanges at the municipal level and above in nursing societies, and the number of scientific research awards at the municipal level and above all increased compared with the previous ones with statistical significance. Conclusions:Implementing the grid management joint scientific research clinic is beneficial for improving overall nursing research capabilities, nurses' self-efficacy, and the effectiveness of scientific research training. This provides a reference for other hospitals to enhance the training of nursing staff's scientific research capabilities.

Objective To investigate the effects of atorvastatin calcium on thyroid function, immune response and C-Jun N-terminal kinase/p38 mitogen-activated protein kinase (JNK/p38 MAPK) signaling pathway in rats with hypothyroidism. Methods A total of 30 healthy adult male SD rats were randomly divided into control group, hypothyroid group (PTU group) and atorvastatin calcium treatment group (ACT group), with 10 rats in each group. Rats in the PTU group and the ACT group were injected with PTU subcutaneously at the dorsum of the neck every day for 28 consecutive days; instead of PTU, rats in the control group were injected subcutaneously with 0.3 mL of saline. After 2 weeks of PTU treatment, rats in the ACT group were gavaged with 3 mL of atorvastatin calcium saline solution (containing 5 mg/kg of atorvastatin calcium), which was administered once daily; the control group was gavaged with an equal amount of saline in the same way. The body weight, food intake and water intake of rats were measured weekly. The histopathological changes of the thyroid gland were observed in histopathological sections of rats in each group. Enzyme-linked immunosorbent assay (ELISA) was performed to determine the levels of triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), interferon γ (IFN-γ) and interleukin-4 (IL-4) in serum; quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) was performed to detect the mRNA expression levels of IFN-γ, IL-10, Foxp3 and IL-4; western blot was performed to determine the levels of p-JNK/JNK and p-p38/p38 MAPK. Results Compared with control group, PTU-induced hypothyroidism rats showed a significant decrease in body mass and food and water consumption (P < 0.05). After 2 weeks of treatment with atorvastatin calcium, the body mass loss of PTU rats was inhibited, food and water consumption was improved, and the differences were statistically significant (P < 0.05). Atorvastatin calcium was able to significantly increase the serum T3 and T4 levels and decrease the serum TSH level in hypothyroid rats (P < 0.05). Atorvastatin calcium treatment was able to significantly alleviate histopathological changes such as follicular cell proliferation and related hypertrophy induced by PTU, and increase follicular size (P < 0.05). After treatment with atorvastatin calcium, the spleen mass of PTU rats increased significantly, and the expression of IFN-γ mRNA in hypothyroid rats decreased significantly, but the expression levels of IL-10 mRNA, Foxp3 mRNA and IL-4 mRNA increased significantly (P < 0.05). After treatment with atorvastatin calcium, the levels of p-JNK/JNK and p-p38/p38 MAPK in thyroid tissue of hypothyroid rats decreased significantly (P < 0.05). Conclusion Atorvastatin calcium treatment for hypothyroidism has the function of promoting the normalization of thyroid hormone imbalance, balancing Th1/Th2 cytokines, and inhibiting the activation of JNK/p38 MAPK signaling pathway.

