Yersinia pestis, the cause of plague and a potential biological weapon, has always been a threatening pathogen. Some strains of Y. pestis have varying degrees of antibiotic resistance. Thus, this systematic review was conducted to alert clinicians to this pathogen’s potential antimicrobial resistance. A review of the literature was conducted for experimental reports and systematic reviews on the topics of plague, Y. pestis, and antibiotic resistance. From 1995 to 2021, 7 Y. pestis isolates with 4 antibiotic resistance mechanisms were reported. In Y. pestis 17/95, 16/95, and 2180H, resistance was mediated by transferable plasmids. Each plasmid contained resistance genes encoded within specific transposons. Strain 17/95 presented multiple drug resistance, since plasmid 1202 contained 10 resistance determinants. Strains 16/95 and 2180H showed single antibiotic resistance because both additional plasmids in these strains carried only 1 antimicrobial determinant. Strains 12/87, S19960127, 56/13, and 59/13 exhibited streptomycin resistance due to an rpsl gene mutation, a novel mechanism that was discovered recently. Y. pestis can acquire antibiotic resistance in nature not only via conjugative transfer of antimicrobial-resistant plasmids from other bacteria, but also by gene point mutations. Global surveillance should be strengthened to identify antibiotic-resistant Y. pestis strains by whole-genome sequencing and drug susceptibility testing.

Objective: To study the clinicopathological features and therapeutic regimens of primary testicular lymphoma (PTL). Methods: The clinical data of 16 patients diagnosed with PTL from January 2005 to December 2015 in Jiangsu Province Hospital were collected, and the clinicopathological characteristics were retrospectively analyzed. Kaplan-Meier method was used to make the survival analysis. Results: The median onset age of 16 patients was 63 years old (33-81 years old). According to Ann Arbor stage, there were 8 cases of stage Ⅰ_E, 2 cases of stage Ⅱ_E, 6 cases of stage Ⅲ-Ⅳ. The initial symptoms included painless solid enlargement of the testis (9 cases), painful testis (3 cases), distending pain of testis (1 case), and the patients had no other systemic symptoms. The pathological type was diffuse large B-cell lymphoma (DLBCL), of which 2 patients were germinal center B-cell (GCB) type and the other 14 patients were non-GCB type. All the patients received the orchiectomy, of which 14 received chemotherapy alone after the operation, 2 received chemotherapy and radiotherapy. Complete follow-up data were available for 14 patients, and the median follow-up time was 23.5 months (1.0-97.0 months). Among 14 patients, complete remission was achieved in 11 patients, partial remission in 1 patient, no response in 1 patient, and 1 patient was undergoing treatment. Among 11 patients with complete remission, 5 patients relapsed, and the recurrence occurred at the central nervous system (3 cases), skin of right lower extremity (1 case), and contralateral testis (1 case). The mean progression-free survival (PFS) time was 19.0 months (14.0-95.0 months). Conclusions Most PTL is primary testis DLBCL, and the comprehensive treatment based on surgery is the main therapy of PTL. Postoperative chemotherapy with or without radiotherapy is recommended to prevent relapse.

Objective To investigate the level of inflammation after interventional treatment in patients undergoing intracranial stent implantation by measuring the changes in the plasma levels of monocytes and high-density lipoprotein cholesterol（HDL-C） and monocyte to high-density lipoprotein cholesterol ratio （MHR） after stent implantation for intracranial atherosclerotic stenosis （ICAS） in high-altitude areas， as well as the causes of such changes and their value in predicting clinical prognosis. Methods The ICAS patients who were consecutively admitted to Qinghai Provincial People’s Hospital， from June 10， 2017 to March 1， 2022 and underwent interventional treatment were enrolled， and all patients signed the informed consent. Clinical data and the data on interventional surgery were collected， and blood samples were collected before interventional treatment， within 72 hours after interventional treatment， and at 3 months after interventional treatment to measure the levels of monocytes and HDL-C. The above indicators were compared before and after interventional treatment， and such changes were analyzed in terms of their association with the site of cerebrovascular stenosis and NIHSS score. Results A total of 123 patients with severe ICAS who underwent intracranial stent implantation and had complete data were included. Compared with the data before surgery， there was a significant increase in the plasma level of monocytes at 72 hours after stent implantation [（0.64±0.21）×109/L vs （0.53±0.17）×109/L， P<0.001]， while there was a significant reduction in the plasma level of monocytes at 3 months after stent implantation [（0.43±0.14）×109/L vs （0.53±0.17）×109/L，P<0.001]. Compared with the data before surgery， there was no significant change in HDL-C within 72 hours after surgery[（0.93±0.21）mmol/L vs （0.93±0.18）mmol/L， P>0.005]， while there was a significantly increase in HDL-C at 3 months after surgery[（1.05±0.21 mmol/L vs （0.93±0.18）mmol/L， P<0.001）. There was no significant correlation between monocytes/HDL-C/MHR and NIHSS score before surgery and at 72 hours after surgery （P>0.005）； there was no significant correlation between monocytes/HDL-C/MHR and NIHSS score before surgery and within 72 hours after surgery （P>0.005）；at 3 months after surgery， monocytes and MHR were significantly negatively correlated with NIHSS score （r=-0.271，P<0.05；r=-0.320，P<0.005），while HDL-C was significantly positively correlated with NIHSS score （r=0.213， P<0.001）. Conclusion Balloon dilatation and ischemia/reperfusion after intracranial stent implantation may cause inflammatory response in the body， thereby leading to increases in the level of monocytes and the value of MHR. Therefore， monocytes， HDL-C， and MHR may be used as predictive factors for the improvement in neurological defects in the convalescence stage after stent implantation.
Monocytes