Objective:To evaluate the efficacy of daily use of a test emollient combined with topical glucocorticoids applied at the weekend for delaying the recurrence of atopic dermatitis (AD) in children during the maintenance period.Methods:A randomized, blank-controlled, multicenter clinical study was conducted in children with moderate AD from Beijing Children′s Hospital, Capital Medical University, Children′s Hospital of Chongqing Medical University and Shenzhen Children′s Hospital from March 2021 to February 2022. A total of 127 children aged 0 - 12 years with moderate AD were treated with topical glucocorticoids combined with emollients during the run-in period, 112 out of them achieved the investigator′s global assessment (IGA) score ≤ 1 point, and then the 112 patients were randomly divided into a test group (56 cases) and a control group (56 cases) at a ratio of 1∶1. Patients in the test group received treatment with a test emollient twice a day in combination with topical glucocorticoids applied at the weekend, and those in the control group were only treated with topical glucocorticoids at the weekend. Patients in the two groups were followed up at baseline, week 2 (± 3 d), week 4 (± 5 d), and week 12 (±7 d), as well as at the time of AD relapse, and the effect of the test emollient on the remission rate of AD in children during the maintenance period was evaluated, so were its effects on the dosage of topical glucocorticoids, pruritus, sleep, and skin pH. The occurrence of treatment-related adverse events was evaluated and recorded at the same time. Study endpoints were defined as AD relapse during the maintenance period, end of 12-week follow-up, or occurrence of serious adverse events. Comparisons of efficacy indicators between groups were conducted by using chi-square test, Kaplan-Meier survival analysis, Satterthwaite t′ test and Mann-Whitney U test. Results:In the full-analysis set, 45 (80.36%) patients with AD maintained remission in the test group (56 cases) and 30 (53.57%) in the control group (56 cases), and the remission rate difference between the two groups was 26.79% (95% confidence interval [ CI]: 10.09%, 43.49%; χ2 = 9.11, P = 0.003) ; the 12-week follow-up during the maintenance period showed that the time to first relapse was 75.05 ± 25.07 days in the test group, which was significantly longer than that in the control group (49.55 ± 33.92 days, t′ = 4.52, P < 0.001). At the study endpoint, the test group showed significantly decreased AD disease severity score (eczema area and severity index [EASI] score: 0.00 [0.00, 1.20] points vs. 0.60 [0.00, 4.00] points), pruritus visual analog scale (VAS) score (0.00 [0.00, 2.00] points vs. 2. 00 [0.00, 10.00] points), and sleep VAS score (0.00 [0.00, 0.00] points vs. 1.00 [0.00, 4.00] points) compared with the control group ( Z = -2.77, 2.43, 3.48, P = 0.006, = 0.015, < 0.001, respectively), while there was no significant difference in the pH value at the lesional sites between the test group and control group ( t = 0.97, P = 0.335). For the group aged 0 - 2 years, the average daily glucocorticoid dosage at the weekend in AD children during the maintenance period was significantly lower in the test group than in the control group ( Z = -1.97, P = 0.049) ; for the group aged >2 - 12 years, there was no significant difference in the average daily glucocorticoid dosage at the weekend between the two groups ( Z = -0.25, P = 0.802). During the study period, no significant difference was observed in the incidence of treatment-related adverse events between the test group (2/56, 3.57%) and control group (3/56, 5.36%; P = 1.000), and no serious adverse events occurred. Conclusion:Compared with the weekend treatment with topical glucocorticoids alone, the daily use of the test emollient combined with topical glucocorticoids at the weekend could markedly improve the remission rate of AD, prolong the time to relapse, and reduce the disease severity at relapse in children with AD during the maintenance period, which provides a new option for maintenance treatment of children with AD.

Abstract: Objective To explore the dynamic characteristics of stigmatization in HIV/AIDS patients and provide scientific evidence for psychological care. Methods HIV/AIDS patients receiving antiretroviral therapy (ART) treatment in Nanning Fourth People's Hospital were randomly selected for baseline and 1 year follow-up questionnaire survey including internalized HIV stigma, anticipated HIV stigma, exposure to HIV stigma. The differences between the two groups at different time points were dynamically compared to analyze the changing characteristics of stigma in HIV/AIDS patients. Results After one year of ART treatment, among the eight items of internalizing stigma, five items including the proportion of feeling ashamed of being infected with HIV/AIDS, feeling unclean because of being infected with HIV/AIDS, feeling inferior to others because of having HIV/AIDS, feeling guilty because of having HIV/AIDS, and having a poorer self-perception due to how others view HIV/AIDS decreased significantly from 34.0% to 43.5% at the baseline to 19.5% to 29.5%, showing significant improvement with statistical significance (χ2=18.586, 14.277, 10.473, 12.219, 9.934, P<0.05); among the nine items of anticipated stigma, four items including the proportion of community/community workers not taking my needs seriously, discriminating against me, refusing to provide services for me, and healthcare workers avoiding contact with me decreased significantly from 16.0% to 27.5% at the baseline to 7.0% to 15.5%, respectively, showing significant improvement with statistical significance (χ2=13.690, 15.787, 12.034, 12.593, P<0.05); among the 16 items of exposure to HIV stigma, six items including the proportion of experiencing physical attacks, psychological pressure from spouses/partners, being refused sexual relationships, losing jobs or other economic sources, being rejected or losing a job opportunity due to HIV/AIDS, changing job nature due to HIV/AIDS, or being refused medical services decreased significantly from 2.5% to 15.0% at the baseline to 1.0% to 8.0%, respectively, showing significant improvement with statistical significance (χ2=8.619, 15.558, 6.061, 9.049, 5.432, 8.156, P<0.05). Physical assaults on people with HIV/AIDS increased by 5.5 percent(χ2=5.368, P<0.05). Conclusions Through 1-year dynamic monitoring, 48.48% of the three dimensions of stigma of HIV/AIDS patients were alleviated. Treatment intervention, self-acceptance and the creation of a good non-discriminatory social environment have an important impact on the stigma of HIV/AIDS patients and deserve the attention of society as a whole.