Objective: To study the main factors that influencing Pneumoconiosis patients' healthcare seeking behaviors. Methods: Conducting a descriptive analysis to analyze the relationship between the annual hospitalization rate and social security status (medical insurance, location of medical insurance, proportion of insurance used for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, whether to apply for compensation after diagnosing pneumoconiosis, whether they receive social assistance and a minimum allowance) , social relationship status of patients (whether there is pneumoconiosis in the family or relatives, whether there is a pneumoconiosis in a friend or a colleague, and whether or not he/she has received financial assistance) , life quality of patients (subjective feelings) and living standard of patients (dietary level) based on data acquired from 120 pneumoconiosis patients. Results: The results of single factor analysis reveal that the location of medical insurance, the proportion of insurance for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, whether to apply for compensation after diagnosing pneumoconiosis are statistically significant in pneumoconiosis patients' hospital utilization ratio (P<0.05) . The place where medical insurance is located is the current place of residence, the reimbursement ratio of medical insurance for pneumoconiosis is listed as 50%-70%, the work unit has medical insurance, those who have not applied for compensation for pneumoconiosis have a higher utilization rate of hospitalization services. The annual hospitalization rate was 73.3%, 80.0%, 60.6%, 63.0%, respectively. Conclusion The location of patient medical insurance, the proportion of insurance used for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, and whether to apply for compensation after pneumoconiosis are the influencing factors of the patients' annual hospitalization rate.

Objective: To understand the situation and characteristics of out-patient utilization of urban and rural pneumoconiosis patients in Jiangsu province, and to provide a reference for the formulation of relevant policies. Methods: Using a questionnaire on patients with pneumoconiosis and their influencing factors, 120 patients with pneumoconiosis were randomly selected in Nanjing, Wuxi, Suzhou, Yancheng Vocational Defense Institute or CDC. The rate of outpatients with pneumoconiosis in urban and rural areas and the choice of out-patient hospitals were analyzed. Results: Of the 75 patients with severe pneumoconi-related symptoms such as chest tightness and dyspnea in the first two weeks of the survey, 36 (48.0%) lived in cities and 39 (52.0%) lived in rural areas. Patients with pneumoconiosis who live in urban and rural areas have different aggravating conditions within two weeks. Two weeks of aggravated symptoms in outpatient consultations accounted for36 (48.0%) . Of the 36 patients who used outpatient treatment, rural residents mainly chose 8 people from a hospital and a township health hospital, accounting for 34.8%, while 10 people from urban residents chose a nursing home or nursing home, accounting for 40.0%. The main reason why urban and rural pneumoconiosis patients did not go to the doctor is "conscious symptoms are lighter" and "feel that the doctor is useless." Conclusion The rate of outpatients with pneumoconiosis in Jiangsu province within two weeks is lower than that of ordinary elderly residents. There may be differences in treatment behavior patterns of urban and rural pneumoconiosis patients.Economic factors have a certain influence on the outpatient treatment behavior of pneumoconiosis patients. The recognition of outpatient service is the main factor affecting the outpatient treatment of pneumoconiosis patients. It is very important to popularize the knowledge of pneumoconiosis and do a good job in propaganda of occupational diseases and health education for pneumoconiosis patients. Focusing on the outpatient treatment of pneumoconiosis patients and making targeted medical policies is very important to standardize and improve the rehabilitation of pneumoconiosis patients.

ObjectiveTo study the conceptual framework and methodological system of the International Classification of Functioning, Disability and Health (ICF) in occupational therapy and its systematic implementation in clinical practice. MethodsBased on the ICF theory and the policy documents of the World Federation of Occupational Therapists, the conceptual framework of occupational therapy and the systematic implementation in clinical settings based on the ICF framework were analyzed. ResultsThis study constructed a conceptual framework and approach for occupational therapy based on ICF, and clarified the goals, principles, and implementation methods of integrated occupational therapy interventions in rehabilitation services. The goal of occupational therapy interventions was to improve the individual activity and participation through multidisciplinary and cross-cutting implementation of integrated occupational therapy programs to optimize functioning. Occupational therapy was based on the bio-psycho-social model, adhered to the principles of person-centeredness and functioning orientation, and implemented individualized intervention programs in different context. In clinical practice, it was recommended to follow ICF-based standardized process and systematically use World Health Organization Family International Classifications: functioning and unmet needs analysis using ICHI; functional classification, assessment and coding using ICF; disease classification, diagnosis and coding using ICD; intervention of occupational therapies using ICHI to build a systematic occupational therapy service system. ConclusionAn ICF-based occupational therapy concept and methodological system has been built, a comprehensive clinical occupational therapy implementation model has been established, the goal of activity and participation oriented occupational therapy interventions has been clarified, and the systematic, structured, standardized and refined level of occupational therapy has been enhanced.

The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea